menotropins and Adnexal-Diseases

To report a rare case of sequential bilateral adnexal torsion in a pregnant woman after a single cycle of gonadotropin ovulation induction with IUI. To review the literature with regards to the causation and aspects of the management of adnexal torsion, particularly after assisted conception.. Case report.. Fertility department within a teaching hospital.. A 35-year-old woman with a twin pregnancy after a cycle of gonadotropin ovulation induction and IUI.. Gonadotropin ovulation induction with IUI; two laparotomies, salpingo-oophorectomy, stabilization of adnexa with stay suture.. Continuation of pregnancy until 37 weeks gestation with the abdominal delivery of healthy twins.. The case of a woman with a multiple pregnancy and ovarian hyperstimulation syndrome after ovulation induction and IUI who developed sequential bilateral adnexal torsion is used to illustrate the risk factors and management options for adnexal torsion. Physicians should be aware of the increased incidence of adnexal torsion in the rising number of women undergoing ovulation induction in order to effect early surgical intervention and adnexal salvage. Consideration should be given to the anchoring of bulky adnexae to prevent torsion recurrence.

Topics: Adnexal Diseases; Adult; Chorionic Gonadotropin; Clomiphene; Female; Humans; Infertility, Female; Insemination, Artificial, Homologous; Menotropins; Ovulation Induction; Pregnancy; Torsion Abnormality; Uterus

Adnexal torsion of enlarged ovaries during early pregnancy is an infrequent but serious complication of menotropin therapy. Over 4 years, we encountered four cases of adnexal torsion among 648 menotropin-induced pregnancies. Multiple gestation may be a predisposing factor. The history of exogenous gonadotropin use, the acute clinical presentation, and the use of pelvic sonography facilitate the diagnosis. Although adnexectomy is well tolerated and pregnancy outcome is acceptable, future efforts should involve identifying preventive measures and more conservative means of therapy in these women.

Topics: Adnexal Diseases; Female; Humans; Menotropins; Ovulation; Pregnancy; Retrospective Studies; Superovulation; Syndrome; Torsion Abnormality

Adnexal torsion has not been reported previously following hMG/hCG for superovulation induction during an IVF cycle. It is clear that the enlarged ovary from the superstimulation cycle and coital activity contributed to the torsion in this case. Portable ultrasonography helped in making the diagnosis and may be an aid for diagnosis in future cases. Medications used for ovulation induction should be used cautiously and judiciously with close monitoring. Clinicians involved with this type of therapy are obligated to keep a constant watch for such infrequent but devastating complications.

Topics: Adnexal Diseases; Adult; Chorionic Gonadotropin; Female; Fertilization in Vitro; Humans; Menotropins; Ovulation; Ovulation Induction; Superovulation; Torsion Abnormality

Topics: Adnexa Uteri; Adnexal Diseases; Adult; Anovulation; Chorionic Gonadotropin; Danazol; Endometriosis; Female; Humans; Infertility; Laparoscopy; Laparotomy; Male; Menotropins; Ovarian Neoplasms; Pregnancy; Pregnancy, Tubal; Preoperative Care; Urinary Bladder Neoplasms