Ovarian Torsion after Controlled Ovarian Hyperstimulation Cycles with a Prolonged Recovery State: A Case Series and Review of the Literature.

Abstract

We aim to present two rare cases of ovarian torsion immediately following controlled ovarian hyperstimulation and their prolonged recovery state at an academic fertility center. Patient 1 is a 38-year-old nulligravid woman with a history of prior right oophorectomy and patient 2 is a 37-year-old nulligravid woman with a previous left oophorectomy. The main objective of our paper is to characterize the recovery time after ovarian detorsion surgery. These case reports highlight that ovarian torsion after controlled ovarian hyperstimulation may be associated with prolonged systemic symptoms including increased abdominal pain, persistent low-grade fevers, and mild leukocytosis for several weeks following laparoscopic ovarian de-torsion. A proposed mechanism for this extended inflammatory state could be due to higher levels of luteinizing hormone surge activating Phospholipase C-Protein Kinase C pathway and vascular endothelial growth factors involved in follicular growth and luteinization.