Unilateral vulvar hematoma after laparoscopic detorsion of the ipsilateral ovary following oocyte retrieval for IVF: A case report and review of anatomy and surgical planning

Abstract

A case is reported of delayed ovarian torsion following controlled ovarian hyperstimulation and uncomplicated oocyte retrieval, further complicated by post-laparoscopic ipsilateral vulvar hematoma.

A 37-year-old nulliparous woman with a history of polycystic ovary syndrome presented with clinical symptoms of ovarian torsion on post-retrieval day 8 and underwent laparoscopic detorsion. Her case was complicated by a large non-traumatic vulvar hematoma on post-laparoscopy day 1.

Despite safe aspiration of follicles at oocyte retrieval and onset of menses on post-operative day 6, her ovaries' prolonged enlargement placed her at risk of delayed ovarian torsion. She had no known underlying risk factors or vascular pathology to explain the etiology of her post-laparoscopy vulvar hematoma. The patient ultimately underwent a successful single euploid embryo transfer, followed by an uncomplicated vaginal delivery of a full-term neonate.

Ovarian torsion is a rare event amongst patients undergoing in vitro fertilization, with occurrence after the onset of menses even more uncommon. Clinicians should consider close post-retrieval monitoring of patients with high oocyte yield who are at risk of delayed ovarian healing. In addition, vulvar hematoma is a rare complication after laparoscopy, but patients with altered anatomy or in the setting of enlarged ovaries must be given unique consideration.