 |
Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue2
Subject Area: Medicine
-
DOI: 10.5272/jimab.2026322.6829
Published online: 27 April 2026
Original article
J of IMAB. 2026 Apr-Jun;32(2):6829-6833
ADNEXAL TORSION AFTER IVF: RISK FACTORS AND PREVENTION
Nadya Magunska1, 2
, Alexander Boyadzhiev2, Elitsa Valerieva2, Ivan Bochev3, 4, Mariya Yunakova5, 6,
1) Department of Public Health and Health Care, “Angel Kanchev” University of Ruse, Bulgaria.
2) Department of Gynecology, Hospital Dr. Shterev, Sofia, Bulgaria.
3) Department of Molecular Immunology, Institute of Biology and Immunology of Reproduction, Bulgarian Academy of Sciences, Sofia, Bulgaria.
4) IVF Department, Hospital Dr. Shterev, Sofia, Bulgaria.
5) Department of Obstetrics and Gynecology, Medical Faculty, Medical University Sofia, Bulgaria.
6) University Hospital of Obstetrics and Gynecology “Maichin Dom” Sofia, Bulgaria.
ABSTRACT:
Objective: To investigate the incidence, risk factors, and prevention strategies for adnexal torsion (AT) following in vitro fertilization (IVF) procedures at a high-volume fertility center.
Methods: A retrospective case-control study was conducted at a single IVF center from January 2017 to December 2023. Medical records of 5,683 patients undergoing 8,932 oocyte retrievals were reviewed. Ovarian torsion was surgically confirmed in 11 cases (0.12%). Patient demographics, ovarian response, and treatment protocols were analyzed to identify risk factors. Preventive strategies for ovarian hyperstimulation syndrome (OHSS) and AT were also examined.
Results: All torsion cases occurred after fresh embryo transfer (ET) and without OHSS. Mean patient age and BMI were 33.4 years and 22.2, respectively. Seven patients had a history of abdominal surgery. The mean anti-Müllerian hormone (AMH) level was 3.73 ng/mL. The torquated ovary had an average of 4.55 dominant follicles, with significantly larger ovarian diameter post-symptom onset compared to the contralateral ovary (82.5 mm vs. 50.2 mm, p = 0.037). Right-sided torsion predominated (63.6%). At torsion, 81.8% of patients were pregnant, a rate significantly higher than the overall IVF pregnancy rate (p = 0.01); multiple gestations were present in three cases. All underwent laparoscopic detorsion without complications, and most pregnancies progressed to term.
Conclusion: Adnexal torsion is a rare but significant IVF complication, mainly occurring after fresh ET in early pregnancy, even without OHSS. Risk increases in pregnant patients, especially with multiple gestations. Individualized stimulation, freeze-all protocols, and vigilant monitoring may reduce AT risk. Prompt laparoscopic treatment ensures favorable outcomes.
Keywords: Adnexal torsion, in vitro fertilization, ovarian hyperstimulation syndrome,
- Download FULL TEXT /PDF 495 KB/
Please cite this article as: Magunska N, Boyadzhiev A, Valerieva E, Bochev I, Yunakova M. Adnexal Torsion After IVF: Risk Factors and Prevention. J of IMAB. 2026 Apr-Jun;32(2):6829-6833. [Crossref - 10.5272/jimab.2026322.6829]
Correspondence to: Nadya Magunska, Gynecology Department, Ob/Gyn Hospital Dr. Shterev, Sofia; 25-31, Hristo Blagoev Str., 1330 Sofia, Bulgaria; E-mail: magunska.n@gmail.com
REFERENCES:
1. Kontoravdis A, Chryssikopoulos A, Hassiakos D, Liapis A, Zourlas PA. The diagnostic value of laparoscopy in 2365 patients with acute and chronic pelvic pain. Int J Gynaecol Obstet. 1996 Mar;52(3):243-8. [PubMed]
2. Rackow BW, Patrizio P. Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization. Fertil Steril. 2007 Mar;87(3):697.e9-12. [PubMed]
3. Dokuzeylül Güngör N, Yurci A, Güçlü M. Retrospective analysis of ovarian torsion incidence in 5186 women undergoing controlled ovarian hyperstimulation. J Health Sci Med. 2021; 4(5):630-633. [Crossref]
4. Ju W, Zhang J, Wang Y, Pan K, Zhang Q, Zhao S, et al. Ovarian Torsion at 8 weeks of Gestation in a Woman with Threatened Abortion After Frozen-Thawed Embryo Transfer: A Case Report. Int J Womens Health. 2024 Nov 29;16:2043-2050. [PubMed]
5. Mashiach S, Bider D, Moran O, Goldenberg M, Ben-Rafael Z. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990 Jan;53(1):76-80. [PubMed]
6. Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005 May;14(2):86-92. [PubMed]
7. Aiob A, Shushan Marom SB, Gumin D, Lowenstein L, Sharon A. Identifying reliable predictors of ovarian torsion in acute gynecological presentations: A retrospective case-control study. Eur J Obstet Gynecol Reprod Biol. 2025 Sep;313:114627. [PubMed]
8. Schenker JG, Weinstein D. Ovarian hyperstimulation syndrome: a current survey. Fertil Steril. 1978 Sep;30(3):255-68. [PubMed]
9. Haning RV Jr, Austin CW, Carlson IH, Kuzma DL, Shapiro SS, Zweibel WJ. Plasma estradiol is superior to ultrasound and urinary estriol glucuronide as a predictor of ovarian hyperstimulation during induction of ovulation with menotropins. Fertil Steril. 1983 Jul;40(1):31-6. [PubMed]
10. Berkkanoglu M, Coetzee K, Bulut H, Ozgur K. Risk of ovarian torsion is reduced in GnRH agonist triggered freeze-all cycles: a retrospective cohort study. J Obstet Gynaecol. 2019 Feb;39(2):212-217. [PubMed]
11. Turocy J, Rackow BW. Adnexal torsion after IVF. In: Assisted Reproduction Techniques: Challenges and Management Options. 2nd edition. Sharif K, Coomarasamy A. eds. 4 June 2021. Chapter 71. P.447-452. [Crossref]
12. McGovern PG, Noah R, Koenigsberg R, Little AB. Adnexal torsion and pulmonary embolism: case report and review of the literature. Obstet Gynecol Surv. 1999 Sep;54(9):601-8. [PubMed]
13. Novoa M, Friedman J, Mayrink M. Ovarian torsion: can we save the ovary? Arch Gynecol Obstet. 2021 Jul;304(1):191-195. [PubMed]
14. Mathur R, Sumaya W. Prevention and management of ovarian hyperstimulation syndrome. Obstet Gynaecol Repro Med. 2007 Jan;18(1):18–20. [Crossref]
15. Practice Committee of the American Society for Reproductive Medicine. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2016 Dec;106(7):1634-1647. [PubMed]
Received: 03 September 2025
Published online: 27 April 2026