title: Acute abdomen in early pregnancy due to ovarian torsion following successful in vitro fertilization treatment.
abstract: OBJECTIVE
  Ovarian torsion is an acute abdomen requiring prompt intervention. Ovarian torsion seldom occurs during pregnancy. However, with in vitro fertilization (IVF) treatments, ovarian hyperstimulation may increase the size of the ovaries and result in the occurrence of adnexal torsion. Here, we report two cases of ovarian torsion after IVF and discuss the optimal management of this emergency medical condition.
  
  
  METHODS
  The first case was a 23-year-old woman who received IVF-embryo transfer due to tubal factor infertility. Sudden-onset, lower abdominal pain developed at the 6th week of pregnancy. Conservative treatment with antibiotics was the initial approach, but a right oophorectomy had to be performed due to right ovarian torsion with hemorrhagic and gangrenous changes. The second case was a 38-year-old woman diagnosed with bilateral ovarian torsion at 8 weeks' gestation due to the sudden onset of low abdominal pain. Laparoscopy was arranged immediately after the diagnosis was confirmed. The left ovary was successfully preserved due to prompt intervention. Both pregnancies continued without problems after surgery.
  
  
  CONCLUSIONS
  Ovarian hyperstimulation during IVF-embryo transfer treatment is a risk factor for developing adnexal torsion. Early diagnosis and prompt surgical intervention is the only way to protect the ovary and preserve the pregnancy. Laparoscopic surgery in early pregnancy causes no harm to the fetus and should be encouraged once the diagnosis is confirmed. Delaying surgery may induce serious infection and jeopardize the lives of both the fetus and mother.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Hsing-Chun
authors.initials: HC
authors.lastname: Tsai
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Tian-Ni
authors.initials: TN
authors.lastname: Kuo
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Chung
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Mike Y S
authors.initials: MY
authors.lastname: Lin
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan.
authors.forename: Chieh-Yi
authors.initials: CY
authors.lastname: Kang
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Chi-Mei Medical Center, Tainan, Taiwan; Department of Sports Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; Department of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: yung0613@ms2.hinet.net.
authors.forename: Yung-Chieh
authors.initials: YC
authors.lastname: Tsai
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D047109:Fetal Development; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D010049:Ovarian Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016471:Ovarian Hyperstimulation Syndrome / Q000150:complications* / Q000000981:diagnostic imaging; D010052:Ovariectomy / Q000379:methods*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011256:Pregnancy Outcome; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D054159:Torsion, Mechanical; D014463:Ultrasonography; D055815:Young Adult
keywords: in vitro fertilization; laparoscopy; ovarian hyperstimulation; ovarian torsion; pregnancy