title: Association between peak estradiol levels and ovarian torsion among symptomatic patients receiving gonadotropin treatment.
abstract: OBJECTIVE
  Ovarian torsion is a surgical emergency that can be clinically challenging to diagnose. Patients who have received assisted reproductive technologies (ART) are a subset of women with an increased risk for torsion. As the ART population continues to increase, there is a need to delineate risk factors for the development of ovarian torsion in this unique population. A pilot study was performed to determine the proportion of patients with suspected ovarian torsion who have received ART and to identify possible diagnostic biomarkers for ovarian torsion among these patients.
  
  
  METHODS
  A single institution retrospective cohort study of patients taken to surgery for suspected ovarian torsion over a 5-year period.
  
  
  RESULTS
  During the study period, 171 patients were taken to surgery for suspected ovarian torsion. Patients receiving ART constituted 19 (11%) of these patients. Among the 19 fertility treatment patients, 16 had received treatment with gonadotropins, 10 of which had surgically confirmed ovarian torsion. These ten patients had higher preoperative peak estradiol levels (3122 versus 1875 pg/mL, p = 0.05) and a larger ovarian diameter (9.7 versus 7.6 cm, p = 0.05) than the six patients receiving gonadotropins found to not have ovarian torsion.
  
  
  CONCLUSIONS
  These results suggest infertility treatment using gonadotropins for ovarian hyperstimulation may be an independent risk factor for ovarian torsion as suggested by the disproportionate number of such individuals represented in the study population (9% of all patients, 84% of fertility patients). Additionally, among women taking gonadotropins, an association exists between peak estradiol levels, ovarian diameter, and risk for ovarian torsion.
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Ob/Gyn, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. PRomanski@partners.org.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Romanski
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Ob/Gyn, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Melamed
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Elias
authors.affiliation: Division of Reproductive Sciences, Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA.
authors.forename: Aleksandar K
authors.initials: AK
authors.lastname: Stanic
authors.affiliation: Center for Infertility and Reproductive Surgery, Department of Ob/Gyn, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Anchan
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006062:Gonadotropins / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D010049:Ovarian Diseases / Q000097:blood* / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D016471:Ovarian Hyperstimulation Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D010053:Ovary / Q000473:pathology / Q000601:surgery; D010062:Ovulation Induction / Q000009:adverse effects; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D006062:Gonadotropins; D004958:Estradiol
keywords: Adnexa; Gonadotropins; Infertility; Ovarian torsion; Peak estradiol