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Mrs. SA, 26 years, married for 3 years 10 months came to us on 30/11/2004 for primary infertility. Her menstrual cycles were irregular. Her USG revealed a just normal uterus measuring 6.0 x 3.0 cm with polycystic ovaries . Her diagnostic hysterolaparoscopy was normal. Her husband's semen analysis revealed necrozoospermia. Consent was obtained for donor insemination and after failing two cycles of TDI, the couple temperarily discontinued treatment. They once again reported to us in 2006 and opted forART.
She underwent ART- ICSI cycle on 23/1/07 and had moderate to severe OHSS. We retrieved 34 oocytes from her and with stringent monitoring of all haemodynamic and biochemical parameters, 3 grade II embryos were transferred at patient's own request, while the rest were frozen. She conceived with a single intra uterine gestation. Owing to the OHSS, patient underwent transabdominal ascitic tapping twice and transvaginal aspiration of ascitic fluid thrice, but was hemodynamically and biochemically stable.
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During the 8th week of pregnancy, she complained of severe abdominal pain and underwent a diagnostic laparoscopy for suspected torsion. Intra-operatively there was left ovarian torsion which was corrected and bilateral oophero-pexy was done by fixing the ovaries in the adnexa using 1-0 vicryl. |
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The antenatal period was uneventful until the 26th week when once again she developed left ovarian torsion which was untwisted yet again laparoscopically which has not been attempted at this stage in pregnancy. Two weeks later, to our own anguish and patient's despair, she had left ovarian torsion once again and this time we had no choice but to perform a mini-laprotomy and proceed with left salpingo-oopherectomy.
She was maintained with tocolytics and antibiotics and the rest of the pregnancy went by uneventfully. She delivered a healthy male baby on 12/9/2007 at 4.56pm weighing 2.40kg. This is a rare case where there was recurrent ovarian torsion despite bilateral oophero- pexy. It was also one where a challenging laparoscopic intervention was attempted in advanced gestation.
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| 1. |
Should we have cancelled the cycle in the first place? |
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Would blastocyst transfer have helped to tide over the initial OHSS crisis? |
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Predicting one's response to OHSS does not really help in identifying those at real risk of repeated ascites and ovarian torsion. |
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| 1. |
Darius Djavadian,Wilhelm Braendle, and Fritz Jaenicke. Laparoscopic oophoropexy for the treatment of recurrent torsion of the adnexa in pregnancy: case report and review. Fertility Sterility 2004; Vol 82: No 4, pp 933-936. |
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| 2. |
Salim Bassil, Ulrich Steinhart and Jacques Donnez1. Successful laparoscopic management of adnexal torsion during week 25 of a twin pregnancy. Human Reproduction 1999; Vol 115: No 3, pp 855-857. |
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