Terminology Tuesday: Twisted Ovary

By Dr. Mary Hinckley

Twisted ovary is not the name of a new punk rock band. Twisted ovary is now the most feared diagnosis in infertility care.

Twisted ovary, otherwise known as ovarian torsion, occurs when an ovary twists off its blood supply. This usually leads to intense pain, requiring immediate treatment.

When I explain twisted ovary to my patients, I often use the analogy of a hammock- the kind that gently sways on the beaches in Hawaii. If you push a hammock full of children too high, the hammock can flip over on itself and spill the rambunctious children on the grass, while twisting the chains at either end. This never happens when there’s no one in the hammock, and it rarely happens when adults are gently taking an afternoon nap in a hammock.

Much like this analogy, an ovary will usually only flip over on itself when it is full (such as when it is full of follicles right before or after an egg retrieval for in vitro fertilization/IVF). Or, an ovary could flip over on itself when it is being bounced around. And when it flips, the blood supply is cut off, causing the ovary to “die” or become necrotic.

A few things to note about twisted ovary:

1. The pain of a twisted ovary is sharp and intense, like a knife stab on one side of the lower abdomen.
2. Pain is intermittent, coming and going every few minutes.
3. The ovary usually needs to be enlarged with a fluid filled cyst or cysts to be prone to twisting.

What to do if you suspect a twisted ovary:

1. Call your doctor. Many fertility clinics, such as Reproductive Science Center of the Bay area, always have a doctor on call, every day of the year, every hour of the day.
2. Take pain medicine, such as ibuprofen or acetaminophen.
3. Try to find a position that makes the pain go away. For some, this may be curled up in the fetal position, on one side or the other. It is possible to untwist the ovary, especially if it is only a ¼ or ½ twist.

Things to ask your doctor:

1. Should you find yourself in the emergency room and your fertility specialist is not around, make sure you tell the emergency room doctor that you just had an egg retrieval.
2. Make sure that you get an ultrasound with Doppler to check the blood flow to the ovary to possibly avoid unnecessary surgery.
3. Make sure that they don’t remove the ovary at surgery without checking to see if blood flow can return. Often, untwisting an ovary can turn a black ovary back into a healthy ovary right before the surgeon’s eyes.

Know that exercise can influence your likelihood of developing twisted ovary. It is important to rest at home and avoid any bouncing or jostling exercise, such as kickboxing, until your ovaries have shrunk back down to size.

Ask your doctor for more recommendations about taking care of yourself during IVF.

Dr. Mary Hinckley is a leading reproductive endocrinology and infertility specialist at the Reproductive Science Center of the San Francisco Bay Area. She has extensively published articles in peer-reviewed journals on blastocyst transfer, avoiding triplet pregnancies, monozygotic twinning, operative hysteroscopy, correction of uterine anomalies, and biochemical pathways involved in ovulation and fertilization. She serves as a member of the Society for Reproductive Endocrinologists, the Christian Medical and Dental Society and the American Society for Reproductive Medicine. Her areas of interest include laparoscopic surgery, premature ovarian failure, oocyte freezing, and recurrent pregnancy loss. Dr. Hinckley offers infertility education on YouTube.