ADNEXAL TORSION AFTER IVF: RISK FACTORS AND PREVENTION

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.