Treatment Pathway
Treatment of Ovarian Torsion
Ovarian torsion is the twisting of an ovary around its supporting ligaments, cutting off its blood supply. It causes sudden, severe pelvic pain and is a gynaecological emergency requiring urgent surgical intervention to preserve the ovary.
RCOG (Royal College of Obstetricians and Gynaecologists)ESHRE (Reproductive Medicine)ACOG (American)BFS (British Fertility Society)NICE
Ovarian torsion is the twisting of an ovary around its supporting ligaments, cutting off its blood supply. It causes sudden, severe pelvic pain and is a gynaecological emergency requiring urgent surgical intervention to preserve the ovary.
First-Line Treatment Principles
- ✓Identify underlying cause: hormonal, structural, tubal, male factor, or unexplained
- ✓Lifestyle optimisation before fertility treatment: weight, smoking, folic acid
- ✓Ovulation induction with clomifene or gonadotrophins for anovulatory infertility
- ✓IVF/ICSI when other approaches have failed or irreversible causes (tubal occlusion, severe male factor)
- ✓HRT for menopausal symptoms: lowest effective dose for shortest duration
Non-Pharmacological Management
- •Weight management: BMI 18.5–25 kg/m² optimises conception rates and reduces obstetric complications
- •Folic acid 400mcg/day: before conception and for 12 weeks in pregnancy (5mg in high-risk)
- •Smoking cessation and alcohol avoidance: improve fertility and reduce miscarriage
- •Regular exercise: moderate-intensity; avoid extreme exercise that suppresses ovulation
- •Stress reduction and psychological support during fertility treatment
- •Pelvic floor physiotherapy: for pelvic pain, prolapse, and urinary incontinence
Treatment Goals
🎯Live birth rate: IVF cumulative live birth rate 40–60% per cycle in women <35y
🎯Symptom control in endometriosis and PCOS
🎯Menopausal symptom relief with acceptable safety profile
🎯Prevention of obstetric complications in high-risk pregnancies
Monitoring Parameters
- ◆Day 21 progesterone: confirm ovulation
- ◆AMH (anti-Müllerian hormone) and antral follicle count: ovarian reserve assessment
- ◆Semen analysis: concentration, motility, morphology — both partners assessed
- ◆Transvaginal ultrasound: follicle monitoring during stimulation cycles
- ◆Endometrial thickness: before embryo transfer (>7mm adequate)
- ◆HCG levels: early pregnancy monitoring; doubling every 48h confirms viable implantation
Escalation Criteria
- →Ovarian hyperstimulation syndrome (OHSS): freeze-all embryos if severe; hospitalisation if critical
- →Ectopic pregnancy: urgent surgical or medical (methotrexate) management
- →Recurrent pregnancy loss (≥3): full investigation panel; specialist reproductive medicine referral
- →Endometriosis not responding to medical therapy → laparoscopic surgery consideration
Special Populations
PCOS: weight loss first-line if overweight; metformin for insulin resistance; letrozole preferred over clomifene
Premature ovarian insufficiency: HRT mandatory until natural menopause age; fertility preservation counselling
Male factor: urological assessment; surgical sperm retrieval for severe oligospermia
Cancer patients: fertility preservation before gonadotoxic therapy
Clinical Insights
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