Understanding the Link Between Ovarian Torsion and Female Infertility

Asha (name changed) clutched her lower belly while at work in 2023. A sharp pain was taking her breath away. At first, she thought it was just another bad cramp. But within minutes, the pain turned unbearable. It spread to her back, made her nauseous and within minutes she fainted.

Asha was just 28 and a newly-wed lady. Staff had to rush her to the hospital. An emergency USG ultrasound scan reported ovarian torsion, a condition in which blood supply of ovary is compromised. The doctors explained that immediate laparoscopic surgery was needed. They acted fast, they could save her ovary by untwisting the ovary and resuming the blood supply.

In January of 2025, Asha gave birth to a healthy baby boy. But then all women are not lucky like Asha, some ignore the symptoms and face ovary removal.

In simple words, you have lesser chances of being a mother. So, today let’s discuss the A to Z of ovarian torsion and how you can avoid facing a situation like Asha or others.

What is Ovarian Torsion?

Ovarian torsion or a twisted ovary in simple words means a critical medical situation, when the female’s ovary twists around its ligaments. The ovarian torsion causes restricting blood supply or ischemia. Ovarian torsion constitutes about 3% of acute gynecological emergencies. As per the WHO, women aged 15–45 are often found to face this situation.

Diagnosis is challenging because of overlapping symptoms with other conditions like appendicitis or ruptured ectopic pregnancy. But we always suggest that early detection is crucial.

Delayed intervention can lead to ovarian necrosis, ovarian rupture, and can later cause infertility. In India, research underlines the importance of quick medical care. Timely intervention will improve the patient’s situation amid persistent ovarian torsion symptoms.

Also Read: Ovarian Hyperstimulation Syndrome and Pregnancy

Causes and Risk Factors of Ovarian Torsion:

Several factors increase the risk of ovarian torsion. We are listing the key ones because recognizing these will help you save the ovarian function and prevent complications.

• Ovarian cysts or tumors, especially those larger than 5 centimeters. These often add weight and imbalance, making torsion more likely.
• Fertility treatments stimulate the ovaries. In some cases these may lead to hyperstimulation, increasing the risk of a twisted ovary.
• Hormonal changes during pregnancy or during perimenopause in certain cases have also been found to increase ovarian size. Enlarged ovaries are more susceptible to ovarian torsion.
• Some people are born with longer ovarian ligaments. This makes then prone to ovarian torsion.
• Twisted ovary from cyst: Girls and teens with ovarian cysts or fibroids are also at higher risk.
• In active women also, sudden movements or intense physical activity has been seen to sometimes trigger the ovary to twist.

Must Read: Comparing Ovarian and Uterine PRP for Your Path to Parenthood

Symptoms of Ovarian Torsion:

Quick diagnosis and surgery are important to save the ovary and prevent serious problems. So if you face the following symptoms, contact the best fertility expert near you:

• Primary symptom – sudden, severe, single-sided lower abdominal pain or even pain in the pelvis.
• This pain often increases over time causing gastro-intestinal symptoms like nausea and vomiting.
• During other ovarian torsion symptoms, some patients report a beaming out pain that shifts from the back to flanks or thighs.
• Fever is uncommon. But a twisted ovary from cyst may cause fever. This can be due to  infection or necrosis.
• Blood tests may show a slight increase in white blood cells. But then this is not a sure sign of ovarian torsion.
• Ovarian cysts, large ovaries, tumors (benign or cancerous both), a complicated pregnancy and in the past any sterilisation surgery (tubal ligation) also increase the risk of a twisted ovary.

Diagnosis of Ovarian Torsion:

The doctor will first check your clinical history, like if you have faced the primary ovarian torsion symptoms like lower abdominal painful cramps, nausea and vomiting, which does not subside. If during examination the doctor finds a palpable mass, then he/she would go for the following:

• Transvaginal ultrasound with Doppler (First choice) – Enlarged ovary with reduced or absent blood flow on Doppler. The ultrasound will also rule out other conditions that give similar symptoms like appendicitis, ectopic pregnancy, kidney stones or ruptured cysts.
• You will also be asked to undergo blood tests because a slight increase in white blood cell count could indicate the level of infection.
• CT/MRI (In special conditions) of the adnexa always confirms ovarian enlargement, twisted ovary/cystic ovary or free fluid in the pelvis.
• In some cases, laparoscopy has proved to be a definitive diagnosis & treatment. Laparoscopy helps doctors see the twisted ovary directly. It confirms the twisted ovary as well as allows them to fix it or remove the ovary if needed.

The absence of ovarian blood flow on doppler sonography appears to be a good predictor of ovarian torsion. Women with pathologically low flow are more sensitive to experience torsion. Abnormal ovarian flow has a sensitivity of 44% and specificity of 92%, with positive and negative predictive values of 78% and 71%, respectively.

Treatment for Ovarian Torsion:

Ovarian torsion symptoms removal demands surgery. But do not be afraid of anything. After the procedure, your doctor may give you medication. This will also save you from facing the same situation again. You need to understand that your life is precious and timely treatment will also help you become a mother, if you are facing infertility.

Types of Surgery to Treat a Twisted Ovary:

1. Laparoscopy (Minimally Invasive):

• A small camera is moved into your body through a tiny cut in your lower belly.
• Another small cut is made to access the ovary.
• Your doctor will gently untwist the ovary using special tools. This will save your ovary and increase your chances to become pregnant, that too safely.
• Done under general anesthesia, so it usually allows you to go home the same day.
• Preferred for pregnant women.

2. Laparotomy (Open Surgery):

• A larger cut is made in your lower belly to reach the ovary.
• The doctor untwists it manually.
• Requires general anesthesia and a short hospital stay.

If the Ovary is Too Damaged

3. Oophorectomy is done where the damage is irreversible and ovary looks dead. In such cases, leaving the ovary inside increases risk of infection and postoperative complications. Then, doctor will remove the twisted ovary.

CTA:

Timely detection of ovarian torsion causes, its diagnosis and treatment increase your chances to save the ovaries. So do not ignore the symptoms. Reach out to us on a call or the best gynecological expert near you. Your safety is every medical practitioner’s priority!