Correspondence

Ectopic Ovary and Unicornuate Uterus

N Engl J Med 2003; 348:667-668February 13, 2003

Article

To the Editor:

Ectopic ovaries are characterized by their attachment to an area above the level of the common iliac vessels.1 Although they may occur in women with a normal uterus, the incidence is reported to be as high as 20 percent when the uterus is absent and 42 percent in cases of a unicornuate uterus.2 Despite the well-known association of ectopic ovaries and a unicornuate uterus, ectopic ovaries are reported only sporadically, suggesting the possibility that many cases go unrecognized.3-5 We report two cases in which an ectopic ovary was detected in association with a unicornuate uterus.

A couple was referred with a history of primary infertility for two years. The female partner had normogonadotropic anovulation, and a moderate male factor was found. On hysterosalpingography and laparoscopy, a unicornuate uterus, a right-sided ovary, and a patent salpinx were found. Two attempts at intrauterine insemination after ovarian hyperstimulation with clomiphene citrate were unsuccessful. During the next clomiphene citrate–stimulated intrauterine insemination cycle (with 50 mg of clomiphene citrate daily from day 5 until day 9), a discrepancy between serum estradiol levels and ovarian follicular growth was observed (estradiol, 250 pg per milliliter, without follicular growth on ultrasonography). An ectopic ovary was suspected but could not be confirmed on vaginal and abdominal ultrasonography. Magnetic resonance imaging (MRI) revealed a left-sided ectopic ovary, seen as a cord-like structure, which contained several follicles. Cranially, its border reached the left side of the second lumbar vertebra. Caudally, the ovary stretched to the internal inguinal canal (Figure 1Figure 1Coronal T₂-Weighted MRI Scan Showing a Left-Sided Ectopic Ovary.).

A second couple was referred with a history of primary infertility for four years. A unicornuate uterus with one left-sided tube and ovary had previously been documented in the female partner. Only one ovary was seen on ultrasonography. An infertility workup of the male partner revealed no abnormalities. Intrauterine insemination after ovarian stimulation was started, and on day 13 of the first cycle, the serum estradiol level reached 415 pg per milliliter, with only one follicle, 12 mm in diameter, observed ultrasonographically. Because of this discrepancy, MRI was performed, and it confirmed the presence of a right-sided ectopic ovary in the upper part of the pelvis, anterior to the intersection of the psoas and iliac muscles. The ovary contained numerous follicles.

Identification of ectopic ovaries may be important in monitoring ovarian hyperstimulation and in exploring unexplained cyclic abdominal pain. Our experience with these cases and three others leads us to propose that MRI be performed after ovarian stimulation as a potentially useful approach to the diagnosis of ectopic ovaries, such as those associated with a unicornuate uterus.

Willem Ombelet, M.D., Ph.D.
Geert Verswijvel, M.D.
Eric de Jonge, M.D., Ph.D.
East Limburg Hospitals, 3600 Genk, Belgium
willem.ombelet@pandora.be

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Citing Articles (4)

Citing Articles

1. 1

   David E. Reichman, Marc R. Laufer. (2010) Congenital uterine anomalies affecting reproduction. Best Practice & Research Clinical Obstetrics & Gynaecology 24:2, 193-208
   CrossRef

2. 2

   Jennifer E. Dietrich, S. Paige Hertweck, Sheldon Bond. (2007) Undescended Ovaries: A Clinical Review. Journal of Pediatric and Adolescent Gynecology 20:2, 57-60
   CrossRef

3. 3

   Bulent Haydardedeoglu, Erhan Simsek, Esra Bulgan Kilicdag, Ebru Tarim, Erdogan Aslan, Tayfun Bagis. (2006) A case of unicornuate uterus with ipsilateral ovarian and renal agenesis. Fertility and Sterility 85:3, 750.e1-750.e4
   CrossRef

4. 4

   Willem Ombelet, Karen Deblaere, Martin Grieten, Geert Verswijvel, Martine Nijs, Piet Hinoul, Eric de Jonge. (2003) Intrauterine pregnancy following transperitoneal oocyte and/or sperm migration in a woman with an ectopic (undescended) ovary. Reproductive BioMedicine Online 7:1, 110-113
   CrossRef