Long-term fertility after surgical management for adnexal torsion

Adnexal torsion (AT) is a surgical emergency due to potential impact on fertility. Indications for preservation of fertility have been extended to include any condition that may affect fertility but there is no real consensus regarding patients treated for AT.

Primary objective was to compare fertility of patients with AT to a control group (CG, digestive or urological surgery). Secondary objectives were to evaluate time to conception and occurrence of early menopause in both groups and rate of AT recurrence.

This retrospective, bicentric study included patients treated for AT in two tertiary University Hospitals, from January 1996 to December 2021, aged less than 43 years and with desire for pregnancy post-operatively. Each patient in AT group was matched with 3 patients of CG according to age and year of surgery. Primary endpoint was post-operative pregnancy rate. Secondary endpoints were time to pregnancy, age at menopause and torsion recurrence rate.

56 patients were included in AT group and 168 in CG. There was no significant difference between AT and CG regarding postoperative pregnancy rate (94.64 % vs 88.69 % respectively (p = 0.299)). There was no difference between AT and CG in mean time to pregnancy (6.89 vs 6.6 months respectively (p = 0.845) and in occurrence of early menopause (1.79 % vs 0.6 % respectively (p = 0.44)). Rate of AT recurrence was 14.3 %.

AT does not appear to impact on fertility. There would be no indication for systematic fertility preservation. Further studies are needed to validate these data.