Ovarian maldescent

OBJECTIVE: To describe and assess the incidence and impact of ovarian maldescent in infertile women. DESIGN: Observational clinical study. SETTING: Referral infertility practice. PATIENTS: Women undergoing operative intervention as part of infertility evaluation or treatment. INTERVENTIONS: Anatomic observation at laparoscopy or laparotomy. RESULTS: Failure of the gonad to descend into the true pelvis occurred in 5 of 2,025 operative observations of patients evaluated and treated for infertility. Inappropriate descent of the ovary is associated with a short infundibulopelvic ligament and attachment of the superior pole of the ovary above the pelvic brim adjacent to the fimbriated end of an elongated, ipsilateral fallopian tube. It may be bilateral or unilateral and sometimes is associated with Mullerian duct abnormalities. CONCLUSIONS: The incidence of ovarian maldescent is low, its relationship to infertility is unclear, and it does not necessarily preclude conception when other infertility factors are recognized and treated. Its rarity and altered anatomy has the potential for therapeutic misadventure at laparoscopy, laparotomy, and IVF oocyte retrieval.