Unicornuate uterus and ectopic (undescended) ovary
A 31-year-old woman was referred to our infertility clinic with a history of primary infertility for more than two years. During the routine infertility exploration a hysterosalpingography (HSG) showed a left sided unicornuate uterus with a patent tube (). On vaginal ultrasound only one ovary could be detected at the normal position, with a normal size and a normal number of antral follicles. On the right hand side no ovary could be visualized.\nA 3D ultrasound was performed confirming the presence of a unicornuate uterus and a normal leftsided ovary with normal blood supply ().\nDue to our previous experience with ectopic ovaries associated with a unicornuate uterus (Ombelet et al., 2003b; Ombelet et al., 2003c) an MRI after mild ovarian clomiphene citrate (CC)-stimulation was carried out. MRI was performed using an extended phased array body coil on a 1.5 Tesla (Siemens, Germany) scanner. Axial, coronal and sagittal T1 (TurboFlash) and T2 weighted (HASTE) images were acquired, without intravenous contrast. The images through the level of the pelvis demonstrated a left sided unicornuate uterus with a single vagina and a single cervix. The left ovary was located anteriorly in the fossa adjacent to the uterus and contained several tiny cysts. Furthermore, small cysts were found posterior from the hepatic flexure of the colon, interpreted as follicles in the right ovary (). The right kidney was absent (). Numerous subcentimetric tiny cysts vertically oriented posterior of the ascending part of the colon, like a string of beads could be demonstrated (), interpreted as small isovolumetric follicles in a ‘stretched’ right sided ovarian structure. According to the MRI images it was not sure whether the rightsided ectopic ovary was located intra- or extraperitoneally.\nA laparoscopy confirmed the diagnosis of a unicornuate uterus with one normal patent tube and one normal ovary on the left side. On the right side no rudimentary horn could be seen. High up in the abdomen, just below the liver, an ectopic ovary could be visualized with a rudimentary tube. The distal, fimbriated end of the fallopian tube was developed adjacent to the ectopic ovary.\nAn infertility work-up of the male partner revealed an isolated teratozoospermia with 2% ideal forms using strict criteria of sperm morphology (Ombelet et al., 1997; Cooper et al., 2010). It was decided to start with a first-line treatment with intrauterine inseminations.