Case 1: Bilateral ovarian maldescent
A 21-year-old woman presented with 3 years of primary infertility (Height: 162 cm; body weight: 64 kg; body mass index (BMI): 24.4 kg/m2; Chromosome: 46 ther XX). Karyotype analysis showed normal female chromosomes. The menstrual cycle was 30-90 days and the menstrual period was 3-5 days. No abnormality was found in basic sex hormones (AMH:11.25 ng/ml). The results of B-ultrasound (Figure 1) showed the size of the uterus was about 40 × 32 × 25mm, and the left ovary was unclear, the size of the right ovary was about 19.8 × 10.5 mm, the structure was solid. Besides, no obvious follicular echo was found. The results of 3 D ultrasound salpingography showed bilateral distal tubal obstruction. Laparoscopic hysteroscopy was performed on July 4, 2016 (Figure 2). The= the uterus (4 × 3 × 2.5 cm) was observed under laparoscopy, and its surface was smooth. The bilateral ovaries had a long and narrow shape. The upper ovary bifurcated beyond the common iliac vessels and extended to the ipsilateral intracolonic sulcus. The cortex was thick (10 x 3 x 2.5 cm). No ovulation spot was found. The bilateral fallopian tubes were about 18 cm long, with the ipsilateral ovary extending, and the umbrella end opened in the para-colonic sulcus. The bilateral proper ovarian ligament lengthened about 5 cm and the ovarian suspensory ligament shortened about 1 cm. Methylene blue in the umbrella of bilateral fallopian tubes successfully overflowed after methylene blue was injected into the uterine cavity through the uterine catheter. The course of bilateral ureter was normal. The development of uterine cavity under hysteroscopy was normal.
Case 2: Undescended right ovary
A 34 years oldwoman presented with primary infertility for 1 year.(Height: 163 cm; Body weight: 53 kg; BMI: 19.95 kg/m2; Menstrual cycle: 30-60 days; Menstrual period 5-6 days; Menstrual volume was normal). Sex hormones were in normal range. The Figure 3 showed results of B-ultrasound. We can found that left ovary had a PCO（polycystic ovary）change and the right ovary was unclear (Figure 3). The Hysterosalpingography showed that the appearance of the uterus was normal and the bilateral fallopian tubes extended to the level of the third lumbar vertebra. Tubal patency was judged by displaying opaque fluid adjacent to the colon. The left fallopian tube was blocked; the right fallopian tube was lifted and unobstructed (Figure 4). Hysteroscopy was performed on January 4, 2018 (Figure 5). The size of uterus was normal, and its surface was smooth in. The right ovary was long oval. The inferior pole of the ovary was in the bifurcation of the common iliac vessels. And the upper pole was in the right interintestinal sulcus of the lateral node after crossing the common iliac vessel bifurcation(a thick cortex (6 x 4 x 3 cm) without ovariectasis). The length of the right fallopian tube waa about 18 cm, accompanying with the ipsilateral ovary, and the umbrella end opened in the right intracolonic sulcus. The proper ovarian ligament on the right side was lengthened about 6 cm, and the ovarian suspensory ligament was shortened about 1cm. The position of the left ovary was normal (5 × 4 × 3 cm), and the thickened cortex was white. There was no ovulatory spot, and the length and shape of the left fallopian tube were normal. Scattered lesions of pelvic endometriosis were found in the pelvis. When methylene blue was injected into the uterine catheter, it could be seen that the umbrella end of both fallopian tubes spilled smoothly. Hysteroscopy showed that the development of uterine cavity was normal.
Case 3: Bilateral undescended ovaries with right tubal ectopic pregnancy
A 28-year-oldparturient woman presentedwas admitted. Cesarean section was performed because of "menopause 38 days, vaginal bleeding 4 days, lower abdominal pain 1 day" and sudden syncope emergency. Urine HCG was positive. The results of Gynecological double examination showed that uterine tilt with normal size was found, and it did not connect with bilateral ovaries. Normal uterus and uniform thickening of endometrium (13 mm), without signs of pregnancy (intrauterine or extrauterine) were found in the results of Transvaginal ultrasound. Pelvic and abdominal effusion (maximum anterior and posterior diameter 66 mm). No bilateral appendages were observed. Abdominal puncture took out 10 ml non-coagulation blood. The patient was diagnosed as ectopic pregnancy. Laparoscopic exploration found normal uterus, bilateral ovarian decline and bilateral fallopian tubes were too long. The superior pole of the bilateral ovary extends beyond the bifurcation of the common iliac vessels to the ipsilateral intracolonic sulcus. The bilateral fallopian tubes were associated by the lengthening of the ipsilateral ovary, and the umbrella end opened in the para-colonic sulcus. The ampulla of the right fallopian tube was enlarged by 3cm, with blood clot attached and active bleeding at the end of the umbrella. There were about 1500 ml pelvic hemorrhage and blood clots (Figure 6).
Case 4: Undescended left ovary
A 32-year-old virginwoman presented with underwent laparoscopic myomectomy for uterine leiomyoma in July 2019. The patient had no menstrual changes and the basic sex hormones were normal. During the operation, intramural myoma of the posterior wall of the uterus was found to be 9◊8◊7 cm. The left ovary was narrow and oblate. The upper ovary was located above the bifurcation of the total iliac vessels (8.5◊4◊2.5 cm). (Figure 7)
The cortex was thick, and ovulation spots could be found. The left fallopian tube was about 20 cm long, accompanied by the ipsilateral ovary, and the umbrella end opened in the left intracolonic sulcus. The proper ligament of the left ovary was lengthened about 3 cm. The ovarian suspensory ligament was shortened about 1 cm. The position and shape of the right ovary and fallopian tube were normal. (Figure 7)