Groundbreaking: Israeli doctors save fetus’s ovaries, preserve fertility

Rarely seen in utero, large cysts had twisted both ovaries, cutting off vitally needed blood flow. 

By World Israel News Staff

In what they are calling a world first, doctors in an Israeli hospital saved the ovaries of a fetus after an ultrasound showed they were in danger by performing an emergency cesarian section and then immediately operating on the newborn.

The case of Baby Levy – reported in several Israeli media – occurred at the Hadassah-Ein Kerem Medical Center in Jerusalem in February, but the hospital only publicized it Monday. The mother, Tamar, had gone for a routine ultrasound in a local clinic at the 35-week mark of her pregnancy, and the technician noticed “something abnormal,” she said.

After consulting her gynecologist, she was sent to Hadassah’s emergency room, she explained, where Dr. Shay Porat performed a second, in-depth ultrasound. He told her that there were fluid-filled sacs, called cysts, on both of her unborn infant’s ovaries, and their weight had twisted the egg-producing organs around. Such ovarian torsion can cut off blood flow to the organs, leading to their death, meaning that Levy’s child would be infertile.

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“Normally, you don’t see a fetus’s ovaries in a regular scan, but the ovaries in this fetus were so large due to the cysts that they took up much of the abdomen and were impossible to miss,” Porat said. “They were each almost 4 cm (1.6 inches) in size.”

Porat credited an enhancement made to the hospital’s ultrasound just a few weeks earlier that made it possible to see that there was still some blood flowing to both ovaries. This told him that “we still had something to save,” as he said, but time was of the essence.

“I prayed that it wouldn’t be too late,” Levy said. “These were very stressful moments, but Dr. Porat… made me feel that everything was under control.”

Porat recommended delivering the baby immediately in an emergency c-section as the safest option. The tiny newborn was then rushed into her own surgery, where Dr. Dan Arbel, head of the pediatric oncology surgery unit, made a miniscule cut in her abdomen, lifted out the ovaries, drained the cysts, and put them back in their proper position, with blood feeding the organs normally again.

This is a common procedure for women, and sometimes girls, who have such cysts twisting their ovaries – an extremely painful occurrence that cannot be ignored. But surgery on a preemie, Arbel noted, is much more difficult.

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“We were able to operate in record time – half an hour after her birth she was inside the incubator in the neonatal intensive care unit,” he said.

Ovarian cysts are not uncommon in fetuses, but they usually disappear on their own. Ovarian torsion in utero is much rarer, Porat said, and it almost always occurs in one ovary, not both, with the condition detected too late to rescue the organ. Baby Levy’s case of bilateral torsion “is not documented at all” in the medical literature, he noted.