Supernumerary Ovaries - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The supernumerary ovary is another ovary in the female reproductive system and is situated separately from the other two ovaries. This is a rare gynecological condition. The third ovary develops with no connection to the uterus and ovarian ligament. The supernumerary ovaries' condition can be cancerous in the long run. The supernumerary ovaries usually do not cause any symptoms. They are identified in one of the thirty thousand autopsies (dissection and examination of the dead body to know the cause of death) cases.

Where Are the Ovaries Normally Situated?

The ovaries are two in number and located on the right and left side of the uterus in the lower abdomen of the female reproductive system. The ovaries are held in position by several muscles and ligaments in the pelvis. The uterus and ovaries do not touch; they connect the ovaries to the uterus.

Where Are the Supernumerary Ovaries Located?

The supernumerary ovaries are situated in the pelvic region. The supernumerary ovaries are small and located near the uterus (womb), urinary bladder, pelvic wall, retroperitoneum (anatomical space situated behind the abdominal cavity), mesentery (the fold of membrane that attaches the intestine to the abdominal wall and holds it in place), pouch of Douglas (rectouterine pouch). The supernumerary ovaries structurally have follicles and develop from a different primordium. They are situated away from the other two ovaries.

What Is the Difference Between the Supernumerary Ovary and an Accessory Ovary?

The supernumerary ovary has ovarian tissue located separately from the normal ovaries and has no direct connection. The accessory ovary is near the normal ovaries and has a direct connection.

What Are the Causes of the Supernumerary Ovaries?

The causes of the supernumerary ovaries are as follows:

• The supernumerary ovaries occur due to the abnormal separation of a tiny portion of the developing and migrating ovarian primordium (which undergoes differentiation to develop into an ovary).

• The supernumerary ovaries have an embryological origin or acquired origin.

• The ovarian cells are implanted at an abnormal location with subsequent ovarian development.

• Also arises due to ovarian tissue implantation during surgery.

• Another cause is due to post inflammatory implantation.

• Migration of the gonadal ridge after germ cell development.

• Migration of germ cells to a site other than where the normal ovaries must be placed.

• Accidental disruption of the ovarian tissue during surgery is another cause of supernumerary ovaries.

• In Mayer-Rokitansty-Kuster-Hauser (MRKH) syndrome is a disorder that affects the female reproductive system and causes the absence of the vagina and the uterus. The affected individuals do not get periods as the uterus is absent. In this syndrome case, there is a possibility of the formation of supernumerary ovaries.

What Are the Symptoms of the Supernumerary Ovaries?

Usually, the supernumerary ovaries do not cause any symptoms or signs. They are considered nonfunctional. Sometimes they develop chronic abdominal and pelvic pain. The supernumerary ovaries develop in the pelvic region and also cause endometriosis (formation of cells similar to which line the uterus on fallopian tubes and other structures).

What Are the Complications Associated With Supernumerary Ovaries?

• Bicornuate Uterus: The bicornuate uterus means a uterus that is shaped irregularly.

• Unicornuate Uterus: The unicornuate uterus is the presence of only half of the uterus (womb).

• Bifid Fallopian Tubes: The fallopian tubes (two in number present on either side of the uterus) are bifurcated.

• Accessory Tubal Ostia: It means the fallopian tube fimbriae present at the start of the tube, which helps to collect eggs, are situated at a distance from the normal.

• The supernumerary ovaries can become malignant in the long run and can be life-threatening.

• There are congenital abnormalities associated with supernumerary cysts.

• Degeneration of kidney.

• Agenesis of the ureter.

• Duplicated ureter.

• Accessory adrenal glands.

• Lobulated liver.

• Enlargement of the supernumerary ovary causes abdominal pain.

• Torsion of supernumerary ovary (they twist on the ligaments which support them).

• Other complications of supernumerary ovaries are corpus luteal cysts (a normal mass consisting of fluid), endometriomas (cystic lesions formed due to endometriosis), and dermoid cysts.

• Mucinous cystadenomas are large multilocular cysts consisting of fluid of various viscosities. They are developed in association with supernumerary ovaries.

• Brenner Tumor: These tumors are benign, and they are surface epithelial ovarian tumors. They are uncommon subtypes.

• Fibroma is a benign (non-cancerous) tumor containing fibrous connective tissue.

How Are the Supernumerary Ovaries Diagnosed?

The supernumerary ovaries are diagnosed through the following methods:

• Computed Tomography (CT) Scan: Computed Tomography (CT) scan helps to diagnose the supernumerary ovaries.

• Magnetic Resonance Imaging (MRI) Scan: MRI scan help identify supernumerary ovaries.

• Ultrasonography: Ultrasonography (non-invasive ultraviolet rays are utilized to view the internal organs) helps to detect supernumerary ovaries.

• Color Doppler Examination: If there is no visibility of the vascular structure in color Doppler examination, then supernumerary ovaries can be suspected. The supernumerary ovaries do not have blood vessels connected to normal ovaries or pelvic muscles.

• With these methods, the complete, accurate diagnosis of supernumerary ovaries is impossible.

• The examination of the pelvic area.

• Blood tests.

• Hormonal tests.

• Urine tests help in the detection of supernumerary ovaries.

What Is the Treatment for Supernumerary Ovaries?

The ideal treatment of the supernumerary ovaries is the excision of the extra ovary. The supernumerary ovaries can be cancerous in the long run. Perform surgery using a laparoscope (a tiny tube with a camera to view the internal organs), identify the correct supernumerary ovary, and remove it. But in some situations, like adnexal ovarian torsion, the ovary twists around the ligament that holds it in position and decreases blood supply to the ovary. The ovary becomes dead and must surgically remove them. If the supernumerary ovary is present in the pelvis, it can act as a functional ovary. They can supply the necessary follicles for future fertility. In such cases, there is a dilemma about removing the supernumerary ovaries or preserving them for fertility. The surgical removal of ovaries is known as oophorectomy. The supernumerary ovaries are screened for pathology during the oophorectomy surgical procedure.

Conclusion

The supernumerary ovaries are generally nonfunctional and do not cause any symptoms. But recommended removing them as they can cause malignancies and elevate estrogen levels to a greater extent. The supernumerary ovaries are rare; hence, proper and frequent screening tests are essential to identify them.