Ovary

The ovaries are paired organs of the female reproductive and endocrine systems. They lie within the ovarian fossa on the posterior wall of the true pelvis. 

Gross anatomy and relations

The ovaries are ovoid in shape and measure approximately 1.5-3cm x 1.5-3cm x 1-2cm (length x width x thickness) and(1.2-9.4 cc)and weigh 2-8g. They double in size in pregnancy. 

The suspensory ligament of the ovary, a peritoneal fold, runs from the side wall of the pelvis to the ovary. The ovarian vessels run in this, crossing over the external iliac vessels.

Each ovary is attached to the back of the broad ligament by the mesovarium, which is continuous with its outer coat. A fourth attachment, the ovarian ligament, which is a continuation of the round ligament and attaches the ovary to the side of the uterus.

Despite all its attachments, the ovary is very mobile, especially in women who have had children. it is frequently found behind the uterus in the pouch of Douglas and have a variable relationship with the uterus:

• anteflexed uterus - lateral or posterlateral
• retroflexed uterus - superolateral

Relations ^3-4

• anteriorly - broad ligament, mesovarium, ovarian vessels, obliterated umbilical vein
• posteriorly - ureter, internal iliac vessels, pelvic wall
• superiorly - external iliac vessels
• inferiorly - levator ani
• medially - ovarian ligament
• laterally - obturator vessels and nerves

Blood supply

• arterial supply - ovarian artery
• venous drainage - pampiniform plexus to the ovarian veins:
  • right ovarian vein drains into the inferior vena cava
  • left ovarian ven drains into the left renal vein

Nerve supply

• aortic, renal and superior and inferior hypogastric plexuses form the ovarian plexus

Lymphatic drainage

• travel with the ovarian vessels to pre-aortic nodes

Radiological appearance

Ultrasound

• first line investigation
• homogenous echotexture with a central echogenic medulla
• volume on ultrasound can be calculated with following formula 5: 
  • 0.523 x length (cm) x width (cm) x depth (cm)

CT

• can be difficult to identify or may be confused with enlarged lymph nodes ⁵
• its position may be determined by the following techniques ⁵: 
  • anterior or anterolateral to the pelvic ureter if in a typical position
  • tracking the ovarian vein from the IVC or left renal artery anterior to the psoas major to the region where the ovary lies
  • suspensory ligament of the ovary - usually extends from the ovary to the external or common iliac vessels; most easily identifiable of the pelvic ligaments
• the ovary can be differentiated from lymph nodes, which are extraperitoneal and displace the ureter medially or anteromedially or efface the common iliac vessels when enlarged ⁵

Related pathology

• Müllerian duct abnormalities
• ectopic pregnancy : ovarian
• pelvic inflammatory disease
• endometriosis
• ovarian cyst
• ovarian dermoid
• ovarian cancer