Congenital unilateral absence of an ovary medicolegal case

Recently I was asked to provide an expert opinion on the causation of a missing ovary discovered at  a third laparoscopy. It was alleged by another expert witness that this must have been surgically removed at one of the 2 previous laparoscopies, both of which were brief procedures. The witness stated that in his experience congenital absence of one ovary had never occurred.

In fact there have been a number of case reports of just such congenital absence of only one ovary: in 1978 Sivisena reported absence of a left tube and ovary and referred to 3 similar previous case reports; in 1986 Sivanesaratnam reported 2 cases in Malaysia; in 1992 Eustace reported 2 cases in England and in 2009 Ackuyu reported 4 cases in Turkey. Subsequently Pabuccu, also from Turkey, reported another case in a 21 year old girl with 3 years of primary infertility. That 2011 paper cited another 7 cases in the world literature: 3 of those had associated uterine and renal developmental anomalies. Sivanesaratnam estimated that the incidence of unilateral absence of an ovary was lower than 1:11,000 women.

Eustace (1992) postulated that such unilateral ovarian absence could also arise from asymptomatic torsion of an ovary either in utero or during postnatal life. Pabuccu favoured a theory of causation involving a vascular accident.

Last year (2013) Liu et al reported one case and analysed a further 38 cases in the world literature!

References:
1. Sirisena LA (1978) 54 Postgraduate Medical Journal 423-424
2. Sivanesaratnam V (1986)  22 European Journal of Obstetrics & Gynecology & Reproductive Biology 103-105
3. Eustace DL (1992) 46 European J Obstetrics & Gynecology and Reproductive Biology 157-159
4. Ackuyu et al (2009) 91(3) Fertil Steril 936:e5-e8.
5. Dueck et al (2001) 17  Pediatric Surgery International 228-229
6. Pabuccu et al (2011) 96 Fertil Steril e55-e57
7. Liu Q et al (2013) 288 Archives of Gynecology and Obstetrics 555-561.