Female - Suspensory Ligament of Ovary

1. Overview

The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, is a fold of peritoneum that extends from the lateral aspect of the ovary to the lateral pelvic wall. Unlike structural ligaments, its primary function is to serve as a conduit for the ovarian neurovascular bundle. It plays a vital role in maintaining ovarian blood supply and securing the ovary's position within the pelvic cavity.

2. Location

The suspensory ligament of the ovary arises from the lateral pole of the ovary and ascends superiorly and laterally to attach to the lateral wall of the pelvis, near the pelvic brim. It lies lateral to the ovary and fallopian tube and is continuous with the broad ligament's upper edge. This ligament bridges the space between the ovary and the pelvic sidewall, passing above the ureter and anterior to the iliac vessels.

3. Structure

The suspensory ligament is a peritoneal fold composed of:

• Double layer of peritoneum: Continuous with the broad ligament.

• Ovarian artery and vein: The main blood vessels supplying the ovary. The ovarian artery arises from the abdominal aorta, and the ovarian vein drains into the inferior vena cava (right) or left renal vein (left).

• Lymphatic vessels: Drain lymph from the ovary and fallopian tube to the para-aortic lymph nodes.

• Nerves: The ovarian plexus, which carries autonomic fibers to the ovary, also runs within this ligament.

It does not contain muscle fibers and is not a structural support ligament in the traditional sense but a vital vascular pedicle.

4. Function

The main functions of the suspensory ligament of the ovary include:

• Vascular conduit: Transmits the ovarian artery, vein, lymphatics, and nerves from the retroperitoneum to the ovary.

• Ovarian positioning: Helps suspend the ovary in a relatively fixed position adjacent to the pelvic wall and fallopian tube.

• Support during ovulation: Maintains spatial alignment with the fimbriae of the fallopian tube for efficient oocyte capture.

5. Physiological Role(s)

Although not hormonally active itself, the suspensory ligament plays key physiological roles by:

• Maintaining ovarian perfusion: The ovarian artery within the ligament delivers essential nutrients and oxygen for follicular development, ovulation, and hormone production.

• Lymphatic drainage: Helps prevent fluid and toxin accumulation in the ovary and fallopian tube by facilitating lymphatic return.

• Autonomic signaling: The nerve fibers carried within the ligament regulate vasomotor tone and possibly influence ovarian hormone secretion indirectly.

Thus, the ligament serves as a lifeline for the ovary, ensuring its metabolic and functional viability.

6. Clinical Significance

The suspensory ligament of the ovary is highly relevant in clinical and surgical settings:

• Oophorectomy (ovary removal): The suspensory ligament must be clamped and ligated to control ovarian blood supply. It is a critical step during salpingo-oophorectomy procedures.

• Ovarian torsion: Twisting of the ovary may involve the suspensory ligament, compromising blood flow through the ovarian vessels and leading to ischemia—often requiring emergency surgical intervention.

• Ligation in sterilization procedures: Care must be taken not to damage the suspensory ligament during tubal sterilization or hysterectomy, especially when ovaries are preserved.

• Endometriosis and adhesions: Pathological conditions may affect or distort the suspensory ligament, leading to chronic pelvic pain or infertility due to impaired blood supply or altered anatomy.

• Tumor spread: Ovarian cancers can involve lymphatic channels in this ligament. Hence, it is examined during staging laparotomy for malignancy.

Surgeons and radiologists must have a clear understanding of the suspensory ligament’s anatomy to avoid complications related to vascular injury or incomplete ovarian excision.