Suspensory Ligament of the Ovary

The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, is a structure that extends from the ovary to the pelvic wall. It is located in the upper pelvic region, running along the lateral side of the ovary. This ligament carries important blood vessels, including the ovarian artery and ovarian vein, which supply blood to the ovary. The suspensory ligament attaches to the lateral pelvic wall, near the pelvic brim, and suspends the ovary within the pelvic cavity. It connects the ovary to the peritoneum and is part of the broader support system for the female reproductive organs.

Structure and Anatomy

The suspensory ligament of the ovary, also known as the infundibulopelvic ligament, is a vital structure within the female reproductive system that provides support to the ovary and carries critical blood vessels. Below is a detailed description of its anatomy, including its location, structure, and relationship to surrounding structures.

Location and Position

The suspensory ligament of the ovary is located in the upper part of the pelvic cavity, extending from the ovary to the lateral pelvic wall.

• Ovarian Attachment: The ligament originates from the superior pole of the ovary (the upper end) and extends outward toward the pelvic wall. This attachment suspends the ovary within the pelvic cavity and is an important point for providing support.
• Pelvic Wall Attachment: The other end of the ligament is anchored to the lateral wall of the pelvis, near the pelvic brim. It connects the ovary to the peritoneum, which lines the pelvic cavity, and ensures that the ovary remains in its proper anatomical position.
• Position Relative to Other Structures: The suspensory ligament is positioned laterally to the ovary and is located near the infundibulum of the fallopian tube, which is the funnel-shaped opening at the end of the tube. The ligament is also close to the psoas major muscle and the iliacus muscle, which are located on the posterior abdominal wall.

Structure and Composition

The suspensory ligament is composed of dense connective tissue that supports the ovary and carries important blood vessels and nerves.

• Connective Tissue: The ligament is primarily made up of strong collagen fibers, which provide the tensile strength necessary to support the weight of the ovary and maintain its position within the pelvic cavity. This fibrous tissue gives the ligament its stability, ensuring that the ovary is securely suspended.
• Peritoneal Fold: The suspensory ligament is technically a fold of peritoneum (the serous membrane that lines the abdominal cavity). It forms part of the broad ligament of the uterus, which supports the uterus and other reproductive organs. The suspensory ligament extends from the upper lateral edge of the broad ligament to the ovary.

Blood Supply and Vascular Components

One of the most important functions of the suspensory ligament is to serve as a conduit for the ovarian blood vessels, which supply the ovary with oxygenated blood and remove deoxygenated blood.

• Ovarian Artery: The ovarian artery runs through the suspensory ligament. This artery originates from the abdominal aorta, just below the renal arteries, and travels through the suspensory ligament to supply blood to the ovary. The artery enters the ovary at its superior pole, delivering oxygen and nutrients necessary for ovarian function.
• Ovarian Vein: The ovarian vein also runs through the suspensory ligament. On the right side, the ovarian vein drains directly into the inferior vena cava, while on the left side, it drains into the left renal vein. The venous system ensures that deoxygenated blood is removed from the ovary and returned to the systemic circulation.
• Additional Vascular Structures: In addition to the ovarian artery and vein, the suspensory ligament also contains smaller blood vessels that supply the surrounding tissues of the pelvic cavity and the reproductive organs.

Nerve Supply

The suspensory ligament carries nerves that supply the ovary with both autonomic and sensory innervation.

• Autonomic Nervous System: The ovarian nerves include branches from the ovarian plexus, which is part of the inferior hypogastric plexus. The autonomic nerves include both sympathetic and parasympathetic fibers, which regulate ovarian function and blood flow.
• Sympathetic Innervation: The sympathetic nerves stimulate the ovarian arteries to constrict or dilate, controlling blood flow to the ovary. These nerves originate from the T10-T12 spinal nerves.
• Sensory Nerve Fibers: The suspensory ligament also carries sensory nerves that provide pain and sensory feedback from the ovary. Pain during ovulation (known as mittelschmerz) or in conditions such as ovarian torsion can be transmitted through these sensory nerves.

Lymphatic Drainage

The suspensory ligament is a pathway for the lymphatic vessels that drain lymph from the ovary and surrounding structures.

• Lymphatic Drainage Pathways: Lymphatic vessels within the suspensory ligament drain lymph from the ovary to the lumbar (para-aortic) lymph nodes, which are located along the abdominal aorta. These lymph nodes filter the lymph and play a role in the immune defense of the reproductive system.
• Role in Cancer Spread: The lymphatic vessels in the suspensory ligament are important in the context of ovarian cancer, as malignant cells can spread through the lymphatic system to the lumbar lymph nodes. Understanding the lymphatic drainage pattern is important in the staging and treatment of ovarian cancer.

Embryological Development

The suspensory ligament of the ovary is derived from the mesonephric structures during embryonic development.

• Mesonephric Duct Derivatives: The suspensory ligament is part of the remnants of the mesonephric duct (also known as the Wolffian duct) that forms the urogenital structures during embryogenesis. This ligament develops as part of the supporting structures for the ovaries and other reproductive organs.
• Development of Blood Supply: During fetal development, the ovarian artery and vein develop in conjunction with the suspensory ligament to provide vascular support to the ovaries as they descend into the pelvic cavity.

Relationship to the Broad Ligament

The suspensory ligament of the ovary is closely associated with the broad ligament, which supports the uterus, ovaries, and fallopian tubes.

• Part of the Broad Ligament: The suspensory ligament is technically considered an extension of the broad ligament. It arises from the upper lateral part of the broad ligament and forms a distinct fold that supports the ovary and provides a pathway for its blood vessels and nerves.
• Connection to the Fallopian Tube: The suspensory ligament runs parallel to the infundibulum of the fallopian tube, which is the funnel-shaped portion near the ovary. The ligament’s proximity to the fallopian tube ensures that the ovary remains close to the fimbriae of the tube, which are responsible for capturing the egg during ovulation.

Histological Features

The suspensory ligament has distinct histological characteristics that reflect its role in support and vascular supply.

• Connective Tissue Composition: The ligament is primarily composed of dense connective tissue, consisting of collagen fibers that provide strength and support. These fibers ensure that the ligament can hold the ovary in place while maintaining the flexibility needed for movement during changes in intra-abdominal pressure.
• Blood Vessels and Nerves: Within the connective tissue matrix, the suspensory ligament contains numerous blood vessels and nerves, which are crucial for the function and health of the ovary. The ovarian artery and vein are surrounded by protective connective tissue as they pass through the ligament.

Function

The suspensory ligament of the ovary (infundibulopelvic ligament) plays several key roles in supporting the ovary and providing critical pathways for blood vessels, lymphatics, and nerves. Below is a detailed explanation of its functions.

Support and Stabilization of the Ovary

The suspensory ligament is a key structure in suspending and stabilizing the ovary within the pelvic cavity.

• Anchoring the Ovary: The suspensory ligament extends from the upper pole of the ovary to the lateral pelvic wall, creating a support system that keeps the ovary in its correct anatomical position. This stabilization is essential for maintaining the ovary’s relationship with the fallopian tube and other reproductive organs. By anchoring the ovary to the pelvic wall, the ligament prevents excessive movement, which is critical during activities such as walking, standing, or changes in intra-abdominal pressure.
• Preventing Ovarian Torsion: The suspensory ligament, along with other supporting structures like the ovarian ligament, helps prevent ovarian torsion, a condition in which the ovary twists around its supporting ligaments, cutting off its blood supply. The suspensory ligament reduces the likelihood of torsion by maintaining a stable connection between the ovary and the pelvic wall.

Conduit for Blood Supply to the Ovary

One of the primary functions of the suspensory ligament is to act as a conduit for the ovarian artery and vein, which supply the ovary with blood.

• Ovarian Artery: The suspensory ligament houses the ovarian artery, which originates from the abdominal aorta and travels through the ligament to reach the ovary. The ovarian artery supplies oxygenated blood to the ovary, ensuring that the ovary receives the necessary nutrients and oxygen to maintain its functions, including hormone production and ovulation.
• Ovarian Vein: The ligament also contains the ovarian vein, which carries deoxygenated blood away from the ovary. This venous drainage is critical for maintaining healthy circulation within the ovary and preventing the buildup of waste products. On the right side, the ovarian vein drains into the inferior vena cava, while on the left, it drains into the left renal vein.
• Vascular Protection: The dense connective tissue of the suspensory ligament protects the ovarian blood vessels from compression or injury. By surrounding the blood vessels, the ligament ensures that they remain securely in place as they pass through the pelvic cavity.

Pathway for Lymphatic Drainage

The suspensory ligament provides a pathway for the lymphatic vessels that drain the ovary.

• Lymphatic Drainage from the Ovary: The lymphatic vessels within the suspensory ligament drain lymph from the ovary and carry it to the lumbar (para-aortic) lymph nodes. This drainage is essential for removing excess fluid, waste products, and pathogens from the ovarian tissue. The lymphatic system also plays a key role in immune surveillance, protecting the ovary from infections and cancerous growths.
• Clinical Importance of Lymphatic Drainage: The lymphatic drainage system within the suspensory ligament is significant in the context of ovarian cancer, as malignant cells can spread through these lymphatic channels. The spread of ovarian cancer to the para-aortic lymph nodes often indicates advanced disease, making the ligament’s lymphatic role critical in cancer staging and prognosis.

Nerve Supply to the Ovary

The suspensory ligament also acts as a pathway for nerves that innervate the ovary, providing both autonomic and sensory nerve fibers.

• Autonomic Nerve Supply: The suspensory ligament contains branches from the ovarian plexus, which is part of the inferior hypogastric plexus. These autonomic nerves regulate the ovarian blood supply and hormone production. The sympathetic fibers (originating from the T10-T12 spinal levels) control vasoconstriction and dilation of the ovarian blood vessels, while parasympathetic fibers (from the pelvic splanchnic nerves) play a role in regulating blood flow and ovarian function.
• Pain and Sensory Feedback: The suspensory ligament also carries sensory nerves that transmit pain signals from the ovary to the central nervous system. Conditions such as ovarian torsion, cysts, or even mittelschmerz (pain during ovulation) can trigger these sensory nerves, leading to the perception of pain in the lower abdomen or pelvic area.

Facilitating Ovarian Function

By providing vascular and neural connections to the ovary, the suspensory ligament plays an indirect role in supporting ovarian function.

• Hormone Production: The blood supply delivered via the suspensory ligament ensures that the ovary has the oxygen and nutrients necessary to produce hormones, including estrogen and progesterone. These hormones regulate the menstrual cycle and are essential for reproductive health.
• Ovulation Support: The blood supply to the ovary is critical for ovulation, the process in which a mature egg is released from the ovarian follicle. Adequate oxygen and nutrients provided by the ovarian artery help support the follicle’s development and eventual rupture during ovulation.

Protecting the Ovary During Changes in Intra-Abdominal Pressure

The suspensory ligament helps maintain the ovary’s position during fluctuations in intra-abdominal pressure caused by activities such as sneezing, coughing, or lifting heavy objects.

• Stabilizing the Ovary: The suspensory ligament’s firm attachment to the lateral pelvic wall ensures that the ovary remains stable during these changes in pressure. This stabilization is important for preventing the ovary from shifting or twisting, which could lead to conditions like ovarian torsion.
• Flexibility for Movement: While the suspensory ligament stabilizes the ovary, its connective tissue structure also allows for a degree of flexibility, enabling the ovary to move slightly within the pelvic cavity without becoming displaced. This balance between stability and flexibility is crucial for the ovary’s normal function.

Role in Surgical Procedures

The suspensory ligament is important in various gynecological surgeries, particularly those involving the ovaries.

• Surgical Landmark: In surgeries such as oophorectomy (removal of the ovary) or cystectomy (removal of ovarian cysts), the suspensory ligament serves as an important anatomical landmark for surgeons. The ovarian artery and vein, which pass through the ligament, must be carefully ligated to prevent excessive bleeding during surgery.
• Avoiding Vascular Damage: During surgical procedures, care must be taken to avoid damaging the ovarian vessels within the suspensory ligament. Injury to these vessels could lead to complications such as hemorrhage or disruption of the ovary’s blood supply, potentially compromising ovarian function.

Coordination with Other Ligaments

The suspensory ligament works in conjunction with other pelvic ligaments to provide a comprehensive support system for the ovaries and other reproductive organs.

• Ovarian Ligament: The ovarian ligament, which connects the ovary to the uterus, works with the suspensory ligament to stabilize the ovary. While the ovarian ligament prevents the ovary from moving medially, the suspensory ligament anchors it laterally to the pelvic wall.
• Broad Ligament: The suspensory ligament is considered an extension of the broad ligament, which supports the uterus, fallopian tubes, and ovaries. Together, these ligaments form a network that keeps the reproductive organs in proper alignment within the pelvic cavity.

Clinical Significance

The suspensory ligament of the ovary (infundibulopelvic ligament) is clinically significant because it serves as a vital conduit for the ovarian artery, vein, nerves, and lymphatics. Its primary importance arises in gynecological surgeries, such as oophorectomy (removal of the ovary) or ovarian cystectomy, where surgeons must carefully identify and ligate the vessels within the ligament to prevent excessive bleeding. Damage to the ovarian vessels during surgery can compromise ovarian blood supply and lead to complications.

Additionally, the suspensory ligament is involved in conditions like ovarian torsion, a medical emergency where the ovary twists around the ligament, cutting off its blood supply, leading to severe pain and potential ovarian damage. The lymphatic drainage provided by the ligament is also clinically significant, as it can be a route for the spread of ovarian cancer to the para-aortic lymph nodes, impacting cancer staging and treatment decisions. Proper understanding of the suspensory ligament’s anatomy is crucial in managing ovarian health and performing safe pelvic surgeries.