The suspensory ligament of the ovary (infundibulopelvic ligament, IP ligament) connects the ovary to the lateral pelvic sidewall and transmits the ovarian artery and vein, the ovarian nerve plexus, and lymphatics from the ovary. It is not the same as the ovarian ligament proper (which connects the ovary to the uterus). The ureter runs just medial to the IP ligament as it crosses the pelvic brim.
Suspends the ovary from the lateral pelvic sidewall, transmits the main ovarian blood supply, and maintains ovarian position within the pelvis.
The suspensory ligament is divided during salpingo-oophorectomy and in oophorectomy alone, requiring identification and protection of the ureter that passes just medial to the ligament at the pelvic brim. The IP ligament is also the structure containing the ovarian vessels for ovarian stimulation in IVF and for ovarian remnant identification after prior surgery. Ovarian torsion twists the ovary on the suspensory ligament, occluding the ovarian vascular pedicle; surgical untwisting with preservation of the IP ligament restores ovarian blood flow in viable ovaries.
The ureter crossing the pelvic brim just medial to the infundibulopelvic ligament is the most at-risk structure during laparoscopic salpingo-oophorectomy; identification of the ureter by retroperitoneal dissection before clipping or stapling the IP ligament prevents ureteric ligation, which may go unrecognised until post-operative ureteric obstruction.
