suspensory ligament of the ovary

The suspensory ligament of the ovary, also called the infundibulopelvic (IP) ligament, is a peritoneal fold extending from the lateral pelvic wall to the ovary. It carries the ovarian artery (a direct branch of the abdominal aorta arising near L2), ovarian vein (right drains into the IVC, left drains into the left renal vein), lymphatics, and autonomic nerve fibers. This is distinct from the ovarian ligament proper, which connects the ovary to the uterus, and the round ligament of the uterus, which runs from the uterus through the inguinal canal to the labia majora—both of these are remnants of the gubernaculum.

Clinically, the suspensory ligament is highly significant in gynecologic surgery. During procedures such as salpingo-oophorectomy or hysterectomy with bilateral salpingo-oophorectomy, surgeons must ligate the ovarian vessels within this ligament. The ureter courses retroperitoneally in close proximity to the IP ligament as it crosses the pelvic brim near the bifurcation of the common iliac artery, putting it at risk for inadvertent injury or ligation during this step ("water under the bridge" mnemonic, analogous to the uterine artery-ureter relationship, though here it's the ovarian vessels crossing near the ureter at the pelvic brim). Careful identification of the ureter before clamping the IP ligament is a key surgical principle to prevent ureteral injury, which can lead to urinoma, hydronephrosis, or fistula formation.

Embryologically, the ovarian vessels form via the gonadal vessels that originate near the developing kidneys and descend with the ovaries during fetal development, explaining their high origin from the aorta/renal vein rather than from pelvic vessels like the uterine artery.