In 2014, a 34-year-old woman from Ivory Coast visited our clinic with signs of pelvic inflammatory disease (PID) and a positive chlamydia antibody test. Ultrasound imaging revealed large abscesses, and blood tests showed elevated infection parameters. She underwent laparoscopic surgery; during which, the left obstructed tube was drained and the right tube was removed due to pyosalpinx. A purulent fluid was drained from the pyosalpinx and sent for microbiologic examination. A general culture was negative, and PCR for Chlamydia was also negative. Recent cervical swabs were also negative for sexually-transmitted infections. The removed tube was send for pathology, and the histology sample showed fibrotic tissue with small granuloma's and mild necrosis. Further investigation with Ziehl-Neelsen, Periodic Acid Shift (PAS), and Grocott was performed and no signs of yeast, actinomyces, or tuberculosis could be found.
After the operation, the patient was referred to our fertility clinic for a full work-up, but did not follow through with the appointment until 2018. History revealed that she had one child with another partner, fourteen years prior. Hormonal status was normal, and ultrasound showed a normal uterus with a 3.5 mm endometrial thickness and a left ovary with a small cyst (33 x 26 mm) containing cloudy fluid, which was considered to be an endometriosis cyst. The patient and her partner underwent in vitro fertilization (IVF). IVF with embryo-transfer was the choice of treatment. Four embryos could be grown and two embryos of, however, low quality, were transferred into the uterus. Unfortunately, the patient did not become pregnant. Due to COVID-19, further treatment was postponed until 2022, when the patient and partner started an intracytoplasmic sperm injection (ICSI) procedure and the patient became pregnant.