pyometra is a rare complication of in vitro fertilization and embryo transfer . in this paper
a 30-year - old female , married for 7 years presented to our clinic with primary subfertility .
she had a history of recurrent ovarian cyst on the left ovary for which both laparoscopic cystectomy and laparotomy had been done .
a day 2 transvaginal ultrasound showed an antral follicle count of seven on the right side .
six fertilized and three 8 cell embryos were transferred on the 3 day after egg collection .
the sonologist reported a cystic mass in the left adnexa , which was suggestive of hydrosalpinx .
eight eggs were retrieved , seven fertilized and three 8 celled embryos were transferred ( day 3 ) .
twelve days after embryo transfer ( et ) she complained of pain in the lower abdomen and orange colored , odorless discharge per vaginum .
on transvaginal ultrasound scan , the uterine cavity appeared to be distended with fluid and the endometrium was bright and echogeneic .
the total white blood cell count was 4000 and the differential count was also within normal limits .
a single intrauterine gestation was seen 5 days later and the fetal heart was documented a week later .
the catheter was removed at this stage as there was minimal pus in the drain .
the patient was discharged from the hospital and resumed antenatal care on the outpatient basis .
she underwent regular first trimester screening for down 's syndrome , which was reported as low risk .
she had impaired glucose tolerance at 20 weeks and was advised a diabetic diet , which she followed throughout her pregnancy .
she had an elective cesarian at 39 weeks and delivered a healthy boy baby weighing 3.2 kg .
it has been reported previously in patients after egg collection . at the time of diagnosis , the endometrium seemed bright and echogenic and the beta hcg was positive .
a conservative approach was considered to be the patient was otherwise asymptomatic and there were no systemic features of infection ( the blood counts were normal and blood culture was negative ) .
the source of the collection was unknown . whether the recurrent cyst aspiration was contributory or was it due to fresh inoculation during et remained a mystery .
there was a plan to perform a laparoscopy to identify the source and perform corrective surgery if there was no spontaneous reduction within a week or if systemic features were to manifest earlier . in view of the early viable pregnancy ,
however , as the pus was sterile and the patient parameters were stable a conservative approach was considered acceptable .
there were suggestions to terminate the pregnancy as there were concerns if the pyometra could adversely affect the fetus and the mother .
as the pregnancy was progressing well as assessed by serial ultrasound , no active interventions were thought necessary .
however , orange colored vaginal discharge seemed out of place and she was called in for examination and ultrasound scan .
this case also tells us those patients concerns however strange should not be summarily dismissed without proper evaluation .
specific signs should be looked for , such as fever and masses with fluid levels on ultrasound in the uterus , adnexa or pelvis .
the mechanism of post - ivf / et infection apart from direct inoculation of vaginal microorganisms by puncture through the nonsterile vagina , could also be due to reactivation of an old pelvic inflammatory disease , or through inadvertent direct puncture of the bowel with spillage .
the most probable source of pus in this case was drainage of the hydrosalpinx and therefore an iatrogenic problem .
if drainage of the pus is not adequate to eradicate the focus of infection , removal of the affected organ ( salphingooopherectomy or hysterectomy ) might be necessary .
review of published literature showed case reports of pyometra in  postmenopausal  women ; and there are only two case reports of  nontuberculous  pyometra in the  reproductive  age group after ovum retrieval for ivf .
biopsy in one of the cases revealed endometritis , while the other was negative for it .
it has also been reported that early and reliable diagnosis of genital tuberculosis involving state of the art technology , such as dna polymerase chain reaction ( pcr ) and/or mrna - based reverse transcription - pcr ( rt - pcr ) ; and treatment before development of the fulminant genital tuberculosis has resulted in higher pregnancy rates .
genital tuberculosis should thus be considered for differential diagnosis of pyometra in young infertile patients as it may aggravate the disease ; and resultant peritonitis , which may be life - threatening . a rare case of tuberculous pyometra in a young infertile female confirmed by mrna - based rt - pcr
they concluded that a combination of high degree of clinical suspicion and  high precision  gene detection methods ( e.g. mrna ) in culture - negative cases may be useful in diagnosis of genital tuberculosis .
most cases described in the literature are associated with failed ivf , and even if the procedure is successful , the rate of pregnancy loss is high .
therefore if the condition is detected prior to et , consideration should be given to cryopreserving the embryos and treating the infection first , followed by a frozen et cycle .
successful pregnancies have been reported following treatment cycles complicated by infection , even when surgical drainage has been required for resolution .
the couple should be adequately counseled about the condition and should be involved in the decision making process .
the fact that successful term pregnancy is possible after diagnosis of pyometra tells us that there is a role for conservative management in pregnancy as long as the maternal condition is stable .
 a 30 year old woman presented 12 days after embryo transfer with lower abdominal pain and orange vaginal discharge . 
 she was diagnosed to have pyometra . 
 a conservative management with drainage of the pyometra was followed by an uneventful pregnancy and term delivery . 
 conservative management in a case of pregnancy with pyometra needs close supervision to ensure maternal and fetal well being . 
INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION