Pyometra is the accumulation of purulent material in the uterine cavity. Its reported incidence is 0.01−0.5% in gynecologic patients; however, as far as elderly patients are concerned, its incidence is 13.6% [3]. The most common cause of pyometra is malignant diseases of genital tract and the consequences of their treatment (radiotherapy). Other causes are benign tumors like leiomyoma, endometrial polyps, senile cervicitis, cervical occlusion after surgery, puerperal infections, and congenital cervical anomalies. Spontaneous rupture of the uterus is an extremely rare complication of pyometra. To our knowledge, only 21 cases of spontaneous perforation of pyometra have been reported in English literature since 1980. This paper reports an additional case of spontaneous uterine rupture.

BackgroundT- shaped uterus may be associated with infertility and adverse pregnancy outcomes. Hysteroscopic metroplasty may improve the reproductivity for these cases. To our knowledge, there is no data in literature about the clinical consequences of in vitro fertilization (IVF) in patients undergoing hysteroscopic metroplasty for T-shaped uterus. The principal objective of the current study is to assess the impact of hysteroscopic metroplasty for T-shaped uterus on the reproductive outcomes of IVF.MethodsIVF outcomes of 74 patients who underwent hysteroscopic metroplasty for T- shaped uterus and 148 patients without any uterine abnormalities and with diagnosis of unexplained infertility (control group) were retrospectively analyzed.ResultsPatients in metroplasty and control groups were comparable with respect to age, BMI, partner’s age and duration of infertility. Number of patients with a history of pregnancy beyond 20 weeks of gestation was significantly lower in the metroplasty group (4.1% vs 18.2%; p < 0.05). Number of previous unsuccessful cycles and percentage of patients with ≥3 unsuccessful IVF cycles (35.1% vs 17.6%; p < 0.05) were significantly higher in the metroplasty group. There were no significant differences in the reproductive outcomes such as the pregnancy rate, clinical pregnancy or live birth rate between the metroplasty and control groups. There were non-significant trends for higher rates of miscarriage (18.8% vs 8%, p > 0.05) and biochemical pregnancy (20.0% vs 10.7%, p > 0.05) in the metroplasty group compared to the control group.ConclusionsReproductive results of the IVF cycles after hysteroscopic correction of T-shaped uterus were comparable to those of the patients without any uterine abnormalities and with diagnosis of unexplained infertility. Hysteroscopic metroplasty may contribute to improved IVF outcomes in patients with T-shaped uterus.

Objective: To compare the rates of blastocyst stage development between embryos fertilized after one (MPN) or more than two pronucleus (PN) (3PN, 4PN-multiPN) with those after 2PN in the same patients. Material and Methods: The embryos of patients who had both abnormal PN (MPN, 3PN or 4PN) and normal fertilized (2PN) embryos after intracytoplasmic sperm injection (ICSI) fertilization, were followed with a time-lapse system following the ICSI procedure. The rates of reaching the blastocyst stage were compared between normal and abnormally fertilized embryos. Results: One thousand eight hundred and twenty oocytes were collected from 140 patients and 1280 (70.3%) of them were fertilized. MPN, 2PN and 3PN, 4PN (multiPN) ratios of the embryos in the pronuclear stage were 11.4%, 83.13% and 5.47%, respectively. The rates of reaching the blastocyst stage among these embryos were 17.1%, 60.8% and 42.8% for MPN, 2PN and multiPN, respectively. The proportion reaching blastocyst development was significantly higher following 2PN compared to those after MPN and multiPN (p<0.05). Embryos developing after multiPN had significantly higher rates of reaching the blastocyst stage compared to those after MPN (p<0.01). Conclusion: The majority of abnormally pronucleated embryos arrest without reaching the blastocyst stage. MultiPN embryos have a higher rate of blastocyst development than MPN embryos.