Secondary infertility due to intrauterine fetal bone retention: A case report and review of the literature


Background: Intrauterine retention of fetal bone fragments is a rare condition that could happen after abortion (especially illegal abortion). It can cause secondary infertility as bon fragments can work as an intrauterine contraceptive device.

Case: A 25-year-old Iranian woman was referred to Shariati Hospital due to infertility. During infertility work up to normal semen analysis, adequate ovarian reserve with regular ovulatory cycles was documented. An ultrasound scan revealed focal echogenic shadowing lesions inside the uterine cavity. Hysteroscopy was conducted and many intrauterine bone fragments were revealed. Six months after hysteroscopic removal of fetal bones, the patient became pregnant and delivered a healthy and term baby.

Conclusion: Intrauterine fetal bone retention is a scarce event that happens after pregnancy termination due to the incomplete evacuation of fetal tissues. It can cause dysfunctional uterine bleeding, menorrhagia, dysmenorrhea, pelvic pain, abnormal vaginal discharge, and secondary infertility. The detection of the problem and the removal of the remained bones by hysteroscopy have made possible to treat the patient safely and restore normal uterine function and female fertility.

[1] Xiao S, Tian Q, Xue M. Infertility caused by intrauterine fetal bone retention: a case report. J Med Case Rep 2014; 8: 177.

[2] Lanzarone VF, Pardey JM Retained intrauterine fetal bone as a rare cause of secondary infertility. Aust N Z J Obstet Gynaecol 2009; 49: 700–701.

[3] Kramer HM, Rhemrev JP. Secondary infertility caused by the retention of fetal bones after an abortion: a case report. J Med Case Rep 2008; 2: 208.

[4] Lewis V, Khan-Dawood F, King M, Beckmann C, Dawood MY. Retention of intrauterine fetal bone increases menstrual prostaglandins. Obstet Gynecol 1990; 75: 561–563.

[5] Goldberg JM, Roberts S. Restoration of fertility after hysteroscopic removal of intrauterine bone fragments. Obstet Gynecol 2008; 112: 470–472.

[6] Usha Kiran TS, Bhal PS. The potential consequence of early recognition and treatment of retained fetal bony fragments. J Obstet Gynaecol 2002; 22: 443–444.

[7] Chervenak FA, Amin HK, Neuwirth RS. Symptomatic intrauterine retention of fetal bones. Obstet Gynecol 1982; 52: 58S–61S.

[8] Parente RC, Patriarca MT, de Moura Neto RS, de Oliveira MA, Lasmar RB, de Holanda Mendes P, et al. Genetic analysis of the cause of endometrial osseous metaplasia. Obstet Gynecol 2009; 114: 1103–1108.

[9] Tulandi T, Al-Sunaidi M, Arseneau J, Tonin PN, Arcand SL. Calcified tissue of fetal origin in utero. Fertil Steril 2008; 89: 217–218.

[10]Roth E, Taylor HB. Heterotopic cartilage in the uterus. Obstet Gynecol 1966; 27: 838–844.

[11] Khan SN, Modi M, Hoyos LR, Imudia AN, Awonuga AO. Bone in the endometrium: A review. Int J Fertil Steril 2016; 10: 154–161.