Retained Intra-uterine Foetal Bones Resulting in Secondary Infertility: A Case Report

Abstract

Termination of pregnancy (abortion) is a reasonably safe procedure when properly performed. However, even after being performed with due precautions, complications may occur. Retention of fetal products following a mid-trimester abortion is a rare complication of abortion which can then result in secondary infertility. We are here presenting the case of a young woman who underwent an abortion in the 15th week of gestation due to anencephaly in the fetus and who then failed to conceive for the next five years. Transvaginal ultrasonographic examination suggested the presence of bone-like structures in the uterine cavity which were removed hysteroscopically. The patient was able to conceive after the hysteroscopic removal of bony fragments. Retained bony fragments from a previous mid-trimester abortion should thus be kept in the list of differentials of secondary infertility.

Retained fetal bone post‐abortion causing infertility

“…This case highlights the difficulty in diagnosing the cause of secondary infertility and abdominal discomfort by noting that the first ultrasound scan as well as the MRI scan did not show any foreign bodies inside the endometrium. Potential differential diagnoses may include osseous metaplasia driven by chronic inflammation causing dystrophic calcification, 3 endometrial ossification driven by chronic inflammation, and tissue destruction in the mature endometrial stroma 4 . These two differential diagnoses can be ruled out because the segment retrieved by hysteroscopy looked like a fetal long bone, and the histology showed dead bone fragments but no active tissue.…”

“…This effect is similar to that of an Intrauterine Contraceptive Device (IUCD) in situ. Some research has suggested that the fetal bone may have a direct toxic effect on the developing embryo, thereby causing infertility 4 …”

“…Some research has suggested that the fetal bone may have a direct toxic effect on the developing embryo, thereby causing infertility. 4 Currently, hysteroscopy is used in most cases as the treatment of choice to retrieve a foreign body to treat infertility [1][2][3][4] or menstrual complaints, including chronic pelvic pain. 5 However, there is a lack of national guidance regarding gold standard investigations or treatments.…”

“…Potential differential diagnoses may include osseous metaplasia driven by chronic inflammation causing dystrophic calcification, 3 endometrial ossification driven by chronic inflammation, and tissue destruction in the mature endometrial stroma. 4 These two differential diagnoses can be ruled out because the segment retrieved by hysteroscopy looked like a fetal long bone, and the histology showed dead bone fragments but no active tissue.…”

“…Some research has suggested that the fetal bone may have a direct toxic effect on the developing embryo, thereby causing infertility. 4 …”