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Secondary Infertility and Retained Fetal Bone Fragments

Winkelman, William D. BA; Frates, Mary C. MD; Fox, Janis H. MD; Ginsburg, Elizabeth S. MD; Srouji, Serene MD

doi: 10.1097/AOG.0b013e3182917c9c
Case Report

BACKGROUND: Retained fetal bone fragments may be an underreported and underappreciated cause of secondary infertility among women with an antecedent spontaneous or induced abortion.

CASES: Three patients with a history of an antecedent induced abortion presented with secondary infertility. The infertility evaluation diagnosed retained intrauterine fetal bone fragments. After removal of the bone fragments, two of the three patients successfully conceived.

CONCLUSION: Secondary infertility may be the only presenting symptom for women with retained fetal bone fragments. Women with secondary infertility and antecedent spontaneous or induced abortion may benefit from uterine evaluation with ultrasonography before initiating infertility treatment. For patients with findings of focal echogenic shadowing lesions at ultrasonography, we recommend ultrasonography-guided hysteroscopy to ensure that bone fragments embedded within the myometrium are not missed and are completely resected.

Secondary infertility may be caused by retained fetal bone fragments, and hysteroscopic and ultrasonographic uterine evaluation should be considered in women with an antecedent induced or spontaneous abortion.

Harvard Medical School, and the Departments of Radiology and Obstetrics/Gynecology: Reproductive Medicine, Brigham and Women's Hospital, Boston, Massachusetts.

Corresponding author: William D. Winkelman, BA, Brigham and Women's Hospital, Center for Reproductive Medicine 75 Francis Street, Boston, MA 02115; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists.