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Iatrogenic secondary infertility caused by residual intrauterine fetal bone after midtrimester abortion

1997; Elsevier BV; Volume: 176; Issue: 2 Linguagem: Inglês

10.1016/s0002-9378(97)70500-3

1097-6868

Hwa Sook Moon, Yang Hee Park, Hyuck Yung Kwon, Sook Hee Hong, Sang Kap Kim,

Prenatal Screening and Diagnostics

Eleven women with secondary infertility had ultrasonographic findings of intrauterine calcification. Infertility developed in all women after operative termination of midtrimester pregnancy. Dilation and curettage or hysteroscopic removal confirmed residual fetal bony fragments. The removal of these bony fragments was associated with therapeutic success for infertility.Reported are 11 cases from a Korean medical center in which retained fragments of fetal bone after midtrimester abortion were contributing to secondary infertility. All 11 women underwent induced abortion at 16-24 weeks of gestation. The duration of infertility ranged from 1 to 5 years. Although 10 women had normal hysterosalpingograms, vaginal ultrasonography revealed a linear echogenic density suggestive of calcified lesions. Diagnostic dilation and curettage were performed, with or without hysteroscopy, and complete removal of fetal bone fragments was confirmed by transvaginal ultrasonography. In 10 cases, the fragments were suggestive of fetal skull bone. In midtrimester abortion, instrumentation tends to detach the fetal head and the skull may have to be crushed. The retention of a bony structure in the endometrial cavity or ossification of the endometrium may play the role of an IUD in preventing conception. After treatment, all the women, except 1 with bilateral tubal occlusion, conceived and delivered full-term infants. In 8 cases, conception occurred within 3 months of bone fragment removal. Infertile women with a history of late first trimester or midtrimester abortion should be evaluated by vaginal ultrasonography to rule out the presence of intrauterine fetal bone.