Osseous metaplasia of the endometrium – an unusual etiology of secondary infertility in a nulliparous woman

Abstract

The presence of bony tissue within the endometrium is an uncommon finding, usually uncovered during assessments for infertility. Most of the cases present with a clinical history of recurrent miscarriages, pelvic pain, dyspareunia, and menstrual irregularities, such as hypermenorrhea and dysmenorrhea. The other names of this rare entity are endometrial ossification, ectopic intrauterine bone, and heterotopic intrauterine bone formation. We present one such rare case with a review of the literature on a 21-year-old female presenting with secondary infertility. Endometrial osseous metaplasia should be considered in the differential diagnosis of intrauterine calcifications in women presenting with infertility or menstrual abnormalities. In the present case, ultrasonography demonstrated multiple linear calcifications with posterior acoustic shadowing in the lower endometrial cavity and endocervical junction. Hysteroscopy revealed four bony fragments, which were excised and sent for histopathological examination. The histopathological findings were consistent with endometrial osseous metaplasia. Hysteroscopic removal is considered the preferred treatment and may improve fertility by restoring the normal endometrial cavity.