Retained Intrauterine Bony Fragments as a Cause of Secondary Infertility in a Tertiary Level Indian Hospital

BACKGROUND: Midtrimester surgical abortions often result in retained intrauterine fetal bones and consequent secondary infertility. AIM: To study the incidence of women presenting with retained intrauterine bones as a cause of secondary infertility in a tertiary level Indian hospital and pregnancy rates following retrieval of these fragments. SETTING AND DESIGN: Retrospective data analysis in the infertility clinic of PGIMER (Post Graduate Institute of Medical Education and Research), a tertiary level hospital of Northern India. MATERIALS AND METHODS: Women diagnosed with retained intrauterine bony fragments were subjected to hysteroscopic removal of these fragments. Incidentally diagnosed retained bones on hysteroscopy were also removed. Such women were followed for spontaneous resumption of fertility or were subjected to ovulation induction, and pregnancy rates were noted. RESULTS: Retained fetal bones accounted for 0.28% of all women with infertility and 12% (22/144) of all the uterine causes of infertility requiring an operative hysteroscopic procedure for treatment. Only 5 (27.7%) of 18 women conceived after the hysteroscopic retrieval of bony fragments: three had full-term vaginal deliveries, one had a midtrimester abortion, and one woman is in her third trimester. CONCLUSION: Despite surgical retrieval, fertility rates may be lower due to inflammatory damage to the endometrium.