title: Osseous metaplasia of the endometrium associated with infertility: a case report and review of the literature.
abstract: BACKGROUND
  Endometrial ossification is an uncommon disease related to secondary infertility and its etiology and pathogenesis are controversial. More than 80% of reported cases occur after pregnancy.
  
  
  METHODS
  A 33-year-old Caucasian woman was admitted with a history of secondary infertility and with a regular menstrual cycle. She reported a miscarriage at 12 weeks of gestation 7 years previously and subsequent dilatation and curettage in another medical facility. Vaginal ultrasound was performed and showed an intrauterine structure described as a hyperechogenic image suggesting calcification related to chronic endometritis. Office hysteroscopy revealed a wide endometrial cavity and proliferative endometrium, with a coral-like white plaque 1.5 cm in length on the right horn and posterior wall of the uterus. The lesion was treated by hysteroscopy without complications. Microscopic examination showed endometrial tissue with osseous metaplasia in the stroma. Nine months after the procedure, the patient became pregnant spontaneously.
  
  
  CONCLUSIONS
  In our patient, hysteroscopy was effective in the diagnosis and treatment of osseous metaplasia of the endometrium associated with infertility.
authors.affiliation: Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, São Paulo, Brazil. juliocrs@convex.com.br.
authors.forename: Julio César
authors.initials: JC
authors.lastname: Rosa-E-Silva
authors.forename: Ionara Diniz
authors.initials: ID
authors.lastname: Barcelos
authors.forename: Paula Andrea
authors.initials: PA
authors.lastname: Navarro
authors.forename: Ana Carolina Japur de Sá
authors.initials: AC
authors.lastname: Rosa-E-Silva
authors.forename: Antonio Alberto
authors.initials: AA
authors.lastname: Nogueira
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani