title: Secondary infertility and retained fetal bone fragments.
abstract: BACKGROUND
  Retained fetal bone fragments may be an underreported and underappreciated cause of secondary infertility among women with an antecedent spontaneous or induced abortion.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Harvard Medical School, and the Departments of Radiology and Obstetrics/Gynecology: Reproductive Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: William D
authors.initials: WD
authors.lastname: Winkelman
authors.forename: Mary C
authors.initials: MC
authors.lastname: Frates
authors.forename: Janis H
authors.initials: JH
authors.lastname: Fox
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Ginsburg
authors.forename: Serene
authors.initials: S
authors.lastname: Srouji
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects; D000328:Adult; D001842:Bone and Bones / Q000000981:diagnostic imaging; D005260:Female; D005333:Fetus; D006801:Humans; D015907:Hysteroscopy; D007247:Infertility, Female / Q000209:etiology* / Q000601:surgery; D011247:Pregnancy; D014463:Ultrasonography