Bone Fragments Left from Aborted Babies Can Cause Infertility

Bone fragments left in women's uteruses after abortions cause some cases of infertility and should be treated using ultrasound to make sure all the tiny pieces are removed, according to researchers at the University of Ottawa.

The researchers, Kimberly Elford and Paul Claman of the Division of Reproductive Medicine at Ottawa Hospital, published a case report in the April issue of Fertility and Sterility describing the treatment and its success.

"Our case stresses the need to perform endovaginal ultrasound in all women who present with secondary infertility who had a previous pregnancy that progressed beyond 11 weeks gestation and then ended in spontaneous or therapeutic abortion," the authors write.

Small pieces of bone from babies killed in their mothers' wombs can become embedded in the uterus, leading to irritation and the inability of future embryos to implant and grow, the report states.

The problem can occur when an unborn baby is aborted after about 12 weeks of pregnancy, when the bones have already begun to harden.

Although doctors have been aware of this problem for years, it has long been considered a rare occurrence or that the fragments could also be caused by the hardening of tissue due to inflammation or trauma. That view may be changing, according to Elford and Claman.

"Recently, it has been suggested that the incidence of this complication, after induced or spontaneous abortions, was underestimated in the literature," the authors write. A study in the 1990s "found more than 50 cases in the literature, with 80% of them occurring after pregnancy."

The case of a 36-year-old woman is discussed in the Fertility and Sterility report. After having an abortion when she was a teenager, the woman was unable to carry a pregnancy to term. The researchers describe her as having "a 15-year history of secondary infertility."

The woman and her partner wanted to begin in vitro fertilization treatments, and her uterus was examined by a routine pelvic ultrasound. Two tiny, bright objects could be seen in the uterine tissue during the ultrasound. Further tests were done.

Normally, in such cases a doctor will perform a hysteroscopy, using a tiny camera to examine the physical state of the uterus and uterine lining. In this case, the researchers report, no abnormalities could be seen during the hysteroscopy. However, when some tissue was removed for further study, "multiple tiny bone fragments" were discovered.

Another hysteroscopy was performed, and it too showed nothing wrong. The doctors again used ultrasound and were able to remove the remaining pieces of bone with its guidance.

After waiting 15 years to conceive another child, the woman became pregnant four months after the ultrasound-guided procedure and delivered a healthy baby boy.

According to the Post, previous studies have also shown that "virtually all women who had such fragments removed were able to get pregnant soon afterward."

"The simplicity of the treatment and the good postoperative prognosis justify an accurate and complete ultrasound examination of the endometrium in all women with secondary infertility who have a history of abortion," Elford and Claman write. "Not only will ultrasound identify unusual endometrial pathology, it may identify uterine anomalies that may have been previously missed."