Osseous metaplasia of endometrium: a rare cause of secondary infertility


  • Nitin H. Shah Department of Obstetrics & Gynaecology, Vardann Hospital: Centre of Excellence for laparoscopy and IVF, Mumbai, Maharashtra, India
  • Kalyani G. Kale Department of Obstetrics & Gynaecology, Vardann Hospital: Centre of Excellence for laparoscopy and IVF, Mumbai, Maharashtra, India
  • Vaishali N. Shah Department of Anesthesiology, Vardann Hospital: Centre of Excellence for laparoscopy and IVF, Mumbai, Maharashtra, India




Osseous, Metaplasia, Endometrium, Infertility


Osseous metaplasia of the endometrium is a rare condition with formation of bony tissue inside the uterus, particularly the endometrium. The etiology of this disorder is not completely understood, with various hypotheses being put forward to explain its occurrence. It is an important cause of secondary infertility, although it may present with various other gynecological symptoms. It can be suspected on ultrasonography due to its peculiar appearance and can be completely cured following hysteroscopic resection. Here we present a case of a 30 years old female presenting with hypomenorrhoea and secondary infertility following a first trimester abortion. Ultrasonography showed presence of dense linear echogenic band in the uterus suggestive of calcification. Hysteroscopy revealed multiple bony fragments of varying shapes and sizes (0.2-2cm) in the uterine cavity which were removed using a hysteroscopic grasper and the cavity was restored to normal. There were no procedure related complications. Presence of bony tissue was confirmed on histopathology. Patient had a spontaneous conception 3 months after the procedure and delivered a healthy male child at term. Thus, in our case, hysteroscopy was a safe and effective modality for diagnosis as well as treatment of this rare condition. Successful hysteroscopic treatment was followed by a spontaneous conception and a good pregnancy outcome.


Adamson NE, Sommers SC. Endometrial ossification: report of two cases. Am J Obstet Gynecol. 1954;67:187-90.

Onderoglu LS, Yarali H, Gultekin M, Katlan D. Endometrial osseous metaplasia: an evolving cause of secondary infertility. Fertil Steril. 2008;90(5):2013.e9-11.

Hsu C. Endometrial ossification. Br J Obstet Gynaecol. 1975;82:836-9.

Bhatia NN, Hoshiko MG. Uterine osseous metaplasia. Obstet Gynecol. 1982;60:256-9.

Bahçeci M, Demirel LC. Osseous metaplasia of the endometrium: a rare cause of infertility and its hysteroscopic management. Hum Reprod. 1996;11:2537-9.

Umashankar T, Patted S, Handigund R. Endometrial osseous metaplasia: Clinicopathological study of a case and literature review. J Hum Reprod Sci. 2010;3:102-4.

Lainas T, Zorzovilis I, Petsas G, Alexopoulou E, Lainas G, Loakimidis T. Osseous metaplasia: Case report and review. Fertil Steril. 2004;82(5):1433-5.

Kouakou F, Loué V, Kouamé A, Adjoby R,Koui S, Koimé H et al. Endometrial osseous metaplasia and infertility: a case report. Clin Exp Obstet Gynecol. 2012;39(4):559-61.

Cayuela E, Perez-Medina T, Vilanova J, Alejo M, Cañadas P. True osseous metaplasia of the endometrium: the bone is not from a fetus. Fertil Steril. 2009;91:1293.e1-4.

Bedaiwy MA, Goldberg JM, Biscotti CV. Recurrent osseous metaplasia of the cervix after loop electrosurgical excision. Obstet Gynecol. 2001;98:968-70.

Campo S, Campo V, Zannoni GF, Gambadauro P. Simultaneous ovarian and endometrial osseous metaplasia: A case report. J Reprod Med. 2007;52:241-2.

Landim FM, Tavares JM, de Melo Braga DN, da Silva JE, Jr, Bastos Filho JB, Feitosa RG. Vaginal osseous metaplasia. Arch Gynecol Obstet. 2009;279:381-4.

Shimizu M, Nakayama M. Endometrial ossification in a postmenopausal woman. J Clin Pathol. 1997;50:171-2.

Marcus SJ, Bhattacharya J, Williams G, Brinsden P, Hamou J. Endometrial ossification a cause of secondary infertility. Am J Obstet Gynecol. 1994;170:1381-3.

Shroff CP, Kudterkar NG, Badhwar VR. Endometrial ossification-- report of three cases with literature review. Indian J Pathol Microbiol. 1985;28:71-4.

Parente RC, Patriarca MT, de Moura Neto RS, de Oliveira MA, Lasmar RB, de Holanda Mendes P, et al. Genetic analysis of the cause of endometrial osseous metaplasia. Obstet Gynecol. 2009;114:1103-8.

Tulandi T, Al-Sunaidi M, Arseneau J et al. Calcified tissue of fetal origin in utero. Fertil Steril. 2008;89(1):217-8.

Madaan M, Suman S, Sharma R, Kapoor N, Garg P, Raj SS. Osseous metaplasia of the endometrium and successful hysteroscopic resection: report of two cases and a review of the literature. Asian J Endosc Surg. 2015;8(1):63-6.






Case Reports