2 Figure 1: Transvaginal ultrasonography of the uterus revealed calciﬁc areas. Figure 2: Hysteroscopic view of the uterus. Figure 3: Bony fragments removed from the uterus. eﬀect); (2) prevention of implantation as a result of the chronic inﬂammatory eﬀect of intrauterine bony fragments (intrauterine device like eﬀect); (3) direct toxicity of osseous particles on the embryo (embryo toxicity) [4]. It has been shown that the removal of these fragments reduces the local concentration of prostaglandins in 15% [5]. The diagnosis is suspected at ultrasound and conﬁrmed on hysteroscopy and histopathologic examination. Treatment is by ultrasound guided curettage or by hysteroscopic removal [6]. Besides retained bones, other causes of calciﬁcation, namely, tuberculosis, foreign body, and copper-T also need to be ruled out. Case Reports in Obstetrics and Gynecology 3. Conclusion To conclude, bony fragments in the uterus can be a possible cause of infertility especially following medical termination of pregnancy and can even occur after ﬁrst trimester abor- tion. A strong possibility should be kept when ultrasound shows hyperechoic endometrium, and removal of bony fragments by hysteroscopy and curettage is associated with therapeutic success. References [1] F. A. Chervenak, H. K. Amin, and R. S. Neuwirth, “Symp- tomatic intrauterine retention of fetal bones,” Obstetrics and Gynecology, vol. 59, no. 6, supplement, pp. 58S–61S, 1982. [2] N. N. Bhatia and M. G. Hoshiko, “Uterine osseous metaplasia,” Obstetrics and Gynecology, vol. 60, no. 2, pp. 256–259, 1982. [3] S. F. Marcus, J. Bhattacharya, G. Williams, P. Brinsden, and J. Hamou, “Endometrial ossiﬁcation: a cause of secondary infertility,” American Journal of Obstetrics and Gynecology, vol. 170, no. 5 I, pp. 1381–1383, 1994. [4] L. S. Onderoglu, H. Yarali, M. Gultekin, and D. Katlan, “En- dometrial osseous metaplasia: an evolving cause of secondary infertility,” American Journal of Obstetrics and Gynecology, vol. 176, no. 2, pp. 369–370, 1997. [5] V. Lewis, F. Khan-Dawood, M. King, C. Beckmann, and M. Y. Dawood, “Retention of intrauterine fetal bone increases menstrual prostaglandins,” Obstetrics and Gynecology, vol. 75, no. 3, pp. 561–563, 1990. [6] I. Cepni, B. Kumbak, P. Ocal, M. Idil, and F. Aksu, “Infertility due to intrauterine residual fetal bone fragments,” Journal of Clinical Ultrasound, vol. 32, no. 5, pp. 253–255, 2004.