A while back, when I was doing my monthly volunteer staffing at the indigent population clinic for the OB/Gyn residents, we came across a patient who came in for an ultrasound. She had delivered a baby seven years ago in her home country, but never got pregnant after that. Despite not getting pregnant naturally, she no longer wanted to get pregnant. In fact, she wanted to make sure of it and desired to get her tubes tied. It’s always a bit of a change of pace for me to see women who WANT to become infertile.

She was referred to us because she had been denied as a candidate for a tubal ligation because an ultrasound had shown her to have an IUD in her uterus. The story didn’t make sense. She fiercely denied ever having an IUD placed. She was from Central American and not from China. In China, there have been patients who have had IUD’s placed against their wishes, although not without their knowledge. We weren’t sure what to make of it, so we went ahead and did our own ultrasound. Sure enough, there were two very bright lines in her uterus, which did not look like anything natural. We did a pelvic exam and looked for the string to remove the IUD, but could not find one. After questioning her some more, I was leaning towards believing her story.

We set her up to get hysteroscopic surgery.

Today, I got an email from the residents. They had completed the surgery and fished out the objects. The pathology report identified them as being BONE, with some cartilage. It is a phenomenon described in the medical literature as heterotopic endometrial calcification. So she was telling the truth after all about never having an IUD placed. Although technically, the bone in her uterus would act as a very effective biological IUD. The source of this bone tissue is still controversial. The theories range from retained fetal bones to embryological development from stem cells after a pregnancy termination. So we still will never know exactly how they got there.

Now I am reminded to add “Bone Fragments in the Uterus” to the long list of thing that cause infertility.

This entry was posted on Friday, December 5th, 2008 at 3:44 pm and is filed under Real Stories. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.