Retained Fetal Bone Following Dilation and Evacuation (D&e) in an Ivf Patient: A Preventable Cause of Secondary Infertility

Objective: To evaluate the clinical impact of retained fetal bone following a 17-week D&E in an IVF patient, emphasizing the importance of provider training to prevent complications and preserve fertility. Introduction: Retained fetal bone is a rare cause of secondary infertility, often diagnosed via hysteroscopy. We present a case in which SIS (saline infusion sonogram) identified bone embedded in the myometrium, missed on 2D ultrasound, in a patient with longstanding infertility. Case Presentation: A 33-year-old woman with primary infertility due to stage IV endometriosis, tubal factor, and a variant T-shaped uterus conceived through IVF (in-vitro fertilization). At 17 weeks, she underwent D&E for missed abortion. Postoperative bleeding persisted, and while her OB’s 2D ultrasound was normal, her infertility provider identified suspected retained osseous POC (products of conception). SIS revealed a 2.5 cm hyperechoic area embedded in the myometrium. Hysteroscopy confirmed and removed multiple bone fragments, including parts of the calvarium and ribcage. Pathology revealed osseous metaplasia. Follow-up SHG (sonohystogram) showed a small residual fragment. Despite the emotional toll and fertility concerns, the patient remained committed to pursuing IVF. Discussion: Of the 1.3 million U.S. women seeking infertility treatment annually, 2% undergo IVF (1). Secondary infertility, often linked to unsafe abortions, is most common (2). Though rare, mid-trimester abortions can result in retained fetal bone, especially in anomalous uteri, with an estimated incidence of 0.15% (3, 4, 5). These fragments can cause bleeding, pain, and endometrial damage, further impairing fertility. Conclusion: This case highlights the need for adherence to D&E protocols—including ultrasound guidance, fetal part counts, and post-op scans—to prevent retained fetal bone. Proper training is critical to avoid preventable complications in IVF patients and to support their chances of achieving a live birth.