We spoke with Dr Shalu Gupta, Senior Clinical Director, Department of Fertility, Cloudnine Group of Hospitals, Gurgaon, to understand endometrial ossification, its possible causes and symptoms, how it may affect fertility, and the treatment options available.
What Is Endometrial Ossification?
Endometrial ossification means that bone tissue is found within the endometrium, the lining of the uterus. Doctors may also refer to it as endometrial osseous metaplasia or intrauterine bone formation.The condition is very uncommon, but it deserves attention when infertility or recurrent miscarriage occurs, particularly after a previous pregnancy loss.
Why Can It Happen After a Miscarriage?
The exact reason endometrial ossification develops is not always clear, but several factors may play a role:- Retained pregnancy tissue: May calcify and become bone-like tissue.
- After miscarriage: Healing changes may lead to bone formation.
- Uterine procedures: Previous curettage may be linked to the condition.
- Unknown cause: Sometimes, no clear cause is found.
How Can Endometrial Ossification Affect Fertility?
The uterus needs a healthy, receptive endometrium for an embryo to implant. Bone fragments or bony areas inside the uterine cavity may interfere with this environment.They can act somewhat like a foreign body, potentially causing local inflammation and changes that make implantation more difficult. This may contribute to infertility or, in some cases, repeated early pregnancy loss.
Because endometrial ossification is uncommon, recurrent miscarriage has many other, much more frequent causes. These can include chromosomal abnormalities, uterine structural problems, hormonal or metabolic conditions and certain clotting or immune-related factors.
What Symptoms Can You Notice?
Endometrial ossification does not always cause obvious symptoms. When symptoms occur, they may include:- Difficulty becoming pregnant after a previous pregnancy
- Repeated early miscarriages
- Irregular or heavy menstrual bleeding
- Painful periods
- Pelvic discomfort
- Pain during intercourse
- Unusual vaginal discharge
- Passage of small hard fragments during menstruation
How Is Endometrial Ossification Diagnosed?
Your doctor may recommend the following checks to look inside the uterus:- Medical history: Your doctor may ask about previous miscarriages, fertility problems and uterine procedures.
- Transvaginal ultrasound: May show bright or calcified areas inside the uterus.
- Hysteroscopy: Allows the doctor to directly examine the uterine cavity.
- Tissue testing: Removed tissue can be examined to confirm the presence of bone.
How Is Endometrial Ossification Treated?
Treatment depends on the amount and location of the abnormal tissue and the woman's symptoms and fertility plans.Hysteroscopic removal is commonly used because it allows the doctor to see the uterine cavity and remove the bony tissue under direct vision. It is generally considered a fertility-preserving approach.
After removal, your doctor may recommend follow-up imaging or hysteroscopy to make sure the uterine cavity has healed appropriately before trying to conceive.
Can Fertility Improve After Treatment?
Yes, fertility may improve after the abnormal tissue is removed, although treatment does not guarantee pregnancy. Removing the tissue may help restore a more suitable uterine environment for implantation.A 2026 systematic review looked at 37 studies involving 128 women with endometrial osseous metaplasia. Among 60 women who pursued pregnancy after treatment, 78.3% conceived. Of those who conceived, 59.6% became pregnant spontaneously, while others conceived with assisted reproductive technology or ovulation induction. The average time to conception was 6.7 months.
When Should You See a Doctor?
Speak with your gynaecologist or fertility specialist if you have:- Repeated miscarriages
- Difficulty conceiving after a previous pregnancy
- Persistent abnormal bleeding after a pregnancy loss
- Unexplained pelvic pain or unusual discharge
- An ultrasound showing unexplained calcification or a bright area inside the uterus
- A history of uterine procedures followed by ongoing fertility problems
FAQs on Endometrial Ossification: Causes, Symptoms, Treatment and Fertility
- Is endometrial ossification the same as retained foetal bone?
Not necessarily. Retained foetal bone may remain after a pregnancy loss and later become calcified. Endometrial ossification can also occur when the woman's own endometrial cells transform into bone-forming tissue. Histopathology helps distinguish between these possibilities. - Is endometrial ossification cancerous?
No. Endometrial ossification is not considered a cancer. It involves bone formation within the uterine lining or cavity. However, tissue removed during a procedure may be examined in a laboratory to confirm the diagnosis and rule out other causes of abnormal tissue. - Can endometrial ossification affect IVF treatment?
It may potentially interfere with embryo implantation if abnormal tissue remains inside the uterine cavity. If it is identified before IVF, your fertility specialist may recommend treating the uterine abnormality first and assessing the cavity before proceeding with embryo transfer.