Intrauterine bone contraceptive device: an accident of nature.

ABSTRACT

PIP: The case is described of a 26-year olf woman, gravida 2, para 1, who presented with failure to conceive 18 months after revomal of a Lippes Loop IUD worn for 12 months. The IUD had been inserted following a miscarriage at 18 weeks gestation, in which vaginal evacuation was bloody and difficult. The patient had a normal menstrual cycle and normal blood loss. The pulse, blood pressure, temperature, and pelvic examination were normal. A postcoital test was satisfactory, the tubes were patent, and serum levels of follicle stimulating hormone, luteinizing hormone, prolaction, progesterone at days 18 and 22, and testosterone were all normal. The pelvic ultrasonogram showed a persistent focus of intrauterine illumination, and hysterosalpingography revealed an irregularity in the right cornu. Results of laparoscopy were negative. 4 thin plates of bone, each 10 mm in the long axis, were removed at an exploratory dilatation and curettage. Microscopic examination showed necrotic bony trabeculae and bone marrow in the intervening spaces. A pregnancy test was positive 3 months later and patient gave birth to a health female weighing 3.3 kg. In both this and a similar previously reported case, the bone fragments were located in the fundus. The contraceptive action was possibly related to an increase of prostaglandin concentration in the fundal endometrium, which is a common site for blastocyst implantation. Prolonged intrauterine retention of fetal skeletal parts should be added to the list of possible causes fo secondary infertility.