Uterine cavity calcifications: a report of 7 cases and a systematic literature review

We report 7 uterine cavity calcification cases and systematically review the literature on cases presenting this finding. In our series of cases, the mean age of patients was 31.6 ± 5.4 years, with an infertility period ranging from 2 to 8 years. None of our patients had a history of intrauterine contraceptive device use, and 3 had undergone operative termination of pregnancy. Diagnostic and therapeutic hysteroscopy with complete removal of the calcifications was performed in all patients with fertility restoration in 5 of them. Our review included 35 articles published from 1989 to 2013 reporting endometrial calcification cases, with a total of 85 cases. Analyzed variables included patient age, abortion antecedents, clinical presentation, diagnostic method, treatment, and outcome. The mean age of the analyzed cases was 34.3 years, ranging from 19 to 62 years. Abortion antecedents were present in most patients (76.5%). The most frequently used diagnostic methods were ultrasound (88.5% of articles) and hysteroscopy (85.7%). Regarding the clinical presentation, infertility was the most common feature (72.9% of cases) followed by menstrual abnormalities (30.3%). Hysteroscopic removal, whether alone or combined with other techniques, was the most used method for the removal of osseous tissue (70.6% of cases) followed by curettage (27.1%). After removal of the bony fragments, 55.6% of the infertile patients achieved a pregnancy. A total of 14 cases reported relief of symptoms other than infertility. All of the data concerning outcome were stratified according to the treatment modality used. We conclude that endometrial calcifications in the uterine cavity are a relevant cause of secondary infertility, which can generally be properly diagnosed and treated through hysteroscopy, with successful restoration of fertility in most cases.