{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:42:32Z","timestamp":1783942952575,"version":"3.55.0"},"reference-count":46,"publisher":"Hamad bin Khalifa University Press (HBKU Press)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Endometrial osseous metaplasia (OM) is a rare condition characterized by the transformation of endometrial tissue into bone cells. Despite its rarity, OM remains a significant contributor to infertility. Although the underlying mechanism remains debatable, an association with previous abortions and curettage has been suggested.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Case presentation:<\/jats:bold>\n                    We present two cases of OM presented to the infertility clinic and discuss their similarities and discrepancies in presentation and risk factors. A transvaginal ultrasound raises suspicion about the diagnosis of OM with a hyperechoic mass and post-acoustic shadowing. An office hysteroscopy showed white, mesh-like bony sheets. Both cases underwent operative hysteroscopy to address surgical challenges, and the two cases were followed postoperatively for one year.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Discussion:<\/jats:bold>\n                    A comprehensive literature review examined various aspects of OM, including diagnosis, therapeutic options, outcomes, prognosis, and follow-up. Our aim was to raise awareness of this intriguing condition by providing up-to-date knowledge and emphasizing the central role of hysteroscopy in diagnosis and treatment. Here, we present two cases with the same complaint, infertility. Moreover, although the same treatment method was used in both cases, only one achieved pregnancy. This highlights that OM is a possible underlying cause of infertility, in addition to considering other factors that contribute to the overall clinical picture.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion:<\/jats:bold>\n                    OM should be considered in the evaluation of infertility despite its rarity, especially with hyperechoic lesions and acoustic shadowing on ultrasound examination. Hysteroscopy is the gold standard for diagnosis and therapeutic approaches. A complete understanding of the reasons that trigger its growth is crucial. To rule out other differential diagnosis, a holistic evaluation of the patient's history, imaging, and histopathological examination is needed.\n                  <\/jats:p>","DOI":"10.5339\/qmj.2025.24","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T03:30:26Z","timestamp":1745206226000},"source":"Crossref","is-referenced-by-count":1,"title":["Endometrial osseous metaplasia presented as infertility cases with intra-operative obstacles: Two case reports and literature review"],"prefix":"10.5339","volume":"2025","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0524-8518","authenticated-orcid":true,"given":"Zeena","family":"Helmi","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mustansiriyah University, Baghdad, Iraq*Correspondence: Wassan Nori. Email: dr.wassan76@uomustansiriyah.edu.iq"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8749-2444","authenticated-orcid":true,"given":"Wassan","family":"Nori","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Mustansiriyah University, Baghdad, Iraq*Correspondence: Wassan Nori. Email: dr.wassan76@uomustansiriyah.edu.iq"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3277","reference":[{"issue":"52:","key":"CIT0001","series-title":"Clin Imaging","first-page":"260\u2013263","article-title":"Ultrasound features of osseous metaplasia of the endometrium-Case series and review of the literature","author":"Grigore\n \nM\n,","year":"2018"},{"issue":"(4):","key":"CIT0002","series-title":"Gynecol Minim Invasive Ther","first-page":"244\u2013246","article-title":"Osseous metaplasia of the endometrium and successful hysteroscopic resection: A video case and review of the literature","volume":"11","author":"Kadirogullari\n \nP\n,","year":"2022"},{"issue":"(Suppl 1):","key":"CIT0003","series-title":"J Obstet Gynecol India","first-page":"290\u2013294","article-title":"CYP24A1 gene expression in spermatozoa of human and other oxidation level controlling enzymes as biomarkers of infertility","volume":"72","author":"Helmi\n, \nZ.R.\n,","year":"2022"},{"issue":"265:","key":"CIT0004","series-title":"Eur J Obstet Gynecol Reprod Biol","first-page":"150\u2013155","article-title":"Osseous metaplasia of the endometrium: a multicenter retrospective study","author":"Garzon\n \nS\n,","year":"2021"},{"key":"CIT0005","series-title":"Hysteroscopy","first-page":"683\u2013687","article-title":"Endometrial osseous metaplasia","author":"Cayuela\n \nE\n,","year":"2018"},{"issue":"25:","key":"CIT0006","series-title":"Middle East Fertil Soc J","first-page":"35","article-title":"Imaging of endometrial osseous metaplasia\u2014an uncommon but treatable cause of infertility","author":"Wani\n \nAH\n,","year":"2020"},{"issue":"19:","key":"CIT0007","series-title":"BMJ Case Rep","first-page":"2010:bcr0420102931","article-title":"Osseous metaplasia of the endometrium","author":"Gulec\n \nUK\n,","year":"2010"},{"key":"CIT0008","article-title":"Endometrial osseous metaplasia","author":"Weerakkody\n \nY\n,"},{"issue":"(4):","key":"CIT0009","series-title":"Gynecol Minim Invasive Ther","first-page":"243\u2013245","article-title":"Endometrial osseous metaplasia: an hysteroscopic incidental finding\u2013an overview","volume":"12","author":"Damiani\n \nGR\n,","year":"2023"},{"issue":"(5):","key":"CIT0010","series-title":"Obstet Gynecol Sci","first-page":"430\u2013440","article-title":"Can follicular fluid 8-oxo-2\u2019-deoxyguanosine predict the clinical outcomes in ICSI cycle among couples with normospermia male?","volume":"66","author":"Nori\n \nW\n,","year":"2023"},{"issue":"(1):","key":"CIT0011","series-title":"Ital J Gynaecol Obstet","first-page":"38\u201347","article-title":"The effect of adipose tissue StAR gene expression on ICSI among polycystic ovarian syndrome cases and matched controls: a case-control study","volume":"36","author":"Helmi\n \nZ\n,","year":"2024"},{"issue":"(5):","key":"CIT0012","series-title":"Korean J Obstet Gynecol","first-page":"361\u2013365","article-title":"A case of endometrial osseous metaplasia treated by hysteroscopic operation","volume":"55","author":"Lee\n \nJY\n,","year":"2012"},{"issue":"(3):","key":"CIT0013","series-title":"J Midlife Health","first-page":"237\u2013240","article-title":"Malakoplakia of endometrium with osseous metaplasia on evaluation of postmenopausal leukorrhea: a rare case report","volume":"12","author":"Venkatesh\n \nYS\n,","year":"2021"},{"issue":"(2):","key":"CIT0014","series-title":"Eur J Contracept Reprod Health Care","first-page":"141\u2013143","article-title":"Intrauterine foreign bodies, other than contraceptive devices and systems, may affect fertility-report of two very different cases","volume":"19","author":"Grigore\n \nM\n,","year":"2014"},{"issue":"(4):","key":"CIT0015","series-title":"Current Women's Health Reviews","first-page":"67-72","article-title":"A copeptin as a predictor marker for insulin resistance among women with polycystic ovary syndrome","volume":"18","author":"Ali\n \nAI\n,","year":"2022"},{"issue":"(Suppl1):","key":"CIT0016","series-title":"Ann Med Health Sci Res","first-page":"S10\u2013S12","article-title":"Endometrial osseous metaplasia: case report with literature review","volume":"3","author":"Patil\n \nSB\n,","year":"2013"},{"issue":"(1):","key":"CIT0017","series-title":"Radiol Bras","first-page":"62\u201363","article-title":"Metaplasia \u00f3ssea endometrial: aspecto ultrassonogr\u00e1fico, radiol\u00f3gico e histopatol\u00f3gico","volume":"49","author":"Guerra\n \nLF\n,","year":"2016"},{"issue":"(1):","key":"CIT0018","series-title":"J Gynecol Surg","first-page":"40\u201343","article-title":"Osseous metaplasia of endometrium: the bony womb and its hysteroscopic management","volume":"37","author":"Kapur\n \nA\n,","year":"2021"},{"issue":"(10):","key":"CIT0019","first-page":"1803","article-title":"Endometrial osseous metaplasia-a rare cause of infertility with unknown 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\nA\n,","year":"2019"},{"issue":"52:","key":"CIT0001","series-title":"Clin Imaging","first-page":"260\u2013263","article-title":"Ultrasound features of osseous metaplasia of the endometrium-Case series and review of the literature","author":"Grigore\n \nM\n,","year":"2018"},{"issue":"(4):","key":"CIT0002","series-title":"Gynecol Minim Invasive Ther","first-page":"244\u2013246","article-title":"Osseous metaplasia of the endometrium and successful hysteroscopic resection: A video case and review of the literature","volume":"11","author":"Kadirogullari\n \nP\n,","year":"2022"},{"issue":"(Suppl 1):","key":"CIT0003","series-title":"J Obstet Gynecol India","first-page":"290\u2013294","article-title":"CYP24A1 gene expression in spermatozoa of human and other oxidation level controlling enzymes as biomarkers of infertility","volume":"72","author":"Helmi\n, \nZ.R.\n,","year":"2022"},{"issue":"265:","key":"CIT0004","series-title":"Eur J Obstet Gynecol Reprod Biol","first-page":"150\u2013155","article-title":"Osseous metaplasia of the endometrium: a multicenter retrospective study","author":"Garzon\n \nS\n,","year":"2021"},{"key":"CIT0005","series-title":"Hysteroscopy","first-page":"683\u2013687","article-title":"Endometrial osseous metaplasia","author":"Cayuela\n \nE\n,","year":"2018"},{"issue":"25:","key":"CIT0006","series-title":"Middle East Fertil Soc J","first-page":"35","article-title":"Imaging of endometrial osseous metaplasia\u2014an uncommon but treatable cause of infertility","author":"Wani\n \nAH\n,","year":"2020"},{"issue":"19:","key":"CIT0007","series-title":"BMJ Case Rep","first-page":"2010:bcr0420102931","article-title":"Osseous metaplasia of the endometrium","author":"Gulec\n \nUK\n,","year":"2010"},{"key":"CIT0008","article-title":"Endometrial osseous metaplasia","author":"Weerakkody\n \nY\n,"},{"issue":"(4):","key":"CIT0009","series-title":"Gynecol Minim Invasive Ther","first-page":"243\u2013245","article-title":"Endometrial osseous metaplasia: an hysteroscopic incidental finding\u2013an overview","volume":"12","author":"Damiani\n \nGR\n,","year":"2023"},{"issue":"(5):","key":"CIT0010","series-title":"Obstet Gynecol Sci","first-page":"430\u2013440","article-title":"Can follicular fluid 8-oxo-2\u2019-deoxyguanosine predict the clinical outcomes in ICSI cycle among couples with normospermia male?","volume":"66","author":"Nori\n \nW\n,","year":"2023"},{"issue":"(1):","key":"CIT0011","series-title":"Ital J Gynaecol Obstet","first-page":"38\u201347","article-title":"The effect of adipose tissue StAR gene expression on ICSI among polycystic ovarian syndrome cases and matched controls: a case-control study","volume":"36","author":"Helmi\n \nZ\n,","year":"2024"},{"issue":"(5):","key":"CIT0012","series-title":"Korean J Obstet Gynecol","first-page":"361\u2013365","article-title":"A case of endometrial osseous metaplasia treated by hysteroscopic 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Med Health Sci Res","first-page":"S10\u2013S12","article-title":"Endometrial osseous metaplasia: case report with literature review","volume":"3","author":"Patil\n \nSB\n,","year":"2013"},{"issue":"(1):","key":"CIT0017","series-title":"Radiol Bras","first-page":"62\u201363","article-title":"Metaplasia \u00f3ssea endometrial: aspecto ultrassonogr\u00e1fico, radiol\u00f3gico e histopatol\u00f3gico","volume":"49","author":"Guerra\n \nLF\n,","year":"2016"},{"issue":"(1):","key":"CIT0018","series-title":"J Gynecol Surg","first-page":"40\u201343","article-title":"Osseous metaplasia of endometrium: the bony womb and its hysteroscopic management","volume":"37","author":"Kapur\n \nA\n,","year":"2021"},{"issue":"(10):","key":"CIT0019","first-page":"1803","article-title":"Endometrial osseous metaplasia-a rare cause of infertility with unknown etiology","volume":"59","author":"Tica\n \nVI\n,","year":"2023"},{"issue":"(4):","key":"CIT0020","series-title":"Ultrasound Obstet Gynecol","first-page":"402\u2013406","article-title":"Bony fragments in the uterus: an association with secondary subfertility","volume":"22","author":"Basu\n \nM\n,","year":"2003"},{"issue":"(1):","key":"CIT0021","series-title":"Diagn Pathol","first-page":"7","article-title":"Aspiration biopsy versus dilatation and curettage for endometrial hyperplasia prior to hysterectomy","volume":"16","author":"Hwang\n \nWY\n,","year":"2021"},{"issue":"7:","key":"CIT0022","series-title":"Gynecol Surg","first-page":"211\u2013216","article-title":"The role of hysteroscopy in diagnosis and management of endometrial cancer","author":"Al-Talib\n \nA\n,","year":"2010"},{"issue":"2:","key":"CIT0023","first-page":"1164","article-title":"Novel management of endometrial osseous metaplasia","author":"Sood\n \nA\n,","year":"2019"}],"container-title":["Qatar Medical 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