Can Abortion Cause Infertility?

In medical terminology, the term “abortion” can mean a planned termination of a pregnancy or a pregnancy that ends in miscarriage. However, when most people refer to abortion, they mean an induced abortion, and that is how the term is used in this article.

If you’ve had an induced abortion, you may be concerned about what that means for future fertility and pregnancies. However, having an abortion doesn’t usually affect your ability to get pregnant again at a later time.

A very rare exception is if you have scarring after a surgical abortion, a condition called Asherman syndrome.

This article will explore different types of abortions, future fertility, and what to do if you’re having difficulty getting pregnant after abortion.

What are the types of abortion?

Though rare, sometimes the type of abortion you have may affect your fertility in the future. Typically, the method of abortion will depend on how far along a pregnancy has progressed. Timing may also factor in if a person requires a medical or surgical abortion.

Medical abortion

A medical abortion occurs when a woman takes medications to induce abortion. Sometimes, a woman may take these medications because she has experienced a miscarriage. The medications help to ensure all products of conception are passed to avoid infection and so that a woman can conceive again in the future.

Which medical abortion option a doctor may prescribe often depends on gestational age or how many weeks into a pregnancy the individual is.

Examples of medical abortion approaches with regards to timing include:

• Up to 7 weeks pregnant: The medication methotrexate (Rasuvo, Otrexup) can stop cells in the embryo from rapidly multiplying. A woman then takes the medication misoprostol (Cytotec) to stimulate uterine contractions to release the pregnancy. Doctors don’t widely prescribe methotrexate — this approach is usually reserved for women with ectopic pregnancy, where the embryo implants outside the uterus and the pregnancy will not be viable.
• Up to 10 weeks pregnant: Medical abortion may also involve taking two medications, including mifepristone (Mifeprex) and misoprostol (Cytotec). Not all doctors can prescribe mifepristone — many must have a special certification to do so.

Surgical abortion

A surgical abortion is a procedure to either end the pregnancy or to remove remaining products of the pregnancy. As with medical abortions, the approach may depend on timing.

• Up to 16 weeks pregnant: Vacuum aspiration is one of the most common approaches to abortion. This involves using special equipment to remove the fetus and placenta from the uterus.
• After 14 weeks: Dilation and evacuation (D&E) is the surgical removal of the fetus and placenta. This approach may be combined with other techniques like vacuum aspiration, forceps removal, or dilation and curettage. Doctors also use dilation and curettage (D&C) to remove remaining products of conception if a woman has miscarried. Curettage means a doctor uses a special instrument called a curette to remove pregnancy-related tissue from the uterine lining.
• After 24 weeks: Induction abortion is an approach that is rarely used in the United States, but is indicated in the later stages of pregnancy. Laws regarding abortion after 24 weeks vary by state. This procedure involves getting medications that induce delivery. After the fetus is delivered, a doctor will remove any products of conception, like the placenta, from the uterus.

According to the Guttmacher Institute, an estimated 65.4 percent of abortions were conducted when a woman was 8 weeks pregnant or earlier. An estimated 88 percent of abortions occur in the first 12 weeks of pregnancy.

When an abortion is done in a clean, safe medical environment, most procedures will not affect fertility. However, always talk to your doctor about any concerns you have.

What are the risks from abortion?

According to the American College of Obstetricians and Gynecologists (ACOG), an abortion is a low-risk procedure. The risk of death following an abortion is less than 1 in 100,000. The later in her pregnancy a woman has an abortion, the greater her risk for complications; however, the risk of death following giving birth is 14 times higher than the risk of death following an early abortion.

Some of the potential complications associated with abortion include:

• Bleeding: A woman can experience bleeding after an abortion. Usually, the blood loss isn’t so extreme that it’s a medical problem. However, rarely, a woman may bleed so much that she requires a blood transfusion.
• Incomplete abortion: When this happens, tissue or other products of conception may remain in the uterus, and an individual may need a D&C to remove the remaining tissue. The risk for this is more likely when a person takes medications for an abortion.
• Infection: Doctors will usually give antibiotics before an abortion to prevent this risk.
• Injury to surrounding organs: Sometimes, a doctor may accidentally injure nearby organs in an abortion. Examples include the uterus or bladder. The risk that this will occur increases the further along a woman is in a pregnancy.

Technically, anything that causes inflammation in the uterus has the potential to affect future fertility. However, it’s very unlikely this will occur.

What is Asherman syndrome?

Asherman syndrome is a rare complication that can occur after a woman has a surgical procedure, such as D&C, that can potentially damage the uterine lining.

The condition can cause scarring to develop in the uterine cavity. This can increase the likelihood that a woman may have a miscarriage or have problems conceiving in the future.

Asherman syndrome doesn’t happen very often. However, if it does, doctors can often treat the condition with surgery that removes the scarred areas of tissue inside the uterus.

After a doctor surgically removes the scar tissue, they will leave a balloon inside the uterus. The balloon helps the uterus remain open so it can heal. Once the uterus has healed, the doctor will remove the balloon.

What is the outlook for fertility following abortion?

According to ACOG, having an abortion doesn’t generally affect your ability to get pregnant in the future. It also does not increase the risks for pregnancy complications if you do choose to get pregnant again.

Many doctors recommend using some type of birth control immediately after abortion because it’s possible a woman can get pregnant again when she starts ovulating.

Doctors will also usually recommend a woman refrain from sexual intercourse for a certain time period after an abortion to allow the body time to heal.

If you do have difficulty getting pregnant after an abortion, it’s important to consider some of the other factors that could potentially affect your fertility, since a past abortion isn’t likely to cause problems conceiving. These factors can also affect fertility:

• Age: As you age, your fertility decreases. This is especially true for women older than age 35, according to the Centers for Disease Control and Prevention (CDC).
• Lifestyle habits: Lifestyle habits, such as smoking and drug use, can affect your fertility. The same is true for your partner.
• Medical history: If you have a history of sexually transmitted infections (STIs), such as chlamydia or gonorrhea, these can affect your fertility. The same is true for chronic diseases such as diabetes, autoimmune disorders, and hormonal disorders.
• Partner’s fertility: Semen quality can affect a woman’s ability to get pregnant. Even if you have gotten pregnant with the same partner in the past, lifestyle habits and aging may affect your partner’s fertility.

If you are experiencing problems getting pregnant, talk to your gynecologist. They can advise you on lifestyle steps that may help, as well as recommend a fertility specialist who can help you identify potential underlying causes and possible treatment options.

The takeaway

An abortion is any medical procedure or taking of medications to end a pregnancy. According to the Guttmacher Institute, an estimated 18 percent of pregnancies in the United States in 2017 ended due to abortion. Regardless of the approach, doctors consider abortions to be very safe procedures.

Having an abortion does not mean you can’t get pregnant at a later time. If you are having problems conceiving, your gynecologist can help.

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