Will an abortion affect my future fertility?

 

The cut-to-the-chase answer to this question is: It might. As is often the case with discussion surrounding abortion, the truth lies in-between the extreme warnings and the quick dismissals you might be receiving from various sources. Any surgery carries risk to it - especially when it is "invasive," which means it involves inserting an instrument into your body. All surgical abortion procedures are invasive, and therefore they all carry a normal surgical risk. The likelihood of having a complication depends on the skill of your abortion provider, how long the procedure takes, how many times the instruments are inserted into your body, etc. An uncomplicated abortion, however, should not have an impact on future fertility.

 

Possible Complications

  • A bacterial infection can occur during the procedure whenever surgical tools enter the uterus. (This often happens multiple times during an abortion.) Infection occurs most frequently when there is an underlying STD that is not diagnosed at the time of the abortion. Therefore, it is vitally important that you be tested for STDs at the abortion clinic prior to the abortion. Infection is the most common post-abortion complication, and it can lead to Pelvic Inflammatory Disease (PID). PID causes cobweb-like scars to form in the uterus and fallopian tubes, and this is what makes it hard to get pregnant later on. It becomes difficult for a fertilized egg to implant in a uterus that has too much scar tissue, and it also increases the chance that a fertilized egg will get stuck in the fallopian tube and implant there, causing an ectopic pregnancy. If you do get pregnant, the scarring might lead to placenta previa or miscarriage, since the placenta might not be able to attach to the lining of the uterus as it normally would.
  • A cut or torn cervix can occur when the doctor dilates the cervix, grasps the cervix with the tenaculum, or inserts the cannula into the uterus. While smaller cuts will most likely heal naturally, a major cut may lead to a weakened cervix - making carrying a future child to term difficult. Women with a weakened, or "incompetent," cervix begin to dilate early in their pregnancy - causing a miscarriage or stillbirth. A stitch, called a cerclage, can be placed in the cervix to keep it closed if your doctor discovers the problem in time.
  • The uterus may be perforated (punctured) during the abortion when the doctor rubs the cannula against the soft walls of the uterus, causing abdominal bleeding and/or infection. You may require surgery to repair the puncture, and rarely you may need a hysterectomy (removal of the uterus) to stop the bleeding. The perforation causes scarring, as does any resulting infection. (See the information above regarding bacterial infection for more about scarring.) A hysterectomy would make it impossible for you to get pregnant.
  • Scarring of the uterus can occur when the wall of the uterus is rubbed with the cannula. When scarring occurs in this manner, it is referred to as Asherman's Syndrome, and it can affect your ability to get pregnant and stay pregnant. (See the information above regarding bacterial infection for more about scarring.)
  • Maternal death occurs in a reported 1 out of every 100,000 abortions (this includes all types of abortion).

 

What are the chances you'll have a complication?

Now that you understand the different complications that can have an effect on your future fertility, you're probably wondering what the odds are that something will happen to you. The following statistics are approximate, and they include all complications - not just those that impact fertility.

  • If you have a first trimester manual or vacuum aspiration, you have a 1-2% chance.  
  • If you have a first trimester D&C abortion, the odds climb to around 5%.
  • If having a D&E or D&X procedure in the second or third trimester, the chance of complication climbs to 7%.
  • If you use an induction procedure during the second or third trimester, you have a 25% chance of having complications. 
  • Hysterotomy procedures have not been studied in terms of complications, because this procedure is very rare. 
  • Medical abortions, such as RU-486 and methotrexate abortions, have not been studied in terms of having an impact on future fertility as of yet. The medical abortions are not invasive, however, so their risks to future fertility would be lower.

 

How can you avoid these complications?

Select an abortion provider by asking a trusted source, like a family doctor. Research your abortion provider by going to your state's medical board (find a list of here). This will show whether s/he has had disciplinary procedures filed. You can also ask your family doctor, OB/GYN, and anyone you know who has had an abortion what they know about the provider you have selected. When you go in for your appointment, be completely honest about your health history, especially noting any STDs, current medications/herbs, and prior abortions and/or surgeries. Follow through with all of the post-procedure instructions even if you're feeling fine, and be sure you go to the 2-week followup appointment. If an emergency does occur after your abortion, be sure to call your abortion provider immediately or go to the nearest emergency room. Always remember to look out for yourself - you are your own best advocate in this situation!