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Can Abortion Cause Infertility?
If you’ve had an abortion or are considering having one, you might wonder whether it could lead to infertility (the inability to get pregnant when you’re trying to). When performed safely under the care of a qualified healthcare professional and without complications, an induced abortion does not cause infertility, says Alex Robles, MD, a reproductive endocrinologist and infertility specialist at Columbia University Irving Medical Center in New York City.
Abortion might refer to different things. Sometimes a pregnancy ends early on its own, which healthcare providers call a spontaneous abortion or miscarriage. When we talk about abortion in this article, we mean induced abortion, which is when someone chooses to end a pregnancy with medical help from a healthcare provider.
There are different ways to end a pregnancy, and the type of abortion depends on how far along the pregnancy is, the woman’s health, and personal preferences. Healthcare providers typically recommend one of two options: medical abortion or procedural abortion. Both are safe and effective when done under proper care.
Medical Abortion
A medical abortion is typically used in the early stages of pregnancy, usually up to 10 weeks. This type of abortion is also called medication abortion or the “abortion pill” and doesn’t require surgery or anesthesia.
It involves taking two medications to terminate the pregnancy. The first pill, mifepristone (Mifeprex), blocks the hormone progesterone, which is needed for pregnancy to continue. The second medication, misoprostol (Cytotec), is taken 24 to 48 hours later to help the uterus (womb) contract and empty. These medications may be taken at home, at a clinic, or both, depending on local laws and healthcare guidance.
You may choose a medical abortion if you prefer a more private experience or want to avoid a procedure. But it’s important to follow up with a healthcare provider to make sure you’re recovering as expected.
Procedural Abortion
In a procedural abortion, also called in-clinic abortion or surgical abortion, a healthcare provider removes the contents of the uterus. The method used depends on the stage of your pregnancy.
For pregnancies up to about 16 weeks, healthcare providers can perform a vacuum aspiration. This procedure uses gentle suction to remove the pregnancy and takes about 5 to 10 minutes.
For pregnancies at 12 to 24 weeks, a dilation and evacuation (D&E) may be performed.This involves dilating (opening) the cervix and using suction and other medical instruments to empty the uterus.
A procedural abortion is generally a quick procedure that can be performed from very early pregnancy through the second trimester. Before 12 weeks, it’s typically completed in one visit to the clinic and is done under the care of a healthcare provider in a medical setting.Pregnancies more than 12 weeks along may require two visits.
Most abortions, whether medical or procedural, are safe when performed by trained healthcare providers. But as with any medical intervention, there are some risks to be aware of.
Infection
Infection is one of the more serious complications of abortions, though it’s uncommon, explains Dr. Robles.
You may develop an infection of the uterus (called endometritis) if bacteria enter the uterus during or after the procedure. If left untreated, endometritis can spread to the fallopian tubes and ovaries, causing pelvic inflammatory disease (PID), says Robles. PID can cause scarring or blockages in the fallopian tubes, which may make it harder to get pregnant in the future, he adds.
Healthcare providers typically give antibiotics at the time of procedural abortions to prevent infection, says Eve Feinberg, MD, a reproductive endocrinologist, infertility specialist, and the medical director at Northwestern Fertility and Reproductive Medicine in Chicago. But an infection can still occur, particularly if an abortion is performed under unsafe conditions, such as without clean, sterilized equipment or by someone without proper medical training.
Excessive Bleeding
Heavy bleeding can occur after either type of abortion. Excessive bleeding is a bigger risk with medical abortions, says Prati Sharma, MD, a board-certified gynecologist, reproductive endocrinologist, and infertility specialist, and a medical adviser at Bird&Be.
In rare cases, excessive bleeding may require medications to control it or a blood transfusion, says Dr. Feinberg. While it can be alarming, excessive bleeding typically doesn’t affect fertility, explains Robles.
Retained Pregnancy Tissue
Sometimes, not all of the pregnancy tissue is expelled or removed from the uterus after an abortion (known as an incomplete abortion). When this occurs, you may require a follow-up procedure, like a dilation and evacuation, to remove the remaining tissue, says Robles.
An incomplete abortion itself usually doesn’t affect fertility. But repeated procedures can increase the risk of uterine scarring, which can affect the ability to get pregnant in the future, he adds.
Asherman’s Syndrome
Asherman’s syndrome is a rare condition in which scar tissue forms inside the uterus. It’s more likely after surgical procedures like dilation and curettage (D&C) or if multiple procedures are needed, says Robles.
This condition can interfere with the menstrual cycle and make it harder for a fertilized egg to attach to the uterine wall, which needs to happen for pregnancy to continue, says Robles. It can also increase the risk of miscarriage. But Asherman’s syndrome can often be treated with surgery.
Uterine Perforation
A small hole can accidentally occur in the uterine wall during a surgical abortion, says Feinberg. This is called a uterine perforation and rarely happens. “Most uterine perforations heal without any long-term consequences,” she says. But if the perforation affects blood vessels in the uterus, it can cause significant bleeding and may require emergency surgery, such as a hysterectomy, she says.
A uterine perforation can also weaken the uterine muscle, says Dr. Sharma. This weakness may lead to problems with future pregnancies, such as uterine rupture (in which the uterus tears) or issues with the placenta (the organ in the uterus that supplies nutrients and oxygen to the baby).
An abortion generally doesn’t affect your ability to get pregnant later. While some complications can affect fertility, most people who have an abortion are able to conceive and have a healthy pregnancy in the future, says Robles.
If you’ve had an abortion and are having trouble getting pregnant, other factors unrelated to the abortion itself may be involved. Here are a few factors that can affect fertility after an abortion.
- Age As you get older, fertility naturally declines.
- Ovarian Reserve Issues The number of eggs in your ovaries (your ovarian reserve) decreases with age, which can make it harder to get pregnant.
- Health Conditions Medical conditions like fibroids (noncancerous growths), polyps (small growths in the uterine lining), damaged fallopian tubes, or uterine malformations can interfere with pregnancy.
- Hormonal Imbalances Conditions that affect your hormone levels, such as thyroid disorders or polycystic ovary syndrome (PCOS), can interfere with ovulation, making pregnancy more difficult.
- Male Factor Infertility These include problems with sperm count and movement, which can contribute to fertility challenges.
- Repeated Surgical Abortions Although it’s rare, having several surgical abortions can affect the lining of the uterus, which may make it harder for an embryo to implant or increase the risk of miscarriage.
- Lifestyle Factors Things like smoking, excessive drinking, stress, or being significantly over or underweight can affect fertility.
If you’re having difficulty getting pregnant, Feinberg recommends seeing your healthcare provider or a fertility specialist for an evaluation. “This typically includes an assessment of ovarian reserve (egg supply), an evaluation of the uterine cavity and fallopian tubes, and a semen analysis for the partner,” she says.
Feinberg says that having had a previous abortion can be an encouraging sign for future fertility. It shows that your reproductive system was able to successfully create a pregnancy in the past.
If you’ve had an abortion and are thinking about getting pregnant again, or if you’re already expecting, you can take steps to support a healthy pregnancy.
Start Planning Before You Conceive
The best time to prepare for a healthy pregnancy is before you get pregnant, says Sharma. She recommends starting your health journey three to four months before you plan to conceive. This includes scheduling a checkup with your healthcare provider to address any underlying medical conditions.
Take Prenatal Vitamins Early
Begin taking a high-quality prenatal vitamin before you start trying to get pregnant, advises Sharma. Look for one that contains easily absorbed folate to help prevent birth defects, iron for healthy blood, and docosahexaenoic acid (DHA), which is an omega-3 fatty acid that can help support the baby’s brain and eye development.
Focus on Healthy Lifestyle Habits
A balanced diet that includes plenty of fruits, vegetables, lean proteins like chicken and fish, and dairy products can help support your reproductive health, says Robles. It’s also important to reach a healthy body weight before becoming pregnant, as being significantly over- or underweight can affect fertility.
Regular physical activity, such as 30 minutes of moderate exercise like walking, swimming, or yoga most days of the week, can also support your reproductive health, he adds. It’s important to avoid smoking, alcohol, and recreational drugs, and to manage stress levels. If you have chronic conditions like diabetes or thyroid disorders, work with your healthcare provider to keep them well controlled.
Consider Genetic Counseling and Testing
During your preconception visits, discuss genetic carrier screening to identify any potential inherited conditions that could be passed on to your baby, says Ruchi K. Amin, MD, a fellowship-trained reproductive endocrinologist and infertility specialist at Genesis Fertility in Brooklyn, New York.
Your healthcare provider might suggest genetic counseling depending on certain factors. These factors include a family history of genetic conditions, multiple miscarriages or infant deaths, or ongoing fertility challenges. Genetic counseling can help you understand your risks and make informed decisions about your pregnancy journey.
Don’t Skip Follow-Up Care
Regular prenatal visits are an important part of a healthy pregnancy, says Dr. Amin. These check-ins help your healthcare provider catch any potential issues early and ensure you’re on track for a healthy pregnancy and delivery.
It might be worth it to see a fertility specialist if you’ve been trying to get pregnant without success. But when to seek help depends largely on your age and specific circumstances.
If you’re under 35, most experts recommend seeing a fertility doctor if you haven’t conceived after one year of trying. If you’re 35 or older, it’s best to check in after six months of trying. And if you’re over 40, it’s a good idea to seek help right away, says Sharma, as fertility naturally declines with age.
According to Robles, you may want to see a fertility specialist regardless of age, if:
- You have very painful or irregular periods.
- You’ve been diagnosed with PCOS, endometriosis, or another reproductive condition.
- You’ve had multiple miscarriages.
- There are known or suspected fertility issues with your partner.
Seeing a fertility specialist doesn’t mean you’re committing to treatment right away. “Rather, it’s often just a helpful first step toward exploring your options,” says Robles.
- An induced abortion performed safely by trained healthcare providers generally does not cause infertility.
- While complications from abortion are rare, they can include infection, retained pregnancy tissue, and uterine scarring, which in rare cases may affect future fertility.
- Factors that may affect fertility are similar regardless of past abortions, and include age, hormonal imbalances, underlying health conditions, or male infertility.
- Consider seeing a fertility specialist if you’ve been trying to conceive without success, especially if you’re over age 35, have irregular periods, or have a known reproductive health condition.
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