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Will I be able to have a baby after an abortion?
Last updated: 25 January 2016
"If I have an abortion will I be able to have a baby later?" This is a commonly asked question by women considering an abortion. Websites run by abortion clinics offer reassurance in regards to this question, stating that, provided there are no major complications, a legally-performed first trimester abortion will not affect a woman's fertility.
For example, a website for a Sydney abortion clinic states the following:
"Will my future fertility be affected?
Provided that there are no major complications, (which are rare), and the procedure is performed in a clinical setting by an experienced doctor, future fertility is not affected by one, or even several abortions."
The truth is more complicated than this.
Major immediate complications from terminations are uncommon but it is an exaggeration to describe them as being "rare". For example, the Royal College of Obstetricians and Gynaecologists has estimated that the rate of perforation of the uterus during termination of pregnancy is between one to four per thousand abortions.1
Even in abortions without major complications, it is still possible for a woman's future fertility to be affected by the procedure. There are a range of possible complications after an abortion which have the potential to adversely affect a woman's future ability to get pregnant and have a child.
The immediate physical complications of termination of pregnancy include:
- Haemorrhage (bleeding)
- Retained tissue from the baby and placenta
- Uterine perforation and cervical laceration.
A major 2011 study from Ontario, Canada found that "Overall in Ontario, emergency department/same-day surgery visits or hospitalizations within fourteen days and for any reason were observed after 4.5 per cent of abortions, (while) 0.4 per cent of abortions resulted in hospitalization".2
Specifically the ways in which abortion may result in infertility are as follows:
1. Asherman's Syndrome: During an abortion, the lining of the uterus (the endometrium) can be damaged leading to scar tissue forming on the uterine lining. This is known as Asherman's Syndrome (also known as intrauterine adhesions).
Even with relatively few scars on the uterine lining, the endometrium may then fail to respond to oestrogen. Often, women will experience secondary menstrual irregularities characterized by a decrease in flow and duration of bleeding. This leads to infertility.
According to the website of the International Asherman's Association:
"The risk of Asherman's Syndrome increases with the number of D&Cs performed; after a single termination the risk is 16%, however, after 3 or more D&Cs, the risk increases to 32%".
For more information on Asherman's Syndrome see: http://www.ashermans.org
2. Infection: Pelvic Inflammatory Disease is a term used to describe an infection of the uterine lining, the Fallopian tubes and/or the ovaries. It occurs when bacteria from the vagina or cervix move into the ovaries. It occurs when bacteria from the vagina or cervix move into the uterus, Fallopian tubes or ovaries.
Abortion, whether surgical or medical, is a well-known cause of Pelvic Inflammatory Disease.3 Normally a woman's cervix is closed, preventing bacteria in the vagina from entering the womb. During an abortion, the cervix is opened and bacteria can be spread to the uterus and, from there, to the Fallopian tubes or ovaries.
Antibiotics are routinely given following an abortion to prevent infections becoming established but, despite this, women can still develop chronic infections in the lining of their womb, Fallopian tubes or ovaries as a result of aboriton (pelvic inflammatory disease) 3,4.
These infections may cause symptoms such as pelvic pain, fevers or vaginal discharges. Some infections will be asymptomatic (that is, the woman will feel perfectly well) but pelvic inflammatory disease can cause chronic scarring or inflammation to the lining of the womb or the Fallopian tubes, significantly increasing the risk of ectopic pregnancy or of infertility.
3. Damage to the Cervix: During a surgical abortion the cervix is artificially dilated (forced open) to allow instruments to be inserted into the uterus. The cervix can be weakened by this process. A weakened cervix (known as an incompetent cervix) will not be strong enough to support a baby in the later stages of pregnancy, leading to either premature birth or second-trimester miscarriage with later pregnancies.
In addition to cervical damage from being dilated during an abortion, the cervix can suffer trauma such as lacerations (cuts) during the procedure. The Royal College of Obstetricians and Gynaecologists has estimated the rate of cervical trauma from surgical abortion to be around 1 in 100.1
It is well established that a single surgical abortion produces an increase in risk of premature birth (of about 30%) with a subsequent pregnancy. Two surgical abortions produce a larger increase in risk of premature birth (of about 90%) with a subsequent pregnancy and the risk rises more steeply with three or more abortions.5
1. RCOG, 2011. The Care of Women Requesting Induced Abortion. Evidence-based Clinical Guideline Number 7. Recommendation 5.6. 40.
The full text of Recommendation 5.6 at Page 40 states:
Women should be informed of the uncommon complications that may occur and of their possible clinical consequences. These may include:
- severe bleeding requiring transfusion; the risk is lower for early abortions, occurring in less than 1 in 1000, rising to around 4 in 1000 at gestations beyond 20 weeks.
- uterine perforation (surgical abortion only); the risk is in the order of 1-4 in 1000 and is lower for early abortions and those performed by experienced clinicians.
- cervical trauma (cervical abortion only); the risk of damage to the exteran os, [the external opening of the cervix, where the cervix meets the top of the vagina], is no greater than 1 in 100 and is lower for early abortions and those performed by experienced clinicians.
Women must be informed that, should one of these complications occur, further treatment in the form of blood transfusion, laparoscopy or laparotomy may be required."
2. Dunn S et al. Reproductive and Gynaecological Health. At Bierman AS, ed: Project for an Ontario Women's Health Evidenced-based Report (POWER). Vol 2. 2011. 89.
3. Nielsen et al, 1992. Pelvic Inflammation after Induced Abortion. 2743-6.
4. Brewer C, 1993. Prevention of Post-abortion Infection. 802.
5. Voigt et al, 2008. The Influence of Previous Pregnancy Terminations, Miscarriages and Stillbirths on the Incidence of Babies with Low Birth Weight and Premature Births as well as a Somatic classification of Newborns.