Can a past abortion impact my fertility?

Around 85,000 abortions are performed every year in Australia for 85,000 different reasons. With that number, I suppose it stands to reason we so often get asked about abortion and whether it could be playing a role in how a persons fertility experience is playing out.

1 in 6 women in her 30’s has had a termination

The two approaches and why it matters

Medical Abortion

Medical abortion uses medication to end and remove a pregnancy.  In Australia, medical abortion is usually used up until week 9, most often with the combination of two pharmaceuticals - mifepristone and misoprostol.

2014 research looked at 11,800 women who used misoprostol in first trimester and found that that medical abortion is safe for the carrier, highly effective and has no impact on the likelihood of becoming pregnant later.

Older research (published in 2007) supports the notion that medical abortion doesn’t play a role in pregnancy complications like preterm birth, low birth weight, miscarriage or ectopic pregnancy.

Surgical Abortion

Surgical abortion is removal of the pregnancy via a surgical procedure, either through vacuum curettage or dilation and evacuation.

In the majority of cases, surgical abortion will have no impact on the ability to conceive later.  Of course, complications, although rare do occur, may play a role if you are having difficulty conceiving and do warrant further investigation. In a very small number, complications can lead to:

1.     Asherman’s Syndrome

Surgical abortion is the leading cause of Asherman’s syndrome. Categorised as a ‘rare’ disorder, Asherman’s syndrome is an acquired condition, where scarring and adhesions form inside the uterus. It can occur after any trauma to the uterus.

Some researchers estimate that up to 13% of surgical abortions will result in Asherman’s syndrome, however this 2021 study found the condition was confirmed by ultrasound following a surgical abortion in just 1.2% of cases, with risk of developing Asherman’s increasing for women who have had three or more surgical abortions. That is a low risk - and it is worth keeping in mind Asherman’s syndrome doesn’t necessarily equate with difficulty conceiving.

Other symptoms of Ashermans include:  

• very light, or no periods

• cramping with periods

• pelvic pain

• recurrent miscarriage

 Sound like you? Asherman’s Syndrome can be confirmed by hysteroscopy or hysterosalpingogram (HSG) and is a manageable condition.

2.     Untreated Pelvic Inflammatory Disease (PID) and tubal disease

PID is essentially infection of the reproductive organs which can lead to a blockages in the fallopian tubes preventing the egg and sperm from meeting.  This tubal occlusion accounts for around 20% of couples with infertility.

PID following a safe abortion is extremely unlikely, given follow up care monitors for, and treats infection long before it is likely to impact the fallopian tubes, in fact PID is more likely to be a complication of gonorrhoea or chlamydia.

Symptoms of PID in acute stage are common infection symptoms like fever, nausea and vomiting. Unfortunately, there are no symptoms of tubal blockage. Women with tubal occlusion can have a regular, consistent, pain free cycle.

Think your history could indicate PID at some point? Tubal occlusion can be diagnosed via HyCoSy or HSG.

3. Incompetent cervix

An incompetent cervix occurs when the tissues of the cervix are weakened or damaged, causing dilation early in a pregnancy and resulting in miscarriage or preterm birth. This study looked at over 1 million women, 16,000 of whom reported a previous termination. They saw an association between surgical abortion and premature birth from incompetent cervix but importantly, stated their research found:

“Women who have had a termination of pregnancy have an increased risk of preterm delivery [… ] although absolute risks were low”

Older research from Scotland (published in 2012) also demonstrated a small, but increased chance of incompetent cervix, and noted an increased likelihood with increased number of surgical terminations.

Cervical incompetence has a number of other causes - previous labours or a genetic predisposition for example.

The take away

Does medical abortion impact fertility? There is currently no research to show that medical abortion has any impact on fertility or future pregnancies.

Does a surgical abortion impact fertility? Like any surgical procedure, abortion carries risks, but is statistically highly unlikely - particularly in a country where abortion is legal and therefore comparatively safer. Of course, if you have concerns it is always worth discussing them with a health professional and considering investigations where appropriate.

A note: Fertility can be hard and abortion is a triggering and polarising topic. If a termination has been a part of your fertility story, it really is OK. And you’re not alone - 1 in 6 women in their 30’s has already written, or will write this same chapter - similar, yet totally unique.

I do hope this next chapter is positive for you.

Want to know more about tests pertaining to fertilty? Try this read next.