Can a past abortion hurt your chances of getting pregnant?

When Joselyn Mahoney* was a young adult, she was working hard and partying hard. She was on the birth control pill but didn’t always follow the guidelines—she skipped pills and took antibiotics, both of which reduce the efficacy of the contraceptive. She had three pregnancies and three surgical abortions. “I knew for certain all three times that I was not ready to have a child, nor was I caring for my body the way that I aspired to before conceiving,” she says.

Mahoney also knew she wanted to have a family one day, and she worried that the procedures could affect her future fertility and ability to carry a child. However, she was too scared and ashamed to ask the doctors and doesn’t recall any of them bringing it up.

Fast-forward to age 32 and she was healthy, married and ready to try for a baby. Buried emotions and questions bubbled to the surface. Is my uterus healthy? Have my chances of conceiving and carrying to term been jeopardized? Would the abortion I had in the second trimester cause more problems? She discussed her concerns with her family doctor, who told her it’s very unlikely that her abortions affected her fertility. Still, she worried.

Mahoney is not alone. About 100,000 women in Canada have an abortion every year and many of them hope to have children when they’re ready. About 10 percent of the women fertility doctor Beth Taylor sees at Olive Fertility Centre in Vancouver tell her they’ve had an abortion, and many of them assume it’s the reason they can’t conceive. “Women should not feel badly for having an abortion,” Taylor says. “It’s very unlikely to have negative consequences on their fertility.”

A 2018 article published in the European Journal of Obstetrics & Gynecology and Reproductive Biology confirms that, on a population scale, abortion is not associated with a higher risk of future infertility. In fact, a woman is fertile within days after terminating a pregnancy, though the risk of miscarriage is slightly higher in the three months that follow.  

An abortion can be done by taking medication to induce a miscarriage or by having surgery to empty the contents of the uterus. In Canada, medical abortions—the name for abortions done by taking medication—can only be done up to nine weeks’ gestation, and surgical methods vary depending on the stage of pregnancy.

Abortions are safer than childbirth, but complications, such as infection and retained products of conception, occur in about two percent of cases. “Complications that are significant down the road are super rare,” says Carol Scurfield, medical director at the Women’s Health Clinic, which provides abortions in Winnipeg. “A little bit of retained products that cause you to bleed for a month instead of a week is not uncommon, but insignificant when it comes to fertility.” Though, in some cases, an infection could damage the uterus or travel up the fallopian tubes to block them. In very rare circumstances surgery can cause damage to the cervix or uterus which might lead to scarring, but in the vast majority of situations this scarring is minor and not a problem with respect to future pregnancy.

Abortions done after the first trimester are more likely to result in complications because the procedures are more involved. “If you have an unintended pregnancy that you want to terminate, do it sooner rather than later, if at all possible,” says Scurfield. “The earlier you have a pregnancy termination, the safer it is.”

In most cases, women would know if they experienced complications, though some scarring may not be detected until there’s a problem. If a fertility specialist suspects scarring or blocked tubes, a hysteroscropy (an endoscopy of the uterus) or a hysterosalpingogram (a specialized X-ray also known as HSG) can confirm the diagnosis. Surgery to remove scar tissue and unblock tubes can be attempted, but it’s not always successful, so some women may opt for IVF or surrogacy.

A study published in 2018 in the International Journal of Gynecology & Obstetrics shows that IVF outcomes are worse after an abortion, especially two or more surgical procedures. The researchers found that the endometrium, the membrane that lines the uterus, is thinner, which makes it difficult for an embryo to implant, and the miscarriage rate is 18 percent compared to 10 percent among women who have not terminated a pregnancy.

However, there are many reasons a woman may have difficulty conceiving and a previous abortion is one of the least likely, Taylor says. Age is by far the most significant factor affecting a woman’s fertility, so someone who accidentally got pregnant in her 20s could have trouble conceiving again in her mid-30s even though she’s tracking her ovulation and scheduling sex.

A number of studies have explored the potential link between a previous abortion and future pregnancy complications and have found conflicting results. A review of 10 studies on first-trimester vacuum aspiration abortions, the standard surgical method, found no connection to miscarriage, preterm birth or low birth weight. However, a meta-analysis of 37 studies concluded that women who have had abortions are more likely to deliver early and have low-birth-weight babies—with the likelihood increasing with the number of abortions.

Scurfield says it’s difficult to draw conclusions from the studies as they may not control for other factors that lead to poor outcomes. Regardless, she adds, preterm labour and birth weight can be monitored for during pregnancy. “With good care, generally those women and those babies do OK,” she says.

Mahoney got pregnant within the first three months of trying, but it was only after she made it past the first trimester that she was convinced her abortions didn’t affect her ability to carry a child. After having a son, she went on to have a girl who was conceived on the first try two years later. They were both born 10 days past their due date, weighing more than nine pounds.

Scurfield and Taylor urge women to tell their healthcare providers about past abortions and any complications so risks can be properly assessed. “Those of us in women’s health and infertility provide nonjudgmental care,” Taylor says. “Abortions are part of the reproductive cycle.”

*Name has been changed.

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