The World Health Organization reports that almost half of all pregnancies each year are unintended and that 61% of these pregnancies end in induced abortion. The decision to have an abortion is a very personal one, but statistics show it is very common and nothing to be ashamed of.
Even if women know they want to have children at some point in their lives, they may become pregnant without intending to before they are ready. Fearing that having an abortion will affect their future fertility may be a factor in whether or not they decide to go through with the procedure.
Women should be free to choose if and when they want to have children. Unfortunately, the negative stigma around abortion often prevents people from gaining accurate information, making it difficult for women to make informed decisions about their course of treatment.
Whether you have had an abortion in the past or are considering an abortion, worrying about how it might affect your future fertility is completely normal and we aim to address these concerns in this article.
What are the different kinds of abortions?
There are two types of abortions available, the procedure a woman can have depends on how many weeks pregnant she is.
- Medical abortions can be performed for women who are up to ten weeks pregnant. In this type of abortion, women take two pills that ultimately terminate the pregnancy. While there is no surgery or anesthesia required in medical aborting, women will likely experience heavy bleeding and abdominal cramping as a result. This kind of abortion has almost no likelihood of causing any future fertility issues.
- Surgical abortions are surgical procedures carried out to terminate pregnancies that are over 10 weeks along. This procedure either involves removing pregnancy tissue through a special vacuum, or a procedure called dilation and curettage, or D and C. Depending on the laws where you live, surgical abortions can be carried out until 12 weeks, 20 weeks, or in 10% of clinics up to 24 weeks.
What are the potential risks of abortions?
To start, data shows that an abortion carried out with no complications has virtually no chance of causing future fertility issues. The chance of experiencing any complications that could lead to infertility (assuming the abortion is safely carried out) are 0.23%.
Making a decision about having an abortion shouldn’t be rushed. However, the earlier in pregnancy the abortion takes place, the lower the likelihood of complications is. While major complications are rare, as with any medical procedure, there are potential risks.
- Infection: Some doctors will automatically prescribe antibiotics after an abortion as a preventative measure. That being said, only around 1 in 100 women will get an infection after an abortion. For these women, antibiotics can usually be used to treat the infection.
- Incomplete abortion: This can occur when tissue remains in the uterus after an abortion. This is more common after medical abortions than surgical abortions. Women may experience abdominal pain or heavy bleeding as a side effect of incomplete abortion. While in some cases this can be dangerous, between 82% and 96% of cases can be managed successfully with no future consequences on fertility.
- Heavy bleeding: While it is not uncommon for women to experience bleeding after an abortion, there are some rare cases of postabortion hemorrhage or blood loss to the point of requiring a transfusion. One study found that postabortion hemorrhage occurred after 3.9% curettage surgical abortions and 1.9% after vacuum
- Injury to adjacent organs: In rare cases, doctors can cause injury to the bladder, bowels, or uterus during a surgical abortion. In these cases, surgical intervention is required.
It should be noted that according to multiple studies, legally performed abortions have a lower chance of negative outcomes than vaginal childbirth or C-section. In fact, the risk of death from childbirth is 14 times more likely than from abortion.
Future pregnancy outcomes
As previously stated, there is no evidence to support that having had a complication-less abortion in the past will lead to an increased risk of spontaneous abortion, ectopic pregnancy, preterm birth, or low birth weight in future pregnancies.
There is also no evidence to show decreased fertility or difficulty conceiving postabortion. However, in a small number of women who developed an infection and did not treat it right away, there is some risk.
Asherman’s Syndrome
Asherman’s Syndrome is a disorder in which scar tissue lines the walls of the uterus, and can sometimes occur after a surgical procedure such as C and D surgical abortion. One study found that out of 844 women only 0.7% were found to have Asherman’s Syndrome following sharp curettage and repeat curettage procedures.
Unfortunately, most women who have Asherman’s Syndrome do experience menstrual and fertility problems. In a study of 16 women with Asherman’s Syndrome who had not undergone treatment, only three patients achieved term deliveries.
The good news, however, is that hysteroscopic treatment of Asherman’s Syndrome has shown promising results, with a pregnancy rate of 62.5% in women under 35 years of age.
Thankfully, legal and safe abortions have a very low percentage of risk to women’s health and fertility. However, while women in parts of North America and Europe generally have access to abortions, there are many women around the world who do not.
The rate of serious abortion-related complications is much more likely in parts of the world in which the procedure is illegal or difficult to obtain. Many of these cases go unreported, but it is estimated that 8-11% of maternal death worldwide is the result of unsafe abortions.
Restricting the availability of the procedure is the most dangerous risk involved in abortions We must remove the stigma that surrounds abortion in order to give women the right to choose the course of care that is safest for them.
