Can abortion lead to infertility? The truth about termination of pregnancy and the ability to have children

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Many young women fear that after one or more planned abortions (pregnancy terminations) they may later face infertility and therefore not be able to have children when they want and intend to.

Fortunately, the answer to the question “Can abortion lead to infertility?” has a simple answer: NO. But there are also situations, rare indeed, when a surgical abortion can leave certain scars in the uterine cavity, which increases the probability that a woman will suffer a miscarriage and have problems conceiving in the future. It’s also important to point out that repeated spontaneous abortions—that is, not planned, drug-induced, or surgical—can signal a problem that requires medical attention from an infertility specialist.

We learn more details about the risk of infertility in case of abortion, but also vice versa – about the risk of abortion in case of infertility – from Dr. Andreas Vythoulkas, obstetrician-gynecology specialist with overspecialization in infertility.

Read also: Autoimmune diseases and infertility – 4 conditions that prevent you from getting pregnant

Types of planned abortion

Termination of pregnancy or planned abortion consists in the voluntary abandonment of pregnancy, for various reasons. This type of abortion can be of two kinds, depending on how advanced the pregnancy is.

Thus, a woman can make the decision to do drug-induced abortion (be careful, it’s not about the morning-after pill!). These abortion pills are available with a doctor’s prescription and only if the gestational age is less than 9 weeks.

Of course, before performing this procedure, a full gynecological consultation is mandatory, as well as an ultrasound to determine the age of the pregnancy and to exclude an ectopic pregnancy or other medical conditions that contraindicate medical abortion.

Also, after taking the abortion pills, the patient must return for a follow-up for the doctor to make sure that the abortion is complete and that all products of conception have been removed.

If it is found that the abortion is incomplete or if the gestational age is more than 9 weeks but less than 14 weeks, the decision can be made to carry out a surgical abortion.

“Depending on the particularities of the patient, the doctor can practice suction under vacuum, dilation and evacuation or abortion by induction. When abortion is performed in a clean and safe medical environment, the procedures will not affect fertility. But complications can occur if the abortion is carried out late in the pregnancy, such as heavy bleeding requiring transfusions, infections – untreated, these can lead to pelvic inflammatory disease, a common cause of infertility and ectopic pregnancy – or damage to the uterus or of the urinary bladder. Anything that causes inflammation in the uterus has the potential to affect fertility,” says Dr. Andreas Vythoulkas.

Also read: When IVF becomes the only option for getting pregnant

What is Asherman’s syndrome, occurring after surgical abortion

A rare complication that can increase the risk of infertility or miscarriage after surgical abortion is Asherman’s syndrome, which is the development of scarring or adhesions in the uterine cavity that causes the space in the uterus to shrink.

“The risk of developing this condition is also higher if you have had a hysteroscopy, a caesarean section or have not followed the correct treatment for pelvic inflammatory disease or cervicitis (inflammation of the cervix). Also, radiation therapy in the treatment of cervical cancer can favor the appearance of Asherman’s syndrome”, adds the doctor.

Among the signs that may suggest the existence of this syndrome – although there are cases when the condition is completely asymptomatic – include:

  • Strong cramps in the pelvic area (below the navel)
  • Hypomenorrhea (low amount of menstrual blood)
  • Metrorrhagia (abnormal uterine bleeding that occurs outside of menstruation)
  • Amenorrhea (absence of menstruation)
  • Difficulty getting pregnant or carrying the pregnancy to term (miscarriages)

To establish the diagnosis of Asherman’s syndrome, the doctor will recommend investigations such as transvaginal ultrasound, hysteroscopy or saline ultrasound (sonohysterography).

“Fortunately, there are several treatment options for Asherman syndrome. These may consist of surgical removal of scarred areas and the fitting of an intrauterine balloon for a certain period, adjuvant hormone therapy or the use of anti-adhesive substances based on hyaluronic acid. However, it should be noted that the pregnancy obtained after the surgical treatment of Asherman’s syndrome is one with increased obstetric risk and must be closely monitored by the attending physician. adds Dr. Vythoulkas.

Read also: 2 in 1 analysis – detect and eliminate uterine fibroids

Repeated miscarriages, a reason to consult an infertility specialist

If until now we have talked about termination of pregnancy and the risk of infertility, now is the time to change the optics. Namely – can infertility, or more precisely its causes, lead to miscarriage? Well, this time the answer is YES.

If you have repeatedly gone through the painful experience, especially from a psychological point of view, of miscarriage during the first 12 weeks of pregnancy, consider visiting an infertility specialist – it may be a sign that there is a problem affecting your fertility !

There are many causes that can cause spontaneous abortion (pregnancy loss). These include:

  • Blood clotting disorders (antiphospholipid syndrome)
  • Genetic disorders (chromosomal abnormalities)
  • Infections (STDs, Toxoplasmosis, Listeria, Rubella, etc.)
  • Abnormalities of the uterus (heart-shaped bicornuate, septate or double uterus)
  • Polycystic ovary syndrome
  • Uterine fibroma
  • Thyroid diseases or diabetes, which are not properly treated

“However, such pathologies can mostly be treated, so once resolved, fertility can be restored and the risk of spontaneous abortion is much reduced. If repeated pregnancy losses are based on genetic causes, there are also solutions in this case. For example, pre-implantation testing of cells extracted from embryos obtained by in vitro fertilization using the PGT method can be recommended. In this way, only embryos without genetic abnormalities (euploid) are selected, which have the best chance of developing into a healthy pregnancy. details Dr. Andreas Vythoulkas.

In conclusion, termination of pregnancy rarely leads to fertility problems, especially when we talk about abortion performed surgically, in an advanced stage of gestation or in inappropriate conditions. On the other hand, recurrent miscarriage (so repeated pregnancy losses) is a sign that the visit to the infertility specialist can no longer be postponed – the cause that prevents you from carrying the pregnancy to term must be discovered and treated.

Read also: Termination of pregnancy, a woman’s great ordeal


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