Can Having an Abortion Affect Your Fertility?

It’s been more than a year since Roe v. Wade was overturned, with 20 states in the U.S. now either restricting or banning abortion outright. With women’s reproductive rights still slowly being chipped away in this country, misinformation and scare tactics pertaining to abortion continue to run rampant, especially when it comes to how this procedure affects fertility.

What’s important to remember when discussing abortion, is that both forms – medication and surgical – are not only safe, but surgical abortions are actually one of the safest medical procedures available when performed by a qualified provider. By comparison, according to a 2019 New York Times article, the risk of complications leading to infertility is much higher with a full-term pregnancy and delivery, as opposed to an abortion. The article also noted that the risk of dying from giving birth in the United States is 14 times greater than the risk of dying from an abortion.

It is understandable, though, for patients to exhibit some concern about their fertility if they’ve previously undergone an abortion. So we spoke with Jessica Ryniec, MD, a reproductive endocrinologist with CCRM Boston, to help separate the facts from fiction.

Can having an abortion affect your fertility?

The only reason a patient’s fertility could potentially be impacted by an abortion, says Dr. Ryniec, is if there are complications. Such as “uterine or cervical injury, infection that is not appropriately treated, or bleeding that requires surgery.” But she emphasizes that these instances are rare – they occur less than 0.5% of the time when performed by a qualified medical provider – and that “a safe, uncomplicated abortion does not affect your fertility.”

Probably the most significant fertility risk following an abortion is the possibility of Asherman syndrome, which can cause difficulty in subsequently becoming pregnant. Asherman syndrome occurs when the inner lining of the uterus is scarred by a curet – an instrument used in surgical abortions. However, the critical factor here is that this risk tends to develop only following multiple surgical abortions.

What exactly makes abortion such a safe procedure?

“Uncomplicated abortions do not impact the uterus, fallopian tubes, or the menstrual cycle, all keys to future fertility,” says Dr. Ryniec. “When done in the appropriate setting and with the appropriate pre-and post-abortion care, there is nothing about either medical or surgical abortion that would increase risk of infertility unless there are complications.”

This is why, despite the overturning of Roe v. Wade, access to safe, legal abortion remains imperative in the United States. Complication rates are very high in areas of the world where abortion is illegal and performed under dangerous circumstances. These complications can include uterine and bowel injury, as well as severe infections, all of which can impact future fertility if the uterus and/or fallopian tubes are scarred – or if a hysterectomy is required.

The future of medication abortion in the United States is also at risk, even though it is a perfectly safe option, according to Dr. Ryniec. (It also accounted for more than half of all U.S. abortions in 2020, according to the Guttmacher Institute.) Medication abortion is currently legal in 36 states – with 15 of those states offering restricted access. Further restrictions, however, specifically on mifepristone, which is one of the two drugs taken for a medication abortion, could be forthcoming. For now, due to a Supreme Court stay on the Fifth Circuit Court of Appeals decision of Alliance for Hippocratic Medicine v. FDA, mifepristone remains available in states where medication abortion is legal. This case is likely to be decided by the Supreme Court.

Trying to conceive after an abortion

Just like after a miscarriage, it’s a good idea to take things slowly if you do want to try to conceive again following an abortion. “Physically it takes time for the menstrual cycle to return, and depending on the circumstances leading to the abortion, someone may want to consider a different form of contraception moving forward if pregnancy is not desired,” advises Dr. Ryniec. She also suggests being mindful of your mental health: While she says there isn’t evidence to support abortion-causing significant psychological problems, “there can be feelings of grief, loss, depression, and anxiety,” so it’s important to wait until you are ready to try again.

Unless there are complications during an abortion – and, to reiterate, these are rare in the United States, even in a post-Roe society – Dr. Ryniec says the procedure, be it surgical or medication, would not have any impact on any future pregnancies. Your ability to conceive would depend on the usual predictors of fertility. That includes age, prior medical and surgical history, how long you’ve been trying to conceive, prior pregnancy history, and general menstrual and reproductive health.