Can Abortion Make You Infertile?

Emily Capps|November 5, 2022||Abortion

In this article:

The short answer is: yes, it can. There are cases where women become infertile after their abortions. There is also evidence showing that abortion can increase risk of future miscarriage. However, the exact probability of either is unclear, given the mixed results of studies. This is likely due to the difficulties of studying such personal and controversial issues.

Also, while an abortion itself may not necessarily cause infertility, many potential complications of abortion are known causes of infertility.

Planned Parenthood and other medical sources say that the risk of infertility is rare unless there are complications—and this last phrase is key. Planned Parenthood and other medical organizations downplay the risks of abortion, but much evidence suggests that those risks are very real. Complications are more common than they wish to admit—complications sometimes even resulting in death.

Difficulties Studying Abortion and Infertility

There are many reasons why studies on abortion and infertility have mixed results.

First of all, infertility itself is difficult to study. It is a personal issue often not discovered until a couple tries to conceive, and sometimes not even until months or years of trying. It is also difficult to diagnose causes of infertility since there are so many factors at play.

Secondly, abortion is even more difficult to study, since many women are hesitant to admit an abortion out of guilt or fear. Because of this, many studies have too few post-abortive subjects to be accurate. In other studies, the statistics are affected because women did not admit their abortion. Furthermore, if the patient’s doctor isn’t informed about the abortion, the doctor won’t even know to consider it as a cause of infertility.

Additionally, because there is a lack of abortion follow-up care, many women are unaware of its effects on their health and fertility. In one case study, the doctors found that the patient’s infertility was due to bone fragments left from an incomplete abortion. However, the patient had no idea there had been any abortion complications. Nor did the doctor realize it at first because they were unaware of the abortion, and the first scans didn’t find any evidence.

Such issues make it difficult for anyone to realize whether abortion causes infertility.

Finally, those who support abortion may be influenced by political concerns. As Gregory K. Pike (Senior Research Fellow at the Bios Centre in London) says in his research: “it is quite conceivable that the literature as it exists is biased.”¹

What Planned Parenthood Says About Infertility and Abortion

Planned Parenthood claims that there is no increased risk of infertility from abortion “unless there’s a rare and serious complication that’s not treated.” But this last phrase is key.

In his overview of studies on abortion and infertility, Pike responds to Planned Parenthood:

This implies that complications serious enough to affect fertility are rare (0.01% to 0.1%…²), and only present a problem if untreated. However, some quite serious abortion complications are not rare (e.g. blood transfusions required in up to 0.6% of [chemical] abortions, and [pelvic inflammatory disease] in up to 4.9% of surgical abortions).³

While this still is not very common, it’s quite possible that these statistics are even higher given the previously-mentioned issues in studying abortion and infertility. In other words, the risks of serious complications from abortion are higher than abortion supporters would like to admit.

What Medical Organizations Say About Infertility and Abortion

Other medical organizations admit there may be some risks of infertility from abortion, though in the end they generally downplay these risks. They say that there isn’t enough evidence to claim a definite connection. Some even expressly state that abortion does not cause infertility, against evidence to the contrary.

For example, many medical organizations mention a small risk from abortion complications, such as infections and scarring of the uterus. The NHS says that “most infections are treated” before they lead to pelvic inflammatory disease (PID)—though, as mentioned previously, PID still occurs in almost 5% of surgical abortions (and those are only the recorded cases). Mayo Clinic and the British Pregnancy Advisory Service also admit that studies show “a link between prior surgical abortion and a slight increased risk of premature birth and low birth weight,” risks which increase with each abortion.

After all this, though, they still argue that “there is no proven connection between abortion and future infertility, ectopic pregnancy or other pregnancy complications.”

Admittedly, there are not enough studies on abortion and infertility (for the reasons mentioned above), and those that exist are not always reliable. Nonetheless, there is evidence of at least some risk of infertility from abortion. There are recorded cases of women who became infertile because of complications from their abortions. And these complications are known causes of infertility, as we shall see. Thus, as Pike argues, there is a “variety of reasonable grounds for a link” between abortion and infertility.

Abortion Complications That Can Cause Infertility

Pike’s research identifies several abortion complications that can affect fertility:

Cervical damage
Infection and pelvic inflammatory disease (PID)
Incomplete abortion
Adhesions from damage to the uterus (Asherman Syndrome)
Poor mental health (depression, anxiety, etc.)

Since these are all risks of abortion, and most of them known causes of infertility, it only makes sense that abortion could cause infertility.

Cervical Damage

According to the NHS in 2019, the risk of cervical damage from surgical abortion was about 1%—damage which could lead to infertility. The NHS acknowledges that cervical scarring and mucous generation issues may cause infertility. Admittedly, “a link via cervical damage from abortion remains theoretical,” but “it should be the subject of further research.”⁴

Infection and PID

We can confidently say, however, that infection from abortion can lead to PID (pelvic inflammatory disease), and thus infertility. This applies to both chemical and surgical abortion, since “your cervix opens during an abortion and allows bacteria to enter your genital organs more easily.”

As one study notes, “Abortion clinics are often not equipped with the optimal instruments for reliable diagnosis… [to] protect patients from serious infection.”

Such infections can lead to PID if left untreated (which is quite possible given the lack of post-abortion care, and the fact that patients with PID do not always show symptoms). Based on various studies, PID is a known cause of infertility—between 10% and 40% of infertility cases.⁵

According to several studies done in the 80s, between 10% and 28% of women who had abortions developed PID. And this statistic would be even higher if it included cases that went undetected because of a lack of symptoms.

More recent studies affirm this connection. In a 1995 study, Stevenson et al. claim that pelvic infection is the most common complication from abortion. A 1996 case study found that 56% of women with PID had at least one abortion, and a 2007 study estimated that women with an untreated STI from abortion have a 63% chance of developing PID.

According to Pike, there is up to 1% chance of getting infertility from abortion due to PID alone—though this number would be even higher if it included cases of asymptomatic PID.⁶

Incomplete Abortion

An incomplete abortion raises the risk of infection and PID, and requires surgery to remove the remaining fetal parts. The surgery carries further risks of infection and damage, thus further augmenting the risk of infertility issues.

Indeed, “the retention of bone fragments after abortion has been linked to secondary infertility.”

While retained fetal parts were found in only about 0.15% of women who had a hysteroscopy (an examination of their uterus),⁷ “this might be misleading,” as a previously-mentioned case study shows. In the case study, the doctors did not identify the incomplete abortion at first, since the first scans did not find the retained fetal parts and the doctors were unaware of the past abortion. Only later did they discover that an incomplete abortion was causing the woman’s infertility.

Intrauterine Adhesions (Asherman Syndrome) and Endometrial Thinning

If the endometrial lining is damaged during an abortion, bands of scar tissue can form inside the uterus, causing the sides of the uterus to stick together. These bands of scar tissue are known as intrauterine adhesions (IUAs), which can cause infertility.

Although studies are inconsistent about the exact percentage, “the evidence for a link between abortion and IUAs is clear.”⁸ This is especially true for surgical abortion and even more so for incomplete abortion.

“The link between IUAs and infertility is perhaps even more established.” says Pike. IUAs, “depending on the severity, may lead to infertility in up to 43% of such cases.” In another study from 2007, Kodaman and Aydin affirm that “Intra-uterine adhesions can cause recurrent pregnancy loss and infertility.”⁹ Furthermore, The American Society for Reproductive Medicine says that, after treatment, the chance of pregnancy can be anywhere from 20% to 80% or lower, depending on the severity of the damage.

One 2018 study also discovered that abortion caused endometrial thinning, a higher chance of miscarriage, and a lower chance of pregnancy (though it only examined success with IVF). And the more surgical abortions the woman had undergone, the higher the risk.

Thus, we see that IUAs “may be a hidden yet significant cause of infertility after abortion. And yet the research has been so limited that women will receive minimal if any guidance.”

Mental Health

While this remains theoretical and controversial, it is also possible that the impact of abortion on mental health can affect fertility.

Not surprisingly, mental disorders are much more common for couples struggling with infertility. And though abortion supporters will deny it, many woman find their mental health affected by abortion, leading to depression and even suicide. Thus, the effect of abortion on mental health and of mental health on fertility is certainly worth more research.

Abortion and Risks of Miscarriage

After abortion, there may also be a risk of future miscarriage.

A study from 2003 found that “a higher risk of miscarriage, particularly those occurring within the first 3 months of gestation, is associated with prior first trimester induced abortion.” This seemed to at least be true of vacuum aspiration abortions, since the majority of the abortions in this study were done by this technique.

While the study acknowledges that “results from previous studies are conflicting,” many factors (such as small sample sizes and subjects all coming from the same hospital) make their accuracy questionable.

The researchers suspect that damage and infections from abortion may cause delay in the embryo’s implantation, thus leading to miscarriage.

Another study indicated that a medical abortion may carry less risk of miscarriage than surgical abortion.

As with studies on infertility and abortion, there are not enough studies on abortion and miscarriage to come to a conclusive answer. And again, the controversial and personal nature of abortion and miscarriage make the issue difficult to study.

Abortion Alternatives

If you are considering an abortion, please know that there are alternatives to ending the life of your child.

And please do not hesitate to reach out for guidance and support from your local crisis pregnancy center. And make sure you understand why abortion is wrong if you are unsure.

For those dealing with a past abortion, we know the effect it can have on your mental health. Find a support group or pro-life therapist to help you heal.

Infertility Treatments and Support

If you or a loved one is struggling with infertility, there are many treatment options, resources, and support available to you.

For more information on ethical infertility treatments in line with Church teaching:

For spiritual advice and encouragement:

Endnotes

[1] Pike, G. K. (2020). Abortion and Infertility. Issues in Law & Medicine, 35(1/2), 173–195.

[2] These definitions have been determined by the Council for International Organizations of Medical
Sciences (CIOMS), an organization established by WHO and UNESCO. They are described in the CIOMS training manual, which can be found at http://www.who.mt/medicines/areas/quality_safety/safety_efficacy/trainingcourses/definitions.pdf. Accessed 28 Jun 2018.

[3] Pike, G. K. (2020). Abortion and Infertility.

[4] Pike, ibid.

[5] Also see Wiesenfeld, Harold C., Hillier, Sharon L., et al. Subclinical Pelvic Inflammatory Disease and Infertility. Obstetrics & Gynecology: July 2012. Volume 120, Issue 1, p. 37-43
doi: 10.1097/AOG.0b013e31825a6bc9

[6] “If symptomatic PID, even after antibiotic treatment, occurs at a frequency of between 2.4% and 4.9%, and infertility after PID between 10% and 20% for symptomatic cases, then in total there could be up to 1% infertility (20% of 4.9%) after abortion from PID alone. However, that figure could treble if asymptomatic PID is taken into account” (Pike, ibid).

[7] Winkelman, William D. BA, et al. Secondary Infertility and Retained Fetal Bone Fragments. Obstetrics & Gynecology: August 2013 – Volume 122 – Issue 2 PART 2 – p 458-461 doi: 10.1097/AOG.0b013e3182917c9c

[8] Pike, ibid.

[9] Kodaman, Pinar H; Arici, Aydin. Intra-uterine adhesions and fertility outcome: how to optimize success?. Current Opinion in Obstetrics and Gynecology: June 2007 – Volume 19 – Issue 3 – p 207-214 doi: 10.1097/GCO.0b013e32814a6473