Induced abortion: What effects can I expect on my fertility
On 25 September 2020, a new WHO article was published in which there were a number of interesting figures about abortion. It seems that geography has a huge effect on the abortion rate in a country. ranging from 1 abortion per 66 pregnancies in Australia and New Zealand to 1 per 20 pregnancies in North Africa and the Middle East. This means that 73 million pregnancies are voluntarily aborted every year and 30.000 in the Netherlands alone (1). In the Netherlands, there are about 30,000 voluntary abortions per year. Abortion is a human right that allows women to make better choices about their lives, but there's still a lot of nonsense on the internet. So read up on this no-nonsense guide!
Getting pregnant again and blood loss during pregnancy
First up: there's no evidence that getting an abortion negatively affects your chances of getting pregnant again. A large study of more than 60,000 women compared women who had had a voluntary abortion compared to women who had fulfilled their pregnancies. This study looked at how difficult it was to become pregnant again (after delivering a baby or having an abortion). In this population there was no significant link between having an abortion and subsequent difficulties in becoming pregnant. (2)
Research shows that the risk of bleeding after childbirth was higher if you have had an abortion than if you had fulfilled your pregnancy. (3) However, women who have had an abortion have a reduced risk of high blood pressure during pregnancy (4).
Preterm births and miscarriages
Other studies have tried to look at the risk of premature birth or miscarriage in a next pregnancy, which showed that there is no connection. However, these studies are very outdated, because the abortion methods used in them are no longer carried out. (5)
A study of more than 300,000 women found that having multiple abortions increases the risk of preterm birth. This effect was according to a dose-response relationship. So the more abortions, the higher the chance of having a preterm birth in the next pregnancy. (6, 7). Chances are 55% higher after one induced abortion, 63% after two and 74% higher after three induced abortions compared to the risk of a preterm birth among women that did not have an induced abortion.
Over the years, a lot of research has been done on breast cancer. This has shown that pregnancy provides a protective effect against breast cancer. As a result, it was thought that women who opted for an abortion were therefore not protected. (10) However, none of that appears to be true. (10) A study of more than 300,000 women showed that the risk of breast cancer was not increased. Other studies also support this. (11, 12)
The only real risk that research has shown when you’re getting an abortion is Asherman syndrome. When you get an abortion, you run the risk of developing adhesions in your uterus if you choose to have an abortion with curettage. These adhesions are the cause of Asherman syndrome. With a curettage, the tissue is removed with a type of 'spoon'. Research has shown that up to 1 in 10 women develop Asherman syndrome after having a curettage. (13) Because you have adhesions in your uterus with Asherman syndrome, you also run a higher risk of having a miscarriage later (14). On the other hand, women with Asherman syndrome have a reduced risk of developing cervical cancer. (13) Other complaints of Asherman syndrome are a reduced menstrual flow and (in some cases) substantial pain with menstrual flow.
In conclusion: having an abortion is stressful enough and worrying about the consequences and reading all the stories on the internet can only increase the stress even more. It is therefore important that you pay attention to your mental health in addition to your physical health. After all, your overall health remains a balance of both.
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Bearak J, Popinchalk A, Ganatra B, Moller A, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. The Lancet Global Health. 2020;8(9):e1152-e1161.
Holmlund S, Kauko T, Matomäki J, Tuominen M, Mäkinen J, Rautava P. Induced abortion - impact on a subsequent pregnancy in first-time mothers: a registry-based study. BMC Pregnancy and Childbirth. 2016;16(1).
Woolner A, Bhattacharya S, Bhattacharya S. The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register-based cohort study in Aberdeen, Scotland. BJOG: An International Journal of Obstetrics & Gynaecology. 2013;121(3):309-318.
Jackson J, Grobman W, Haney E, Casele H. Mid‐trimester dilation and evacuation with laminaria does not increase the risk for severe subsequent pregnancy complications. International Journal of Gynecology & Obstetrics. 2006;96(1):12-15.
The Safety and Quality of Abortion Care in the United States. 2018;.
Klemetti R, Gissler M, Niinimaki M, Hemminki E. Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland. Human Reproduction. 2012;27(11):3315-3320.
KC S, Gissler M, Virtanen S, Klemetti R. Risks of Adverse Perinatal Outcomes after Repeat Terminations of Pregnancy by their Methods: a Nationwide Register-based Cohort Study in Finland 1996-2013. Paediatric and Perinatal Epidemiology. 2017;31(6):485-492.
Atrash H, Rowland Hogue C. The effect of pregnancy termination on future reproduction. Baillière's Clinical Obstetrics and Gynaecology. 1990;4(2):391-405.
Daling J, Weiss N, Voigt L, Spadoni L, Soderstrom R, Moore D et al. Tubal infertility in relation to prior induced abortion*. Fertility and Sterility. 1985;43(3):389-394.
Russo J, Russo I. Susceptibility of the mammary gland to carcinogenesis. II. Pregnancy interruption as a risk factor in tumor incidence. American Journal of Pathology. 1980;100(2):497-512.
Brewster D, Stockton D, Dobbie R, Bull D, Beral V. Risk of breast cancer after miscarriage or induced abortion: a Scottish record linkage case-control study. Journal of Epidemiology & Community Health. 2005;59(4):283-287.
Goldacre M, Kurina L, Seagroatt V, Yeates D. Abortion and breast cancer: a case-control record linkage study. Journal of Epidemiology & Community Health. 2001;55(5):336-337.
Smikle C, Yarrarapu S, Khetarpal S. Asherman Syndrome. Treasure Island, Florida: StatPearls; 2020.
Al-Inany H. Intrauterine adhesions: An update. Acta Obstetricia et Gynecologica Scandinavica. 2001;80(11):986-993.