Did the abortion cause my infertility?

Q I am 20 years old. I had an abortion two years ago, and now I’m having difficulty getting pregnant again. What could possibly be the cause?

A Many women who have had an abortion in the past usually blame the abortion as the reason they are unable to conceive. However, this is a possible but unlikely cause, as there could be many reasons that you have not been able to get pregnant again.

An abortion can be done by either taking medication to induce a miscarriage or by having surgery to empty the contents of the uterus (womb). If done by a qualified professional, complications are quite rare. However, if complications arise, it may affect your future fertility. Abortions done after the first trimester, as well as surgical abortions, are more likely to result in complications because the procedures are more involved.

Complications, such as an infection, occur in only about two per cent of cases. However, an infection could damage the uterus or travel up the Fallopian tubes to block them. If this occurs, it will affect you ability to get pregnant.

In very rare circumstances, surgical abortion can cause damage to the cervix or uterus, which might lead to scarring. In the majority of cases, this scarring is minor and not a problem as it relates to future pregnancy. However, significant scarring can affect your ability to get pregnant.

In most cases, women would know if they experienced complications, though some scarring may not be detected until there is a problem.

Asherman syndrome

The complication most likely to affect your future fertility as a result of uterine scarring is called Asherman syndrome. Asherman syndrome is a rare complication that can occur after a woman has a surgical abortion procedure that causes damage to the lining of the uterus.

The damage can increase the likelihood that a woman may have a miscarriage or have problems conceiving in the future.

Asherman syndrome does not happen very often. However, if it does, doctors can attempt to treat the condition with surgery that removes the scarred areas of tissue inside the uterus.

If blocked tubes is suspected, a specialised X-ray procedure called a hysterosalpingogram, also known as HSG, can confirm the diagnosis. Surgery to unblock Fallopian tubes can be attempted, but it is not always successful, so some women may opt for in vitro fertilisation.

Complications that will affect future pregnancy are more likely to occur after surgical abortion, especially after two or more surgical procedures. Research has found that the endometrium, the membrane that lines the uterus, is thinner in these patients, which makes it difficult for an embryo to implant, and for pregnancy to occur.

Abortion Least Likely Cause

With all that being said, there are many reasons a woman may have difficulty getting pregnant, and a previous abortion is one of the least likely.

Since you are having difficulty getting pregnant after an abortion, it is important to consider some of the other factors that could potentially affect your fertility, as a past abortion is unlikely to cause problems conceiving.

Other factors that can also affect fertility:

n Age: As you age, your fertility decreases. This is especially true for women older than age 35.

n Lifestyle habits: Lifestyle habits, such as smoking and drug use, can affect your fertility. The same is true for your partner.

n Medical history: If you have a history of sexually transmitted infections, such as chlamydia or gonorrhea, these can affect your fertility. The same is true for chronic diseases such as diabetes, and hormonal disorders.

n Partner’s fertility: Getting pregnant requires two people, and your partner’s semen quality can affect your ability to get pregnant. Even if you have got pregnant with the same partner in the past, lifestyle habits and ageing can affect your partner’s fertility.

If you feel anything discussed is related to the problems you are experiencing with getting pregnant, talk to your gynaecologist. They can advise you on lifestyle steps that may help, as well as recommend a fertility specialist who can help you identify any potential underlying causes and possible treatment options.

And please remember, having an abortion does not mean you cannot get pregnant in the future.

n Send your questions to outlook@gleanerjm.com.