Abortion Does Not Increase the Risk of Infertility
Modern evidence demonstrates that induced abortion, whether surgical or medical, does not cause infertility in women. The most robust data from a nationwide Finnish registry study of 88,522 women who underwent abortion found that only 0.4% required IVF treatment afterward, and abortion-related factors (gestational age, method, or complications) showed no association with subsequent infertility 1.
Evidence-Based Safety Profile
The comprehensive 2018 National Academies of Sciences, Engineering, and Medicine report established that abortion care by any method—medication or procedure—is safe and effective 2. This finding is reinforced by clinical practice guidelines that classify abortion procedures as low-risk interventions with minimal impact on future reproductive capacity 2.
Key Findings from High-Quality Research
No procedural link to infertility: The Finnish nationwide study comparing 379 women who needed IVF after abortion to 7,434 women with spontaneous pregnancies found no statistically significant differences in gestational age at abortion, method of abortion, or complications that would predict future infertility 1
Risk factors are age-related, not abortion-related: Women requiring IVF after abortion were older at the time of their abortion and had fewer previous deliveries—both recognized independent risk factors for infertility unrelated to the abortion itself 1
Infection rates are minimal: The incidence of postoperative infection after first-trimester therapeutic abortion is low, though repeated procedures may theoretically increase pelvic infection risk 3
Distinguishing Myths from Medical Reality
Common Misconceptions
Patients rarely express concern about procedural complications causing infertility; instead, they have complex thoughts about how abortion fits into their reproductive life plans, including age-related concerns, missing their "chance" to have children, or religious fears about divine punishment 4. These psychological concerns should not be confused with actual medical risk.
Actual Complications That Could Affect Fertility (Rare)
- Asherman's syndrome: May occur after septic therapeutic abortion, with low pregnancy rates after treatment 3
- Cervical incompetence: First-trimester pregnancy terminations do not significantly increase the incidence of prematurity due to cervical incompetence or surgical infertility 3
- Pelvic inflammatory disease: Not directly caused by the abortion procedure itself but related to sexually transmitted diseases, particularly in cases of repeated procedures 3
Clinical Implications
Abortion is statistically safer than carrying a pregnancy to term, and this safety profile extends to future fertility 2. The CDC's contraceptive use guidelines classify post-abortion contraception initiation with the same safety ratings as postpartum contraception, indicating no special fertility concerns 2.
Counseling Recommendations
When discussing abortion with patients concerned about future fertility:
- Reassure patients that modern abortion techniques do not cause infertility 1
- Address age-related fertility decline as the primary concern for older patients, not the abortion procedure itself 1
- Screen for sexually transmitted infections before and after the procedure to prevent pelvic inflammatory disease, which is the actual fertility risk factor 3
- Distinguish between procedural fears and reproductive life planning concerns when patients express anxiety about future fertility 4
Important Caveats
While abortion itself does not cause infertility, certain clinical scenarios warrant attention:
- Multiple repeat abortions may theoretically increase cumulative risk of pelvic infection, though this is related to STI exposure rather than the procedures themselves 3
- Second-trimester procedures carry slightly higher complication rates than first-trimester procedures, but still do not significantly impact future fertility 2
- Septic abortion (now rare with modern techniques) can lead to Asherman's syndrome 3
The evidence is clear: induced abortion does not cause infertility, and women can be confidently counseled that their future reproductive capacity will not be compromised by choosing abortion care.