Surgical Abortion Does Not Decrease Fertility in Women with Severe Endometriosis
Surgical abortion itself is not associated with decreased fertility in women with severe endometriosis—the fertility impairment comes from the endometriosis disease process itself and from surgical treatment of the endometriosis, not from pregnancy termination procedures.
Understanding the Fertility Impact
The provided evidence addresses endometriosis-related fertility concerns but does not identify surgical abortion as a risk factor for reduced fertility. Here's what actually impacts fertility in this population:
Primary Fertility Threats in Severe Endometriosis
Endometriosis itself causes sustained reduction of ovarian reserve through inflammatory reactions, reactive oxygen species production, and tissue fibrosis, with severity directly related to ovarian reserve decline 1.
Women with untreated endometriosis have lower fecundity rates than normal couples, with nearly half of women with surgical evidence of endometriosis failing to achieve spontaneous pregnancy 2, 3.
The disease causes anatomical distortions from adhesions and fibrosis, along with endocrine abnormalities and immunological disturbances that impair fertility 4.
Surgical Risks That Actually Matter
The real surgical threat to fertility in endometriosis patients comes from endometriosis excision surgery, not abortion procedures:
Surgery for severe endometriosis results in lower ovarian reserve after excision of ovarian endometriomas due to incidental removal of normal ovarian tissue along with the endometrioma wall 5.
Surgical treatment of endometriosis leads to ovarian injury during resection of endometriotic tissue, causing deterioration of ovarian reserve 1.
Ovarian reserve can be reduced both by endometriosis itself and by the process of removing endometriosis 1.
Clinical Implications
Standard surgical abortion procedures (suction curettage or dilation and evacuation) do not involve ovarian tissue manipulation or endometriosis excision, and therefore do not carry the same fertility risks as endometriosis surgery.
Fertility preservation procedures should be considered for reproductive-age women at risk of impaired fertility related to endometriosis progression or endometriosis surgical treatment—not abortion 5.
The concern in severe endometriosis is balancing the need for disease treatment against preserving ovarian reserve, which requires multistep surgical techniques to minimize ovarian damage 1.