Does Abortion Affect Fertility?

For women considering an abortion or who have undergone one in the past, concerns regarding the potential impact of abortion on future fertility are common and clinically relevant. Understanding the relationship between abortion and fertility is essential in making informed decisions about reproductive health and family planning.

This article outlines the clinical implications of abortion on fertility, associated risks, and recommendations for reproductive health optimisation.

Understanding the Link Between Abortion and Fertility

When performed safely by a licensed medical professional, abortion, whether medical or surgical, does not typically impair fertility. In Singapore, abortion is regulated under the Termination of Pregnancy Act. This ensures that abortion procedures are carried out in sterile and accredited facilities under strict medical supervision.

Both medical and surgical abortions are safe when conducted according to clinical guidelines. Long-term fertility impairment is uncommon following medically supervised procedures.

However, complications can arise, particularly from unsafe or unregulated procedures. These complications, though rare in Singapore, may impact future fertility. It also highlights the importance of seeking abortion care from an experienced and accredited gynaecologist.

Potential Risks of Medical Abortion

Medical abortion in Singapore involves taking two types of medication, mifepristone and misoprostol, to end a pregnancy. This is typically performed within the first 10 weeks of a pregnancy. When supervised by a qualified gynaecologist, it is both safe and effective. 

Some possible risks include:

• Treatment Failure: While medical abortion is generally effective, there is a small risk of treatment failure. In a study co-authored by Dr Daniel Koh, 96.8% of women successfully completed their abortions without requiring surgical intervention, demonstrating a high success rate with the combined use of mifepristone and buccal misoprostol. For the remainder of women, a surgical procedure called evacuation of the uterus may be necessary.

• Pain: Pelvic pain is a common side effect of medical abortion. Most women experience moderate to strong pain as the uterus contracts to expel the pregnancy tissue. This pain typically begins within the first hour after taking misoprostol and may last for several hours.

• Bleeding: Heavy bleeding is expected during a medical abortion. In rare cases, bleeding may be prolonged or excessive and require medical evaluation. 

• Incomplete abortion: In these cases, the retained pregnancy tissue may require surgical removal via evacuation of the uterus. Delay in addressing an incomplete abortion may lead to pelvic infection and can potentially be life threatening.

• Infection: Serious infections can result if the uterus fails to fully expel its contents. In addition, pre-existing infections such as chlamydia or gonorrhoea, can increase the risk of pelvic infections like pelvic inflammatory disease (PID), which may impact future fertility if left untreated.

Potential Risks of Surgical Abortion

Intrauterine adhesions

Surgical abortion is typically performed under sedation or general anaesthesia to ensure patient comfort and safety. Complications are rare but can include:

• Intrauterine Adhesions (Asherman’s Syndrome): Surgical abortion can cause the formation of scar tissue inside the uterine cavity (Asherman's syndrome). This can be caused by excessive curettage or repeated abortion procedures.It can affect subsequent fertility by impairing the embryo implantation process. It can also result in recurrent miscarriages.Fortunately, Asherman's syndrome is rare, especially when the procedure is performed by an experienced gynaecologist.

• Cervical trauma: Cervical trauma can occur if the cervix is dilated too aggressively. This may lead to cervical insufficiency, which can increase the risk of miscarriage or preterm birth in future pregnancies.

• Uterine perforation: This is a rare complication of abortion. This occurs when  surgical instruments penetrate beyond the uterine wall. The incidence of uterine perforation reported by Singapore Medical Journal is 0.8 per 1,000 procedures (0.08%) during elective first-trimester abortions. To reduce the risk of uterine perforation, cervical priming with misoprostol is commonly used. This softens and dilates the cervix, making the procedure safer.

To reduce the risk of complications during surgical abortion, Daniel Koh Clinic offers intraoperative ultrasound guidance and anti-adhesion gels.

How to Minimise Risks with Proper Care

When performed in an appropriate clinical setting, abortion is rarely associated with adverse effects on fertility. Additionally, the following measures may support optimal recovery and fertility preservation:

• Follow your doctor’s post-procedure instructions carefully.

• Attend all follow-up appointments to confirm complete resolution of pregnancy and ensure full recovery.

• Look for signs of infection, such as unusual discharge, fever, or persistent cramping, and seek immediate medical attention if these occur.

• Screen for sexually transmitted infections (STIs) prior to the procedure. Untreated infections such as chlamydia or gonorrhoea can lead to pelvic inflammatory disease (PID) and fallopian tube damage.

• Avoid inserting anything into the vagina (e.g. tampons, intercourse) for a minimum of two weeks post-procedure or as advised by your gynaecologist.

• If you are planning future pregnancies, schedule a preconception checkup to assess your reproductive health.

Other Factors Influencing Fertility Outcomes

It is important to note that fertility is influenced by multiple physiological and anatomical factors. In most cases, abortion does not cause fertility issues. 

Factors influencing fertility outcomes include:

• Maternal age 

• Ovarian reserve and egg quality

• Health of fallopian tubes and uterine lining

• Pre-existing endocrine conditions like PCOS or thyroid disease

• History of pelvic infections or endometriosis

If you have concerns about fertility, Daniel Koh Clinic offers fertility screening and tailored fertility packages for women at different life stages.

Will One Abortion Affect My Pregnancy Later?

In the absence of complications, a medically managed abortion will not usually reduce the chances of future pregnancy. This was supported by the findings of a study by the Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists titled “Outcome of pregnancy following induced abortion”.

Choosing a Safe and Reputable Abortion Clinic in Singapore

The quality of your care provider is a key factor in minimising complications and safeguarding your future fertility. When selecting an abortion clinic in Singapore, ensure that:

• The clinic is licensed by the Ministry of Health (MOH)

• The doctors are experienced and up to date in both medical and surgical abortion protocols

• The clinic provides detailed post-procedural instructions and ensures access to appropriate follow-up care

• The clinic provides ultrasound guided procedure and takes precautions against uterine adhesions 

Dr Daniel Koh is a specialist obstetrician and gynaecologist with dual subspecialty interests in the fields of reproductive medicine and maternal-fetal medicine. His clinical research with mifepristone (RU486) has contributed to advancements in medical abortion protocols in Singapore. Dr Daniel Koh was also in charge of the clinical pathways for termination of pregnancy and mid trimester pregnancy termination during his employment with KK Women’s & Children’s Hospital.

Dr Daniel Koh is a believer in providing quality care to all his patients. He was awarded multiple Singapore Health Quality Service Awards (Silver, Gold, Star and Superstar finalist), and is also accredited by MOH to perform termination of pregnancy in Singapore.

Learn More About Abortion with Daniel Koh Clinic

At Daniel Koh Clinic, we provide a medically supervised, confidential setting for women to access accurate information, undergo safe procedures, and discuss their future fertility goals.

Contact Daniel Koh Clinic to arrange for a consultation regarding procedure suitability and reproductive health planning.