Probably not. However, in rare cases, the aftereffects of an abortion — such as an infection or issues affecting the fallopian tubes — may create obstacles in achieving pregnancy. In some cases, there is also a risk of injury to the cervix, the endocervical canal, or the endometrial cavity.
Any procedure that dilates the cervix (a process required in most abortions) can potentially weaken the uterus. The hysteroscopy method, during which a very thin camera (5–6 mm) is inserted through the cervix to examine the uterine cavity, is a diagnostic procedure that can often provide both diagnosis and simultaneous treatment of endometrial abnormalities.
In addition, if you have had more than one abortion in the past and become pregnant, a possible injury to the cervix may have caused cervical insufficiency. This condition might need to be managed during pregnancy with a cervical cerclage to prevent premature birth.
In general, however, a single abortion in the past does not affect your ability to conceive a healthy baby in the future, unless complications occurred during the procedure that damaged the uterus. Today, since pregnancy terminations are performed in hospitals under proper antiseptic conditions, the risk is significantly lower, though not eliminated.
For this reason, proper prevention and contraception are always strongly recommended.
Medical vs. surgical abortion: is there a difference?
Medical abortion does not involve instruments inside the uterus and has not been associated with problems in a later pregnancy. According to large studies, the same applies to a single surgical vacuum aspiration performed without complications. The risk increases slightly with repeated curettages and when there has been an infection. For the procedure itself, see the article on abortion.
Rare complications that can affect fertility
- Intrauterine adhesions (Asherman syndrome): scar tissue inside the uterus, mainly after repeated curettages. It shows up as very light or absent periods and is treated hysteroscopically.
- Infection: if it spreads to the fallopian tubes, it can leave damage. It is prevented by testing for chlamydia and preventive antibiotics.
- Cervical insufficiency: rare, after multiple dilations. In a later pregnancy, cervical length is monitored and, where needed, the doctor performs a cervical cerclage.
When fertility returns
Quickly. Your first ovulation can occur as early as two to three weeks after the termination, before your first period arrives. If you do not want another pregnancy right away, contraception should start immediately.
When to get checked
- your period has not returned six to eight weeks later,
- your period has become much lighter than before,
- you had a fever, severe pain or foul-smelling discharge after the procedure,
- you have been trying to conceive for 12 months, or 6 if you are over 35, without success.
To learn how a termination of pregnancy is performed, with medication or surgery, and what applies in Greece, read the guide on abortion (termination of pregnancy).
What large studies show about fertility after abortion
The worry that an abortion “closes the door” on a future pregnancy is very widespread. The data do not support it. Large studies of hundreds of thousands of women, mainly from countries with complete medical records, did not find that an uncomplicated first-trimester termination increases the risk of:
- infertility or delayed conception,
- miscarriage in a later pregnancy,
- ectopic pregnancy, unless there was a previous infection of the fallopian tubes,
- birth defects in the next child.
International medical societies, such as the British RCOG and the American ACOG, reach the same conclusion: safe abortion does not affect future fertility. The risk is concentrated in the few cases with complications.
Preterm birth: where there is a real association
Some studies have shown a small increase in the risk of preterm birth in a later pregnancy after surgical abortions, especially when there were several or when they were done by curettage without cervical preparation. This association is not seen after medical abortion. Modern techniques, using vacuum aspiration and medication to prepare the cervix, have greatly reduced trauma. If you have a history of multiple surgical terminations, your obstetrician may simply measure your cervical length at the second-trimester ultrasound.
The Rh factor and your next pregnancy
If your blood type is Rh-negative and the fetus is Rh-positive, a small amount of fetal blood can pass into your circulation. Your body may then make antibodies that, in a future pregnancy, attack the red blood cells of an Rh-positive baby.
For this reason, Rh-negative women are considered for anti-D immunoglobulin at the time of the termination, depending on the week and the method. In your next pregnancy:
- tell your obstetrician if you are Rh-negative and whether you received the injection,
- antibody screening at the start of pregnancy shows whether sensitization has occurred,
- even if antibodies are present, the pregnancy is monitored in a specialized way and in most cases goes well.
Should I tell my obstetrician about the abortion?
Yes, and in complete confidence. The information is medical, not moral. It helps your doctor properly assess:
- the risk of cervical insufficiency, if you have had several surgical procedures,
- the need for Rh antibody screening,
- the likelihood of intrauterine adhesions, if your period has changed,
- the position of the placenta on ultrasound, since any procedure on the uterus is one of the history factors taken into account.
Mentioning it in your history does not mean your pregnancy is considered high risk. In the vast majority of cases, monitoring is completely routine.
Preparing for pregnancy after an abortion
Once you decide you are ready, preparation is the same as for any other woman, with a few extra checkpoints:
- Make sure your period has returned normally. Flow and duration similar to before are a good sign that the endometrium has regenerated.
- Start folic acid at least one month before conception.
- Get tested for sexually transmitted diseases, if you were not tested before the termination or if you have a new partner.
- Have a Pap test and check your immunity to rubella and chickenpox, if these have not been done recently.
- Track your fertile days from your first normal cycle. See the guide on how to get pregnant.
How long to wait before your next pregnancy
There is no single right answer for everyone. The World Health Organization, in an older recommendation, suggested an interval of at least six months after a miscarriage or termination of pregnancy. Newer data, mainly from women with early miscarriage, have shown no additional risk when conception happens sooner. In practice, doctors take into account:
- Physical recovery: after an uncomplicated first-trimester termination, the body is usually ready after the first normal period.
- Dating: one normal period before the new conception makes the estimate of gestational age more accurate.
- Anemia: if there was significant bleeding, it takes time to replenish iron stores.
- Emotional readiness: this is often the most important factor, and only you can judge it.
If, on the other hand, you are not planning another pregnancy soon, remember that ovulation can return within a few weeks. An IUD inserted after the termination can be removed whenever you wish, and fertility returns almost immediately.
After a termination for medical reasons or a fetal anomaly
Some women end a wanted pregnancy because a serious fetal anomaly was found or because the pregnancy threatened their health. In this case, the next pregnancy raises different questions:
- What was the cause? If genetic testing of the fetus was done, the result shows whether it was a random event or a condition that may recur.
- Genetic counseling: for certain anomalies the parents are also tested, so that the risk of recurrence can be estimated.
- Targeted testing in the next pregnancy: an earlier nuchal translucency scan, a detailed anatomy ultrasound and, where indicated, invasive prenatal screening.
- Maternal medical conditions: if the termination was due to preeclampsia, heart disease or another condition, an assessment is needed before the new conception, often with early preventive treatment.
In most cases the risk of recurrence is low, and most women have a healthy baby in their next pregnancy.
Emotions in the next pregnancy
There is no “right” way to feel. Many women do not think much about the termination when they become pregnant again. Others feel anxious about whether everything will go well, or feel guilt that comes back unexpectedly, for example at the first ultrasound. Large studies have not shown that abortion by itself causes long-term mental health problems, but every personal experience matters. If your feelings weigh on you, talk to your doctor or a psychologist. Support makes the pregnancy calmer.
Myths about abortion and future pregnancy
- “After an abortion, I will struggle to have a baby.” A safe, uncomplicated termination does not reduce fertility.
- “Fertility takes months to return.” The opposite is true. You can get pregnant even before your first period arrives.
- “Abortion increases the risk of breast cancer.” Large studies and international scientific societies find no such link.
- “Medical abortion is more dangerous for fertility than surgical abortion.” Medical abortion does not involve instruments in the uterus and has not been linked to problems in a later pregnancy.
- “The doctor will notice at delivery and write it down everywhere.” Your medical history is confidential and is used only for your care.
Intrauterine adhesions: how to recognize them and how they are diagnosed
Adhesions inside the uterus are the complication that most concerns women thinking about a future pregnancy. They are rare after a single uncomplicated aspiration and more common after repeated curettages or curettage combined with infection.
The main sign is a change in your period: much less bleeding than before or no period at all, while hormone levels are normal. Some women have cyclical pain without bleeding. Diagnosis is made with a 3D ultrasound or, more reliably, with hysteroscopy, which also allows the adhesions to be removed at the same time. After treatment, many women manage to get pregnant, with closer monitoring of the placenta during pregnancy.
When conception takes longer after an abortion
If you have been trying for 12 months, or 6 after age 35, without success, do not automatically assume the old termination is to blame. Much more often the cause is unrelated: an ovulation disorder, age, a male factor or endometriosis. The workup is the same as for any couple and includes hormone tests, ultrasound, semen analysis and a check of tubal patency with hysterosalpingography (HSG). If there is a suspicion that the uterine cavity has been affected, hysteroscopy is added. With this information, an answer usually comes within one to two cycles.
Contraception after a termination does not reduce future fertility
Many women hesitate to start contraception right after a termination, fearing it will make a future pregnancy harder. The fear is unfounded. Options such as contraceptive pills, the ring, the implant and the IUD can be started on the same day or in the days right after, and fertility returns quickly once you stop them. The only method with a delayed return of fertility is the three-month contraceptive injection, which takes a few months after the last dose. Proper contraception, on the contrary, protects fertility, because it reduces the likelihood of repeated procedures on the uterus.
For a personalized assessment of your case, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.
Frequently Asked Questions
Can I get pregnant after an abortion?
Yes. A single uncomplicated termination of pregnancy does not reduce the chances of a future pregnancy.
Do multiple abortions cause infertility?
Each additional surgical procedure slightly increases the risk of adhesions and cervical damage. The risk remains small, but it is not zero.
How soon can I try for a baby?
Physically, from the next cycle. Many doctors recommend waiting for one normal period, so that the gestational age of the next pregnancy can be calculated correctly.
Does abortion increase the risk of miscarriage later?
The data show no increase after a single uncomplicated termination.
Can I get pregnant before my first period after an abortion?
Yes. Ovulation can occur two to three weeks after the termination, before your first period. If you do not want another pregnancy, start contraception right away.
Does medical abortion affect fertility?
No. Medical abortion does not use instruments inside the uterus, and studies show no effect on future fertility or on the course of a later pregnancy.
I am Rh-negative. What does this mean for my next pregnancy?
Tell your obstetrician if you received anti-D immunoglobulin at the time of the termination. Antibody screening is done at the start of the next pregnancy and, if needed, the pregnancy is monitored in a specialized way.
Should I mention the abortion to my doctor in my next pregnancy?
Yes. The information is confidential and helps your doctor properly assess the cervix, the Rh factor and the position of the placenta. For most women, monitoring does not change.
Does abortion increase the risk of ectopic pregnancy?
An uncomplicated termination does not increase the risk. The risk increases only if there was a previous infection that damaged the fallopian tubes. In the next pregnancy, an early ultrasound confirms that the pregnancy is inside the uterus.
