Abortions and future pregnancies

By Lee Hye-jun

During a fertility consultation with me, a woman makes a confession. “There is something I did not tell you. When I was young...” She pauses. I sense it is about a previous abortion. She continues with tears in her eyes, “Is this why I am not getting pregnant?”

When women have difficulty having a baby or experience miscarriages, many of them blame their problems on previous abortions. Many women are overwhelmed by feelings of guilt and refuse to talk to anyone about this, even their husbands. While an abortion can cause future complications, it’s not always the case.

We sometimes make mistakes, even with contraceptives — condoms break, women forget to take birth control pills, and ovulation occurs on an unexpected day. Nearly half of all pregnancies in the United States are unintended, and about 40 percent of these are aborted. It is illegal to have an induced abortion in Korea except for particular reasons such as genetic disorders of parents, the pregnancy being life-threatening to the mother or pregnancy from rape. Yet, illegal abortions are still frequently performed here.

It is commonly known that an abortion can injure the womb and disrupt future pregnancies. This condition is referred to as intrauterine adhesion. Scar tissue can form in the endometrial lining of the uterus from any type of trauma such as curettage, which is performed during an induced abortion, miscarriage or bleeding after childbirth. Like separating two sheets of paper stuck together with glue, the inner walls of the womb are bound together with scar tissue in between. It may leave little space for a fetus to implant and interfere with sperm passage into the womb. Also, the decreased blood supply of a denuded endometrial lining can result in miscarriage.

However, it is not well known that intrauterine adhesion is a rare complication. When performed safely in the first trimester, an induced abortion does not necessarily increase risks in future pregnancies, or lead to infertility, ectopic pregnancies or miscarriages. In addition, doctors try to minimize the incidence of intrauterine adhesion by using a conservative approach such as using a suction catheter or blunt curette rather than a sharp instrument.

Of course, I am not writing this article to support induced abortion. Without question, it must be reduced by all means such as through contraception, counseling and adoption. Moreover, it is true that an abortion may result in complications, especially when it is repeated. Nevertheless, the consequence of abortion and intrauterine adhesion is somewhat overstated. Too many women suffer from guilt for a rare complication.

First, use contraceptives wisely to avoid any complications that might occur from induced abortions. Even if it has already happened, fortunately, future pregnancies are unlikely to be unaffected. If you experience challenges in having a baby, please seek medical advice. There are many possible causes for infertility and miscarriage. It is rarely entirely your fault.

The writer is a doctor at Maria Fertility Hospital in Seoul. For further questions, send an e-mail to the writer at hyejunlee@mariababy.com, or call the hospital’s English-speaking coordinator at 82 (Korea country code) 2 (Seoul area code) 2250-5577, or visit the hospital’s website, https://eng.mariababy.com/.