There is no specific number of abortions that triggers infertility. A single uncomplicated abortion, whether medication or surgical, does not appear to reduce your ability to get pregnant later. The real risks come not from a count of procedures but from rare complications, particularly infection and uterine scarring, that can occur after any procedure but become somewhat more likely with repeated surgical interventions.
What the Evidence Actually Shows
Medical abortion (using medication to end a pregnancy) does not appear to raise the risk of future pregnancy complications at all. Surgical abortion has also been studied extensively, and the vast majority of research shows little impact on future fertility. A large national cohort study published in BMJ Open compared women who had one surgical abortion with women who had three or four consecutive procedures. The researchers found no dose-dependent effect: women with multiple abortions were not at significantly higher risk of preterm birth than women who had just one.
That said, “little impact” is not the same as “zero risk.” Each surgical procedure introduces a small chance of complications that can affect fertility. Those complications are uncommon, but they’re worth understanding because they’re the actual pathway between abortion and infertility, not the number of procedures on its own.
Uterine Scarring: The Primary Fertility Concern
The complication most directly linked to infertility after abortion is a condition called Asherman’s syndrome, where bands of scar tissue form inside the uterus. This scarring can partially or completely block the uterine cavity, making it difficult for an embryo to implant or for a pregnancy to continue. It develops after dilation and curettage (D&C), the type of surgical procedure that involves scraping or suctioning the uterine lining.
The risk of Asherman’s syndrome after a single D&C is low. It rises with repeated procedures on the same uterus. This is the closest thing to a “cumulative number” effect in the research, but it’s still not a predictable threshold. Some women develop scarring after one procedure; others never develop it after several.
Signs that scar tissue may have formed include periods that become noticeably lighter than before, periods that stop entirely, severe cramping or pelvic pain around the time you’d expect your period, or difficulty getting or staying pregnant. In some cases there are no symptoms at all. If scarring is suspected, a doctor can look inside the uterus with a thin camera (a hysteroscopy) to evaluate the extent of the tissue. The condition is often treatable with surgery to remove the adhesions.
Infection and Tubal Damage
The other major pathway to infertility after abortion is infection. Any time the cervix is opened, whether during a surgical or medical abortion, bacteria from the vagina can travel into the uterus and fallopian tubes. If this leads to pelvic inflammatory disease (PID), the resulting inflammation can scar and block the fallopian tubes, preventing eggs from reaching the uterus.
Post-abortion infection rates vary widely across studies. For surgical abortion, reported rates range from about 0.1% to nearly 5%. For medical abortion, the average across a large review of studies was just under 1%. The UK’s National Health Service places the overall risk somewhat higher, at around 10%, likely reflecting a broader definition of infection that includes milder cases.
The critical factor is not whether a mild infection occurs but whether it progresses to PID and whether it gets treated promptly. Among women who develop symptomatic PID, between 10% and 20% go on to experience infertility or ectopic pregnancy. Even with antibiotic treatment, one study found that 18% of women with PID reported infertility three years later. Untreated or silent PID, the kind that causes no obvious symptoms, can be particularly damaging because the inflammation has time to scar the tubes before anyone knows it’s happening.
Signs of post-abortion infection include fever, foul-smelling discharge, worsening pelvic pain, and prolonged heavy bleeding. Prompt treatment with antibiotics significantly reduces the chance of lasting damage.
Cervical Weakness After Repeated Procedures
Surgical abortion requires dilating (opening) the cervix. Repeated dilation can weaken the cervix, a condition called cervical insufficiency, where the cervix opens too early in a future pregnancy and leads to preterm birth or pregnancy loss. This doesn’t prevent conception, but it can make carrying a pregnancy to term more difficult.
A retrospective cohort study found that women with a history of pregnancy termination had roughly 4.6 times the odds of needing a cervical stitch (cerclage) to hold the cervix closed during a later pregnancy. A separate meta-analysis found that the risk of preterm delivery was modestly elevated after one termination, with an odds ratio of 1.36, and roughly doubled after two or more terminations, with an odds ratio of 1.93. These are relative increases on top of a baseline risk that is already small for most women, so the absolute numbers remain low. Still, this is one area where the number of procedures does appear to matter.
Medication abortions do not require cervical dilation in the same way and are not associated with this risk.
Why the Type of Abortion Matters More Than the Count
The distinction between medication and surgical abortion is more important for future fertility than the raw number of procedures. Medication abortions carry essentially no known risk to future fertility. Surgical abortions carry a small risk per procedure, primarily through scarring and cervical dilation, and that risk can accumulate modestly with repetition.
Modern surgical techniques have also reduced complications considerably. Vacuum aspiration, the most common surgical method used in early pregnancy, is gentler on the uterine lining than older curettage methods. The use of prophylactic antibiotics before the procedure has lowered infection rates. And when complications do arise, they’re usually treatable if caught early.
If you’ve had one or more abortions and are now trying to conceive, the odds are strongly in your favor. Most women who have had abortions, even multiple ones, go on to have healthy pregnancies. The scenarios that lead to infertility are the exception, not the rule, and they typically involve a specific complication rather than the procedure itself.
Signs to Watch For
If you’re concerned about your fertility after one or more abortions, pay attention to changes in your menstrual cycle. Periods that become significantly lighter, stop entirely, or come with unusual pain could signal uterine scarring. Persistent pelvic pain, unusual discharge, or fever in the weeks after a procedure could indicate an infection that needs treatment. And if you’ve been trying to conceive for 12 months (or 6 months if you’re over 35) without success, a fertility evaluation can identify whether scarring, tubal blockage, or cervical issues are involved. Many of these conditions are treatable once identified.