Early Abortion and Infertility: Risks & Contraception Options

Question
I am 31 and have had 3 abortions and 1 ectopic pregnancy.  The ectopic pregnancy and 1 of the abortions happen within a year.  Now I believe I'm pregnant but can not keep it for many reasons.  But at the same time I want to because I don't want to lose the chance of being a mom.  
The question. . . would I be putting myself in grave danger if I had another abortion? and what contraceptives should I consider?  Thank you so much, grown and confused.

Answer
Dear Me,
Thank you for your question on whether abortion can cause problems with future fertility.  The risk that an abortion will cause infertility is extremely low.  Surgical D&C procedures in rare instances can cause Asherman's syndrome.  This syndrome is caused by aggressive scraping of the lining of the uterus during a procedure.  Typically women who have Asherman's syndrome will no longer have a menstrual period or will have very light periods after an abortion.  

There are two early abortion methods that are nonsurgical and do not utilize scraping of the uterus and thus avoid the possibility of Asherman's syndrome. These methods include the abortion pill and the Manual Vacuum Aspiration procedure, also known as Aspiration Abortion.  You also can request a surgical abortion without the scraping.  Scraping is completely unnecessary for early pregnancy (under 12 weeks).  A surgical abortion without scraping is sometimes called a "suction curettage." I am not aware of any studies that compare rates of Asherman's syndrome with suction curettage vs. a surgical abortion with scraping.  

There is no reason to think that you have any current problems with fertility from your prior abortions since you were able to get pregnant again and you didn't mention any menstrual problems.  There is so little risk from surgical abortion, in my opinion you would be safe to get another one.  However, if you want to be absolutely sure that you don't have problems, I would recommend that you try to find a doctor who offers nonsurgical early abortion methods.  The best source for these doctors is at http://www.earlyabortion.com  If you are near New York City our offices specialize in these nonsurgical methods: http://www.earlyabortionoptions.com  There is also more information on this site about health risks of abortion. You may also try gynpages.com and look at the categories of "early abortion" or "medical abortion."

I hope this is helpful,
Doctor Joan
New York City