Question:
Hi Joan, i had an abortion recently, i.e. 2 months back and again my pregnancy test appears to be positive. I am planning to go for abortion again due to personal issues…I have consulted doctor and they saying me not to go for any abortion, because i may face fertility issues for my next pregnancy…please help me on this…

Answer:
Dear Rida,
Thank you for your question about the risks of multiple abortions.  First of all you may not be pregnant.  Sometimes a pregnancy test can remain positive after an abortion for several months.  So, before you do anything, you should confirm that you actually have a second pregnancy. The doctor can do this by either checking an ultrasound, or by checking several blood tests.

If it is confirmed that you are pregnant, there is minimal risk in having a second abortion, or even more.  In some countries, like Russia, women often have more than 5 abortions in their lifetime, and they do not have additional fertility problems.  That said, the safest abortion methods are: 1) Manual Vacuum Aspiration; 2) the Abortion Pill; 3) “suction curettage” abortion.  Both Manual Vacuum Aspiration and the Abortion Pill are endorsed by the World Health organization as the safest abortion methods.  They are considered non-surgical methods. Manual Vacuum Aspiration is a simple gentle method that uses a little handheld device to bring down an early pregnancy.  There is no scraping, no electric machine, and no need for general sedation.  Unfortunately it is hard to find a doctor who offers the Aspiration Procedure.  The abortion pill is more widely available, but not as easy to take.  However it has been shown to have no risk at all for future fertility.  “Suction curettage” is a surgical abortion (electric suction) without the scraping.  If there is no scraping there is minimal risk of scarring, and therefore minimal to no risk for problems with future pregnancies.  So, if the doctor does do a surgical abortion, ask that he does not scrape the uterus.  It is completely unnecessary in early abortion.

I hope this is helpful and a relief to you.
Doctor Joan

Allexperts.com

 
 Answer:
Dear Deanna,
There are no concerns about having brown or dark bleeding for months after an abortion.  For the first months it is common and normal, and usually indicates that there is blood in the uterus that does not come down immediately, so it turns brown before it comes out.  Clots are also common and normal, and indicate the same thing – that the blood stayed in the uterus and started to clot before the uterus expelled it. 
 
Dark brown bleeding that continues for more than a few months often indicates something called “retained products.”  Technically, “retained products” is an abortion complication, but I like to think of it as more of a minor problem that can occur after any pregnancy.  Retained products sounds frightening, but it is usually harmless.  Early pregnancy tissue consists of a lining (like a period) that forms around the cavity, called “decidua.” This tissue is thicker than a period and has a firm consistency, and is tan or brown in color.  It is common and normal for some of this tissue to remain in the uterus after any pregnancy (after a full term birth, after a miscarriage, after abortion with the pill and after abortion with a procedure.)  Typically the uterus just expels the small amount of remaining decidua on its own time.  Sometimes the remaining decidua stimulates additional bleeding. 
 
There is usually no problem with having remaining tissue in the uterus.  It does not typically cause infections.  If you do not have a strong odor and a discharge, there is no reason to think you have an infection.  It does not cause problems with future fertility.  Some people with a minimal amount of “old blood” or decidua get significant cramping.  The doctor then recommends that a procedure is repeated to remove it, so that the cramping resolves.  However, in your situation, you are not having cramping, so it is optional to just wait until it passes on its own, or repeat a procedure to bring it down, and resolve the issue of ongoing irregular bleeding.  I usually leave that decision up to the patient – some women find it disturbing, and want it out.  Others are relieved to know that there is nothing to be afraid of, and that there are no consequences to having a little tissue in the uterus and that it will eventually pass on its own. 
 
I hope this is relieving to you.  If you live in New York City, we are happy to repeat an ultrasound and give you a second opinion. 
 
Doctor Joan