[green-label]Claim:[/green-label] A little-known "abortion pill reversal" procedure allows patients to interrupt or undo a pregnancy termination in progress.
[green-label]WHAT'S TRUE:[/green-label] Some doctors have claimed that medical (not surgical) abortions can be halted or "reversed" through a new procedure.
[red-label]WHAT'S FALSE/UNDETERMINED:[/red-label] That the referenced procedure is safe and works as described, or that a demand for such a procedure exists to any meaningful degree.
[green-label]Origins:[/green-label] On 4 November 2015 Oakside Christian School radio station WOAK published an article titled "Doctor Develops 'Emergency Abortion Pill Reversal Kit,'" relaying information about a doctor's development of an "abortion pill reversal kit" that has "reversed the abortions of more than 100 women":
WJZY-TV reports Dr. Matthew Harrison is the pioneer of the "Emergency Abortion Pill Reversal Kit." The treatment, which is available at over 300 providers nationwide, has reversed the abortions of more than 100 women.
More than 70 women are still pregnant because of the kit.
Harrison explained to WJZY a woman must take a series of progesterone shots within 72 hours of taking the first abortion pill.
Similar information was reported by the conservative Christian pro-life web site LifeSiteNews a few days later:
When Autumn Barnes found out she was pregnant with a second child, she decided to get an abortion. She went to an abortionist and took RU-486, the abortion pill, also called mifepristone.
Dr. Matthew Harrison has developed what he calls "the Emergency Abortion Pill Reversal Kit." Essentially, RU-486 kills the growing baby by starving him or her of progesterone, a hormone the baby needs to grow. After two or three days, the mother is given labor-inducing drugs and delivers her dead baby. Dr. Harrison's Emergency Abortion Pill Reversal Kit counteracts RU-486 by flooding the mother's bloodstream with progesterone.
Autumn's regret spurred her to action. She used Dr. Harrison's reversal kit and was overwhelmed with relief to see her baby the next day via ultrasound, alive and well. "I was so happy, I think my smile was contagious," she said. "Seeing his heartbeat was like oh my goodness that's my baby, and he's safe, and he's alive and hopefully he's healthy."
Irrespective of one's religious, moral, or political beliefs about abortion, these articles should have raised concern due to their presentation of an alarming amount of potentially dangerous and misleading medical information without any reference to extant scientific literature. Moreover, the details presented were shaky: the number of abortions potentially disrupted (or "reversed") to date via the purported therapy jumped from 70 to 137 between the two articles, and neither site qualified how such claims were substantiated.
Claims that medical abortion procedures might be "reversible" aren't new: large web sites previously reported on them in late 2014 and early 2015. A 2012 study published in the Annals of Pharmacotherapy (titled "Progesterone Use to Reverse the Effects of Mifepristone") involving a handful of subjects was the only reference to this form of procedure we found in medical literature, and it described a half-dozen possible attempts at "abortion reversal" (of which two-thirds were possibly successful):
Four of 6 women who took mifepristone were able to carry their pregnancies to term after receiving intramuscular progesterone 200 mg.
Mifepristone has been available in the US since 2000. By 2008, approximately 25% of abortions prior to 9 weeks were accomplished with mifepristone. Some women who take mifepristone wish to reverse the medical abortion process.
Progesterone competes with mifepristone for the progesterone receptor and may reverse the effects of mifepristone. A PubMed literature search from 1996 to May 2012 did not reveal any trials or case studies evaluating the efficacy of progesterone use to reverse the effects of mifepristone.
As the above-reproduced excerpt indicates, the 2012 article documented a study of just six patients, mentioned that no previously published trials or case studies had been conducted in this area, and did not indicate how much demand there was (or might be) for the described procedure beyond a non-specific reference to "some women"
A September 2015 study published in the journal Contraception approached "abortion reversal" from a clinical perspective, identifying a host of flaws in the concept and its execution. Following a "systematic review of the literature on the effectiveness of medical abortion 'reversal' treatment," researchers found that evidence supporting the safety and efficacy of the procedure was worryingly scant:
From 1115 articles retrieved, 1 study met inclusion criteria for abortion reversal, and 13 studies met criteria for continuing pregnancy after mifepristone alone. The one report of abortion reversal was a case series of 7 patients receiving varying doses of progesterone in oil intramuscularly or micronized progesterone orally or vaginally; 1 patient was lost to follow-up. The study was of poor quality and lacked clear information on patient selection. Four of six women continued the pregnancy to term [67%, 95% confidence interval (CI) 30–90%]. Assuming the lost patient aborted resulted in a continuing pregnancy proportion of 57% (95% CI 25–84%). The proportion of pregnancies continuing 1–2 weeks after mifepristone alone varied from 8% (95% CI 3–22%) to 46% (95% CI 37–56%). Continuing pregnancy was more common with lower mifepristone doses and advanced gestational age.
As that study noted, the initial study on which the claims rested was of "poor quality" and involved incomplete data. But most telling was the final sentence: "abortion reversal" procedure success rates hinged on low initial doses of mifepristone and stage of pregnancy (and coincidentally, those factors are also linked with intervention-free failures of medical abortion). Study author Dr. Daniel Grossman explained to Slate that:
In the "exceedingly rare" case in which a woman might take one pill and then decide she wants the pregnancy after all, there's no research to show that progesterone shots will help her save it, he explained. Mifepristone "by itself is not an effective abortion regimen," he said, and so many women who just take the first pill will not miscarry if they simply don't take the second. If he had a patient who changed her mind halfway through, he explained, he would recommend doing nothing and monitoring the pregnancy to make sure it's continuing normally.
The Atlantic reiterated the American College of Obstetricians and Gynecologists [ACOG]'s stance on the procedure, underscoring that it presented false hope to patients considering abortion while maintaining an easily-explained illusion of efficacy (commonly known as "confirmation bias":
What's puzzling about this measure, regardless of one's opinion on abortion, is that the progesterone dose appears to be completely unnecessary. Women who only take the first pill already have a 30 to 50 percent chance of continuing their pregnancy normally, according to ACOG. The limited evidence we have suggests that taking progesterone does not appear to improve the odds of fetal survival by much. The abortion pill binds more tightly to progesterone receptors than progesterone itself does, one reproductive researcher told Iowa Public Radio, and thus the hormone surge is unlikely to do much of anything.
As Cheryl Chastine, an abortion provider at South Wind Women's Center in Kansas, put it recently, "Even if these doctors were to offer a large dose of purple Skittles, they'd appear to have 'worked' to 'save' the pregnancy about half the time."
In an undated statement [PDF], the ACOG similarly cautioned:
Available research seems to indicate that in the rare situation where a woman takes mifepristone and then changes her mind, doing nothing and waiting to see what happens is just as effective as intervening with a course of progesterone. Progesterone, while generally well tolerated, can cause significant cardiovascular, nervous system and endocrine adverse reactions as well as other side effects.
Although multiple web sites carried news reports about "abortion reversal" procedures, that information was apparently published without additional corroboration of its claims. Medical literature on the concept of "abortion reversal" indicates that the procedure carries a success rate similar to that of "doing nothing and waiting," and its outcome hinges solely (or largely) on the initial dose of medication and gestational age (factors that are independent of attempts to interrupt a pregnancy termination). The intervention also carries "significant cardiovascular, nervous system, and endocrine adverse reactions," risks not associated with the likely equally effective course of "doing nothing."
From any perspective, the claims made about "abortion pill reversals" seem inherently dangerous. The procedure appears unlikely to prevent medical abortions from proceeding to completion, and the issue addressed by "abortion reversal" is one probably better handled via thorough counseling prior to abortions rather than through a risky and unproven medical procedure that is seemingly no more effective than doing nothing at all.
[green-label]Last updated:[/green-label] 9 November 2015
[green-label]Originally published:[/green-label] 9 November 2015