Taking progesterone following chemical abortion "may increase the risk of ongoing pregnancy” - Abortion docs

Taking progesterone following chemical abortion \"may increase the risk of ongoing pregnancy” - Abortion docs (Marcon Biniyam/Unsplash)

Pro-choice doctors and abortion providers keep pushing a false narrative that Abortion Pill Reversal (APR) does not work. 

Dr. Daniel Grossman is a pro-choice OB/GYN who uses his Twitter platform in part to spread misinformation and speak condescendingly about APR. Dr. Mitchell Creinin was one of the authors on the very small study which is widely used in pro-choice circles to “debunk” APR  and imply it is dangerous for women to attempt.

To see how how APR works scientifically, click HERE, but to give a quick review: mifepristone, the first drug in the abortion pill regimen, blocks progesterone from binding to the receptors in the uterus. Progesterone is the hormone which maintains the lining of the uterus so the human embryo or fetus can keep receiving nutrients and oxygen. 

APR is simply giving a high dose of progesterone to outcompete the mifepristone. The article linked above also covers some critiques of Creinin and Grossman’s published research and explores how they twist data or frame their results in such a way to cover up the fact that APR does, in fact, work to reverse chemical abortion.

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Well, the American College of Obstetricians and Gynecologists (ACOG)’s October 2020 practice bulletin on medication abortion written by Drs. Creinin and Grossman has some surprising hidden gems, and if they thought the pro-life movement wouldn’t notice, they are dead wrong. 

The standard procedure for someone receiving an abortion is for the abortion provider to counsel them to get on birth control right away, preferably the same day as the abortion appointment.

If you take a look at the practice bulletin under the question, “What is the recommended timing of contraception initiation after medication abortion?” we find that the good doctors actually admit there is evidence for the failure of abortion and for continuing pregnancy if the woman receives a progesterone-only form of contraception on the first day of the procedure. 

What is commonly referred to as “the Depo shot” is formally called depot medroxyprogesterone acetate (DMPA). It is a progesterone-only contraception and is considered to be very effective. Because a shot is only needed every 12 weeks, it is a popular choice for women who want effective birth control without having to remember to take a pill every day or change out a patch or ring. This is the form of contraception that comes with the biggest warning sign for women getting a chemical abortion. Creinin and Grossman state in the practice bulletin:

“Patients who select depot medroxyprogesterone acetate (DMPA) for contraception should be counseled that administration of DMPA on day 1 of the medication abortion regimen may increase the risk of ongoing pregnancy (119).

They go on to state: 

“The CDC and World Health Organization (WHO) support the initiation of almost all methods of contraception on day 1 of the medication abortion or on the same day as mifepristone administration (5, 6, 120)...

Concern has been raised that the immediate use of hormonal contraception that contains progestins could theoretically interfere with medication abortion efficacy...DMPA injection at the time of mifepristone administration may slightly increase the risk of an ongoing pregnancy (119)...Patients should be counseled about this small risk of ongoing pregnancy, which needs to be weighed against the risk of potentially not receiving their desired method of contraception.”

Now, the ACOG bulletin does categorize the above study and the recommendations based on the outcomes as “Level B” evidence, which is “limited or inconsistent scientific evidence.” However, even with that categorization, it is still suggested that abortion providers tell patients who want the Depo shot the day they take the first abortion pill that it could increase their risk of ongoing pregnancy.

The study the bulletin refers to is a 2016 publication in Obstetrics and Gynecology, in which the authors found that women who received the Depo shot on the first day they took mifepristone had a 3.6% chance of still being pregnant at their follow-up visit 1 month later, compared to less than 1% of patients who received the shot after taking the second set of medication (misoprostol) 1-2 days after taking mifepristone. 

The authors of that study are pro-choice and affiliated with Gynuity Health Projects and Planned Parenthood, and the results were presented in many annual abortion-rights meetings. So people in pro-choice medical circles and in big pro-choice organizations are certainly aware of these results, and now the ACOG reflects these findings in an official practice bulletin. 

It’s interesting that as long as the results can be framed correctly, pro-choice doctors and researchers have no issue admitting the study was done because they realized at least theoretically that progesterone could interfere with mifepristone. Not only that, but evidence exists that progesterone actually does increase the chances of pregnancy continuing after taking mifepristone. Indeed, the evidence is exactly consistent with what life-affirming APR medical professionals and researchers have been saying for years. 

Tweet This: Evidence exists that progesterone increases the chances of pregnancy continuing after taking the abortion pill.

Also notable is that these doctors — all OB/GYNs — frame ongoing pregnancy as a “risk.” And let’s be clear, the condition of pregnancy is only ongoing because the prenatal human being is still alive. Apparently, only when a procedure meant to kill a human being fails do some doctors ever consider the continued life of a human to be a “risk.” That sounds like the very opposite of healthcare and medical care.

So there you have it, straight from the pro-choice side. They knew progesterone could theoretically interfere with mifepristone in a chemical abortion. They tested their hypothesis in a study with progesterone-only contraception and confirmed that hypothesis. They incorporated those findings into recommended practices so women getting an abortion can make an informed choice about the contraceptive she chooses afterward. 

But then these same pro-choice doctors turn right around and claim that progesterone given to stop the effect of a chemical abortion as part of APR does not work and that women seeking an abortion should not be told about this life-saving option if they change their minds.

The hypocrisy is astoundingly clear, ACOG, and we see it. But thanks for supporting what we’ve been telling women already for years, even though I’m sure you didn’t mean to.

Editor's note: Heartbeat International manages the Abortion Pill Rescue® Network (APRN) and Pregnancy Help News.

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