April 7 2015 07:37 PM

Sketchy science about abortion pill reversals

abortion_pill_reversal
Photo illustration by Lindsey Voltoline

When Rebekah Buell found out she was pregnant she was 17 and a half, in a bad marriage and already had one baby boy. Living with her parents, she decided she wasn't in a position to have a second child. She went to a clinic that provides abortions near her home and discussed with a nurse the possibility of having a medical abortion. 

A medical abortion is a regimen of ingesting two pills—mifepristone, commonly known as RU-486 or Mifeprex, and misoprostol. Typically used within the first seven to nine weeks of pregnancy, the first pill blocks the receptors of the hormone progesterone, causing the lining of the uterine walls to shed, similar to menstruation. Misoprostol is taken two days later, which induces contractions of the uterus, emptying its contents.

Buell took the first pill, and says she then regretted the decision. She found a website called Abortion Pill Reversal, a portal that promotes a controversial treatment developed by a family physician based in Escondido.

The idea of reversing an abortion is making national waves. On March 30, Arizona formalized a law that requires doctors providing medical abortions to inform patients that the procedure can be reversed. Arkansas followed suit with a similar law on April 7. That is not the law in California.

The development of the idea of reversal started in 2007, when Dr. George Delgado heard that a colleague had given a large dosage of progesterone to a woman to combat the effects of mifepristone. The woman kept the pregnancy. 

Delgado has a medical degree from UC-Davis and works as the medical director for Culture of Life Family Services, which runs a pair of pro-life clinics in San Diego County and is in charge of the Abortion Pill Reversal website.

He got a call a few years later from another woman asking for the same treatment. Hailed as a pioneer in the pro-life community, in 2012 Delgado published a peer-reviewed article in the medical journal The Annals of Pharmacotherapy on abortion-pill reversal, citing six case studies, four of which led to births. Delgado worked on the article while in San Diego County, although not all his patients were from the county. 

The article details Delgado's approach. Basically, after a woman takes the first abortion pill and decides not to take the second pill and keep the pregnancy, the first step is to find out if the embryo is viable—that is, if it still has a heartbeat. Generally, a heartbeat can be detected in an ultrasound in the eighth week of pregnancy. If there is a heartbeat, then a doctor provides large doses of progesterone to counteract the mifepristone. The progesterone is injected, or given orally or vaginally. 

"I have known how to use progesterone in pregnancies to try and prevent miscarriage, so I reasoned that I could use the progesterone to outcompete the mifepristone," Delgado told CityBeat. 

"Let's be clear: These claims are not based in sound science," said Cita Walsh, vice president of marketing and communications for Planned Parenthood of the Pacific Southwest, in an email response from the organization about Delgado's approach. "There is no scientific or medical evidence to suggest that reversing a medication abortion is possible. Furthermore it has not been tested for safety, effectiveness or the likelihood of side effects." 

Dr. Kathleen Morrell, a Reproductive Health Advocacy Fellow with Physicians for Reproductive Health and a working OB-GYN in New York, said that if doctors started experimenting with treatments like Delgado's, they would lose the valued trust between patient and doctor. 

"[It] hasn't gone through that rigorous scientific protocol," said Morrell about abortion-pill reversal. "It really limits us as doctors. I wonder if patients will start to think what doctors are doing to them."

One of the controversial aspects of Delgado's method is the need for the hormone to keep the pregnancy viable. According to Morrell, if women did nothing after they took mifepristone, about 50 percent of the time, which is a ballpark figure (studies have shown it to be between 20 and 70 percent), women would need to take misoprostol to complete the abortion, as the mifepristone was not effective enough alone. 

When mifepristone was first studied in the 1980s, it was used in a far larger dosage and could be used as an abortion pill on its own, Morrell said. However, many studies on the drug have taken place since, and a safer and more reliable regimen is to take the two pills, as mifepristone in given is a far lower dosage. The fact that half the pregnant women who take mifepristone remain pregnant—a fetal heartbeat is still present—has nothing to do with their progesterone levels. 

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Despite a broad consensus in the medical community that Delgado's approach doesn't save a pregnancy, Buell defended her treatment. She started a six-week course of twice-a-week injections and vaginal insertions. She said her medical insurance covered it with a $50 copay. After six weeks, she was still pregnant. She credited her fast reaction time after taking mifepristone.

"I'm not sure what would have happened," she said about doing nothing after taking mifepristone. "I had gotten my injections within 24 hours. Without getting injected with progesterone, I don't think I would have been able to maintain that pregnancy," she said. 

Buell, who gave birth to a second son, is now a pro-life advocate who speaks at events, such as January's Walk For Life in San Francisco. She counsels pregnant women considering Delgado's approach.

"This encounter changed my life," she said about finding Delgado's website and going through his treatment. "I know it sounds cliché, [but] it changed everything. What's wrong with a girl changing her mind?" 

Delgado said some women who decided to take progesterone changed their minds again, and took misoprostol to finish their abortions. 

"We have seen them go back and forth, and that's their choice," he said.  

His treatment is more successful when the pregnancy is farther along, Delgado said. This doesn't surprise Morrell, who said that mifepristone's effectiveness decreases the longer a pregnant woman waits to start an abortion. 

Delgado said that 60 percent of the time he's given progesterone, the woman has kept the pregnancy. Delgado and an international network of doctors connected by the website have given progesterone to 87 women who have given birth. He also said that 75 patients who took progesterone after taking the first abortion pill are currently pregnant.

"Mifepristone is not associated with birth defects, that has been our experience here, too; we have not had any birth defects. It either kills the baby, or it doesn't," he said. 

He said reversal-procedure side effects include swelling around the injection area, fatigue and sometimes heartburn. 

Women who call the hotline on the Abortion Pill Reversal website are set up with a doctor who is willing to give the progesterone. Many of the doctors work in "pregnancy crisis centers," pro-life clinics like Delgado's that provide counseling, ultrasounds and testing for pregnant women, but sometimes give inaccurate or misleading information about abortion without actually providing abortions.

That's the opinion of Sierra Harris, assistant director of ACCESS Women's Health Justice in Oakland, a nonprofit that provides information to women about reproductive options. ACCESS has its own "healthline" where information on abortion procedures is dispensed. The healthline works throughout California. 

"Many of the women who call in have been to a pregnancy crisis center and say that the clinic tells them they can have a free abortion, but they are definitely not clinics that provide abortion services, and end up trying to talk women out of abortion." 

Harris decries the methods used by Pregnancy Crisis Centers (PCCs).

"Their tactics are shaming," she said. "They try to talk women out of it. That's really hard, on a personal level."

Today in California, there are more PCCs (155-plus) than abortion providers, Harris said.

There are at least 16 PCCs in San Diego County. The centers are concentrated in Latino and low-income communities, Harris said, and advertise on bus stops, benches and places low-income women might frequent. 

Delgado said many of the women who want his procedure are influenced by social constraints and are not given enough time to reflect about their decision to have an abortion.

"Women are hardwired to nurture their unborn babies, that's just the way they are developed," he said. "Whenever there is a medical treatment available, these women should know there is that option, and the abortion centers aren't telling them at this point."

Pro-choice advocates disagree strongly.

"Planned Parenthood's health care providers follow rigorous medical standards and guidelines, developed using the most current medical evidence available," Walsh, Planned Parenthood's spokesperson, wrote. "A woman who is thinking about ending her pregnancy receives accurate and unbiased information about her options: parenting, adoption and abortion." 

Morrell questioned how many women actually seek out a way to stop their abortions. 

"Most women are very thoughtful when they decide to have an abortion," she said. In her 10 years of practice, she said she has never come across a patient wanting to stop an abortion. 


Carly can be reached at carlyn@sdcitybeat.com. Follow her on Twitter at @cnairnsf

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