Controversial 'Abortion Reversal' Regimen Is Put To The Test

NPR News (Mar. 22, 2019): Controversial 'Abortion Reversal' Regimen Is Put To The Test, by Mara Gordon:

Dr. Mitchell Creinin, a medical researcher and professor at the University of California, Davis, will be spending the next year or so using a research grant from the Society of Family Planning to put to the test a treatment he sees as dubious — one that recently has gained traction, mostly via the Internet, among groups that oppose abortion. They call it "abortion pill reversal."

Creinin, an OB-GYN, has spent the bulk of his career in family planning research. He has studied topics ranging from different treatments for miscarriage to how women choose birth control methods.

Performing abortions, he says, has always been a part of his practice and philosophy. "I need to provide these services to help women," Creinin says.

Proponents of "abortion pill reversal" say it can stop a medication-based abortion in the first trimester, if the progesterone is administered in time. Dr. Creinin, though, says the progesterone treatments are ineffective at best in halting an abortion that has already begun. Promotion of the treatment, he says, can be potentially harmful by giving pregnant women misleading information that an abortion can be undone.

Legislators in Arkansas, Idaho, South Dakota and Utah have passed laws requiring that doctors who provide medical abortions must tell their patients that "reversal" is an option, although they are not prevented from also telling patients if they think the treatment doesn't work. Medical researchers such as Creinin and the American College of Obstetrics and Gynecology (ACOG) are concerned by that trend.

Proponents of the technique say they do have evidence. That evidence is anecdotal, Creinin says, or comes from studies that lack rigorous controls.

According to the American College of Obstetrics and Gynecology, "as many as half of women who take only mifepristone continue their pregnancies." (If the pregnancy does continue, mifepristone isn't known to cause birth defects, ACOG notes.)

While searching online, many find the website for the Abortion Pill Rescue Network, a nationwide group of clinicians who provide the supposed treatment. The network is backed by Heartbeat International, an anti-abortion rights group, and, according to spokesperson Andrea Trudden, includes more than 500 clinicians willing to prescribe progesterone to patients who have initiated the medication abortion process.

Dr. Daniel Grossman, an OB-GYN at the University of California, San Francisco, says all of the published studies supporting this use of progesterone have been marred by methodological flaws that inflate the "success rate" of the reversal treatment.

Dr. Creinin's study is slated to involve 40 women who are between 44 and 63 days of pregnancy and are seeking to have a surgical abortion. As a condition of the research, the women would have to be willing to take mifepristone, the initial pill that would normally trigger a medical abortion, and then a placebo or progesterone.

Two weeks later, researchers will see if there's any difference in the rates of continued pregnancy. If progesterone can prevent the effects of mifepristone, Creinin says, he'll find that more women in the group that got progesterone still have a pregnancy that's progressing.

Creinin hopes that his work will help medical researchers better understand if this kind of treatment can actually help women who change their minds after taking mifepristone for a medication abortion. If the results show the progesterone doesn't work, Creinin hopes that they will discourage state legislators from mandating that doctors tell their patients about an ineffective treatment.

Creinin started enrolling patients in the study in February. He isn't sure how long the study will take, but says he probably won't have preliminary results for at least a year.