NEWS

Abortion pill reversal: 2nd chance or just chance?

While supporters of the abortion pill reversal method call it simple, critics say that evidence it works is lacking

Shari Rudavsky
shari.rudavsky@indystar.com

Dr. George Delgado doesn't know how many states have passed measures such as the one Indiana is considering that would require doctors to give women information about a controversial procedure to reverse medical abortions.

Nor, he says, has he been involved with drafting any legislation about the method. He has not spoken to the Indiana representative who sponsored the bill and has not testified on its behalf.

Yet, House Bill 1128 owes its existence to the California-based family medicine physician.

Still, Delgado said, he welcomes any effort to inform women that taking the first of two pills for a chemical abortion does not have to end with loss of the pregnancy.

“Any woman who takes mifepristone has the right to know that she has a second chance,” he said in a phone interview last week.

The Indiana House of Representatives passed a version of the bill that would require abortion providers to give women undergoing a medical abortion written information about where to go should they want to reverse the procedure.  That sheet of paper would also provide contact information for the American Congress of Obstetricians and Gynecologists, a mainstream medical organization that says there’s no scientific evidence to support the method that Delgado advocates.

More: Indiana House passes abortion 'reversal' legislation

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The bill also requires that the information sheet include a statement that “no medical study has confirmed that an abortion may be reversed after taking an abortion-inducing drug.” The House passed the bill by a vote of 54-41 at the end of February, and it is currently before the Senate Judiciary committee.

Rep. Ronald Bacon, R-Chandler, is the author of the bill. He said he proposed the bill after hearing a speech by Dr. Christina Francis, a Fort Wayne obstetrician who belongs to a network Delgado started to bring his method to his colleagues.

A respiratory therapist, Bacon said he proposed the legislation to let women know that they might be able to reverse a chemical abortion. He said he was surprised by the controversy it sparked.

“To me, this is the least contentious abortion bill I have seen,” he said. “One of our jobs as healthcare providers is to give our patients as much information as possible to decide what’s best for their health.”

Women undergoing a medical abortion take two pills. The first, mifepristone, blocks receptors from progesterone, a naturally produced hormone necessary to maintain pregnancy. A few days later, the woman takes a second drug that induces an abortion, emptying the uterus of its contents.

The abortion pill reversal method entails a prescription of progesterone, either by mouth or by injection, as soon as possible after the woman takes the first drug.

Supporters offer an explanation of why this method might work as proof it does.

“The idea behind it is quite simple,” said Dr. Donna Harrison, executive director of the American Association of Pro-life Obstetricians and Gynecologists. “When we have a poison with a known mechanism of action and there’s an antidote to that, it’s simple medicine that you give the antidote.”

Such thinking guided Delgado a few years ago when he attempted his first abortion pill reversal. A woman he knew was working a pregnancy hotline when she fielded a call from a woman in El Paso, Texas, who was having second thoughts halfway through her medical abortion.

A family medicine practitioner, Delgado had frequently prescribed progesterone to women at risk of miscarrying. Knowing of mifepristone’s progesterone-blocking properties, Delgado calculated that adding progesterone into the system could counteract the drug’s effect.

From his southern California offices, he located a doctor in El Paso who agreed to treat the woman. Her child is now about 7 years old, Delgado said.

Word got out, and Delgado started receiving more calls about the procedure, which he learned a North Carolina doctor had tried a few years prior.

In 2012, Delgado established the Abortion Pill Reversal website, which runs a 24-hour hotline to advise women and doctors on his method. Since then, Delgado said about 800 women have tried the method, about 40 to 45 percent of callers.

Today the group has a network of more than 350 doctors who embrace the method. About 70 women call the hotline each month, Delgado said.

In 2012, Delgado also published a paper in the Annals of Pharmacotherapy reporting that progesterone had helped prevent a medical abortion in four out of six women prescribed the drug midway through a chemical abortion.

Critics of his work say six patients is not sufficient to prove the method works.

For the past year or so, Delgado has been quoted numerous times saying he is writing a follow-up paper with more than 300 abortion reversals that shows a success rate of 60 to 70 percent.

In a recent interview, Delgado said he has waited to publish that piece to make sure he has the data analysis in place.

A 2015 paper that appeared in the journal Contraception critiqued Delgado’s first study, saying, it “was of poor quality and lacked clear information on patient selection.” That paper concluded evidence was “insufficient” to prove that progesterone could alter a medical abortion.

American Congress of Obstetricians and Gynecologists experts also doubt that adding progesterone to the mix has an impact. Thirty to 50 percent of women who don't take the second drug will see their pregnancies continue, even without the addition of progesterone, they say.

But Delgado contests those numbers, saying the likelihood of continuing a pregnancy after just the first half of a medical abortion is much lower, around 13 percent.

Although the ACOG notes there can be risks with using progesterone, supporters of abortion pill reversal counter that years of use have shown it is safe.

Progesterone’s good track record, Bacon said, should obviate any need for additional studies showing that it can raise a woman’s chances of successfully reversing a medical abortion.

“This is a perfectly legal, safe drug that’s used every day,” he said. “We have studies on progesterone. We should not have to do another study. The only difference here is what we’re using it for now.”

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter and Facebook

Carmel mom is the previously unidentified woman behind Periods for Pence