Abortion Pill Reversal

The abortion pill reversal (APR) procedure can only occur after the first dose of medical abortion (mifepristone/RU-486) is taken orally and is ineffective after the second set of pills (misoprostol). The protocol is only effective within 24 hours of taking mifepristone and  involves a large influx of progesterone into the pregnant woman’s system. This is due to the fact that the first pill, mifepristone, blocks progesterone from being absorbed by the womb.  Mifepristone blocks where progesterone would normally be absorbed, so an influx of progesterone can outcompete for the available binding spaces.

According to Abortion Pill Rescue Network there have been successful reversals when treatment was starting within 72 hours of taking the first abortion pill. However this procedure is not yet FDA approved.

Is Abortion Pill Reversal Safe?

Progesterone, used in the reversal process, has been safely used in pregnancy for more than 50 years. Initial studies show that the birth defect rate in babies born after the APR is less than or equal to the rate in the general population. Neither mifepristone or progesterone is associated with birth defects.

Some say that treatment with progesterone after the first pill (mifepristone) is no more effective than just letting nature take its course, and that excess progesterone can be unsafe. Others show that it is more effective and is indeed safe to use progesterone after mifepristone. So, what is the truth on the subject? Is there enough research or backing to say what works and is safe?

The American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) believes that the procedure is safe and significantly more effective than “seeing what happens” without the second medication, misoprostol. Please know, this use of progesterone for the reversal of mifepristone is not yet FDA approved.

How effective is this method?

The abortion pill reversal group claims that, at least within the first 24 hours, odds are up to 62% that the pregnancy will continue. There is only one very small scientific study that corroborates this percentage.

The data come from what is reported back to them by the doctors and nurses that carry out this procedure. Further research on a larger scale is needed to corroborate this percentage.

Do any organizations support this process?

Yes, the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) supports the procedure and in its public statement on abortion pill reversal, states three important things:

  1. Progesterone has been safely used during pregnancy for decades without undesired effects. (Many physicians agree but only when it is used properly.)
  2. For those infants who survive mifepristone, there is no evidence of birth defects associated with the medication. (ACOG itself has research confirming this).
  3. The efficacy of reversal is, in fact, higher than “sitting and waiting” alone (7- 40%, depending on gestation) to see if a pregnancy continues (this is based on small studies, but this is because there is a small population that chooses reversal in the first place).

Which organizations do not support APR?

There are a few organizations that do not support the use of the reversal procedure, such as NARAL Pro-Choice America, Planned Parenthood, and ACOG (American Congress of Obstetricians and Gynecologists). Their main concerns are:

  1. Success rates from APR are from small studies and are very similar to those who only take mifepristone without any progesterone treatment. (It is true that more studies may be needed, but there is a small population that can even be studied, making it a challenge.)
  2. That offering the reversal procedure undermines a woman’s ability to choose, perhaps by implying that women must not have thought it through, and so need an option to get out. (A woman’s ability to choose does not end the moment she takes mifepristone, and some women have regrets or are initially coerced into getting an abortion.)
  3. That progesterone therapy, when given improperly, can cause damage to some of the body’s main systems, including the nervous, cardiovascular, and endocrine systems. (When treated by a licensed physician that is a part of a group of physicians that performs and discusses the procedure, there is accountability and a way to determine a “safe” dosage/procedure.)

It is important to note that when any medical procedure is performed, the physician informs the patient of whether the process is permanent or may be reversed. Thus, since this is a medical procedure, it would follow that abortion education would include the option for a possible reversal, whether that means simply not taking the second set of pills and continuing prenatal care, or finding a physician that will perform the reversal procedure with progesterone.

How can I find out more information?

The Abortion Pill Rescue Network, 1-877-558-0333.

Compiled using information from the following sources:

1. Abortion Pill Reversal Helpline: https://www.abortionpillreversal.com/

2. The American College of Obstetricians and Gynecologists, Practice Bulletin number 143, March 2014.

3. Chabbert-Buffet, N., Meduri, G., Bouchard, P., & Spitz, I. M. (2005). Selective progesterone receptor modulators and progesterone antagonists: mechanisms of action and clinical applications. Human Reproduction Update, 11(3), 293–307. https://doi.org/10.1093/humupd/dmi002

4. Clark, K., Ji, H., Feltovich, H., Janowski, J., Carroll, C., & Chien, E. K. (2006). Mifepristone-induced cervical ripening: Structural, biomechanical, and molecular events. American Journal of Obstetrics and Gynecology, 194(5), 1391–1398. https://doi.org/10.1016/J.AJOG.2005.11.026

5. AAPLOG Fact Sheet: Abortion Pill Reversal. https://aaplog.org/wp-content/uploads/2017/02/AAPLOG-APR-Fact-Sheet.pdf

6. ASRM Fact Sheet: Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin.

7. Bernard, N., Elefant, E., Carlier, P., Tebacher, M., Barjhoux, CE., Bos-Thompson, MA., Amar, E., Descotes, J., Vial, T. (2013). Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study. BJOG, 120(5), 568-575.