NRL News

ACOG Guidance Admits APR Mechanism Works

by | Mar 19, 2024

Says Progesterone Administration May Lead to Ongoing Pregnancy

By Randall K. O’Bannon, Ph.D., NRL Director of Education & Research

Editor’s note. This appeared in the March issue of National Right to Life News. Please share with your pro-life family and friends.

Read any popular news story on “abortion pill reversal” or “abortion pill rescue” (APR) and you’ll quickly read that reputable medical experts find it “unfounded,” “unproven,” “potentially dangerous” or even “unsafe” (ABC News, 4/20/23).  Medical groups like the American College of Obstetricians and Gynecologists (ACOG) are regularly quoted, saying the treatment is “not backed by science” and “unproven and unethical.”

But now guidance issued by these same experts is warning abortionists using mifepristone not to concurrently offer contraceptive shots with progesterone – the hormone administered in APR – because that “may slightly increase the risk of ongoing pregnancy.”

In other words, they’re admitting that there is some evidence the mechanism employed by the administrators of APR works the way it was intended: it helps the baby stay alive and averts the abortion.

Don’t expect a public apology or retraction from the abortion pill’s proponents. But do ask ACOG and other APR detractors how to explain their opposition given this embarrassing admission in their own official guidance.

A History of Denial, Distraction

Though there has since been more extensive testing and more that 5,000 babies born from successful “reversals,” many of these news articles still cite an “advocacy” page (“Facts Are Important: Medication Abortion “Reversal” Is Not Supported by Science”) that has been posted on the ACOG webpage since at least 2017.

It keys on a small initial “case series” from 2012 which tracks six women that was used only to establish plausibility of the APR concept. Four of those six women receiving a progesterone boost went on to successfully give birth.

The ACOG page makes only passing mention of the more extensive follow up case series done in 2018 by George Delgado and colleagues. That study dealt with more than 700 patients and found reversal rates of 64% and 68% with intramuscular and oral progesterone. This virtual omission leaves the impression that claims of APR success depend entirely on the limited evidence of just those six original cases.

It does, however, make prominent reference to a 2020 “study” of APR by Mitchell Creinin, of the abortion pill’s longtime promoters and one of ACOG’s identified experts on mifepristone. It noted that the study was ended early due “safety concerns among the participants.”  

What is not mentioned on that ACOG webpage, however, is that there were significant bleeding episodes among three of the twelve study participants, the two most serious cases involving patients who received the placebo rather than the progesterone boost. Though data was limited due to the premature ending of the study, it did confirm that twice as many of those who received the progesterone boost had continuing pregnancies than those who received a placebo.

In other words, Creinin’s evidence, limited thought it was, appeared to show, or at least to be consistent with, progesterone safely and success at reversing the effects of mifepristone. What it showed to be dangerous was giving mifepristone and then doing nothing further, just waiting. This is the recommendation Creinin and others (along with the latest ACOG guidance) give for those women who change their minds and want the pregnancy to go to term.

Nevertheless, you’ll continue to see Creinin and ACOG cited as evidence that APR doesn’t work and is potentially dangerous.

ACOG Guidance Tells a Different Story

Now, however, while loudly and publicly making these claims about APR’s ineffectiveness, evidence surfaces that official ACOG documents actually offer clear evidence that the medical mechanism of APR is sound and that it does have the effect that proponents of abortion pill reversal have said it does.

In its official Practice Bulletin on “Medication Abortion   mifepristone administration may slightly increase the risk of an ongoing pregnancy.” This might not sound like much, but when one understands that DPMA is “depot medroxyprogesterone acetate” (popularly known as Depo-Provera), actually a synthetic form of progesterone–the hormone given chemical abortion patients to stave off their abortions in APR–it is quite revealing. 

Progesterone is the body’s natural pregnancy hormone that helps to prepare and maintain the nutritive uterine lining that welcomes the young embryo. Mifepristone normally blocks the action of progesterone, causing the uterine lining to shed and the developing baby to perish as his or her protective, nutritive environment is destroyed.

APR operates on the theory that flooding the body with extra progesterone gives it a chance to outcompete the mifepristone–to grab more of those progesterone receptor sites, to continue signaling the woman’s body to keep feeding and protecting that child. This statement by ACOG validates that theory, despite everything the organization and its experts have said against it.

Despite being a much smaller dose of the synthetic progesterone, if Depo-Provera is able to have these effects– if ACOG fears it has a significant enough impact on continuing pregnancy as to merit a warning in its official guidance to doctors on chemical abortion–then they are essentially admitting that there is evidence that a progesterone boost has the effect that APR advocates say it does.

The simple truth is that ACOG is entirely unwarranted in claiming that APR is “unproven” or “unfounded” when their own guidance provides evidence that the process works as advertised.

Now there may be room for further study or research. For example, they could investigate whether or why or to what extent a stronger, more direct progesterone boost works better than a milder synthetic version such as that found in Depo-Provera. But they can no longer pass APR as unscientific “junk science” from outside the medical mainstream.

It works, and ACOG’s official guidance seems to agree, despite its earlier complaints.

Bias of ACOG and its “Experts” Becomes Apparent

This admission becomes all the more remarkable when one reads at the beginning of ACOG’s Practice Bulletin Number 225 that “This Practice Bulletin was developed jointly by the Committee on Practice Bulletins—Gynecology and the Society of Family Planning in collaboration with Mitchell D. Creinin, MD, and Daniel A. GrossmanMD.”

Creinin you’ve already heard of. He is one of the chief “debunkers” of abortion pill rescue, the abortionist who was supposed to have proven that APR didn’t work and was dangerous, though his own evidence pointed to the contrary. 

Here Creinin is at it again, extolling the virtues of mifepristone. Despite his own admissions in the guidance mentioned above, he still asserting in that same document that “There is no evidence that treatment with progesterone after taking mifepristone increases the likelihood of the pregnancy continuing.” 

Worse yet, Creinin continues to recommend that, instead of the progesterone boost his own research shows to be safe and effective, “In the very rare case that patients change their mind about having an abortion after taking mifepristone and want to continue the pregnancy, they should be monitored expectantly.” This is the advice that resulted in two of his patients having emergency surgery!

Daniel Grossman, the other co-author of the ACOG guidance piece on mifepristone, has also been frequently quoted as an expert on chemical abortion and abortion pill reversal. Grossman repeatedly touts mifepristone’s safety. He has published critiques of APR, declaring the treatment “experimental and unproven” (New England Journal of Medicine, October 18, 2018) shortly after Delgado published his latest case series showing hundreds of successful reversals.

With both of their names on the guidance document, both are responsible for clearly contradictory and concurrent claims that progesterone doesn’t work to prevent chemical abortion AND that small doses of synthetic progesterone “may slightly increase the risk of an ongoing pregnancy.”

Both can’t be true.

The only thing that both of these observations have in common is that both pose threats to the image and reputation of mifepristone and chemical abortion. Creinin’s and Grossman’s mission, officially shared by ACOG, is clearly not primarily to protect women’s health or even their right or ability to make their own reproductive choices. Rather it is to defend and promote the safety and efficacy (and sales) of chemical abortion.

Anything that gets in the way of a successful chemical abortion will be viewed as a threat to be opposed or undermined.

A discerning doctor would note this contradiction and be somewhat wary of the advice or assurances they give. Perhaps chemical abortion isn’t as safe or easy as these “experts” and the abortion industry allies would have people believe. 

There may be reasons other than scientific rigor behind why they publish and promote studies by fellow abortionists but neglect to share information which shows chemical abortion considerably more dangerous and substantially less effective than claimed by their colleagues. 

For solid scientific data that Creinin, Grossman, ACOG, and even the FDA commonly ignore, see the NRLC fact sheet ”Mifepristone Safety & Efficacy, here.

There is solid evidence that Abortion Pill Reversal works. If you, like Creinin, Grossman, and ACOG can’t trust your own published guidance, maybe you should just take note of the more than 5,000 babies born as a result of APR.