Abortion pill reversal proponent discusses science of the process, debate and success stories

More than 60% of abortions in the U.S., according to a study released in March 2024, are brought about via medication. But what if a woman takes the abortion pill and then immediately regrets it? Paul DeBeasi, the director of APRScience.org, a website dedicated to explaining abortion pill reversal, recently spoke with OSV News' Charlie Camosy about the process, which is the subject of legal and medical debates in the post-Dobbs landscape, and what might happen next.

--Charlie Camosy: Readers have probably heard of abortion pill reversal, but maybe don't have a clear idea about what it is, precisely. Can you give us the basics?

--Paul DeBeasi: It is important first to understand that the abortion pill is a two-drug regimen: mifepristone followed by misoprostol 24-48 hours later. Progesterone is a natural hormone that is critical in supporting a healthy pregnancy. It prepares the uterus for embryo implantation, promotes placental development, and suppresses uterine contractions. Mifepristone competitively inhibits the mother's progesterone, separating the embryo from the mother's uterus and causing embryo death. Misoprostol causes uterine contractions and expels the embryo.

Abortion Pill Reversal (APR) therapy involves giving the mother progesterone in a capsule or injection after taking mifepristone. APR increases progesterone concentration levels to better compete with mifepristone and restore a normal pregnancy. Each month, hundreds of women call the Abortion Pill Reversal hotline seeking help. A member of the APR team works with each patient to complete a medical history and complete an informed consent process.

The APR team member then submits an oral progesterone order to a pharmacy, pregnancy resource center, clinic or hospital. If the patient does not tolerate oral progesterone, she can receive progesterone by vaginal capsule or intramuscular injection. The team member recommends a follow-up schedule and assists the patient in finding a pregnancy resource center or provider who can see her for ongoing care. The American Association of Pro-Life OBGYNs (AAPLOG) fully endorses APR.

I'd like to give you a real-world example. Sarah was a single mother of three when she became pregnant with her fourth child. After being pressured by the father, Sarah took the abortion drug, mifepristone. She immediately returned home crying and regretting her decision. Sarah searched the internet for ways to reverse the abortion pill and found the abortion pill reversal hotline. The nurse connected Sarah with a local physician who began APR therapy. Sarah gave birth to a healthy son named Isaiah.

--Camosy: Readers have also probably heard of significant skepticism about abortion pill reversal. Some of this skepticism is merely about raw abortion politics, but what's the steel man case for skepticism and how do you respond?

--DeBeasi: There are two primary criticisms of APR. First, critics allege there may be a safety concern, and second, they reject the scientific evidence. The American College of Obstetricians and Gynecologists (ACOG) claims that using progesterone to reverse the effects of mifepristone is unsafe. ACOG defends its claim by citing a small clinical trial of 10 women led by Dr. Mitchell Creinin, a compensated adviser to medication abortion pill distributor Danco Labs. The authors canceled the study due to "safety concerns" when three women experienced "brisk bleeding" and visited the emergency room.

However, ACOG fails to mention that the only women who received medical intervention were women who did not receive APR and that four of five patients (80%) receiving APR had an ongoing viable pregnancy.

ACOG also neglects to cite APR studies that demonstrate APR safety. For instance, the 2023 Turner study found that "there was no major hemorrhage or other clinically significant adverse events" after APR therapy. The 2018 Delgado study found that there was "no increase in birth defects after receiving progesterone treatment (2.7%) as compared to the birth defect rate in the general population (3%)." The 2017 Garratt study reported "no birth defects" after APR therapy. The American Society for Reproductive Medicine reports no increased risk from using progesterone in early pregnancy.

Regarding the scientific evidence, ACOG claims APR is not supported by science. ACOG justifies its claim by citing one small APR study of six women (Delgado 2012). It dismisses the study as "not scientific evidence." However, ACOG fails to cite data from four additional human studies (Garratt 2017, Delgado 2018, Creinin 2020, Turner 2023) and two animal studies (Yamabe 1989, Camilleri 2023). This body of research shows that 66% of women who receive progesterone soon after taking mifepristone can safely continue their pregnancies.

Other critics dismiss the evidence from the Delgado and Garratt studies because they rely upon observational studies rather than randomized clinical trials (RCT). Many clinicians and researchers consider randomized clinical trials the "gold standard" for medical evidence.

However, Dr. Thomas R. Frieden, former director of the Centers for Disease Control and Prevention, argues that non-RCT data sources, such as observational studies, can be as good and sometimes better than RCTs for making evidence-based health policy decision-making. A large 2024 study found "no difference or a very small difference between effect estimates from RCTs and observational studies."

So, as with many emerging therapies, there are conflicting opinions. However, the evidence in support of APR is growing.

--Camosy: Use of the abortion pill has exploded in the US, but -- just like surgical abortion -- it has been used as a tool of coercion (and even straight up violence) against women. In fact, it is my sense that the pill is an even more effective tool of coercion. Is that your sense as well? If so, how could abortion pill reversal help address such coercion?

--DeBeasi: Across the United States, men are using the abortion pill to coerce women to have an unwanted abortion. The Heritage Foundation is publicly documenting these cases. The abortion pill is an effective tool of coercion because it is easily obtainable, affordable and privately consumed.

APR therapy provides an opportunity to avoid the devastating outcomes of unwanted and coerced abortions. However, APR is a time-sensitive therapy. Women who seek to reverse the abortion pill after taking mifepristone must urgently receive progesterone. However, many women are unaware of APR therapy. This lack of information can cause a delay in receiving APR, which can result in embryo death.

Physicians are legally responsible for disclosing safe and effective treatment options that a reasonable person in the patient's position would find necessary. But virtually all abortion pill providers withhold APR information from women seeking abortion. In addition, abortion advocacy groups block access to APR therapy. They filed lawsuits, passed laws, and threatened medical license revocation to stop clinicians from providing women with APR health care. APR providers have taken legal action in Colorado, California, and New York to defend APR access.

These attempts to withhold APR information and block APR therapy prevent women from exercising their right to choose pregnancy. Sarah was one of the fortunate women who found the APR hotline in time. Countless other women are not so lucky. Women have a right to APR information to make fully informed decisions. Abortion pill providers and public health officials urgently need to inform women of APR.

--Camosy: For readers who want to get women the best resources regarding their options for abortion pill reversal, where is the best place for them to go?

--DeBeasi: There are several excellent resources. A good place to start is AbortionPillReversal.com. The website provides a 24/7 hotline and explains APR in simple language. Those seeking to dig deeper and understand APR evidence should visit APRScience.org. Lastly, clinicians should visit APRNworldwide.com/join to learn about joining the APR medical network.