Dr. Christina Francis, CEO of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG), created the video below to debunk eleven common Abortion Pill Reversal myths. The video run-time is approximately 23 minutes. Refer to the individual myth videos (below) for the latest information.
The following videos focus on an individual myth. Below each of these videos we provide the verbatim transcript and the latest articles, research studies, and clinical data for the myth. If you have comments or suggestions then contact us. We will never share your information.
Introduction
Transcript
As an APR provider I don’t see any reason why any physician, midwife, nurse practitioner or anyone who’s providing obstetric care shouldn’t be a provider of Abortion Pill Reversal. This is a life-saving treatment that can be available to your patient if she requests it and has the significant potential not only to save your preborn patient but also to spare your maternal patient from a lifetime of regrets and instead give her a lifetime of memories with her child.
Myth 1: It is not possible to reverse an abortion once it is started
Transcript
In order to understand how a medication abortion can be reversed or halted, we first need to understand how it works to cause the death of the preborn child. A medication abortion is accomplished through a very specific two drug regimen. The first drug is mifepristone which is also known as mifeprex or RU486 and the second drug is misoprostol. Mifipristone, the first medication, is currently approved through 10 weeks of gestation by the FDA. It is a progesterone receptor antagonist. It binds to the receptor with high affinity. However that binding is reversible. Misoprostol, the second medication, induces uterine contractions and leads to expulsion of the fetus and the gestational sac and any other pregnancy-related tissues. Those of you who provide obstetric care are probably familiar with misoprostol as it’s often used for term labor inductions or even medical management of miscarriage.
Abortion Pill Reversal, or APR, was first performed when two physicians Dr. Matthew Harrison and Dr George Delgado decided to respond to requests that they were receiving from patients who had started medication abortions but then regretted their decision and wanted to know if there was anything that they could do to save their child. Using progesterone to reverse the effects of mifepristone is actually based on a basic biochemical principle known as reversible competitive inhibition. So this idea for the APR protocol wasn’t conjured out of thin air. In fact it’s a generally understood principle that when you have a competitive inhibitor, like mifepristone, that blocks the action of a substrate, like progesterone, that competitive inhibition can be reversed by increasing the amount of substrate in the system.
In fact in this scenario, progesterone acts like a rescue therapy similar to leucovorin which is used as a rescue therapy for methotrexate that people take for chemotherapy. Leucovorin is given as a rescue therapy to spare non-cancer cells from the cytotoxic effects of methotrexate. So APR is simply using progesterone as rescue therapy to reverse the effects of mifepristone on the developing fetus. Progesterone is taken throughout the first trimester.
If a woman decides that she wants more information about Abortion Pill Reversal or she wants to start the process she can call the network hotline which is staffed 24/7 by well-trained nurses who have been trained to counsel the patient and talk to her about the reversal process and what it will involve. Then if she decides to proceed with APR she’s referred to a network provider in her area to prescribe her the progesterone. The APR hotline is now run by Heartbeat International and they are doing an excellent job of keeping APR providers up to date on the latest medical literature and protocols involved with APR.
Myth 2: Fetal survival rates from APR are no different than placebo
Transcript
The data clearly shows the efficacy of APR to reverse medication abortion and save lives. There was a systematic review published in 2017 by Dr. Davenport that looked at all of the literature that exists looking at ongoing pregnancies after a woman started a medication abortion but then did not complete it by taking the second medication. What that showed was that in all of the studies that looked at ongoing viable pregnancies, so not incomplete abortions but actual viable pregnancies, the overall fetal survival rate after taking mifepristone alone was between 10 and 23 percent.
The largest study on APR to date was published in 2018 by doctors Delgado and Davenport. This was an observational case series that looked at 754 women who had attempted reversal. In the end 547 of them were eligible for analysis. What it showed was that the overall survival rate of their babies was 48 percent. However when you pulled out the two most successful groups those were the groups that received progesterone either IM or oral their success rates were 64 and 68 percent respectively. They also showed that the efficacy was the same regardless of when progesterone was given as long as it was given within 72 hours of the woman taking mifeprex and that the farther along she was in her pregnancy when she began her abortion the higher the success rate of reversal. So based on the available evidence, APR increases the chance of fetal survival from approximately 23 percent to 68. This is a significant difference for the babies who are saved and for the women who are able to take back a decision they regret.
Additional Information
- Click here to view historical data for embryo survival rate after taking mifepristone alone.
- Click here to view an analysis of the data for embryo survival rate after mifepristone alone.
- Click here to view latest data for embryo survival rate after taking mifepristone and progesterone.
- Click here to view an analysis of the data for embryo survival rate after taking mifepristone and progesterone.
Myth 3: APR is based upon junk science (not legitimate science)
Transcript
As you probably know, double-blinded randomized controlled trials are often seen as the gold standard for scientific research. However there are many instances in medicine where this simply isn’t possible or it would be unethical. And yet the information obtained from other kinds of studies can still be very valuable and inform our practice. In fact none of the trials that were included in the approval of mifepristone were randomized controlled trials. Those trials either used a historical control group similar to Delgado’s 2018 study or they were a dose comparison study. And yet abortion proponents have no problem using mifepristone even though it was approved not using randomized controlled trials.
Even a self-admitted pro-choice physician Dr Harvey Kliman of the Yale School of Medicine told the New York Times that the reversal of mifepristone with progesterone makes biological sense. And that it’s totally feasible. In fact he said that if one of his daughters was pregnant and accidentally took mifepristone and regretted it that he would tell her to take progesterone two to three times a day for several days just to combat the effects of mifepristone and that he bets it would work.
This reversibility of mifepristone binding has been validated both by the manufacturer studies as well as NIH studies. In animal models the NIH showed that the binding of mifepristone can be reversed. Also the manufacturers when they were developing mifepristone clearly showed that the binding of mifepristone to progesterone receptors is reversible and not permanent. So the active reversal of mifepristone with progesterone has been clearly documented.
[Editor note. See conference proceedings “Baulieu E. E., Segal S. J. 1985. The Antiprogestin Steroid RU 486 and Human Fertility Control.” Refer to the paper in these proceedings “Biochemical Profile of RU 486” by M. Moguilewsky and D. Philibert. See text at bottom on page 89 and Figure 3 at bottom of page 91.]
In animal studies where they have shown that the fetus was able to be saved there was one large study done in 1989 which looked at reversing the effects of mifeprex in pregnant rats. So the study took pregnant rats and divided them into three different groups. The first group did not receive any drugs whatsoever. The second group received mifepristone but nothing else. And the third group, or the reversal group, received mifepristone followed by progesterone. The results of the study were astounding. The first group of rats who had received no medication whatsoever a hundred percent of them had live births. The second group of rats who had received mifepristone but nothing else only 33.3 percent of them had live births. The third group, the reversal group, who’d received progesterone after being given mifepristone had a 100 percent live birth rate showing a significant reversal of the effects of mifeprex with progesterone.
[Editor note: A more recent rat study with similar results was published in Nature Scientific Reports in 2023.]
With the overwhelming evidence that not only is APR scientifically feasible but also supported by clinical experience and basic scientific studies it would be completely unethical to withhold this life-saving treatment from women who change their mind after they start a medication abortion and desire to save the life of their child.
Myth 4: APR is unsafe
Transcript
Dr Mitchell Creinin, a well-known abortion provider from the pro-abortion Bixby Center at UCSF and also a compensated expert from Danco, one of the manufacturers of mifeprex performed a placebo-controlled randomized trial on APR in women who were seeking abortions. As part of this study women who were seeking abortions were given mifeprex followed by either progesterone or a placebo and then they were not given misoprostol. They were then scheduled for a follow-up two weeks later where they had an ultrasound. If they had an ongoing viable pregnancy at two weeks then their abortions would be completed surgically. The trial was very small. Only 12 women total were enrolled when the study was stopped. 10 women were eligible for the final analysis, five women in the progesterone group and five women in the placebo group. The study was stopped early due to severe complications noted in three women.
But it’s important for us to know which group those women were a part of. One woman in the progesterone group presented to the emergency room due to heavy vaginal bleeding but when she arrived she was found just to be completing her abortion and she required no further treatment or management. The other two women actually came from the placebo group and both of them when they arrived at the hospital with heavy vaginal bleeding needed emergency surgeries to complete their abortions and control their bleeding. And one of them actually needed a blood transfusion due to the severity of her hemorrhage. And so Creinin and his colleagues claim that they stopped their study early due to safety concerns from the reversal process but in fact the women who received progesterone didn’t have the severe complications. The study actually showed that the complications came from those women just going through the medication abortion process.
Also Creinin’s study showed that APR works. In the placebo group two out of five women had ongoing viable pregnancies for a 40 percent fetal survival rate. However in the progesterone group, four out of five women had ongoing viable pregnancy rate for a doubling to an 80 percent fetal survival rate. This is very significant. Though this study is very small making it difficult to draw really meaningful conclusions from it, it shows that Abortion Pill Reversal works and it’s safe for women.
Myth 5: APR is experimental and not approved by the FDA
Transcript
Natural progesterones have been used safely in pregnancy for over five decades now. Most notably by reproductive endocrinologists in the support of all IVF pregnancies as well as many pregnancies in women with a history of recurrent pregnancy loss. And the bottom line is Abortion Pill Reversal does not employ a medication or a dose of that medication that hasn’t already been used safely in the first trimester of pregnancy for decades. The American Society for Reproductive Medicine (ASRM) and their educational bulletin on progesterone supplementation in pregnancy states “the weight of available evidence indicates that the most common forms of progesterone supplementation in early pregnancy pose no significant risk to mother or the fetus.”
[Editor Note: Refer to ASRM educational bulletin (2008) “Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin.”]
In the same educational bulletin they noted that in 1999 the FDA had conducted a thorough review of all of the relevant scientific literature on progesterone supplementation in early pregnancy. The FDA has acknowledged that given the extensive history of clinical practice and proven safety, progesterone in the first trimester does not pose a significant risk to mother or the baby. Giving progesterone to women in their first trimester is backed by more than 50 years of clinical experience and proven safety.
Myth 6: The large APR study was withdrawn because it wasn’t IRB approved
Transcript
The final version of Dr. George Delgado’s 2018 study says this; “the study was reviewed and approved by an institutional review board.” But the bottom line is this. Even if you disregard Delgado’s study, multiple other clinical studies done during the development of mifepristone clearly show the feasibility of abortion pill reversal and not a single scientific study points in the other direction.
Myth 7: If APR truly worked, ACOG would endorse it
Transcript
ACOG, the American College of OB/GYNs, has a long and rapidly progressive history of supporting the political agenda of the abortion industry at the expense of the health of our patients. They have a long history of ignoring the medical and scientific literature that show the harms of abortion to women. ACOG has chosen to ignore the wealth of evidence that shows that progesterone can reverse the effects of mifepristone. This despite in their recent practice bulletin on medication abortion. They recommend avoiding giving Depo-Provera for contraception, a large dose of progesterone, at the same time as a woman undergoes a medication abortion because it can and I quote “increase the risk of ongoing pregnancy.”
[Editor note: Refer to Carroll Et al. 2023. “Concurrent Administration of Depot Medroxyprogesterone Acetate With Mifepristone May Decrease Medication Abortion Efficacy: A Retrospective Cohort Study.”]
You might be asking why would ACOG choose to limit women’s options and not tell them about this if it really works? This is part of truly informed consent. After all, we’re not forcing women to choose APR. We’re simply telling them that it’s an option.
One of the basic tenets of medical ethics is informed consent. And part of that informed consent process is talking to patients about the alternatives to whatever therapy or medication we’re recommending. APR truly is an alternative to a woman completing her medication abortion if she changes her mind and regrets it. However, by limiting this information and not talking to women about it, ACOG is abandoning that foundational principle of informed consent in favor of a political agenda of the abortion industry. Does this sound like how you would like to practice medicine? To hide information from women simply to uphold a political agenda? If not, I’d encourage you to look into it more at www.notmyacog.com.
Myth 8: I’d be putting myself at greater medicolegal risk if I provide APR
Transcript
If you decide to become a provider of Abortion Pill Reversal it’s important that you document that you’ve given the woman fully informed consent just like you would for any other procedure or treatment. It’s also important that you inform her that right now APR isn’t 100 percent, so it’s not going to save her baby 100 percent of the time. As long as you document that you’ve discussed this with her and you follow the protocols that are given to you by the APR network you will be practicing within ethical and medically based guidelines.
Even though ACOG has chosen to deny the science that exists that shows that APR works. AAPLOG, the American Association of Pro-Life OB/GYNS, is here to provide you with a professional medical organization and a second expert medical opinion that will support you in your practice as you provide APR to women.
Myth 9: There will be an increased risk of birth defects if a woman does not complete her abortion
Transcript
Even though women are often told at the abortion facility that they must complete their medication abortion or their baby could be born with birth defects, there are no documented cases of birth defects associated with mifepristone exposure alone. This is even seen in the package insert with mifepristone that states that that exposure does not result in birth defects. In fact, birth defects are only seen in women who have been exposed to both mifepristone and misoprostol and then go on to have an ongoing pregnancy. There is one known birth defect associated with misoprostol exposure called Moebius syndrome. This is a congenital paralysis of the facial nerve. However this has not been seen in women who have not taken misoprostol.
A study published in the British Journal of Obstetrics and Gynecology showed that there was no increased risk of birth defects in women exposed to mifepristone over the general population and there was no trend towards a particular defect. In fact they stated that the evidence was clear that the risk evaluation for exposure to mifepristone in the first trimester was minimal. There is an increased risk of hypospadias and male fetuses exposed to progestins in the first trimester. However these differ from natural progesterone and that they act on androgen receptors. Consistent with the whole of medical literature, Delgado’s 2018 study showed no increased risk of birth defects. Additionally, the patients in this study only had a 2.7 percent rate of preterm birth, a significant reduction from the 10 percent rate of the general population.
[Editor note. Refer to: Turner Et al. 2024. “Congenital and Fetal Effects After Mifepristone Exposure and Continuation of Pregnancy: A Systematic Review.” and Bernard Et al. 2013 “Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study.”]
Myth 10: Women are pressured or coerced when they call the APR network
Transcript
When a woman calls in to the Abortion Pill Reversal hotline the network nurse who responds to her call will provide her with information and then will allow her to make the decision as to whether or not she wants to proceed. These nurses are highly trained and they’re able to explain the entire process to the patient, talk to her about why progesterone is so important during pregnancy, and the potential success rates. Then if the patient decides that she wants to proceed the nurse will do an intake form and will connect her with an APR provider in her area.
APR is not even a financial burden for the patient regardless of her insurance status. Many insurance plans will cover the cost of progesterone. But even if they don’t, the APR network or the providers oftentimes will provide the patient with a GoodRx link that she can use to get the medication at a significantly reduced cost. Many pregnancy care centers will provide APR treatment free of charge. Also the APR network is willing to provide reimbursement to women who have had to pay out of pocket for the cost of their progesterone while their Medicaid is pending.
Myth 11: APR will be time-consuming and complicated for me to provide
Transcript
I know that you have many demands on your time as a medical professional. However, I want to reassure you that the APR network has done everything possible to make this a smooth and easy process for you. If you decide to become an APR provider you will be kept up to date through emails on the latest protocols and evidence based support for APR. If you do become a provider and a woman in your area is seeking APR, you will be contacted by one of the network nurses either via text or phone call. She will then give you all of the information you need about that patient, given with the patient’s permission of course. When you contact the patient you will finish her counseling and ensure that she does in fact want to proceed with Abortion Pill Reversal and talk to her about how to take the progesterone.
Then, once you’ve called in the progesterone to her pharmacy, you schedule her to see you in your office to establish care within 24 to 48 hours and at that visit perform an ultrasound to confirm fetal viability. After that initial visit you can continue regular prenatal care with her just like you would with any other patient. Progesterone is continued through the first trimester. Her pregnancy and delivery outcomes are then submitted anonymously to the APR network so that they can continue to track the outcomes of patients who are seeking Abortion Pill Reversal. This can be done easily through their electronic medical system which is also where her medical intake form resides. As an APR provider myself who has successfully managed a reversal, I can tell you that not only is it extremely fulfilling to be able to walk with a woman through this, but it is very easy to do and will not place a substantial burden on your practice.
Conclusion
Transcript
Abortion Pill Reversal is a safe and effective therapy supported by the medical literature that provides an opportunity for an expectant mother to save her child if she regrets her decision to undergo a medication abortion. It is truly a privilege to serve as a provider of this therapy. We would invite you to join us as a provider of Abortion Pill Reversal. You won’t be alone in that you’ll be supported by the APR network which consists of thousands of physicians. We want to support you in your practice as you provide this life-saving treatment to women to allow them not only to save their children but to spare them from a lifetime of regret.
In a world where we talk about women being empowered and having choices, they are not empowered if they don’t have the choice of Abortion Pill Reversal, if they regret their decision to start a medication abortion. I would invite you to learn more today about this life-saving treatment and become an APR provider. I promise you that in the midst of the daily grind of your practice this will be a bright spot that will enrich your practice of medicine and enable you to really be able to impact the lives of both of your patients, both born and pre-born.
In order to find out more information and to sign up to be a provider please visit our website: https://aaplog.org/apr.