COLUMBUS (WKBN) - Can an abortion be reversed using high doses of a hormone called progesterone? That's the question lawmakers are asking with the introduction of a new bill at the Ohio Statehouse.
Lawmakers and pro-life advocates are pushing for a bill that would mandate doctors inform patients before getting an abortion that, under certain circumstances, it could be reversed if they change their mind.
On its face, the legislation is being posed as an informational boon for patients who may not be fully aware of all of their options.
Where opponents disagree is how this would be presented to patients, and if the process is even safe and effective to begin with.
Setting aside whether you think abortion is right or wrong, let's look at the facts.
Any potential reversal only applies when dealing with a medication-induced abortion using a two-drug process. The two drugs are mifepristone, which is taken first and stops the pregnancy by blocking the hormone progesterone, and misoprostol, which makes the uterus contract to complete the abortion.
The two drugs are taken separately.
Supporters of the bill want to flood the body with enough progesterone to counteract the mifepristone. The premise is if there is too much progesterone, the mifepristone can’t stop it all and the pregnancy can continue. This requires high doses of progesterone.
Opponents of this process say it is unknown what can happen if high doses of progesterone are given to women and they're afraid the woman could get hurt.
As with any medical or scientific exploration, studies can be done to try to determine the effects. In this case, some small studies have already been done.
According to the American Congress of Obstetricians and Gynecologists (ACOG), in 2012, a case series reported on six women who took mifepristone and were given varying progesterone doses. Four of those women continued their pregnancies.
To supporters, that is a 66% success rate showing the progesterone saved the pregnancy. However, scientifically, there are problems with that claim.
First, a study of six individuals is nowhere near enough to get an accurate read on success or failure. That sample size also couldn't determine what, if any, side effects may occur in other individuals who do not fit the makeup of the six participants.
Then there is the problem of saying progesterone was the active catalyst to the successful pregnancies after the mifepristone.
According to medical professionals, if a pregnant woman takes mifepristone but decides to stop taking it and never takes the second drug, misoprostol, there is a 7% to 40% chance the pregnancy will continue on its own. In other words, mifepristone is only successful in stopping the pregnancy somewhere between 60% to 93% of the time based on a number of variables.
The point is, simply adding more progesterone to the body may or may not have had an impact on the outcome in that small study, according to the ACOG.
In its report, the ACOG says:
This study was not supervised by an institutional review board (IRB) or an ethical review committee, required to protect human research subjects, raising serious questions regarding the ethics and scientific validity of the results."
About a year after this study was published, Rebekah Hagan found out she was pregnant. She was 18 at the time and already had a 1-year-old son.
Hagan said she didn’t think there was any way she could raise a second child as a 19-year-old going to college with no support from the father. She was also afraid her parents would kick her out of their home.
She decided to get a medication-induced abortion.
As she left the clinic around 4 p.m. that day, clutching the brown bag with the rest of the mifepristone and misoprostol she would need to finish the abortion, she panicked.
“It was almost like I couldn’t believe what I had done, even though I had just done it," Hagan said. "So instantly, I felt panicked and, again, alone and really just kind of stuck in my grief and wishing I could just take back the last 10 or 15 minutes of my life.”
At the time, high-dose progesterone-based abortion reversals were not widely advertised. As she sat in her car in the clinic parking lot, searching the internet for answers on her smartphone, she found a hotline number that connected her with a doctor.
By 10 a.m. the next day, she was given what would become the first of many progesterone shots.
Six weeks later, the shots stopped and at 41 weeks into her pregnancy, she gave birth to a baby boy.
The boy is nearly 6 now and Hagan believes the process helped her carry her baby to term. Still, she understands the concern opponents have with the process.
“I think we have to present what we know. Present the fact that progesterone has been used for many, many years. Not just with women who have a tendency to miscarry, but for women who have all sorts of hormonal issues," Hagan said.
She said women should be told that it is experimental and what they might go through. She said doctors should tell them they might still lose the pregnancy.
"Then she’s given the right to make that decision based on all of that information. I think that we should be able to trust women enough to be able to make that decision. It reminds me of experimental cancer treatment or something like that. We still give people that option even though we don’t know 100% what the outcome will be."
So back to our initial question -- can an abortion be reversed using high doses of a hormone called progesterone?
Maybe. We don’t know for sure.
Some will say there have been nearly 500 babies born as a result of this kind of treatment and that’s good enough evidence for them to believe the answer is yes. State Senator Peggy Lehner, one of the impending sponsors of the legislation, said as much at a news conference on Tuesday.
Others aren't sold yet, including a good portion of the medical community that relies on good scientific research and methods to ensure the reduction of unintended consequences and side effects.
Did Hagan just get lucky? Maybe. Should successes like hers be the basis for prompting others to go down the same path?
The ACOG report was posted in August of 2017 and the small study it focused on happened in 2012.
Heartbeat International, the group helping Ohio Right to Life push this bill to lawmakers, is sticking to its belief that the success rate is around 64% based off a new study published by Dr. George Delgado in 2018.
This new study looked at 754 patients who all stopped taking mifepristone and started taking high doses of progesterone. The study claims a pregnancy success rate of 64%.
In October of 2018, Dr. Daniel Grossman and Kari White, who has a Ph.D. and a Master of Public Health, questioned Delgado’s methodology in the New England Journal of Medicine. They say the statistics are inflated.
Are the statistics good? Should doctors be telling their patients about an experimental procedure they have no idea for sure will work or if there will be side effects? That the procedure itself, even if it does work the way Dr. Delgado says it does, may or may not work without a guarantee?
Some lawmakers, like Sen. Lehner and State Representative Niraj Antani -- who will be introducing the bill in the Ohio House of Representatives -- think they should.
Ohio Right to Life doesn’t like to stick its neck out too far on legislation. According to Stephanie Ranade Krider -- the vice president of the organization -- as the largest anti-abortion organization in the state, they must maintain the credibility and trust they have built, especially with lawmakers.
The organization did not even support the Heartbeat Abortion Bill until about a month before it passed for the second time. It always said it did not support that bill because it couldn’t get through the courts -- that is, until the Supreme Court of the United States saw new members.
When Gov. Mike DeWine signed the bill that had been so embattled over the years and gone through two prior vetoes by his predecessor, Ohio Right to Life was front and center for the historic occasion.
Krider says the group gauges a number of factors before deciding which legislation to push, including the science behind it.
“The studies that we cited today have been peer-reviewed. The studies that Heartbeat International has provided today are all studies that have been done within the United States as they’ve seen these abortion pill reversals taking place.”
And yet, ACOG’s report refutes the validity of those studies:
Facts are important, especially when discussing the health of women and the American public. Claims regarding abortion 'reversal' treatment are not based on science and do not meet clinical standards.”
NARAL Pro-Choice Ohio Deputy Director Jamie Miracle isn't buying it.
“Time after time, what we are seeing is bills introduced in this state legislature that are based on junk science and not actual facts," Miracle said. "The bills that are passing through this legislature should be based in medical science, not science fiction.”
While there has been a recent example of a bill promoting something that actually is medically impossible at this time, this bill may not go quite that far.
There are still questions over whether progesterone is reversing abortions or not. It could be, but more research is needed.
For some in the medical community, that study needs to be done in a scientific way that is acceptable in terms of standards.
Until that happens -- until there is scientific proof or until the medical community can be convinced otherwise -- we will not know for sure if high doses of progesterone can save a pregnancy after mifepristone is taken. All we have now is it might.