Emergency Contraception Factors to consider Language manipulation Bias towards abortion means that new life is not respected. Begining of a new life occurs at fertilization An embryo with complete genetic make up comes into being. Morning after pill Health Committee Meeting 26 Document 72 Pregnancy 1965 - ACOG defines pregnancy as starting following implantation. According to the doctored definition abortifacient now conveniently means anything that interferes with an established pregnancy. 1
Funding for contraceptive research Consider : Funds mainly come from those who have a pecuniary interest ie the manufacturing companies Which research is being quoted? Most global companies or institutions backing a lot of these studies are pan global pro abort companies. Examples; WHO, Bill &Melinda Gates Foundation, Guttmacher Institute,United Nations Population Fund etc 2
The fundamental question to ask is not if the drug is abortifacient, but whether or not the emergency contraceptive is embryocidal. Does it have an action which can kill an embryo? 3
Emergency Contraception Morning after pill 4
LNG and Ella are very different drugs with very different mechanisms of action. Lumping together two very different drugs and calling them 'morning-after pills' allows for clever confusion of what is known about the mechanism of action of each drug, wrote Dr. Harrison, a Michigan-based obstetrician and gynaecologist ( AAPLOG) 5
Emergency contraceptives can: 1. Prevent the ovary from making and/or releasing an egg 2. Prevent the sperm from meeting the egg in the tube 3. Prevent the embryo from surviving the passage through the tube to the lining of the uterus 4. Prevent the embryo from implanting in the lining of the uterus 5. Prevent the embryo who has already implanted from surviving to day 28. 6
Levonogestel (LNG) Emergency Contraception Contraceptive or abortifcient? 7
Leveonogestrel ( Plan B, Next Choice) LNG is a progesterone. Progesterone is a hormone that must be in a woman s body for her to be able to allow the embryo to implant and develop the placental connections between the embryo and the mother. 8
The question of mechanism of action is fundamentally a scientific one. Effectiveness of LNG EC to prevent pregnancy depends on when it is given, before or after ovulation. 9
Mechanism of Action Of LNG 1. Progestins are artificial hormones which resemble natural progesterone, but do not have all the actions of natural progesterone. 2. LNG works poorly as an emergency contraceptive, because it does not have much effect after fertilization. It can delay the release of an egg if taken several days before the LH surge. 3. But, if it is taken immediately before the LH surge, egg release will still happen, but the LH surge will be decreased, causing a luteal phase defect. 4. If a woman has already released an egg and takes LNG, there seems to be little if any effect on her embryo. Single dose LNG after egg release probably does not affect either progesterone production or implantation. 10
Fertile Window ( days -5 to -1) Fertile window Days -5 to -1 Ovulation day (0) and after 11
The period of time that is concerning, is when LNG EC is given before ovulation, in the fertile window. 12
Study by Noe et al Day of ovulation (0 to +1) As expected, the effectiveness of LNG EC - given on the day of ovulation or later - was basically non-existent (7 expected and 6 actual pregnancies). 13
LNG is a poor anovulant Consider this: when LNG EC was given in the fertile window, breakthrough ovulations occurred 62 out of 87 times (71% of cases). 14
LNG has Preovulatory Effects : lower luteal phase hormone levels decreased endometrial receptivity (as evidenced by glycodelin-a levels) shorter luteal phase or earlier bleeding, and very high intrauterine ph levels to as high as 9 (which is a 10-fold increase above the normal intrauterine ph). 15
From study by Noe et al In stark contrast, the effectiveness of LNG EC - given in the fertile window (-5 to -1 days before ovulation) to prevent of pregnancy was complete (13 expected but 0 actual pregnancies). 16
Informed Choice Dr. Trussell and Dr. Raymond (both worldrenowned, staunch supporters of contraception) admit in their review of LNG, to make an informed choice, women must know that [emergency contraceptive pills] may at times inhibit implantation of a fertilized egg in the endometrium. Who are we to ignore this FACT? 17
Conclusion Given that breakthrough ovulations occur the majority of the time when LNG EC is given in the fertile window, together with the scientific support in favor of postfertilization effects that follow, leads to the conclusion that postfertilization effects of LNG EC have NOT been ruled out, but rather, likely occur at a significant rate. To state otherwise is statistically improbable and scientifically untenable. Patrick Yeung Jr., M.D. and Donna Harrison, M.D. 18
Ella One (Ulipristal Acetate) 19
If taken before a woman ovulates, Ella will interfere with progesterone action and prevent the egg from being released. But the critically important question is what happens when you take Ella after ovulation. Ella blocks the action of progesterone at the level of the ovary, and blocks the action of progesterone at the endometrium, both of which interfere with implantation. 20
Ella (ulipristal) is an Anti-hormones /Progesterone blockers - effectively block the actions of natural progesterone. Without sufficient progesterone, an embryo is unable to implant in the womb, and will also die after implantation due to the uterine lining not sufficiently nourishing the embryo. Ella (ulipristal) is as effective in blocking progesterone as is the abortion drug RU-486. Yet, Ella is called an Emergency Contraceptive because that is the indication the manufacturer sought approval for from the FDA. 21
Both RU-486 and Ella can also directly destroy the corpus luteum of the ovary, so that it cannot make progesterone to support the early pregnancy. Progesterone blockers--ru-486 (mifeprex) and ulipristal (Ella)--can directly destroy the embryo by directly blocking the action of progesterone in the womb. So, both RU-486 and ulipristal can both prevent implantation and can cause abortion after implantation. 22
Dr Harrison, who was present at the Food and Drug Administration Advisory Committee's hearing on the approval of Ella, recalled the presentation of data showing that the drug is around 95 percent effective in preventing pregnancy. One of the Advisory Committee members repeatedly pointed out to the manufacturers that there was no way the effectiveness of Ella could be explained by delaying ovulation alone, she recalled. This fact does not take an FDA Advisory Committee member to figure out. If Ella works even when a woman takes it after ovulation, then of course it doesn t work in that woman by preventing ovulation. 23
Harrison noted that Ella also has a bigger problem. Although it is used as emergency contraception, studies supporting its approval by the government showed that the dose in question is high enough to increase the miscarriage rate if a pregnancy is recognized. In point of fact, the doctor observed, any drug which can act to prevent pregnancy after a woman has ovulated must have some post-fertilization effect. Whether it kills the embryo directly, or prevents the embryo from travelling down the tube, or prevents the embryo from implanting, or interferes with ovarian function, or increases immune rejection of the embryo, or directly destroys the placenta, some mechanism must be in place to interfere with the normal embryo functioning and then kill the living embryo. 24
The Precautionary Principle a strategy to cope with possible risks where scientific understanding is yet incomplete, such as the risks of nano technology, genetically modified organisms and systemic insecticides. 25
The Precautionary Principle is defined as follows: When human activities may lead to morally unacceptable harm that is scientifically plausible but uncertain, actions shall be taken to avoid or diminish that harm. Morally unacceptable harm refers to harm to humans or the environment that is threatening to human life or health, or serious and effectively irreversible, or inequitable to present or future generations, or imposed without adequate consideration of the human rights of those affected. The judgement of plausibility should be grounded in scientific analysis. Analysis should be ongoing so that chosen actions are subject to review. Uncertainty may apply to, but need not be limited to, causality or the bounds of the possible harm. Actions are interventions that are undertaken before harm occurs that seek to avoid or diminish the harm. Actions should be chosen that are proportional to the seriousness of the potential harm, with consideration of their positive and negative consequences, and with an assessment of the moral implications of both action and inaction. The choice of action should be the result of a participatory process. Source: http://www.precautionaryprinciple.eu/ 26
Studies presented to supplement presentation. Dr Miriam Sciberras BChD(Hons) MA Bioethics Chairman Life Network Foundation Malta 27