Can EC and regular hormonal
birth
control pills prevent implantation?
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Background material:
The very first processes that lead to the birth of a newborn infant are:
Release of a very lucky spermatozoon about a month before conception from a man's testicle. It is one of hundreds of millions of sister and brother spermatozoa that will subsequently attempt to fuse with an ovum.
Release of an ovum by a woman's ovary shortly before conception.
Sexual intercourse.
Conception occurs. The ovum is fertilized by one spermatozoon to produce a zygote (commonly referred to as a fertilized ovum, fertilized egg, or pre-embryo)
The zygote travels down a fallopian tube towards the uterus. If all goes well, it becomes a blastocyst and starts to implant itself in the wall of the uterus. A week or two after conception, it is fully implanted and the pregnancy can be detected by a urine or blood test.
Initially, medical researchers suspected that EC may prevent pregnancy in three ways:
By preventing ovulation -- the release of an ovum from an ovary. Thus, conception would be impossible.
If ovulation had already occurred, it would prevent conception by making the ovum more resistant to fertilization.
If the ovum was already fertilized, EC might prevent the implantation of the resulting blastocyst in the wall of the uterus.
However, they have since determined that EC only works through the first two processes. The third is only a theoretical possibility and has not been shown to happen in practice. Many pro-lifers reject these findings.
Why is this question important?
It determines whether most religious conservatives, social conservatives, and pro-life advocates will accept or oppose women's access to emergency contraception (EC).
There is general agreement among pro-life, pro-choice groups, and medical professionals that:
Contraceptives include actions, devices, sexual practices or medications that prevent pregnancy from starting.
Abortifacients are actions, devices, or medication that terminate pregnancies that have already begun.
Unfortunately, there is no consensus on exactly when pregnancy begins. Thus there is no agreement on whether EC acts as an abortifacient or birth control.
Most of pro-lifers and other conservatives believe that both a human person and pregnancy begin at the same time, during the process of conception. They base this belief on the fact that a unique human DNA is created at that time.
If EC subsequently prevents implantation of the embryo in the wall of the uterus, then pro-lifers could considered EC to be an abortifacient. That is, it would kill a human person just like they believe RU-486 or an early surgical abortion does. There would be no ethical difference between strangling a newborn infant, taking EC, taking RU-486 or having a surgical abortion.
However if EC only interrupts processes before conception -- by stopping the ovary from releasing an ovum or by causing the ovum to resist sperm -- then it would merely prevent a pregnancy from starting up; it would act as a method of birth control.
Protestant pro-lifers and conservatives generally have no objection to birth control but are unalterably opposed to abortion; they regard it as taking a human life. The Roman Catholic Church is unalterably opposed to both birth control and to abortion. However most Catholic laity has ignored the church's contraceptive teachings and has no objection to "the pill" and other methods of birth control. Further, the abortion rate by Catholic women is equal or perhaps slightly higher than the national average.
Most pro-choicers accept the medical evidece that there is reasonable certainty that EC does not interfere with the implantation of a blastocyst, Also, they follow the medical understanding that pregnancy begins when the blastocyst becomes fully implanted in the wall of the uterus. Thus, even if EC prevented implantation, it would still not be an abortifacient since a pregnancy would not have started. In addition, most pro-choicers believe that human life, in the form of an ovum and spermatozoon becomes a human person only later in pregnancy:
Pperhaps when the fetus first becomes sentient -- i.e. it attains consciousness, becomes at least partly aware of its surroundings, may be able to feel pain, etc., or
Perhaps when the newborn has emerged from its mother during childbirth, or
Perhaps at some other time during pregnancy.
Thus, most pro-choicers have no objection to the use of EC.
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Can EC prevent implantation of a blastocyst?
The answer is a definite yes and no, depending upon whose expertise one draws.
YES: The Roman Catholic Church states that EC does interfere with implantation of the embryo and thus can act as an abortifacient. William Cardinal Levanda, Prefect of the Congregation for the Doctrine of the Faith issued "Instruction Dignitas Personae on certain bioethical questions" on 2008-DEC-08.
Section 23 of the document covers "New forms of interception and contragestation." The document identifies in its footnote 43 that "... the IUD (intrauterine device) and the so-called 'morning-after pills' are the best known interceptive methods." Levanda states as a fact that one of the ways in which emergency contraceptive "certainly" works is as an interception agent that prevents implantation. Since the Church teaches that pregnancy and a human person both begin at the time of conception, preventing implantation kills a human being. The document condemned EC as a type of abortion and thus "gravely immoral."
The document states:
"Alongside methods of preventing pregnancy which are, properly speaking, contraceptive, that is, which prevent conception following from a sexual act, there are other technical means which act after fertilization, when the embryo is already constituted, either before or after implantation in the uterine wall. Such methods are interceptive if they interfere with the embryo before implantation and contragestative if they cause the elimination of the embryo once implanted."
"In order to promote wider use of interceptive methods, it is sometimes stated that the way in which they function is not sufficiently understood. It is true that there is not always complete knowledge of the way that different pharmaceuticals operate, but scientific studies indicate that the effect of inhibiting implantation is certainly present, even if this does not mean that such interceptives cause an abortion every time they are used, also because conception does not occur after every act of sexual intercourse. It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. ..."
"As is known, abortion is 'the deliberate and direct killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth.' Therefore, the use of means of interception and contragestation fall within the sin of abortion and are gravely immoral. Furthermore, when there is certainty that an abortion has resulted, there are serious penalties in canon law."
6
Unfortunately, Levanda does not give any research findings that support his assertion that "the effect of inhibiting implantation is certainly present."
In the vast majority of cases, it seems obvious that women who take EC are hoping and expecting that it will prevent ovulation or prevent conception. They do not expect to induce an abortion.
NO: William Saletan who writes for Slate.com analyzed Cardinal Levanda's document. 5 Saletan wrote in 2009:
"Is the effect of inhibiting implantation 'certainly present'? Let's review the mechanics of morning-after pills, specifically levonorgestrel, marketed as Plan B. The problem with the CDF's statement is that this 'interceptive' is chemically identical to the best-known contraceptive: the pill. And the risk that this drug will prevent implantation of an embryo is purely theoretical. There is no documented case of such a tragedy, since we have no way to verify conception inside a woman's body prior to implantation without causing the embryo's death. Even theoretically, the risk is vanishingly small, since the primary effect of oral contraception is to prevent ovulation, and the secondary effect is to prevent fertilization. To classify oral contraception as abortifacient, one would have to posit a scenario in which the drug fails to block ovulation, then fails to block fertilization, and yet somehow, having proved impotent at every other task, manages to prevent implantation."
"So, the assertion of an anti-implantation effect is theoretically unsound. But what do the data show? Two years ago, the world's leading expert on levonorgestrel, James Trussell, co-authored an analysis of the available research in the Journal of the American Medical Association. 7 The analysis confirmed that that anti-ovulation effects wipe out any data suggesting a possible anti-implantation effect. It concluded:"
'Published evidence clearly indicates that Plan B can interfere with sperm migration by altering the cervical and uterine environment, and that preovulatory use of Plan B usually suppresses the LH surge either completely or partially, which in turn either prevents ovulation or leads to the release of ova that are resistant to fertilization. Epidemiological evidence rules strongly against interruption of fallopian tube function by Plan B. Evidence that would support direct involvement of endometrial damage or luteal dysfunction in Plan B's contraceptive mechanism is either weak or lacking altogether. Both epidemiologic and clinical studies of Plan B's efficacy in relation to the timing of ovulation are inconsistent with the hypothesis that Plan B acts to prevent implantation'." 7
"In fact:
'Progestational drugs, including levonorgestrel, are used therapeutically in assisted reproduction because they increase the rate of successful implantation and pregnancy. That observation a priori reduces the likelihood that Plan B interferes with implantation; it even raises the counterintuitive but undocumented possibility that Plan B used after ovulation might actually prevent the loss of at least some of the 40% of fertilized ova that ordinarily fail spontaneously to implant or to survive after implantation'."
"So, in summary:
'[T]he ability of Plan B to interfere with implantation remains speculative, since virtually no evidence supports that mechanism and some evidence contradicts it. ... [T]he best available evidence indicates that Plan B's ability to prevent pregnancy can be fully accounted for by mechanisms that do not involve interference with postfertilization events'." 5
Saletan commented on whether women who seek to prevent the implantation of an embryo generally intends to have an abortion. Saletan suggests that it would be irrational for her to seek that because there is no evidence that suggests that it could happen. There is a much higher probability that a woman would be seeking to avoid ovulation or prevent conception.
He concludes:
"The perceptive analytical framework established by Dignitas Personae, combined with the best scientific evidence and analysis, clearly implies that morning-after pills are contraceptives, not interceptives. Therefore, from the standpoint of respecting embryonic life, you may take them in good conscience." 5
In another article, 8 he refers to an paper written by physicians at the Catholic Pontifical University of Chile -- of all places. 9 It shows how breast feeding an infant protects women from becoming pregnant in the same way as EC does. He wonders whether the Church will want to stamp out breast feeding as well.
Who is right?
Catholic women are in a lose-lose situation with regard to the use of EC. If it acts only as a contraceptive, as all available evidence seems to indicate, then women are forbidden to use it. If it can also act to discourage implantation, then the woman is regarded as having committed an even more serious sin, equivalent to having an abortion which the church considers a form of murder.
It would appear that there is little or no chance that EC actually inhibits implantation. There is some suggestion that it may enhance implantation.
The following information sources were used to prepare and update the above
essay. The hyperlinks are not necessarily still active today.
Lawrence Morahan, " 'Morning-After' Pill Available at Some DoD
Clinics," CNSNews.com, 2002-JUN-3, at: http://archive.newsmax.com.
"Little Pills: Targeting Youth with New Abortion Drugs," Family
Research Council, at: http://www.frc.org/
FDA panel endorses 'morning after' pill," CNN, 1996-JUN-29, at:
http://www.cnn.com/
John Schwartz, " Morning-After Contraceptive Given Government Approval," The Washington Post, 1997-FEB-25, at: http://tech.mit.edu/
William Saletan, "Coitus Interceptus," Slate magazine, 2009-JAN-05, at: http://www.slate.com
William Cardinal Levanda, "Instruction Dignitas Personae on certain bioethical questions," Congregation for the Doctrine of the Faith, 2008-DEC-08, at: http://www.vatican.va/
Frank Davidoff, James Trussell, "Plan B and the politics of doubt," Journal of the American Medical Association," 2006-AUG-24, at: http://jama.ama-assn.org/
William Saletan, "Where the rubber meets Roe," Slate, 2006-SEP-30, at: http://www.slate.com/
S. Diax, et al., "Relative contributions of anovulation and luteal phase defect to the reduced pregnancy rate of breastfeeding women," Pub Med, 1992-SEP, at: http://www.ncbi.nlm.nih.gov/
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