AAPLOG position on “ELLA,” the newest “emergency contraception”

On August 13, 2010, the Food and Drug Administration approved the application for a new “Emergency Contraceptive” drug, ulipristal acetate, under the label “ella.”

“Ella” is the first selective progesterone receptor modulator (SPRM) available in the United States for the indication of “emergency contraception (EC).” This class of drug (SPRM) blocks progesterone which is necessary to maintain a pregnancy. It disables the uterine lining, compromising it’s ability to form a functional “secretory” endometrium—the lining which nourishes the fertilized, implanting new human baby. This effectively deprives the brand new human child of oxygen and nutrients, and the child dies. This is abortifacient action.

Ella is chemically related to Mifepristone (RU 486), the “medical abortion” drug that kills the baby by blocking placental function. Ella has the same action: they are both selective progesterone receptor modulators (SPRM). The generic name is Ulipristal.

The FDA’s approval, labeling “ella” as emergency contraception, is deceptive and dangerous to women and their newly conceived baby. Women deserve to know that “ella” can cause death of the embryo, and the FDA is deliberately misleading women by mislabeling “ella” only as contraception, and not as abortifacient.

Here is what the FDA approved drug literature says:
“How does “ella” work?
“Ella” is thought to work for emergency contraception primarily by stopping or delaying the release of an egg from the ovary. It is possible that ella may also work by preventing attachment (implantation) to the uterus. “ The latter is clearly abortifacient action.

Why does the FDA not consider this an abortifacient? It is kind of Semantic double-speak. Some medical groups define pregnancy as begining at implantation.” (To them, conception and implantation are defined as the same thing. They say, “pregnancy” is “conceived at implantation.”) ProLifers say that “human life begins with fertilization.” A human life is conceived at fertilization. So their side says “the ella effect is pre-implantation,’ thus is not abortifacient.” We say, “This medicine may result in death of a new human being by preventing implantation, thus is abortifacient.”

Don’t miss this important fact: Ella only delays ovulation if taken in the several days before ovulation happens, i.e., before the luteal surge which stimulates release of the egg. After ovulation, if the egg is fertilized, “ella” works as a progesterone-blocking abortifacient. How often would you guess a woman takes this in just the right widow (several days before ovulation) to delay ovulation? Not often. Taken at other times, it may have no effect on ovulation, but could still affect the development of secretory endometrium.

The egg must be fertilized on the day of ovulation. (After 1 day, it resists fertilization) And why does “ella” work for 5 days after ovulation? Because it is on about the 5th day after ovulation and fertilization that the new baby begins to implant—but can’t, because the uterine lining function is disabled by “ella” This is abortifacient action. And this is why “ella” can be used, as advertised, up to 5 days after intercourse.

The FDA literature hints at this (see quote above from ‘How does “ella” work?’), but the FDA does not use the word “abortifacient.” We find this very deceptive for the women considering using “ella” who would otherwise not even think of having an abortion.

The medical literature claims that Plan B is “up to 89% effective if used within 24 hours of unprotected intercourse, less so if used over the next couple days. The literature also claims that “ella” is “more effective” than Plan B, and effectiveness, although diminished, is still a reality if “ella” is taken 5 days after intercourse.

Q: How many days a month is a woman able to become pregnant?
Fact: About 4 days a month. Thus EC will appear to be effective about 26 days each month!! This is because it is impossible to get pregnant about 26 days a month (see below). Many of the days when women take EC, it is not possible to get pregnant anyway. This fact makes the “effectiveness” statistics look very good.

Some notes on timing:
If the sperm is deposited more than 3 days before ovulation fertilization ordinarily won’t happen, as the sperm is usually “dead” or not effective by ovulation time.
If the sperm is deposited 24 hours after ovulation, fertilization won’t happen, as the egg is “dead,” (i.e., no longer receptive to sperm).

So the narrow window of 2 or 3 days before ovulation to 24 hours after ovulation is the “fertilization window”

Delaying ovulation with use of EC in the preovulatory 2 day window of time apparently works as a contraceptive method by delaying ovulation several days, during which time the sperm dies, so it cannot fertilize the egg

AAPLOG note: Remember, it is not possible to get pregnant 26 days each month. This makes the “effectiveness” statistics look really good—much better than they really are. Also remember that the major studies on Plan B (which claims to be 89% effective) show NO DECREASE IN UNINTENDED PREGNANCY, AND NO DECREASE IN ABORTION RATES, even when the EC was given free, and given to the patient ahead of time to have on hand for emergency use. See http://www.aaplog.org/position-and-papers/emergency-contraception/