Linda Greenhouse was, for many years, the New York Times’ Supreme Court reporter. In a guest column published on November 27, she delivered a Thanksgiving gift to the justices, one that would solve—she asserted—the most contentious of their cases this term, those involving the HHS “contraception” mandate. Greenhouse wrote:
The religiously committed owners of the companies whose cases the court will decide—Hobby Lobby employs 13,000 people in its 500-store chain—say they object not to all birth control but only to the methods they believe act after fertilization to prevent a fertilized egg from implanting and continuing to develop. This belief is incorrect, as a brief filed by a coalition of leading medical authorities demonstrates; although there was once some confusion on this point, the disputed hormonal methods are now understood to prevent fertilization from occurring in the first place.
About the medical facts, Greenhouse and the medical brief written by pro-abortion physicians that she cites are certainly wrong. Hobby Lobby and the other mandate complainants are right: several of the required “contraceptives” can work by killing an embryo before or after implantation, just as they assert in court papers. Perhaps because she is relying on the spin involved in the pro-abortion brief, Greenhouse is so utterly confused about the basics of human reproduction that she quite literally does not know what she is talking about.
Let’s start with her confusion, and work our way up to her grossly mistaken conclusions.
Misleading Terms and False Claims
Greenhouse refers to the potential fate of a “fertilized egg.” There is no such thing. Biologically, when a human sperm cell penetrates a human egg cell, which happens within twenty-four hours after ovulation, the membranes of the sperm cell and egg cell fuse. At the moment of membrane fusion, which is called “fertilization,” the sperm cell ceases to exist, as does the egg cell. There is, in other words, no egg left which could be described as “fertilized.”
What does exist is a one-celled embryo called a “zygote.” A zygote has all the characteristics of a unique human organism: it can direct its own development, can repair itself, has specialized parts that work together for the continued existence of the embryo, and—given nourishment and the right environment—can accomplish its own self-directed growth. These are the same criteria that characterize any human organism.
Prior to the 1960s, the word “conception” was understood to be a lay term for “fertilization.” Ordinary people knew that “pregnancy” began at “conception.” That changed when “contraceptive” drugs and devices became generally available. At that time, the American College of Obstetricians and Gynecologists arbitrarily and unilaterally defined “conception” to mean “implantation,” which is defined as the time when an embryo becomes attached to the lining of the uterus.
This definition change had two distinct advantages for manufacturers. The first was that the death of an embryo before implantation could be classified as a “contraceptive” act, because the embryo’s demise occurred before “pregnancy.” The second was that these new embryocidal actions could then be distinguished from “abortion,” because the definition of “abortion” is “the deliberate termination of a pregnancy.”
The use of the terms “fertilized egg” and “conception” obscures the reality that fertilization can and does take place while using certain types of drugs and devices labeled as “contraceptives.” From the instant when fertilization happens, a new human life exists. That new human being is called an embryo.
Although clouded by confused terminology, Greenhouse’s central claim is that hormonal contraceptives involved in the HHS mandate—which include Ella (ulipristal) and levonorgestrel IUDs such as Mirena— work only (she claims) to “prevent fertilization from occurring in the first place.” However, Greenhouse is clearly wrong to claim that this is the only mechanism at work with these two contraceptives. Mirena and Ella are both FDA-approved hormonal contraceptives. And both drugs do sometimes work by suppressing ovulation and thereby forestalling the possibility of fertilization. But not nearly always, as Greenhouse maintains.
How Do Hormonal IUDs Work?
Levonorgestrel IUDs such as Mirena may suppress some egg release when first inserted. But within a few years after a woman begins using it, egg release happens almost as often in IUD users as it does in women who are not contracepting at all. Yet in these cases the IUD still prevents “pregnancy.” How does this occur?
The answer about the IUD is no scientific or medical mystery. The embryocidal mechanism of action of IUDs has been known for decades. A careful examination of the recent scientific literature demonstrates that:
- The levonorgestrel IUD can interfere with a woman’s ability to make progesterone, which in turn can lead to an endometrium unable to accept an implantation or unable to sustain an embryo that has implanted. (See this study.)
- Although IUDs can decrease the absolute number of sperm that reach the fallopian tubes, sperm are still capable of reaching the fallopian tube even when copper and levonorgestrel IUDs are in use. Sperm have been directly observed and recovered from the fallopian tubes of women using IUDs. (See studies here, here, and here.)
- Fertilization does take place in some IUD users. Embryos have been directly recovered from the fallopian tubes of IUD users. The documented pregnancy rate of approximately 1 percent also proves that embryos can be created during the use of the IUD. (See studies here and here.)
- Embryos created during the use of copper IUDs develop abnormally. This may be due to toxic effects of the copper on sperm, on the egg, or directly on the embryo. (See studies here, here, here, and here.)
- The IUD changes the lining of the uterus, which makes implantation difficult. This is one of the most widely documented mechanisms of action of both copper IUDs and progestin IUDs. (See studies here, here, here, here, here, here, here, here, and here.)
IUDs have been used as “emergency contraception” and are recommended for use in situations where ovulation has already occurred and the woman is late in her cycle. A 2013 review article illustrates this point:
Therefore, copper IUDs can be inserted up to 5 days after ovulation to prevent pregnancy. Thus, if a woman had unprotected intercourse three days before ovulation occurred in that cycle, the IUD could prevent pregnancy if inserted up to 8 days after intercourse.
IUDs placed after day 24—when implantation has already taken place—are “effective” in preventing a positive pregnancy test. That effectiveness must by definition involve embryocidal actions, because embryos are created on day 12-14 of a woman’s cycle. Even by ACOG definitions of pregnancy, the termination of a pregnancy after implantation constitutes an abortion.
How Does Ella Work After Fertilization?
When taken before an egg is released, Ella—the so-called “week-after pill”—can delay or prevent an egg from being released. But this mechanism can only work if Ella is taken before the egg is released. Ella also effectively prevents pregnancy if a woman takes Ella after she has released an egg, and after fertilization has taken place. What is the mechanism of action for Ella after an egg is released? How does one explain why Ella is still effective at preventing “pregnancy” even if taken days after fertilization has already occurred?
Progesterone is a hormone that enables a mother’s body to nourish an embryo. Progesterone is necessary for an embryo to survive, because it readies the endometrial lining to allow the embryo to implant. Progesterone is also necessary for the mother’s blood vessels to intertwine with the embryonic blood vessels and form the placenta, which nourishes the growing embryo and fetus. Ella and RU-486 (Mifeprex) block all of these necessary changes.
Anti-progesterone drugs such as RU-486, which is widely recognized as an abortion-inducing drug, and Ella, which is a “second generation RU-486,” block progesterone actions in the body. In fact, Ella and RU-486 are equally effective at blocking progesterone. All the changes that progesterone produces to allow a woman’s body to nourish an embryo are prevented by both drugs. Both Ella and RU-486 can interfere with ovulation if either drug is taken more than two days before ovulation. But both can also kill an embryo if a woman takes either drug after she has released an egg and formed an embryo.
The dose of Ella used as emergency contraception is lower than the dose of mifepristone used for abortions. So what does the emergency contraceptive dose of Ella do to human pregnancies that are already implanted? One review article shows that the studies submitted to the FDA for approval of Ella as an emergency contraceptive demonstrated that there was an extremely high rate of “miscarriage” in the 5 percent of women in the study whose embryos survived long enough to produce a positive pregnancy test but could not survive the prolonged progesterone blockade caused by Ella. In other words, a new human being was created, and Ella caused it to be aborted.
HHS Mandate and Conscience
Claims that the levonorgestrel IUD and Ella only work by preventing fertilization cannot be supported in the medical literature. On the contrary, studies show that these FDA-approved hormonal contraceptives can work by multiple mechanisms of action, both pre- and post-fertilization, including sometimes by aborting an already implanted embryo.
Levonorgestrel IUD’s and Ella can and do cause embryos to die after fertilization. Americans who are opposed to the killing of unborn human beings shouldn’t be forced by the government to provide coverage for such drugs that can end a human life.
Donna Harrison, MD, is Executive Director of the American Association of Pro-Life Obstetricians and Gynecologists.