Sir,

In her recent overview of emergency contraception (November, 2012) Dr. Batel wrote that emergency contraception (eg, Plan B) does not cause abortion. We disagree. We consider any interruption of human development after fertilization to be abortion (ie, abortifacient). Most researchers agree that Plan B has almost no effect on ovulation if given on the day of ovulation or after, therefore, its’ main effect is reportedly to stop ovulation when given prior to the day of ovulation.1 However, Croxatto et al noted (via ultrasound) that Plan B allowed ovulation 88% of the time when given one or two days prior to ovulation.2 More recently, the same author found that Plan B was 100% effective in stopping clinical pregnancy when given one or two days prior to ovulation.1 Since Plan B’s efficacy is significantly higher than its’ ability to inhibit ovulation on these days, another mechanism of action must be occurring when ovulation does occur, that is, the other 88% of the time; a non-contraceptive action is the most likely explanation by default since the other main effect (ie, thickening of cervical mucus) likely plays little role if Plan B is taken several hours after sexual activity. Dr. Batel states that Plan B is not an abortion pill because it serves “to enhance the progesterone effect” on the endometrium; however, Plan B usually causes menstrual bleeding in about 15% of women taking it within seven days.3 In addition, Kesseru et al noted that intrauterine pH rose to over 9 when a low dose of Plan B was given;4 this is a 10 fold increase in alkalinity above the normal uterine pH. The pH within the fallopian tubes was not measured but if a similar rise in pH occurred, it could easily explain how early embryos might die from Plan B.

1. B Noé G, Croxatto HB, Salvatierra AM, et al. Contraceptive efficacy of emergency contraception with levonorgestrel given before or after ovulation. Contraception 2011; 84:486- 492 1 | Page

2. Croxatto HB, Brache V, Pavez M, et al. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75-mg dose given on the days

preceding ovulation. Contraception 2004; Dec;70(6):442-50.

3. Gainer E, Kenfack B, Mboudou E, Doh AS, Bouyer J. Menstrual bleeding patterns following levonorgestrel emergency contraception. Contraception. 2006 Aug;74(2):118-24.

4. C Ugocsai G, Rózsa M, Ugocsai P. Scanning electron microscopic (SEM) changes of the endometrium in women taking high doses of levonorgestrel as emergency postcoital contraception. Contraception 2002; Dec;66(6):433-7.

5. Kesserü E, Garmendia F, Westphal N, Parada J. The hormonal and peripheral effects of d-norgestrel in postcoital contraception. Contraception. 1974 Oct;10(4):411-24.

6. http://www.planbonestep.com/pdf/PlanBOneStepFullProductInformation.pdf

7.http://www.acog.org/~/media/For%20Patients/faq114.pdf?dmc=1&ts=20121127T1830130312