"Pro-Life" Question

[OkieAllDay]

Many people are now advocating for the "Day After Pill" aka "Plan B" is permissible to be taken because it takes 6+ days for conception to occur. Is this true. I was under the impression that as soon (or maybe a few minutes later?) after sex that the egg would be fertilized. They use the 6+ days as a way to promote taking the pill and to say it is not killing a pre-born child, because a new human being has not been formed.
Is this true?

 

[Paidiske]

It's true that it may take several days for the egg to be fertilised. (When you're trying to fall pregnant, you're often advised to try during the three days leading up to ovulation). 6 days is probably more of an outer limit, but it's possible.

The morning after pill works by stopping or delaying ovulation, so that there's no egg there to fertilise. It is, therefore, indeed not an abortifacient.

 

[jayem]

Many people are now advocating for the "Day After Pill" aka "Plan B" is permissible to be taken because it takes 6+ days for conception to occur. Is this true. I was under the impression that as soon (or maybe a few minutes later?) after sex that the egg would be fertilized. They use the 6+ days as a way to promote taking the pill and to say it is not killing a pre-born child, because a new human being has not been formed.
Is this true?

It takes 24 hrs for a sperm to migrate from the vagina, through the cervix, into the uterus, and then up into the Fallopian tube. Which is where it fertilizes an ovum if ovulation has occurred. And as was noted, the primary action of Plan B (levonorgestrel is the generic name) is to block or delay ovulation. If the ovum has already been fertilized, Plan B has no effect.

 

[zippy2006]

Many people are now advocating for the "Day After Pill" aka "Plan B" is permissible to be taken because it takes 6+ days for conception to occur. Is this true. I was under the impression that as soon (or maybe a few minutes later?) after sex that the egg would be fertilized. They use the 6+ days as a way to promote taking the pill and to say it is not killing a pre-born child, because a new human being has not been formed.
Is this true?

The reason Plan B is considered an abortifacient is because it can prevent the implantation of a fertilized egg. The manufacturer, Barr Pharmaceuticals, lists this possibility on the packing itself.

Plan B consists of two 0.75 mg tablets of levonorgestrel, a type of synthetic progesterone or progestin. Current evidence suggests that the hormone works similarly to normal birth control by preventing ovulation, but previous studies have shown that it prevents implantation of a fertilized egg.​

(Plan B: Emergency Contraceptive Pill | The Embryo Project)​

​

There are those, including the two posters above, who apparently believe that the manufacturer of Plan B is mistaken, as are the studies which support their claim. Be cautious about believing random people on the internet.

Is this true?

Sometimes conception can be delayed, but this is not always the case.

 

[zippy2006]

The reason Plan B is considered an abortifacient is because it can prevent the implantation of a fertilized egg. The manufacturer, Barr Pharmaceuticals, lists this possibility on the packing itself.

<This PDF> gives highlights of prescribing information along with the packaging itself.

• "In addition, it may inhibit implantation (by altering the endometrium)."
  • (Clinical Pharmacology: Mechanism of Action, page 4).
• "It is possible that Plan B® One-Step may also work by preventing fertilization of an egg (the uniting of sperm with the egg) or by preventing attachment (implantation) to the uterus (womb)."
  • (Instructions, page 14)
• "This product works mainly by preventing ovulation (egg release). It may also prevent fertilization of a released egg (joining of sperm and egg) or attachment of a fertilized egg to the uterus (implantation)."
  • (Packaging, pages 32 and 33)

 

[comana]

I think it would be very hard to prove a fertilized egg existed and did not implant due to use of Plan B.

 

[zippy2006]

I think it would be very hard to prove a fertilized egg existed and did not implant due to use of Plan B.

Barr Pharmaceuticals is probably deeply confused about how the drug they produced works. I would suggest that you write them a letter and explain to them how their drug actually works.

 

[comana]

Barr Pharmaceuticals is probably deeply confused about how the drug they produced works. I would suggest that you write them a letter and explain to them how their drug actually works.

I understand what they have stated, however, it is theoretical. It cant be proven to have occurred.

 

[jayem]

The reason Plan B is considered an abortifacient is because it can prevent the implantation of a fertilized egg. The manufacturer, Barr Pharmaceuticals, lists this possibility on the packing itself.

Plan B consists of two 0.75 mg tablets of levonorgestrel, a type of synthetic progesterone or progestin. Current evidence suggests that the hormone works similarly to normal birth control by preventing ovulation, but previous studies have shown that it prevents implantation of a fertilized egg.​

(Plan B: Emergency Contraceptive Pill | The Embryo Project)​

​

There are those, including the two posters above, who apparently believe that the manufacturer of Plan B is mistaken, as are the studies which support their claim. Be cautious about believing random people on the internet.


Sometimes conception can be delayed, but this is not always the case.

Blocking implantation can only occur after fertilization. As I said, it takes 24 hrs for a sperm to reach the Fallopian tube to fertilize the ovum. And then it can take 6 days for the zygote to implant. If levonorgestrel is taken in a timely manner—like 24 or less hours after unprotected intercourse—then ovulation is blocked and the sperm will find nothing to fertilize. Any concern about interference with implantation is null and void when Plan B is taken ASAP.

Edited to add: I forgot to attach a link to the FDA website info on Plan B. This is very recent--from Dec., 2022. And it specifically mentions a review of current data on the implantation issue, which has led to a revision of the Consumer Information Leaflet:

In response to the submission of the applicant’s labeling supplement, as amended, FDA reviewed currently available scientific evidence regarding the mechanism of action for Plan B One-Step. FDA determined the current science supports a conclusion that Plan B One-Step works by inhibiting or delaying ovulation and the midcycle hormonal changes. The evidence also supports the conclusion that there is no direct effect on fertilization or implantation.

Plan B One-Step Information

 

[GodLovesCats]

Every article I read about Plan B says it is most effective when taken within 72 hours. However, they stop short of saying if this means it takes three days to fertilize or three days to implant on the uterine wall.

 

[zippy2006]

Edited to add: I forgot to attach a link to the FDA website info on Plan B. This is very recent--from Dec., 2022. And it specifically mentions a review of current data on the implantation issue, which has led to a revision of the Consumer Information Leaflet:

Interesting. My hunch all along was that the idea behind the pro-choice defense of Plan B is essentially, "This drug is meant to prevent fertilization, and that's what usually happens. There is evidence that the drug can also prevent implantation of a fertilized egg, but the data for this claim is weaker and it is not the primary mode of action. Thus labeling based on this secondary mode of action is unnecessary."

That hunch was correct. The FDA basically took that idea and signed off on a labeling change based on that rationale. See especially, "III. Applicant’s Rationale for Requested Labeling Change," in the FDA's <decisional memorandum>. It is in the first place a marketing strategy; one which is based on a distinction with respect to the "primary mode of action."

This is interesting and all, but from the perspective of moral philosophy neither a marketing strategy nor any of the other relevant facts here change the moral status of Plan B as an abortifacient. I think it was known all along that the prevention of implantation was a secondary mode of action. Perhaps that secondary mode of action is rarer than was first supposed (my guess is that this labeling change will fuel new research), but moral philosophy is not as concerned with the frequency of a mode of action, as marketing and labeling are.

 

[zippy2006]

Blocking implantation can only occur after fertilization. As I said, it takes 24 hrs for a sperm to reach the Fallopian tube to fertilize the ovum. And then it can take 6 days for the zygote to implant. If levonorgestrel is taken in a timely manner—like 24 or less hours after unprotected intercourse—then ovulation is blocked and the sperm will find nothing to fertilize. Any concern about interference with implantation is null and void when Plan B is taken ASAP.

Regarding this argument, I think there are some logical errors. Here is a quote from the FDA <decisional memorandum>, page 6:

"After unprotected intercourse, sperm that reach the fallopian tube generally survive for 3-4 days, although this is variable. The released ovum enters the fallopian tube, and generally must encounter sperm within 12-24 hours in order for fertilization to occur."​

The key point is that there is legitimate motivation for Plan B use even after the 24-hour period you speak of. Such a use could, for example, successfully prevent pregnancy when the sperm are alive and the ovum is released, even when this happens after the first 24 hours. Ergo, levonorgestrel need not be taken within 24 hours in order to be effective.

We could mete this out in more detail, but your premise seems to be that if the sperm finds nothing to fertilize after 24 hours, it will never find anything to fertilize after 24 hours. That premise seems to be wrong (according to the memorandum).

(Or else, if you are only saying that a pro-life woman could safely consume levonorgestrel within 24 hours, but not after, then perhaps you are right. Of course, I would want to consult a medical professional to verify such information.)

 

[GodLovesCats]

It takes 24 hrs for a sperm to migrate from the vagina, through the cervix, into the uterus, and then up into the Fallopian tube. Which is where it fertilizes an ovum if ovulation has occurred. And as was noted, the primary action of Plan B (levonorgestrel is the generic name) is to block or delay ovulation. If the ovum has already been fertilized, Plan B has no effect.

I thought if the ovum was already fertilized, Plan B would kill the zygote on its way to the uterine lining, preventing the official start of pregnancy. Otherwise, there would be no reason for abortion opponents to hate the drug.

 

[zippy2006]

I thought if the ovum was already fertilized, Plan B would kill the zygote on its way to the uterine lining, preventing the official start of pregnancy. Otherwise, there would be no reason for abortion opponents to hate the drug.

This is what the Consumer Information Leaflet for Plan B used to say. As of December 2022, it says something different. Plan B petitioned the FDA to change the drug information because they wanted better marketing, and the FDA complied. How exactly this change relates to the research is unclear. Apparently the more recent research favors the change, while the earlier research did not. In any event, the marketing strategy is only indirectly related to the research. The FDA effectively said, "Hey, if abortion is not the intention of the drug makers, and if abortion only occurs rarely* while using the drug, then you don't have to list it in your drug information."

tldr: Barr Pharmaceuticals changed their labeling after they realized it "polled badly." In a thoroughly pro-choice culture it would have polled well, and they would not have changed it.

* If the data supporting evidence of abortions are "weak to speculative"

 

[GodLovesCats]

I think it would be very hard to prove a fertilized egg existed and did not implant due to use of Plan B.

Totally impossible. And even if that could be done, the government would have absolutely no right to find out, according to the Fourth Amendment of the U.S. Constitution.

Physically Intrusive Abortion Restrictions as Fourth Amendment Searches and Seizures - Harvard Law Review

Successful challenges to abortion restrictions have typically been brought under the Fourteenth Amendment’s Due Process Clause and considered within a right-to-privacy framework. However, legal...

harvardlawreview.org

II. Physically Intrusive Abortion Restrictions as Fourth Amendment Violations​

The Fourth Amendment protects against government-mandated physical intrusions into the constitutionally protected areas of persons, houses, papers, and effects. Such intrusions come in two principal forms under the Amendment: searches and seizures. Section II.A argues that mandatory ultrasounds constitute unreasonable searches. The Supreme Court has explained the protection vis-à-vis searches in two ways: first, as defending reasonable expectations of privacy,41 and second, as preventing physical intrusions as harms in themselves.42 As this Note argues that physically intrusive abortion restrictions constitute Fourth Amendment violations, it applies the physical intrusion test — or “trespass test”43 from United States v. Jones44 and Florida v. Jardines45 — to evaluate whether certain conduct in the abortion-restriction context constitutes a search. Concluding that mandatory ultrasounds are searches, this section then evaluates their reasonableness under a variety of frameworks.

Section II.B argues that mandatory ultrasounds also amount to unreasonable seizures. The intrusiveness of abortion restrictions such as mandatory ultrasounds makes them prime candidates for evaluation under the intrusiveness rather than invasion-of-privacy conception of seizures.46 The analysis will address whether a woman undergoing physically intrusive abortion restrictions would believe she is “not free to leave,”47 and whether the intrusion imposed outweighs its public-interest justification and thus renders it unreasonable.

So whether an obstetrician is able to see a zygote or not would be totally irrelevant.

 

[jayem]

Every article I read about Plan B says it is most effective when taken within 72 hours. However, they stop short of saying if this means it takes three days to fertilize or three days to implant on the uterine wall.

I worked in health care 40+ years. My training and certification is in internal medicine. I'm not an Ob-Gyn, I don't deliver babies, and I don't perform abortions. But I know some gynecology. There's a lot of variation, but on average, the menstrual cycle for a woman of child-bearing age is 30 days. Ovulation occurs once each monthly cycle, generally the mid-point--day 15. That's when an egg cell is released from the ovary and enters the Fallopian tube. It stays there for 12-24 hrs. If a sperm cell makes it way into the tube during that time, the egg will be fertilized. It's then called a zygote. It begins to divide as it travels through the Fallopian tube. When it enters the uterus, it's become a hollow ball of 200-300 cells, which is called a blastocyst. At this stage, it implants into uterine wall. From zygote to implanted blastocyst usually takes 6 days.

On the male side, sperm cells deposited in the vagina during intercourse take 24 hrs to reach the Fallopian tube. Only the hardiest sperm will survive the journey. And for pregnancy to occur, a sperm cell must be in the Fallopian tube on that one day each month when an ovum is present.

So...the greatest chance of getting pregnant is if ovulation occurs 24hrs after intercourse. That's when the egg is most likely to meet a sperm. But there's a lot of variation. Not all women ovulate at the same time every month. Sometimes it's sooner than day 15, and sometimes it's later. And not all sperm can reach the egg in 24 hrs. I know the Plan B instructions say it's effective up to 72 hrs after intercourse. But as I see it, the best time to take Plan B is 24 hrs after intercourse. Levonorgestrel blocks or delays ovulation. It does not prevent a blastocyst from implanting.

Sorry for the long post.