In addition, Randy Alcorn found a paper entitled “The Effect of Oral Contraceptive Pills on Markers of Endometrial Receptivity” (Somkuti, et al, Fertility and Sterility, Vol. 65, No. 3, pp. 484-488, 1996). The paper was designed to determine if oral contraceptive usage alters expression of integrins associated with endometrial receptivity. Integrins are a family of heterodimeric cell adhesion molecules that have been implicated in a number of diverse physiological processes, including a role in fertilization and embryo implantation. The authors found that the expression of those integrins most closely associated with endometrial receptivity is altered in the glandular epithelium of women taking OCs. Stromal integrin expression in OC users also differs from that in cycling women. These alterations in epithelial and stromal integrin expression suggest that impaired uterine receptivity is one mechanism whereby OCs exert their contraceptive actions.

The authors repeatedly state that no scientific proof has appeared in the medical literature demonstrating that the pill is abortifacient. They are correct. The reason is that such proof would require collecting, fixing, staining and serially sectioning all vaginal contents from mid-cycle through menstruation and demonstrating the presence of an early embryo. No one has the time, money or motivation for such an undertaking. In addition, would such a study be morally permissible? We think not. Attempting to prove that any mechanism causes the death of an innocent human individual is an assault on the fifth commandment.

The authors next detail the attributes of the blastocyst, and in support of her or his lack of need for a favorable endometrium, state this thesis: “the blastocyst regularly and successfully implants on tubal ciliated epithelium (commonly referred to as tubal, or ectopic pregnancies).” The authors once again are possibly disingenuous or, at a minimum, unfamiliar with the literature on ectopic pregnancies. It is very important to realize the relatively high frequency and high success rate of expectant management, i.e., careful observation only for the treatment of tubal pregnancies. (Fernandez, et al, “Spontaneous Resolution of Ectopic Pregnancy,” ObstetGynecol. 1988: 71:171, 10 more references available on request) These papers describe 193 cases with 129 successful outcomes (68.8%). Thus, when an unruptured, non-bleeding ectopic is diagnosed, when the size is small (equal to or smaller than 3.5 cm.), when the beta hCG is 1000 or less and falling, non-intervention or expectant management offers freedom from the toxicity of methotrexate and the morbidity of surgery. The issue of contraception use and the risk of ectopic pregnancy was addressed by an article in Contraception 1995; 52:337-341. In the body of the paper (p. 339) Mol, et al, who conducted a meta-analysis on numerous papers between the years 1978-1994 observe that: “Condom use shows no increased risk. OCs show a slightly increased risk, in contrast to IUCD use and tubal sterilization, which shows a strongly increased risk.’

This suggestion from the authors about the lack of need of the blastocyst for a well-prepared endometrium came as somewhat of a surprise. From the first year of their studies and throughout their training, medical students learn about the normal ovarian cycle and of its impact on the endometrium. Under the influence of estrogen derived from the developing follicle, the endometrium undergoes remarkable growth during the first half of the month (proliferative phase). Under the influence of the leuteinizing hormone, the follicle that has grown the most bursts, releasing the egg (ovulation). The cells lining the wall of the now-empty follicle (corpus luteum) now begin to produce another hormone, progesterone, which prepares the uterus for pregnancy. The endometrium becomes much more lush, rich in blood supply and nutrients, ready to receive a tiny girl or boy. This is the type endometrium desired by IVF practitioners to accomplish embryo transfer from the petri dish to the womb, the most difficult technological step to accomplish in that variety of artificial reproduction.

The next question raised by the authors is, “Is there actual clinical evidence of early miscarriage in pill users?” They note that the typical clinical picture of spontaneous abortion (heavy bleeding, severe cramping, passage of tissue) is rarely, if ever, seen by practicing physicians caring for patients on the pill. They seem to overlook the facts that the abortions caused by the BCP occur when the baby is 5 to 14-16 days old and that the lining of the uterus is “less vascular, less glandular, thinner” than normal as they described it. From the clinical perspective, one would anticipate a non-event, just as in over 60% of ectopic pregnancies. From the moral perspective, however, it is quite another story. What we are witnessing here is a tragic loss of God’s children, totally innocent and made in His image. It is well to also remember that, from the moral perspective, the numbers don’t matter. If one child is lost, the tragedy isn’t lessened. Following this, the authors asked, “What is the conception rate for women on hormone contraception?” They answer correctly that it is impossible to say. However, earlier in their paper they noted, quite accurately, that the medical literature documents an incidence of 3-5 pregnancies per 100 women per year for pill users. Dr. Don Gambrell, Jr., a renowned gynecological endocrinologist addressed this issue during the educational segment of this same meeting. He noted a 14% incidence of ovulation in women taking the 50 microgram BCP. This rate varies from pill to pill and patient to patient. Simple logic informs one that every fertilization occurring in women on the pill doesn’t result in a term “pill pregnancy” or a surgically induced abortion. But this is the precise thesis of those stating that the BCP is not abortifacient. Simple logic and deductive reasoning would suggest that many more than the clinically diagnosed pregnancies that occur are aborted because of the acyclic, unfavorable-for-implantation endometrium. If IVF practitioners relied on an endometrium that is “less vascular, less glandular, thinner” than that ideal for implantation, their success rate would approach zero today rather than the tens of thousands of babies born of that technology. More on this subject when viewing the mathematics of the issue.

The signatories were distressed by the statement that “millions and millions” of preborn sisters and brothers have been and will be lost to these hormonal agents which obviously can be abortifacient. Let’s look at the math. Women on BCPs have 28-day cycles and thus have 13 cycles per year (365/28 = 13.3). According to Facts in Brief from the Alan Guttmacher Institute (faxed 3/13/98), 10,410,000 U.S. women are current pill users, 26.9% of all methods. This is second only to sterilization used by 27.7% of contraceptors. This would appear to be another sign of their anti-life nature. Dr. Don Gambrell has informed us that there is a 14% breakthrough ovulation rate in females taking the 50 microgram pills (10,410,000 x 0.14 = 1,457,400 ovulations each cycle). 1,457,000 x 13 cycles per year = 18,946,200 possible exposures to pregnancy each year. The accepted rate for “pill pregnancies” is 3-5 per 100 women years. Noting the fact that there is a 60+% rate of spontaneous tubal abortions with an unfavorable implantation site in ectopic pregnancies, it is reasonable for us to calculate a rate of conceptions lost to early physician (BCP) induced abortion of intrauterine pregnancies in pill users as twice that of term “pill pregnancies”, given once again, an endometrium that is “less vascular, less glandular, thinner” than normal. Thus the possible abortion rate induced by BCPs is 18,946,200´ 0.06 = 1,136,772 or 18,946,200 ´ 0.1 = 1,894,620 per year. We are convinced that the reasoning with regard to the math on this issue is sound.