The myth of ectopic pregnancy transplantation – The BMJ

by pregnancy journalist

Ohio’s bill instructing doctors to “reimplant” an ectopic pregnancy is part of a worrisome trend of lawmakers inventing unproven therapies related to reproductive health, say Daniel Grossman and Yanett Anaya

Legislators in Ohio seem determined to push the limits of medical science. For the second time in the past year, a bill that instructs doctors to “reimplant” an ectopic pregnancy into the uterus as a way to save the developing embryo. If passed, the bill would ban all procedures that terminate a pregnancy, including standard treatment for ectopic pregnancies, unless the patient’s life was at risk. Any physician who uses an evidence based treatment for ectopic pregnancy, rather than attempting transplantation could, therefore, be charged with “abortion murder.”

Unfortunately, ectopic transplantation does not exist. Many patients with an ectopic pregnancy are devastated when they learn that their pregnancy will not be able to continue. They ask if anything can be done to save their baby and, with much remorse, we have to tell them that the answer is no. 

After fertilisation occurs in the fallopian tube, a developing embryo travels to the uterus for possible implantation. However, successful implantation requires that both the uterine lining is receptive and that a 5 day old embryo is competent. These , as this cross-talk between embryo and uterus can only occur during a brief period, referred to as the “.” After that, the endometrium is no longer hospitable to a developing pregnancy. Furthermore, extracting a developing pregnancy from its implantation site would be so disruptive as to cause irreparable damage, and the embryo would not continue to grow. Given the complexity of human implantation, we do not have the technology to transplant a developing pregnancy from the fallopian tube, where the implant, and reimplant the pregnancy in the uterus. 

The only published literature on ectopic transplantation includes two case reports from 1915 and . Few details are given in either report, and the latter case was published 10 years after it purportedly occurred. The most recent report in the medical literature of ectopic transplantation turned out to be , and the British doctor who proclaimed it a success was removed from his post. It’s hard to imagine a flimsier body of evidence upon which policy could be based.

Laws that codify this unproven—and what most physicians would call impossible—treatment are dangerous. The proposed bill allows for exceptions if the situation threatens the life of the pregnant patient, but doctors may feel like their hands are tied unless they are 100% certain that the patient will die unless they intervene. The hesitation this causes may delay indicated treatment, such as surgery or methotrexate therapy. Ectopic pregnancy is the in the United States, and we should never delay life saving therapy—especially at a time when we are facing a crisis of in this country.

Beyond the immediate risks to maternal health, these laws stigmatise and shame women who have experienced and survived an ectopic pregnancy. Many women with ectopic pregnancies wanted to be pregnant and would do anything to be able to continue to term. Rhetoric that inaccurately asserts something could have been done to save the pregnancy may be traumatising to patients who appropriately chose interventions that saved their lives. 

This latest piece of legislation around ectopic transplantation is part of a worrisome trend of lawmakers inventing unproven therapies related to reproductive health. In 2015, for example, legislators in Arizona and Arkansas introduced laws requiring abortion providers to inform their patients about the possibility of “reversing” a medication abortion if they changed their minds. At the time, there was documenting the efficacy of so called “reversal” treatment, and a suggests there may be safety risks. 

Only in the area of pregnancy termination would legislators with no medical training be allowed to write laws that advocate for unproven treatments. It is worth noting that patients having an abortion are disproportionately black, Hispanic, or Asian; black women are also more likely to have an ectopic pregnancy—and. These laws push patients to participate in unmonitored experiments, which is concerning given the history of medical experimentation on black and Hispanic people in the US. From the of untreated syphilis to surgical experimentation on enslaved women to the on Puerto Rican women, black and Hispanic people have been the victims of unethical medical experiments that caused them serious harm. We should be wary of repeating this dark past.

It remains to be seen what will happen with these bills in Ohio. Yet regardless of whether either goes into effect, the fact that they were introduced should be deeply worrying to all healthcare professionals and anyone who respects the integrity of science. All of us need to speak up in loud opposition. Ectopic transplantation belongs in science fiction movies, not laws governing reproductive health.

Daniel Grossman is a professor of obstetrics, gynaecology, and reproductive sciences at the University of California, San Francisco, and the director of Advancing New Standards in Reproductive Health. Twitter

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.

Yanett Anaya is an assistant professor of obstetrics, gynaecology, and reproductive sciences at the University of California, San Francisco, and a reproductive endocrinologist at the Center for Reproductive Health.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.

This content was originally published here.

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