Dr. Horacio Croxatto and the morning-after pill

A letter sent to El Mercurio by Dr. Horacio Croxatto and Professor María Elena Ortiz of the Chilean Institute of Reproductive Medicine. I am copying it here because El Mercurio’s blogs tend to suffer from amnesia:

Dear Editor:

Following the ruling of the Constitutional Court (TC) on the so-called "morning-after pill", we feel bound to denounce that recital thirty-two of that ruling misuses our text, published (page 833) as part of chapter 27 of the book "Selección de temas de Ginecoobstetricia II". (eds) E. Guzmán, A.B. Lalonde. Editorial Publimpacto, Santiago, 2007. For your information and that of your readers, we transcribe both paragraphs below:

1. Text in the TC ruling: "... specialists agree that the mechanisms of action of the aforementioned emergency contraception regimens involve three effects: a) Preventing ovulation; b) Preventing the migration of sperm to fertilize the egg, and c) Preventing implantation (Horacio Croxatto A. and María Elena Ortiz. "Anticoncepción de emergencia con levonorgestrel". In: Selección de temas de Ginecoobstetricia II. Chapter 27 (eds.) E. Guzmán, A.B. Lalonde. Editorial Publimpacto, Santiago, 2007, p. 833, and Report of the Universidad Católica de Chile, p. 3)".

2. Our text in the cited Chapter 27: "Most of the research providing information on the mechanism of action of EC with LNG was published in the first five years of the 21st century. Before these studies only hypotheses had been proposed, which can be summed up in three main ones: that it interferes with the migration of sperm, with ovulation, and with events after fertilization, especially implantation. With no evidence for or against, these hypotheses seeped into the literature and made their way into textbooks, official documents of the United States Food and Drug Administration and of the pharmaceutical industry, and into the minds of many professionals".

In the cited chapter and in other reviews on the subject, available to the TC, we have described and analyzed, objectively and clearly, the studies showing that, in women, the Cebus monkey and the rat, LNG given as an emergency contraceptive prevents pregnancy by interfering with processes prior to fertilization, and they lend no support whatsoever to the hypothesis that it might do so by interfering with the implantation of the embryo.

As specialists in the subject, we do not agree that "Preventing implantation" is one of the mechanisms of action of the aforementioned emergency contraception regimens. We express our annoyance and dismay at the misuse of the quotation from our text, given that it was one of the arguments used as grounds for the TC’s final decision.

The inconsistency between what we published in our text and what the TC states in recital thirty-two of the ruling lays bare a transgression against the truth. We hold that to defend life it is not necessary to bend the truth, which must stand above any other consideration. Personal moral convictions do not justify a few imposing a moral dictatorship on our pluralistic society, even less so when it rests on distortions of the truth.

Dr. Horacio B. Croxatto Prof. María Elena Ortiz
Chilean Institute of Reproductive Medicine