EXECUTIVE SUMMARY

New research shows using a low-sensitivity pregnancy test after a medication abortion is both accurate and safe.

  • The 1,000 mIU/mL low-sensitivity pregnancy test or the five-level multilevel pregnancy test can be used safely without a visit to a provider’s office or clinic.
  • Traditionally, women had to return to the clinic that provided the medication abortion pills to confirm their pregnancy was terminated.
  • This research suggests a way for women to undergo a medication abortion without having to visit a clinic afterward.

As more people access a medication abortion remotely — either through recent pilot studies or as part of temporary rules during the pandemic — a low-sensitivity pregnancy test can be used without in-person contact.

New research shows people can use both a 1,000 mIU/mL low-sensitivity pregnancy test or a five-level multilevel pregnancy test safely without visiting a provider’s office or clinic.1

“I view the study and findings as an adjunct to what’s going on right now in making mifepristone more accessible to women,” says Wing Kay Fok, MD, MS, FACOG, clinical assistant professor of obstetrics and gynecology at Weill Cornell Medicine in New York City. “Our study demonstrates that in-person follow-up is not necessary, and women should have an array of options for how to confirm that their pregnancy has been terminated.”

Traditionally, women who have obtained a medication abortion return to the clinic that provided the drugs for in-person follow-up. This could entail an ultrasound or blood test, Fok adds.

Traditional pregnancy tests purchased over the counter at a pharmacy are not accurate within the first few weeks following a medication abortion because the woman’s pregnancy hormone levels still are decreasing.

“The pregnancy test at a pharmacy is a different type of pregnancy test, and it’s not useful for following up on medication abortion until after four weeks,” Fok says. “It’s a much longer time frame than what [the low-sensitivity pregnancy test] can provide in terms of confirmation of pregnancy resolution.”

This suggests that the low-sensitivity pregnancy test, which can be administered at home and without clinician help, would work better in cases of telemedicine abortion, especially if the goal is for someone to obtain quick confirmation that the abortion worked without having to drive to a clinic for follow-up.

“An alternative is that they have a telephone follow-up where they speak with a clinician and discuss symptoms after taking mifepristone, and if their symptoms are consistent with what we expect after medication abortions, they may be instructed to take a pregnancy test at home, four weeks after taking mifepristone,” Fok says.

Obstacles to Test Remain

The current obstacle is that both the low-sensitivity pregnancy test and the five-level multilevel pregnancy test, which are similar in rapid and accurate results, are not marketed commercially in the United States. The tests are available in parts of Europe, but typically are used in the United States only during research studies.

“The low-sensitivity pregnancy test is not commercially available in the United States, although it may be used under certain protocols in certain clinics,” Fok says. “The five-level pregnancy test is not being used; it’s not mass produced, and there’s not a market for it.”

One goal of studying these two pregnancy tests is to show they can be useful in the case of medication abortions. “Our goal as we attain more evidence of utility and value of both of these tests is it will become available in the United States in years to come,” Fok says.

Clinics could order these tests if desired, but they likely would have to be ordered in bulk supply. “It doesn’t change how mifepristone is dispensed — meaning, in the interim of managing the pandemic, it can be provided to people without an in-person visit,” Fok says.

With more studies like this, it is possible manufacturers will pursue marketing the low-sensitivity pregnancy test in the United States.

“I think this study, along with others before it, confirms there are lots of ways of providing medication abortion safely,” Fok says. “It’s not a one size fits all; there are different ways to provide follow-up of medication abortion, which makes it easier in the pandemic as well as in the long run.”

REFERENCE

  1. Fok WK, Lerma K, Shaw KA, Blumenthal PD. Comparison of two home pregnancy tests for self-confirmation of medication abortion status: A randomized trial. Contraception 2021;S0010-7824(21)00150-5.