After my 20th shot of hormones, I texted my boyfriend, only half kidding, “I’m dying.” We had decided to freeze embryos, but after more than a week of drugs that made me feel like an overinflated balloon and forced me to take several secret naps a day, I no longer cared whether we froze anything. I was not doing this again.

In order to maximize the number of eggs that can be harvested from the human body, most women who undergo an egg retrieval spend two weeks, give or take, injecting themselves at home with a cocktail of drugs. The medications send the reproductive system into overdrive, encouraging the maximum number of egg-containing follicles to grow and mature at once. They can also cause itchiness, nausea, fatigue, sadness, headaches, moodiness, and severe bloating as your ovaries swell to the size of juicy lemons. Some people experience ovarian hyperstimulation, which can lead in rare cases to hospitalization. Studies have found the stress of fertility treatment to be a primary reason people stop pursuing it, even if they have insurance coverage.

Many people who continue with IVF feel that, if they want a child, they have no other choice. “Right now our treatment options are pretty binary,” Pietro Bortoletto, the director of reproductive surgery and a co-director of oncofertility at Boston IVF, told me. “Either you just put sperm inside the uterus. Or you do IVF, the full-fledged Cadillac of treatment.” But a third option is emerging, one that could reduce the cost and time that fertility patients spend at the doctor’s office and mitigate the side effects. It’s called in vitro maturation, or IVM. Whereas IVF relies on hormone injections to ripen a crop of eggs inside the body, IVM involves collecting immature eggs from the ovaries and maturing them in the lab. The first IVM baby was born in Korea in 1991, and since then, the method has generally yielded lower birth rates than IVF. Decades later, new scientific techniques are raising the possibility that IVM could be a viable alternative to IVF—at least for some patients—and free thousands of aspiring mothers from brutal protocols.

The challenge of IVM is to figure out how to make fragile, finicky human eggs mature in a dish as well as they do within the ovaries. The handful of researchers and companies leading the push to make IVM more mainstream are taking different approaches. One Texas-based company, Gameto, uses stem cells to produce something akin to an ovary in a dish, mimicking the chemical signals an egg would receive in the body. Last month, for the first time, a baby was born who was created using Gameto’s stem-cell medium, Fertilo. The fertility clinic at the University of Medicine and Pharmacy at Ho Chi Minh City, in Vietnam, uses a technique that involves first allowing the retrieved eggs to rest, then ripening them. Lavima Fertility, a company that spun out of research at the Free University of Brussels, is working on commercializing that technique.

For now, these new treatments aren’t commercially available in the United States. The Food and Drug Administration hasn’t historically weighed in on the media that human embryos grow in, but it asked Gameto to seek approval to market Fertilo. Gameto is now preparing for Phase 3 clinical trials. Lavima could face similar hurdles. Older IVM methods are available in the U.S., but not widely used. Meanwhile, more than a dozen women in countries where Fertilo has been cleared for use, which include Australia, Mexico, Peru, and Argentina, are carrying Fertilo-assisted pregnancies, according to the company.

Compared with IVF, IVM is far more gentle. Harvesting immature follicles requires only one or two days of hormonal injections, or skips the process altogether. Reducing the hormone doses necessarily means fewer side effects and cases of ovarian hyperstimulation syndrome. (It may also curtail any possible long-term health effects of repeated exposure to these hormones, which have not been well studied.) Skipping or reducing the drugs can also save women thousands of dollars and many visits to a provider for blood work and monitoring. For women who live far from fertility clinics, or can’t commit to so many visits for other reasons, this protocol could make the difference between undergoing treatment and not, Bortoletto said.

Historically, IVM has generated fewer mature eggs and embryos compared with IVF. The stats are improving, but even if IVM maintains an overall lower success rate than IVF, it still could be the better option for several groups of patients. Egg donors, many of whom undergo multiple retrieval cycles, could be good candidates. So could hyper-responders—patients whose ovaries naturally develop more follicles each month, thanks to their young age or conditions such as PCOS. IVM clinicians could gather enough eggs from hyper-responders that even if a smaller number mature in the lab than might have in the ovaries, a patient would still have a good chance of pregnancy. These patients are also at the highest risk for uncomfortable or dangerous IVF side effects. IVM could be a safer choice, and an effective one. In a 2021 committee opinion, the American Society for Reproductive Medicine concluded that IVM reduced the burden of fertility treatment for these groups of patients. Some studies of hyper-responders have found a live birth rate of 40 percent or higher per IVM cycle, a number on par with that of IVF.

Many women seek IVF because they are approaching their 40s and have few eggs left; they will likely never be good IVM candidates. But IVM might work just fine for patients with blocked fallopian tubes, single and LGBTQ people, and young women who want to freeze their eggs. It could also be useful to cancer patients, many of whom don’t have time to undergo a lengthy IVF cycle before beginning cancer treatment that threatens their fertility. The University of Medicine and Pharmacy in Vietnam primarily offers IVM to women with PCOS, women who appear to have a significant reserve of eggs, and women with a condition that mutes their response to hormonal stimulation. Lan Vuong, who heads the department of obstetrics and gynecology, told me the live-birth rate with IVM there is about 35 percent.

IVM could go far in helping to reduce the physical and emotional toll that fertility treatment takes on women at a time when more people than ever are seeking it out. In some ways, IVF’s burden on women has increased: In an effort to improve birth rates, new drugs, with their attendant side effects, have been added to the standard protocols in the decades since 1978, when the first IVF baby was born. Beyond IVM, some companies are exploring new ways to reduce pain points, for instance by replacing needle injections with oral medications, some of which aim to have gentler side-effect profiles, or by having patients monitor a cycle at home instead of schlepping to the doctor every other day. Dina Radenkovic, the CEO of Gameto, told me that, within the fertility industry, there is a “growing recognition that fertility treatments must be not only effective but also more humane.”

Knowing all this, I can’t help imagining how my own experience could have been different. My doctor eventually told me that part of the reason my cycle was so painful was that I was a hyper-responder, even at the advanced age of 37. If a gentler option had been available, I would have been a prime candidate.

Over the past several years, a medication called mifepristone has been at the center of intense moral and legal fights in the United States. The pill is the only drug approved by the FDA specifically for ending pregnancies; combined with misoprostol, it makes up the country’s most common regimen for medication abortions, which accounted for more than 60 percent of terminations in the U.S. in 2023, according to the Guttmacher Institute, a research group that supports abortion rights. And yet, mifepristone is difficult or impossible to acquire legally in about half of states. Since Roe v. Wade was overturned in 2022, multiple federal lawsuits have threatened access to the pill at the national level.

Now a preliminary study suggests that using another drug in place of mifepristone may be just as effective for terminating an early pregnancy. The drug, called ulipristal acetate and sold as a 30-milligram pill under the brand name Ella, was approved by the FDA in 2010 as prescription-only emergency contraception. In a paper published today in the journal NEJM Evidence, researchers from the reproductive-rights nonprofit Gynuity Health Projects, along with partners in Mexico, reported the results of a trial in Mexico City that included more than 100 women with pregnancies up to nine weeks’ gestation. They found that medication abortion using 60 milligrams of ulipristal acetate (the equivalent of two doses of Ella) followed by misoprostol ended 97 percent of patients’ pregnancies without any additional follow-up care. (The FDA-approved regimen of mifepristone followed by misoprostol is about 95 percent effective, but because the new study did not directly compare the ulipristal acetate–misoprostol regimen to any other, researchers can’t yet say whether it’s superior or inferior to the standard regimen of mifepristone and misoprostol or misoprostol alone.)

The new study is small and did not include a control group. But the findings raise the provocative possibility that a drug already marketed as a contraceptive could also serve, at a higher dose, as a medication for abortion—a potential substitute for mifepristone, subject to fewer restrictions, wherever the latter is banned or difficult to get. The American abortion landscape, already fragmented, just got even more complicated.

Ulipristal acetate is a chemical relative of mifepristone and the most effective emergency-contraceptive pill available in the United States. When taken within five days of unprotected sex, it delays ovulation, which in turn prevents fertilization of an egg. Studies show that Ella works better than morning-after pills containing levonorgestrel, such as Plan B One-Step, and is more effective for a longer period of time after sex. Ella may also be more effective than other morning-after pills in people with a BMI above 26, which includes most American women over the age of 20. Although Ella’s 30-milligram dose is enough to prevent pregnancy, previous studies have suggested that the amount is highly unlikely to help end pregnancy as mifepristone does, by blocking a fertilized egg from implanting in the womb or disrupting the uterine lining.

Some experts have long suspected that a higher dose of ulipristal acetate could yield a different result. But the field has been generally reluctant to pursue research on the drug as a possible abortifacient out of concern for its role as an emergency contraceptive. Studies have repeatedly shown that a lower dose of mifepristone can act as an effective emergency contraceptive when taken soon after unprotected sex, with few side effects. It’s sold that way in a handful of countries where abortion is legal and widely available—but in the U.S., it was never approved for emergency contraception, and reproductive-rights advocates have not pushed for it. “Our idea, when we developed ulipristal acetate, was precisely to get away from abortion,” says André Ulmann, the founder and former chair of HRA Pharma, the drug’s original manufacturer. He and his colleagues worried, he told me, that any association with abortion would endanger their ability to market the drug for emergency contraception.

[Read: The other abortion pill]

The new study may very well validate Ulmann’s old fears. If further research confirms its findings, Americans seeking abortions may soon have a safe and effective workaround in places where mifepristone is restricted—and American abortion opponents will have a big new target. In an NEJM Evidence editorial accompanying the Gynuity study, Daniel Grossman, a professor of obstetrics, gynecology, and reproductive sciences at UC San Francisco, argued as much, writing, “There is a risk that the findings of this study could be misapplied and used by politicians to try to restrict ulipristal for emergency contraception.” Beverly Winikoff, the president and founder of Gynuity Health Projects and a co-author of the study, told me that she knew the stakes when she and her colleagues began their research. But part of Gynuity’s mission is to safeguard abortion care. In Winikoff’s view, another potential option for medication abortion in the U.S. was too important to ignore.

In 2022, a coalition of groups that oppose abortion sued the FDA in an effort to pull mifepristone off the market. In June, the Supreme Court unanimously struck down the challenge, ruling that the anti-abortion groups lacked standing. But in October, three states filed an updated version of the same suit in federal court; last week, a federal judge ruled that the case can proceed. Currently, 14 states have a near-total ban on medication abortion, and more than a dozen others limit how the drugs can be distributed, with requirements such as an in-person visit, an ultrasound examination, and a 24-hour waiting period. More restrictions may be on the way: Project 2025, the conservative-policy plan developed by the Heritage Foundation for an incoming GOP administration, calls for the FDA to entirely withdraw the drug’s approval. President Donald Trump, however, has been inconsistent, saying that he doesn’t plan to block access to the abortion pills while simultaneously refusing to rule out the possibility.

In light of the new study, it’s hard to imagine that anti-abortion groups won’t seek similar restrictions on Ella, threatening its availability as an emergency contraceptive. Anti-abortion activists and Republican lawmakers have repeatedly sought to blur the line between abortion and contraception by reasoning that pregnancy begins not, as federal law states, after a fertilized egg has implanted in the uterus, but at the moment when egg and sperm meet. Students for Life of America claims, for example, that all forms of hormonal birth control are abortifacients. “Abortion advocates have long denied Ella’s potential to end an embryo’s life, but this study contradicts that narrative,” Donna Harrison, the director of research for the American Association of Pro-Life Obstetricians and Gynecologists—which was a plaintiff in last year’s Supreme Court case—told me in a statement. “Women deserve to be fully informed about how this drug works, as well as its risks.” (Until now, no evidence had indicated the drug’s abortifacient potential; at the dose approved for emergency contraception, there is still no evidence that Ella can disrupt an established pregnancy.)

[Read: Abortion pills have changed the post-Roe calculus]

The Gynuity study points to a possible role for ulipristal acetate as part of an abortion regimen, Kelly Cleland, the executive director of the American Society for Emergency Contraception, told me. But it doesn’t change what we know about its use for emergency contraception. For now, Ella remains on the market as just that.