When offered a choice of abortion through surgery or treatment with RU486, 60-70% of women choose RU486. Use of RU486 is, however, limited by the cost of the drug and the conservative marketing policy of Roussel Uclaf, holders of the patent. Methotrexate is a drug registered in many countries for several indications, including cancer therapy and psoriasis. In 1993, Creinin and Darney described its use as an abortifacient. Methotrexate when combined with prostaglandins works almost as well as mifepristone (RU486). It is inexpensive, off patent, and readily available in many parts of the world. Moreover, the US Food and Drug Administration has no jurisdiction over the off-label use of methotrexate as an abortifacient and an investigational new drug application is not required. Early trials to determine dosage are now being followed by larger studies of efficacy and side-effects. All of the experimental protocols have used a similar dosage regimen of methotrexate (approximately 80 mg) given intramuscularly, followed by 800 mcg of misoprostol per vagina 5-7 days later. Used before 56-63 days after the last menstruation, the regimen is 88-97% effective, and before 42 days methotrexate may be effective without misoprostol. Uterine emptying can take as long as two weeks and the decidua must be shed spontaneously, as with a spontaneous abortion. Even so, 90% of study participants reported that they would choose the method again if needed. Some investigators use a second dose of misoprostol, while the one in twenty aspiration procedures which seem to be needed with methotrexate abortion could be carried out as for any other minor operation by a trained person. Methotrexate together with the misoprostol costs less than US$7.00, even in the US. The author notes that while methotrexate is teratogenic in animals, and use before conception has been associated with spina bifida, use after conception has not been shown to be harmful and there in reassuring evidence of no long-term adverse effects upon subsequent pregnancies.