The idea of babies not needing a human womb seemed like the stuff of science fiction nightmares not long ago.
Ectogenesis, the term given to pregnancy conducted outside the uterus, has become a big topic in medicine, psychology and ethics but there has been no ‘Dolly the sheep’ moment… for now at least.
But just as cloning before it, the idea is possible in principle and has been demonstrated by ‘birth in a bag’ lambs brought to term, at least in part, without a live womb.
The most prominent experiment kept lamb foetuses in a ‘biobag’ that looked similar to a regular plastic bag for four weeks between the 23rd and 27th week of their development.
It provided a nutrient-rich blood supply and amniotic fluid and is seen as another step towards ‘birth in the bag’ technology.
There are two very different applications of these sorts of devices:
- Artificial womb technology (AWT) substitutes for a real womb right from the start so the foetus never needs to be inside a human and works as if the baby is still yet to be ‘born’
- Neonatal intensive care (NIC) – like in the lamb experiment – is a more well understood replacement for an incubator. It works to improve survival rates in premature births and works ‘after’ the baby is medically seen to have been born
The law in the UK, and 11 other countries, bans human embryos developing outside the body for more than 14 days.
That time is said to be the moment when the ‘primitive streak’ is likely to develop as a guide for where the spine will grow or, as Ali Brivanlou, a professor at Rockefeller University, puts it: ‘It’s that moment where you separate your head away from your butt.’
But experimentation in this field has been going on with goats and mice since the 1980s. The term ‘ectogenesis’ has been around since the 1920s.
With surrogacy growing in awareness, particularly with Kim Kardashian choosing a surrogate for her third and fourth children, what’s the difference between contracting a person to carry your baby and contracting a machine?
And what happens if not needing the parents for the process is actually good for the baby?
‘There are limits to how far we can control pregnant women,’ Dr Anna Smajdor, associate professor of practical philosophy at the University of Oslo, tells Metro.co.uk.
‘If the foetus were in an artificial womb, it would become possible to access it and control the environment without restricting a woman’s autonomy. So in some ways there could actually be benefits for the foetus itself.’
There are clear ethical concerns over growing a baby with a machine rather than a human. IVF and surrogacy – not without their own controversies – still require a human.
The idea of NIC is a lot less problematic to ethicists than AWT, as a human still has to be directly involved in NIC but it raises a lot of questions around abortion.
Severe impairments currently are regularly found in babies born before 28 weeks and informs a lot of the current legal dates around terminating pregnancies.
There are those who wish to use external pregnancies to end the abortion debate, potentially allowing or even forcing those requesting an abortion to transfer their foetus to an artificial womb.
Full ectogenesis would mean that a baby is ‘viable’ from the point of conception so means abortion regulations could change across the world.
Secondly, and perhaps more shockingly, removing the womb from the whole foetal process might actually change how humans evolve.
‘We know that the constraints of the human uterus and pelvis have acted as a brake on the size of the human brain and skull,’ Dr Smajdor says.
‘If freed from the need to be “born” in the normal way, we might open the way for a new evolutionary trajectory.’
This new ‘evolutionary trajectory’ still seems distant though.
With no baby of any species being fully brought to term without a live womb for now, how distant a prospect is this sort of technology?
‘We’re in the process of interacting with the [US Food And Drug Administration] FDA, so it’s not impossible that we could be doing a clinical trial one to two years from now,’ said Dr Alan Flake, of the Children’s Hospital of Philadelphia which carried out the research using the biobag and the lambs.
And he’s not the only one who’s optimistic with timings:
‘It seems probable that we are only several years away from testing on human subjects,’ social ethics and policy academic Elizabeth Chloe Romanis wrote in the BMJ’s Journal Of Medical Ethics.
There have been embryos kept alive in a Petri dish for 13 days (and only ended then because of the 14-day legal rule).
Dr Carlo Bulletti, associate professor at Yale University’s obstetrics, gynecology, and reproductive science department, thinks that a fully functioning artificial womb could be a real thing within the next 10 years.
And while only a design project, students from Artex Product Design Arnhem have even designed what that womb might look like.
Instead of a mother feeling her baby kick or going through the whole journey of carrying a child, they would instead look on at their baby growing without them.
Does this mean that the mother/child bond will be severed for good?
‘Many arguments have been made about the necessity of gestation and childbirth for bonding,’ Dr Smajdor says.
‘Although it may be true that the physical closeness between mother and baby facilitate bonding, it is certainly not true that it is necessary for bonding. If it were, fathers would have no claim to be bonded with their children.
‘Not just this, but it is becoming increasingly clear that traumatic births actually impede maternal bonding, rather than the other way round.’
So could not having to carry a baby help with the special relationship?
‘With developments in technology, increasingly, parents describe the moments of special bonding as being when they see the first scans,’ Dr Smajdor says.
‘So this seems to imply that it is a visual connection that is regarded as being important rather than the physical one per se. Ectogenesis could actually facilitate this kind of visual bonding.’
Each year, around 300,000 women die from pregnancy or complications shortly afterwards. In the UK, 8.8 women die during pregnancy or shortly afterwards for every 100,000 women who gave birth.
‘Most future folk will find pregnancy – especially the delivery of an infant through a birth canal – messy and risky,’ technologist and author Matt Chessen wrote in Wired.
‘Creating a baby inside another human being is hazardous. The child’s health is dependent on the mother’s physical security as she navigates the world, and the foetus is susceptible to infections, poor nutrition and other threats.’
But how does it change what parenthood means forever? Does ectogenesis even the balance between men and women or remove men from the process entirely?
‘Ectogenesis would definitely be a challenge for our current conceptions of parenthood,’ Dr Smajdor says.
‘We already see this to some degree, that with new reproductive technologies, concepts of parenthood are fragmenting.
‘Perhaps there is no such thing as “real” parenthood. People value different aspects of parenthood according to their subjective values, so maybe this is what we need to embrace and accept.’
There’s a further controversy in what happens when artificial gametes (lab-created eggs and semen) are introduced to the process.
The eggs and semen won’t be from a human, the baby will never have been inside a human and there will countless ethical debates about where humanity begins and ends.
Away from the more philosophical debates, there are real practical concern about what happens in an external pregnancy:
‘What if a couple decide to have a child via ectogenesis only for couple to later change their mind and decide they want the child terminated,’ Amel Alghrani, of the University of Manchester, writes.
‘Is this the equivalent of abortion?’
Even more difficult to answer is what happens if one prospective parent wants to keep the baby but the other one does not .
Who gets the deciding vote?
‘It may well be the case that the government will have to re-examine the legal status of the human embryo,’ Dr Alghrani writes.
‘Coming up with a consistent and efficient regulatory framework will be an onerous task.
‘Arguably, both are equally situated in relation to it. Whose wishes shall prevail?’
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