Are we ready for the ‘ecto-baby’?
THE PROSPECT OF ARTIFICIAL WOMBS RAISES QUESTIONS OVER HOW FAR WE GO IN ERASING THE HUMAN ELEMENT
IT’S CLEAR THAT AT SOME LEVEL GROWING EMBRYOS IN DISHES WILL INTERSECT THE TECHNOLOGY TO KEEP EMBRYOS AND FETUSES ALIVE ARTIFICIALLY. THAT IS ABSOLUTELY INEVITABLE AND WILL HAPPEN. — BIOETHICIST ARTHUR CAPLAN
When images emerged l ast year of f etal l ambs growing inside “Biobags” — giant, translucent, polyethylene sacks filled with synthetic amniotic fluid — Anna Smajdor’s visceral and immediate reaction was horror.
Surgically removed from their mother’s wombs at 105 to 115 days, the lambs spent a month swaddled inside what looked a lot like freezer bags, their blood flowing from their umbilical cords to an outside “oxygenator” as they breathed, swallowed and grew from pink, hairless creatures to white, woolly wonders.
“There was one where the lamb seemed to be spasming in the Biobag,” she says.
But what horrified Smajdor, a philosophy professor and ethicist at the University of Oslo, was the use of animals for that lab test — not the idea of “ectogenesis,” or gestation outside the body.
In fact, she says it should be an option to address the “injustice” that the female uterus is still a necessary part of reproduction.
The developers of the Biobag certainly hope to move from tests on lambs to tests on human babies. Their “extra- uterine” device was designed to revolutionize the treatment of severely premature newborns. The goal is to offer a bridge between a natural womb and the outside world to give babies born at 23 to 25 weeks of gestation more time for their fragile lungs to mature.
But as fetal surgeon Alan Flake, who is leading development of the Biobag at the Children’s Hospital of Philadelphia, said: “I want to make very clear that this device is not related to complete ectogenesis — never intended to be, will never be and it’s just not likely to happen.”
For some, that’s a relief. The prospect of synthetic, substitute wombs raises stark questions about how far we want to go in uncoupling reproduction from human bodies, the role of the mother and placenta in fetal development and the way our society thinks about how women are expected to behave during pregnancy.
For others, an artificial womb would be the ultimate gender equalizer — freeing women from the inconvenience, pain and sometimes significant risks of pregnancy and childbirth, and giving single or gay men an alternative to surrogacy.
And many experts disagree that the world’s first “ecto- baby” is either unlikely or all that far off. In addition to the Biobag, two international teams recently succeeded in keeping human embryos conceived through IVF alive in a laboratory for 12 to 13 days — shattering the old record of nine days and one day shy of the “14- day rule,” a voluntary prohibition among scientists limiting human embryo research to the period before the appearance of the “primitive streak,” a band of cells that mark the beginnings of the brain and spinal cord.
At the other end, neonatologists are pushing the boundaries of what is known as the “threshold of viability” — the stage and age at which a fetus would have a reasonable chance of survival outside its mother’s womb without severe brain damage. Today’s neonatal care intensive units can now save babies born as early as 22 or 23 weeks’ gestation, their skin so thin and translucent blood vessels can be seen beneath.
Many believe it’s only a matter of time before the two paths meet. “You do need to get past things like, well, (an early embryo) has no heart or other parts, but it’s clear that at some level growing embryos in dishes will intersect the technology to keep embryos and fetuses alive artificially,” says bioethicist Arthur Caplan. “That is absolutely inevitable and will happen.”
The potential benefits of artificial wombs are obvious. For the fetus, ectogenesis means a tightly controlled, sterile environment, where hormones and nutrients needed for optimal growth can be calibrated and delivered, and doctors can watch from the outside, with access ports ready should the fetus need to be “rescued.”
For mothers, i t would mean easier delivery. And the fetus would be entirely immune to a mother’s “stress, drug habits or oyster eating,” Smajdor wrote in a 2012 article, In Defense of Ectogenesis.
On that last point, she adds in an interview, there’s a lot of confusion not only about how pregnant women should behave — yes to weight gain but not too much, no to soft cheeses, coffee and cola — but how much responsibility they should have for a developing fetus.
“We’ ve r eally become muddled about why it’s her in particular that has to make all these sacrifices,” Smajdor argues, “given that we live in a world where there are many environmental factors that can be detrimental to fetuses, like pollution.”
What’s more, advances in fetal imaging are already opening once unimagined portals into the world of the unborn, changing what we can see, and what medicine can do. “And so long as that fetus is in a human woman, women are going to be subjected to more, rather than less medical intervention in pregnancy,” Smajdor argues. If that’s the trajectory we’re on, full ectogenesis may be better for women, she says.
Artificial wombs would also let women reproduce the way men do, without risking their physical, economic and social well-being. No time needed off work for pregnancy-related complications. No “cataclysmic bodily convulsion,” as Smajdor has described it, at the end of nine months.
And while some have argued psychosocial emotional ties between mother and baby would be l ost if suddenly there was no physical connection between the two, that implies fathers ( or adoptive parents) “don’t love their children as much as mothers do,” Smajdor says. Besides, the mother’s heartbeat, voice and abdominal sounds could be played to the fetus. So could the father’s.
But what if ectogenesis didn’t free women as much as make them powerless and irrelevant? What if employ- ers or insurers coerced them into using artificial wombs to save money? “Immaculate gestation” might also lead to legal limits on a woman’s right to abortion, some scholars say.
Roe versus Wade ruled in favour of a woman’s right not to be pregnant, says Scott Gelfand, a bioethicist at Oklahoma State University, “not to destroy fetal life.” If a viable fetus could be safely removed from a woman’s body in a procedure no more invasive than an abortion, U. S. courts might uphold women’s right not to be pregnant by mandating ectogenesis.
“In the United States, in the year before last, we had over one million abortions,” Gelfand says. “Now, imagine if states like Oklahoma mandated women who were getting abortions to put the fetus into an artificial womb. Let’s say half kept the fetus after it was born and the other half didn’t. Not only would we have a situation where many women who would like an abortion for reasons other than bodily autonomy couldn’t get it. We would have an amazing number of babies.”
Caplan thinks the bigger issue would be natural versus “unnatural” births. In capitalist societies where parents already compete to get their children into the right nursery school, “what makes you think they wouldn’t want to spend a lot of money to grow their kids in an artificial incubator, presuming you don’t rob them of some type of feedback from the pregnant mom that they need to grow well?”
“There will be people who say, ‘it’s just unnatural. That’s just not the way God intended for us to have babies,’ ” Caplan says. When Louise Brown, the first IVF baby, was born on July 5, 1978, her parents received hate mail splattered in blood. But since then, millions of “test tube” babies have been created. And the “natural” argument rarely stops the technology, Caplan points out.
The idea of ectogenesis has been around since the late 18th century, says Dr. Roger Pierson, director of the University of Saskatchewan’s Reproductive Biology Research Institute. “What we’re really talking about now is, what happens after our voluntary moratorium on not culturing embryos past 14 days goes away? And how far backwards can you work from the Biobag and other functions to cover the entire spectrum of gestation?”
If, for example, we can take an early fetus and gestate it in a bag or a box from 23 weeks gestation and “deliver” a healthy infant, what’s the next step? What would we have to do to be able to take them at 21 weeks? And once that set of problems is solved, could we go even earlier?
The other end of things gets more complicated. “We really don’t know how long a conceptus can be cultured (in the lab) due to the moratorium. So, let’s explore that limit,” Pierson said. “Ask the question, what would it take to increase the time that an embryo can be cultured from two weeks, to four weeks? I think we have the technology and knowledge to work through these challenges.”
Flake insists his team is not looking to extend the limits of preemies’ viability and has said that the early events in gestation and fetal development “absolutely require” hormones, growth f ac t ors, antibodies and other elements that only a real mother and placenta can provide. In addition, the lamb fetuses had formed the critical components of the brain, lungs, intestines and other organs before they were placed inside the Biobags.
“It’s a fantasy to think there’s going to be this convergence of growing embryos and extracorporeal support,” Flake insists. “Half our kids in nursing homes with cerebral palsy are derived from extreme prematurity — that’s what this device is designed to address.”
There are important differences between fetal lamb brain maturation and human brain maturation. However, the three surviving “Biobag” lambs appear entirely neurologically normal, according to MRI scans of their brains. The animals were also put through mazes testing their ability to solve problems and recall how they did it, weeks later.
The Biobag lambs performed very well, Flake says.
Even better than sheep grown the old fashioned way.