The biobag that could save babies born too early

In the final part of our series on the brave new world of science, how doctors are pushing ethical boundaries in a race to transform human reproduction

IN THE concluding extract from her compelling new book, JENNY KLEEMAN delves into what the future holds for reproduction, unveiling a world where babies develop not in the womb, but in ziplock bags. It might sound like sci-fi fantasy but it could become a reality sooner than you think …

THE lamb is sleeping. It lies on its side, eyes shut, ears folded back and twitching. It swallows, wriggles and shuffles its gangly legs. Its little half-smile makes it look content, as if dreaming about gambolling in a grassy field. But this lamb is too tiny to venture into the outside world. Its eyes cannot open. It is hairless; its skin gathers in pink rolls. It hasn’t been born yet, but here it is, at 111 days’ gestation, totally separate from its mother, alive and kicking in a research lab in Philadelphia.

It is submerged in fluid, floating inside a transparent ziplock bag, with its umbilical cord connected to bright blood-filled tubes. This is a foetus growing inside an artificial womb.

Two weeks later, at almost full term, it nearly fills the entire space, its flat nose pressing up against the corner of the bag. It is plumper, whiter, covered in fine coils of wool. Definitely a lamb now, but still a foetus.

In two more weeks, the bag will be unzipped, the umbilical cord clamped and the lamb will finally be born.

This is not a total substitute for full pregnancy. The lambs in this trial weren’t conceived in the bag: they were taken from their mothers’ wombs at a gestational age equivalent to around 22 to 24 weeks in humans — and then submerged in the so-called ‘biobag’.

Nor can the experiment yet be replicated in humans. But researchers are racing one another to gestate a human baby in the same way, as soon as they get ethical approval.

The concept of ‘ectogenesis’ — reproduction outside the human body — is not new. The word itself was coined back in 1923 by British geneticist J.B.S. Haldane.

Haldane imagined a future in which ‘we can take an ovary from a woman and keep it growing in a suitable fluid for as long as 20 years, producing a fresh ovum each month, of which 90 per cent can be fertilised, and the embryos grown successfully for nine months and then brought out into the air’. It was his answer to the problem of falling populations.

Today, research into ectogenesis is powered by different motives. There would be clear medical gains for women unable to have children, the one in every 4,500 women born without a uterus, for example. And for men in same-sex relationships who want their own offspring.

Increasingly, too, there are women who want children but don’t want to be pregnant because of the damage to their bodies and careers.

PREGNANCY is ‘barbaric’, academic Dr Anna Smajdor declares. ‘The amount of women who suffer tears and incontinence and things that damage them for the rest of their lives is really high.

‘Yet it’s not adequately recognised because society attaches a strong value not just to motherhood but to giving birth. We expect women to joyfully go through this process for the production of new citizens.’

I can sympathise with that. I found being pregnant a remarkable, lifechanging experience, but I have never felt more like a ‘thing’ than when staring up at a hospital ceiling and trying not to panic while a 20cm needle was plunged into my belly to extract my baby’s DNA for testing; or lying with my legs clamped apart while a surgeon stitched up my cervix because I was at risk of going into early labour.

At present, the only option for avoiding natural birth is surrogacy. But what if technology meant we could have babies without anyone being pregnant? The possibility opens up a new world.

To see how, we need to return to that lamb growing in a bag and waiting for the zip to be opened.

At the Children’s Hospital of Philadelphia (CHOP), the team working on artificial wombs say they are driven only by the desire to save the most vulnerable humans on earth — extremely premature babies.

After three years of tweaking and refinement, their latest prototype of biobag is designed to give babies born too soon a greater chance of survival than ever before.

It was announced to the world three years ago in a research paper which revealed that foetal lambs had been ‘physiologically supported in this extra-uterine device’.

It works like this. The soft plastic bag acts like an amniotic sac, filled with warm, sterile, lab-made amniotic fluid that the lamb breathes and swallows, just like a human foetus would. This fluid flows in and out of the biobag through tubes in two small, watertight apertures.

The placenta is replaced by an artificial circulatory system plugged into veins in the lamb’s umbilical cord, which also delivers nutrients and any necessary medication. The foetus’s heart pumps blood just as it would do in the womb.

The biobag is kept in a darkened environment to mimic a real womb but the covering can be removed and the foetus be visible as never before. If the procedure was ever to be developed for humans, it would mean, says Dr Emily Partridge, one of the CHOP team, that parents would see a lot more than they do during a normal pregnancy.

‘They can actually look at their foetus in real time, see their foetus move and swallow and do all the things that foetuses do, such as swimming and dreaming.’

She describes looking after the lambs in the bags like a mother beside her newborn’s cot: ‘Rolling out a sleeping bag and camping out beside these lambs for weeks at a time. It’s an awe-inspiring sight.’

In their experiments, the team even gave their little lambs names: June, Lily, Little Alan, Eddie, Willow, Bowie, Iggy and Manson.

Most were euthanised at birth so their organs could be studied, but a few lucky ones were allowed to live and were bottle-fed by the team. Iggy did particularly well and

survived at least eight months before being rehomed.

CHOP’s programme, it emphasises, is all about saving very premature babies. That’s all its artificial womb is intended to do. It’s a therapeutic tool only.

Yet I am left wondering if their invention, which they’ve patented and intend to bring to market, is not the first step to natural birth being deemed entirely replaceable by technology.

CHOP is far from alone in its research. At the Women and Infants Research Foundation (WIRF) in Australia, researchers have developed an artificial womb known as ‘Eve’ (it stands for ExVivo Uterine Environment). I catch a glimpse of it on YouTube, with a lamb submerged in yellowish fluid in a transparent bag. Its chest rises and falls, its nostrils flare.

The camera pans to a mass of tubes protruding from the semiopen zip, like veins filled with blood. This is what an artificial womb really looks like. It’s disturbing, uncomfortable viewing.

Matt Kemp, the man in charge, talks about his work like it is simply home brewing, rather than Frankenscience. I ask what the amniotic fluid is made from and he says: ‘It’s a salt-protein-water mix. A kind of Gatorade, really.’

He is collaborating with a big biotech company in Japan, which he believes will give him the edge over CHOP’s biobag. But the big difference between them is that his team is beginning with younger lamb foetuses — at 95 days’ gestation rather than CHOP’s 106.

But clinical trials in human babies are a long way off, he tells me. ‘Anyone who tells you they’re going to be doing this in two years is being a bit sensationalist.’

As with CHOP, WIRF’s ambition is to save the lives of superpremature babies. He tells me that the first human baby to try out the device will likely be a very sick 21-week-old foetus, who has no chance of surviving with the therapeutic tools now available.

This completely floors me. Normal human pregnancy is 40 weeks; any baby born before 37 weeks is considered premature. The 23 to 24-week period is the border of viability, after which modern medicine currently has a hope of keeping babies alive and doctors will attempt to resuscitate a newborn.

To the HSE, a baby born dead at 24 weeks is classed as a stillbirth, whereas a dead baby born at 23 weeks and six days is a miscarriage. It is a brutal boundary, as I discovered when I lost a baby at 20 weeks.

There was nothing wrong with him: he was perfect. When I was nearly 19 weeks pregnant, I got appendicitis and went into premature labour. It happens: if you are pregnant, a serious infection can make your cervix open. The obstetrician told me that if I had been 24 weeks pregnant, everything would have been different.

Now I’m left wondering if an artificial womb could have saved a 20-week-old who was perfectly healthy but unlucky enough to be inside a woman who was ill.

BUT there are limits to what the doctors can practically do and when they can intervene. Matt Kemp tells me: ‘If you can’t get a catheter into the foetus, and the heart is not sufficiently developed to drive blood through the system, then it’s not going to work.’

That, he says, puts an end to any thought of harvesting eggs and putting them into these artificial devices: ‘It’s just not practically possible.’ But all one can truly say is: not yet. Technology pushes relentlessly on. Things change.

The more we understand reproductive medicine, the more likely it is that full ectogenesis will become possible one day. The obstacles will be ethical and legal, rather than technological.

IVF was once science fiction, then an ethical conundrum, then the cutting edge of assisted reproduction. Now it’s a normal part of making families.

Full ectogenesis will not exist for decades. But it is coming. And I have serious qualms about it.

Once bags and tubes can replace a womb, pregnancy and birth will be fundamentally redefined. If gestation no longer has to take place inside a woman’s body, it will no longer be exclusively female. The meaning of motherhood will be changed for ever.

Yes, artificial wombs will free women from the uncertainty, pain and vulnerability of pregnancy and childbirth. But that will come at the cost of women giving up a fundamental power in the only realm where men have always had a subordinate role.

My view is that, by bearing our own children, women gain so much more than we lose. We gain the immediate closeness and intimacy. We gain the creative power of being a mother, the knowledge that our children are definitely our own, the right to choose whether to become a parent at all.

In the end, artificial wombs might be far more beneficial for men than for women.

When artificial wombs do arrive, we must ensure it’s in a society that values women for more than just their reproductive capacity. We do still have time. But maybe not enough.

■ ADAPTED from Sex Robots & Vegan Meat: Adventures At The Frontier Of Birth, Food, Sex And Death by Jenny Kleeman, to be published by Picador on July 9 at €20.99. © Jenny Kleeman 2020.