What Is Ectogenesis?
Simply put, ectogenesis is the growth of a mammal from conception to birth in an artificial womb. It's shown up in pop culture a handful of times – "A Brave New World," "The Matrix," and "Gattaca" – and always sparks conversations about the ethics and morals surrounding such an act. The idea of ectogenesis is still considered fantastical and futuristic to the general population. However, science shows that it might not be that far from reality.
How Did We Get Here?
In 1978, the world watched as the first in vitro fertilization (IVF) baby was successfully implanted, grown, and birthed in the United States. In the 1980s, scientists successfully incubated mouse fetuses for eleven weeks – that’s half of the normal gestation cycle – and Japanese scientists were able to sustain six goat fetuses for three weeks in an artificial womb.
Most recently, and perhaps most notably, in 2017 scientists in Philadelphia were able to transfer a premature lamb from the mother’s womb to an artificial womb called a “Biobag”. Machines then continued gestation for four weeks until the lamb reached the age of viability. At the time of transfer, the lamb was comparable to a human baby at the gestational age of 22-23 weeks. Human viability is 24 weeks. The biobag side-stepped the normal complications and mortality risks associated with extremely premature newborns. The hope is that this artificial womb will soon be cleared for use in human trials and that the survival of premature babies will increase.
What Would Ectogenesis Even Look Like?
Hashem Al-Ghaili, a molecular biotechnologist, released a concept video for EctoLife: The World’s First Artificial Womb Facility. The video showcases a warehouse with 30,000 artificial wombs full of babies. These pods are monitored by artificial intelligence, and all data is accessible by an app on your phone. EctoLife will offer packages ranging from Standard to Elite. The most expensive of which will allow you to genetically alter your baby's DNA to eradicate potential diseases, choose exactly what your baby will look like, and of course, decide on their intelligence level.
Still Sounds Too Futuristic? Scientists Don’t Think So.
Elizabeth Romanis, an academic at the Centre for Social Ethics and Policy at the University of Manchester, wrote in the BMJ’s Journal of Medical Ethics that when it comes to artificial wombs, “it seems probable that we are only several years away from testing on human subjects.” The Philadelphia team agrees.
Dr. George Mychaliska, a pediatric surgeon at the University of Michigan medical school, is a bit more reserved in his views on the applications of artificial wombs. However, he still believes that doctors will soon use them in the care of extremely premature newborns.
So how soon is soon? The answer varies, but the general consensus is around ten years before we see approval for the first human trials. EctoLife may be a fictional company, but the idea is real and most of the technology already exists. It’s simply a matter of putting it all together and making sure the math works.
Why Might We Want This?
You’ve seen the headlines – the world is facing a fertility crisis. If we don’t improve our birth rates, our species will fail (in a few centuries). The arguments for why there is a crisis range from women choosing not to have children to male sperm count being too low. Whatever the reason, complete or partial ectogenesis could be the answer.
The potential to lower the rate of miscarriage, maternal and fetal death, and overall complications in pregnancy? Ectogenesis. Women who don't want to sacrifice their careers or bodies, or those who can't carry a pregnancy? Ectogenesis. The ability to bring extremely preterm babies, 22-24+ weeks, to full term without the inherent complications involved with current Neonatal Intensive Care (NIC) protocols? Partial ectogenesis.
So, What’s the Catch?
While the idea of being able to grow a baby in a pod sounds super cool, the moral and ethical difficulties cannot be overstated. Partial ectogenesis, such as NIC and IVF, already has protocols and laws in place to protect the rights and privacy of those involved. Full ectogenesis has none of that, and there's a lot to hash out before the first human trial even begins.
Right now, neonatal intensive care is about artificial life-preserving methods for a new-born at the edge of self-sustainment. Theoretically, artificial womb technology (AWT) would allow that 24-week boundary to become obsolete. This is partial ectogenesis. Theoretically, this also means there’s the potential for AWT to erase viability concerns entirely by simply bypassing a human womb. Now the conversation moves from the artificial preservation of life, to the artificial creation of life.
Could This Be the End of Abortion?
The argument has been made that complete ectogenesis would erase the debates surrounding abortion – no human womb, no fear of infringing on bodily autonomy. However, considering the current political landscape, it would be reasonable to assume that AWT would complicate the abortion debates further. After all, women aren't going to stop getting pregnant.
A significant concern would be that, with the availability of an artificial womb, lawmakers could force a woman to transfer her pregnancy instead of ending it. But where would that leave the baby? In some US states, women are required to have an ultrasound and see the face of the child they want to abort before moving forward. Would a woman be required to visit the artificial womb in the hopes of coercing her to keep the baby upon delivery? Who pays for the forced transfer and care? Who pays for the c-section necessary for transfer? Can you put an AW-baby up for adoption? Would there be safe-haven laws for unborn AW-babies? If AWT is a safer alternative to natural pregnancy, would insurance companies still be required to cover pregnancy?
But It’s Healthier for the Baby…
As mentioned above, an artificial womb could potentially eliminate many problems and stressors for both mother and child. There would be no worry about addiction, medication use, infection, or physical harm to either party. But what about the parental-fetal bond? We simply don't understand enough about fetal neural development to know what parts of gestation are crucial for long-term mental and emotional well-being.
Seppe Segers, Bioethics Institute Ghent, wrote in an article for BMC Medical Ethics, “We do not know just how much a child’s psychology is impacted by being gestated in utero, but consideration must be given to how isolation from the uterine milieu—including the pregnant person’s voice, moods, heartbeat and touch—might adversely affect the child’s emotional and neuropsychological development.”
Research has found that babies in the NICU have a far greater chance of survival if they're allowed what's called "Kangaroo Care". This is when a baby is placed skin-to-skin with another human – preferably the parent, but any human will do – and the contact helps to regulate temperature, breathing, and increases neuro-sensory input for the baby’s developing brain. If a premature baby benefits so heavily from this direct contact, can we really ignore the implications for a baby in utero?
Unfortunately, this is one of those hypotheticals that can’t be answered until it happens. But do the benefits of ectogenesis outweigh the potential risk of mental harm that may not be realized for years after the baby is born?
What About the Parents?
There is an entire theory of prenatal attachment, originating in the 1950s, suggesting the parental attachment developed during pregnancy creates stronger quality attachments, and an easier transition to parenthood once the baby is born. The level of attachment for the mother also has a direct correlation to feelings of maternal competency upon birth. If a child is conceived, grown, and born out of an artificial womb in a warehouse, where attachment isn’t a priority, what stops babies from becoming the next fashion accessory? Designed, used, and forgotten once the newest trend comes around.
Are We There Yet?
Ectogenesis is coming, whether we want it or not. The profound benefits of partial ectogenesis for premature newborns make the research and effort worth it. Unfortunately, it also opens the door to complete ectogenesis and everything that comes with it. This makes it all the more important to keep an eye on the scientists working to create lab-grown eggs and sperm… in the name of science. In the wise words of Dr. Ian Malcolm, “Your scientists were so preoccupied with whether or not they could, that they didn’t stop to think if they should.”
Written by Sally Cameron.
Cover photo by Victoria_Watercolor.