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Artificial Wombs: From Fiction To Fertility?

Posted on 4 January 2023

The concept of an artificial womb is one that has long been the domain of science fiction, and often comes with a distinct dystopian tint. The term conjures up images of rooms full of vat-grown clones, bred to fix an underpopulated planet or to create an army of super-soldiers. These tropes detract from the real and immediate benefit that a successful artificial womb could bring. Working artificial wombs would save countless premature babies from death or lifelong disability, and might eventually allow people to have children when other methods fail or when pregnancy would put the mother’s life at risk. Yet developing such technology comes with many challenges, both scientific and ethical in nature. Where are we with artificial wombs today, and what are the challenges and dangers of such technology?

What are artificial wombs (and why do we need them?)

An artificial womb is a device that is designed to support the development of a foetus outside of a woman’s uterus. In theory, it would provide a safe and supportive environment for a developing foetus to grow all the way from an embryo produced through IVF to a new-‘born’ baby. This concept, in which gestation takes place entirely outside the body, is known as ectogenesis, and is not likely to be a reality any time soon for reasons we’ll discuss later.

Globally, premature birth is the leading cause of death in children under the age of 5 years.
Photo by Hush Naidoo Jade Photography on Unsplash

By far the more realistic and immediate application of artificial wombs would be to improve the outcomes of preterm births. Babies born prematurely are less likely to survive and have a far greater chance of suffering from lifelong health problems like cerebral palsy and poor hearing or eyesight. Physicians and parents sometimes have to make the difficult decision of whether to resuscitate a very premature infant, knowing that they may spend months in intensive care only to die or be left severely disabled. Instead of undergoing intensive care, premature babies could be returned to an artificial womb designed to mimic a normal continuation of gestation as closely as possible. This might also save the lives of babies who would currently be too premature to survive, essentially lowering the gestational age of viability. These are the real reasons most scientists are currently pursuing artificial wombs – not to provide an alternative to natural pregnancy.

Where is the technology now?

In recent years, two noteworthy proof-of-concept artificial wombs have been developed: the Biobag and the EVE platform (Ex-vivo uterine environment). Both use a similar design: a bag filled with artificial amniotic fluid, with catheters inserted into the umbilical cord to provide water, oxygen and nutrients while removing waste products. This means that the baby doesn’t need to be ventilated when its lungs are still premature (thought to be the primary cause of complications in preterm intensive care). Both designs have been tested on lamb foetuses from a stage of gestation equivalent to ‘just viable’ in humans, and were successfully ‘delivered’ about a month later with survival rates of 100% and 88% respectively.

b: A lamb placed in the biobag at 107 days of gestation after 4 days of support. c: The same lamb on day 28 of support.
An extra-uterine system to physiologically support the extreme premature lamb

While that may sound encouraging, it’s still not encouraging enough to consider putting a premature baby in such a device. These technologies have so far only been tested on a small number of animals, and in the case of the EVE device there was one case of brain damage and a few early signs of liver problems. The risks might be lower than those associated with intensive care, but we still need to understand these risks well. Of course, lambs are not humans, so it’s possible that this technology won’t work as well on human babies. Studies of non-human primates will probably be required before we can think about testing artificial wombs in humans.

As for lowering gestational age at which a premature baby is viable, that technology is probably even further away, as designing an artificial womb for smaller babies presents new problems that haven’t yet been solved. For example, smaller infants don’t pump as much blood. Insufficient blood flow through the artificial womb’s tubing can cause the blood to clot, and nothing has yet been designed that can function adequately at such low flow rates.

Complete ectogenesis – a natural progression?

Some believe that as artificial wombs improve and allow gestation to be completed from an earlier and earlier stage of development, we’ll eventually develop the capability for full ectogenesis, even if that wasn’t our original goal. Such concerns come much to the exasperation of scientists working in the area. Most experts consider this technology to be highly speculative, as it would require the development of other technologies we don’t currently possess.

Current artificial wombs are designed to deliver nutrients and oxygen to a pre-existing circulatory system with a functional heart and a certain minimum blood flow. For complete ectogenesis, an artificial womb would need to be able to support the foetus throughout the entirety of its growth, from a ball of cells to an independent organism capable of breathing its own air. We know that throughout pregnancy, the foetus and the mother exchange hormonal and even genetic signals. The mother’s placenta provides an ever-changing mixture of proteins, lipids, carbohydrates, minerals and growth factors that fine-tune the foetus’s development and have profound long-term consequences. We still don’t fully understand the nature and importance of these interactions, and replicating this environment is well beyond our current abilities.

All this isn’t to say that ectogenesis won’t become a reality one day. Such technology could allow those for whom pregnancy is particularly dangerous or impossible (such as those with a damaged or missing uterus) to have children without the need for surrogacy. However, many people would prefer it if ectogenesis remained firmly in the realm of science fiction due to the ethical concerns that it raises.

The ethics arena

Improving the survival and health of premature babies is a fairly uncontroversial ambition. Most of the ethical questions about using artificial wombs for this purpose concern the point at which it becomes acceptable to test a new technology when the long-term consequences aren’t clear. The first premature baby to be placed in an artificial womb might end up worse off than if they had undergone conventional intensive care. Some worry that the conditions under which this risk is acceptable haven’t been well laid out.

Sensationalist discussions can distract from the real potential and challenges of the technology
Source: EctoLife: The World’s First Artificial Womb Facility

The idea of complete or even partial ectogenesis (the ability to remove a foetus from a woman’s womb and complete its gestation in an artificial one), opens an entirely new can of worms, however. Most concerns relate to equality and women’s reproductive rights. On the one hand, ectogenesis could improve equality by removing the physical, social and financial burdens associated with pregnancy. Women would no longer have to sacrifice progress in their careers in order to have children, for example. On the other hand, a prohibitively expensive artificial womb would exacerbate inequality by restricting ectogenesis to the wealthy. Others question whether ectogenesis would threaten abortion rights, since these are often predicated on the risk to the mother associated with undergoing pregnancy. Some have even imagined a future in which employers require female employees to use artificial wombs in order to avoid maternity leave.

These are valid concerns should ectogenesis ever become a reality, but start to look rather sensationalist considering the current state of research. Some articles discuss these issues as if they are less than a decade away, while researchers are thinking more along the lines of many decades to a century. Videos such as the Ectolife concept video, which did the media rounds recently, don’t exactly help. The video appears to show a facility that is designed to grow around 30 000 babies yearly, offering services such as an app to monitor your baby’s progress from the comfort of your home and the ‘Elite package’ allowing you to choose your baby’s strength, height, eye colour and so on. The video, which already lacked context, was presented by many media outlets as though this was a real, ongoing project. In reality, neither the facility nor ‘Ectolife’, the company behind the project, actually exist.


Whether it comes as a disappointment or as a relief, artificial wombs aren’t going to be offering an alternative to natural pregnancy any time soon. Even if and when they do, they’re likely to be an inferior alternative. However, the use of artificial wombs as an alternative to conventional intensive care might not be too far off and could be extremely valuable. It’s the ethics around this that we should concern ourselves with, not a technology that might not exist for three generations.


References

The path toward ectogenesis: looking beyond the technical challenges: https://doi.org/10.1186/s12910-021-00630-6

An extra-uterine system to physiologically support the extreme premature lamb: https://doi.org/10.1038/ncomms15112

Artificial womb technology and clinical translation: Innovative treatment or medical research? https://doi.org/10.1111%2Fbioe.12701

The Dystopian Fear of Artificial Wombs: https://www.theatlantic.com/science/archive/2017/10/artificial-womb-dystopia/541755/

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