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Artificial Womb for Humans: A Step Forward in Survival for Premature Babies

Imagine a baby that needs to be delivered prematurely. But instead of worrying about the age of viability, care providers can quickly place the baby in an artificial womb, potentially saving the life of a child who would otherwise not have lived.

An artificial womb, also referred to as a biobag, is a device that allows for a baby’s gestation to occur outside of the human body. In the general public, an artificial womb is often regarded as an extraordinary neonatal incubator; however, most scientists or care providers would argue that an incubator and an artificial womb serve very different functions.

An artificial womb is intended to facilitate the process of ectogenesis, which is the development of a fetus in an artificial environment following transfer from a maternal womb. The biobag is a sealed bag that has umbilical cord access and an oxygenator circuit. Much like a maternal womb, the bag is and stays completely sealed to minimize the risk of exposure or infection.

Inside of the bag, amniotic fluid with all of the necessary nutrients and water is constantly exchanged. A cannula acts as an umbilical cord would in the maternal-fetal system, carrying nutrients and oxygen to the baby. Successful oxygenation of the baby is dependent on the heart and an oxygenator working together, which is supposed to mimic normal maternal placental blood flow.

In 2017, the world learned about a highly successful biobag (artificial womb prototype) experiment performed with lamb fetuses by researchers in Philadelphia. After four weeks inside of the biobag, each lamb emerged healthy and without common complications associated with prematurity (lung development, circulation, and infection). The lambs were developmentally equivalent to a 24-week human preterm infant when they were placed in the biobags. The success of this project points toward a very promising future for human fetuses and life after the age of viability.

Should we reach the point where humans can actively engage with and choose to utilize artificial wombs, there are a variety of legal and moral concerns that will have to be addressed.

One is something called the “14-day rule,” which is a law in 12 countries that states that all research on human embryos must be limited to a maximum period of 14 days. This law was created in 1979 in response to the birth of the world’s first successful in vitro fertilization baby.

The 14-day rule has both scientific and moral implications. It was created with knowledge of what humans were capable of achieving at the time. However, the advances of gestational and embryonic science today, including work relating to artificial wombs, make the rule seem practically obsolete. As a result, some people are pushing for an extension of the legal limit of embryo research, while those who attach significant moral implications to these decisions (as they relate to personhood) are pushing back.

Though one cannot disregard the moral and ethical implications of the advancement of artificial womb technology and development, one also cannot deny the assumed purely scientific advantages. Artificial wombs are often discussed in relation to prematurity, but they could have additional applications.

  • Assistance in fetal development: This is related to premature birth. Should a couple find that their child needs to be delivered early, an artificial womb could be used to ensure complete development. This possibility could significantly affect the age of viability, which is currently around 24 weeks. 
  • Initiation of fetal development: For someone who doesn’t have a functioning womb or has been diagnosed with infertility, growing a baby in an artificial womb could potentially offer the chance for full gestation of a child.
  • Fetal surgery implications: At this time, some fetal surgeries cannot be performed until after term delivery. In medically necessary cases, an artificial womb may offer the chance for both successful surgery and term gestation.

At present, the standard age of viability, which is the age at which a fetus can survive outside of the womb, hovers around 24 weeks. Presently, infants born before 22 weeks have no chance of survival. Preterm babies born on the cusp of viability often develop severe complications that result in disability or death. Of the infants born after 26 weeks, 50% have severe long-term impairment and disability.

The ethical considerations of sustaining life inside of an incubator, which is current practice, also cannot be ignored. Treatment at these ages often still leads to death, prolonging the newborn’s physical suffering and the emotional distress of parents. This suffering, by all parties, must be considered when making decisions surrounding gestation, interventions, and medically appropriate care.

It’s difficult to calculate exact artificial womb costs. Should growing a baby in an artificial womb be legislatively approved for use with humans, it’s highly likely that it would be decades (if ever) before they’re approved for use unrelated to preterm birth and survival.

Current prematurity costs in the U.S. exceed $40 million annually. Researchers anticipate that artificial wombs could significantly reduce this amount.

Artificial wombs could significantly alter the reproductive landscape. Like any scientific advancement, decisions related to both the development and potential use of artificial wombs cannot disregard appropriate moral, ethical, social, and cultural implications and considerations. The idea of prolonging, ensuring, or saving lives is an attractive one, but both scientists and legislators need to ask, “what’s the cost?”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127884/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252373/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6860405/

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