According to the WHO, the last recorded rate of premature births in 2020 across countries ranged from 4-16%. That's approximately 13.4 million babies. Pre-term birth is globally responsible for the mortality of children under the age of 5, and the long-term morbidity of those who survive.
To combat the threats of underdevelopment to premature newborns, researchers have been attempting to invent a medical device imitating the conditions of a human womb in which severely premature babies can be accommodated for. This ambition has been around since the early 20th century, first using the term 'ectogenesis.'
The idea was first discussed in a 1923 lecture called 'Daedalus, or Science and the Future' by English biologist Richard Haldane. It was understandably very controversial at the time given its progressive feminist reasoning. Many works of science fiction have since drawn on this concept of artificial or manipulated natural gestation, such as the 1997 movie Gattaca, the futuristic dystopian novel Brave New World by Aldous Huxley, the 2010 movie Splice, the 2022 pseudo-documentary EctoLife: The World's First Artificial Womb Facility and others. However, all the works listed – excluding EctoLife – share in varying degrees a cynical and twisted view of the dark potential humans possess when given the opportunity to interfere with the creation of other living beings. Is it a matter of blasphemy, fear of social and political power imbalances, or incorrigible failure that casts such a dim light on exciting advances in reproductive technology? It may be all of those in combination.
In 2017, researchers at the Children's Hospital of Philadelphia produced a 'biobag' in which a live lamb could be developed until it had grown all its wool, and could then mature normally when removed.
In 2019, BBC News published a video in which a prototype for an artificial womb, designed by Lisa Mandemaker, was being assembled in the Maxima Medical Centre, Netherlands. This was a €2.9 million project, funded by the Horizon 2020 EU programme. The design consisted of 'five big balloons,' as worded by Mandemaker, where transferred babies will be supported in amniotic fluid. Each holding space was connected to various tubes circulating vital substances such as blood that they would receive from their mother. In addition to this, the researchers aimed to mimic the sounds, smell, sight and sensations a baby would experience were it in its mother's natural womb.
Within a very short time frame, doctors must transfer the newborn from the mother to the artificial womb where it is connected to an artificial placenta by an umbilical cord. After around 4 weeks, the baby is 'birthed' once more, this time from the artificial womb. Later in the video, gynaecologist Dr. Guid Oei explains the detriment faced by pre-term babies when kept in an incubator filled with air rather than liquid like in the womb: half of babies in incubators born at 24 weeks do not survive due to air damaging their underdeveloped lungs.
A video published by the Economist in 2023 shows further progress in the project by the team led by Professor Frans van de Vosse at Eindhoven University of Technology in the Netherlands. A demonstration is made using silicon-rubber baby mannequins embedded with flexors and motors. Designed by Juliette van Haren, these models help to visualise what is happening in the system during trials so as to avoid animal experimentation.
To tackle the challenge of a safe, smooth transferal of the baby from its mother's womb to the artificial womb, the team developed a 'liquid tunnel' mechanism. This reduces the risk of infection and overexposure to the air. After this stage, the umbilical cord must be severed and quickly reattached in less than 6 minutes – or else the baby will die from lack of oxygen to the brain. Blood clotting is another challenge throughout this process.
All this said, there has been news that the US FDA is expected to approve the first human trials with the artificial wombs this year. However, there remains much apprehension and stigma regarding the bioethics and success rate of these trials, which cannot be ignored before the devised procedures are tested on humans. If the first human trials were to be approved within this decade, and if they were to be highly successful, could we be prepared for such ramifications? There is no doubt that the success of this reproductive technology would be life-altering, but to what extent could it alter lives outside of pre-term births? Perhaps we should prolong the project development stage. Perhaps this is our one chance at improving millions of lives globally.
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