A Note From The Editor
My wife and I are expecting next month, and it’s been a rollercoaster (to say the least!). Like many couples, we tried to get pregnant for a long time with no luck. Eventually, we turned to fertility treatments – and it finally worked.
We’re incredibly grateful to be expecting. At the same time, however, it’s been a physically grueling pregnancy for my wife: she’s had round-the-clock nausea – for 8 months straight. She was barely able to get out of bed for the first 3-4 months. Then add on physical ailments like round ligament pain, sore limbs, acid reflux, etc. … and it’s been incredibly difficult.
But what if there was a way to take our baby from conception to term … while avoiding all the negative physical side effects my wife has suffered through? I’m not talking about surrogacy; I’m talking about a whole new approach to pregnancy and childbirth that advances in modern medicine might offer.
Let's Dive In
The Deep: Fun fact: there’s a decent chance that in the future, babies will be grown outside of a woman’s uterus.
Jane Doe: You mean, like, in her stomach or something?
D: No, we mean completely outside of her body.
JD: Ok I don’t remember much from biology class, but I’m pretty sure I learned that a woman’s uterus is kinda necessary.
D: You’re remembering correctly. But advancements in modern medicine mean that, in the future, many fetuses may be grown inside lab-made, artificial wombs.
JD: Like the pods from The Matrix?
D: Sort of. Except that babies would be born (and not used as a kind of human power plant).
JD: Why would we want (or need) artificial wombs?
D: For starters, pregnancy and childbirth is still risky (although much, much less so than it used to be). Every year, for example, about 700 women in the U.S. die due to pregnancy- or delivery-related complications. And while our infant mortality rate is as low as it’s ever been, it’s still about 6 deaths per 1,000 births.
JD: Whoa. That’s higher than I would have thought.
D: Another reason artificial wombs might be appealing: pregnancy and childbirth take a physical and psychological toll on many women.
D: For example, 12% of women struggle with postpartum depression, 10% suffer from postpartum anxiety, and another 9% experience some form of PTSD from childbirth. There are (sometimes life-threatening) medical complications that can arise during pregnancy and delivery. And while many of us think of pregnant women as “glowing,” the reality is often far less rosy – even for “normal” (not risky) pregnancies.
JD: Ahhh, you mean morning sickness. But doesn’t that go away pretty quickly?
D: Actually: no, for about 50% of women. Then there are a host of other physical challenges during pregnancy – such as heartburn, digestive problems, back and ligament pain, shortness of breath, exhaustion, leg swelling, insomnia, general discomfort and more.
JD: Ugh. I once had a super-bad hangover that lasted an entire week, so I can relate.
D: Somehow we don’t think most pregnant women would appreciate that. 😬
D: But one of the most compelling arguments for artificial wombs is that they would allow doctors to monitor fetuses 24/7 – and take action if anything goes wrong.
JD: So in other words: they could hypothetically prevent medical issues, avoid complications and save lives.
D: Exactly. Some scientists believe that, once the process is perfected, pregnancies brought to term in artificial uteruses will be far safer and easier to manage than “natural” pregnancies.
JD: But to play devil’s advocate: Aren’t there important benefits to growing babies inside their moms’ bodies? For example: hearing their mom’s voice or her heartbeat, feeling her movements, etc.?
D: It’s a good point. Some doctors argue there are biological advantages to natural pregnancy that would be hard to mimic in an artificial womb, such as “... labor, [the] placental influence of hormones and [other] biochemical signals.” Others worry it could “weaken the mother-child bond” in ways that would have profound effects on both mom and baby.
D: And of course, there are broader ethical concerns. Some ethicists worry that artificial wombs could lead to a “commodification” of pregnancy – while others argue that artificial wombs could alter the very meaning of what it is to be a woman.
JD: Before we get too far ahead of ourselves … How close is science to actually making this happen?
D: Closer than you might think. In 2017, researchers at Children's Hospital of Philadelphia wanted to know if they could use artificial wombs to help babies who are born premature continue developing in (artificial) utero.
D: So they placed premature lambs – who have a lot of similarities to human fetuses – into fluid filled sacs that resembled a uterus. While there, the lambs grew normally. Their brains and organs continued developing, they grew hair, etc.
A premature lamb after 4 days (left) and 28 days (right) in an artificial womb. (Source: The Atlantic)
D: If this technology works on premature human infants, it could potentially save babies who are born extremely premature. The researchers believe they’ll be able to test this technology out on humans within the next 3-5 years.
JD: Holy crap! That’s really soon.
D: Yup. And once that happens, many scientists believe it’s only a matter of time until we are creating embryos externally (like we do with IVF) and placing them into synthetic wombs to develop – without ever being inside a female body. There’s even a name for this process, btw: ectogenesis.
JD: Well, this would certainly be a blessing for people who can’t have kids naturally, right? People with infertility issues, gay couples, etc.
D: It would. Plus it could potentially be a preferable method to surrogacy and uterus transplants, which carry their own health risks and legal dilemmas. It might also be a way for future parents to ensure that their fetus is developing under optimal conditions (contrast this to surrogacy, where parents often don’t know if their surrogate is adhering to the best self-care practices).
JD: Ok so when will human ectogenesis potentially become a reality?
D: There’s no guaranteed date, of course, but scientists are making rapid progress.
D: For starters, a recent study took a mouse embryo all the way to the fetus stage inside an artificial womb; the mouse developed to the point of growing organs. And scientists can now create blastocyst-like structures from adult stem cells – allowing them to study ectogenesis without having to use actual human embryos.
D: But of course, there are a variety of logistical dilemmas that would have to be dealt with for artificial wombs to really become a reality. For example: hospitals would have to figure out how to logistically house, monitor and care for thousands of fetuses at once.
JD: There’s definitely no room at my place for them, so don’t ask.
D: But the largest outstanding dilemma revolves around the ethics of genetic engineering. That’s because artificial wombs would make it much easier for parents-to-be to create ‘designer’ babies (using gene-editing technology like CRISPR).
JD: Oof, that’s so true. It’s a slippery slope.
D: Exactly. While gene editing may prove miraculous when it comes to weeding out genetic disorders and serious medical issues, it’s easy to imagine scenarios where parents start choosing everything from eye color to height to intelligence level.
JD: And would everyone be able to afford it?
D: That’s another problem: no.
D: And if wealthy people are the only ones who can afford gene editing/artificial wombs, will it create an elite class of “super humans” – and leave the rest of humanity behind?
JD: Now if science can only come up with a robot to deal with dirty diapers. No ethical gray areas there.
In the future, how will new life be made?
Header image: Exhibition ‘Chronic Health: If not us then who?’ by Waag