The Artificial Womb: Foetal Personhood and Reproductive Futures

Advancements in medical technology have led to the development of artificial placenta systems, which aim to support the survival and development of extremely premature infants. The placenta plays a vital role in fetal development by facilitating nutrient exchange and waste removal. Premature birth poses significant challenges in neonatal care, with preterm infants facing increased risks of morbidity and mortality. Respiratory failure is a major concern due to the underdeveloped lungs of preterm infants. Artificial placenta models have been designed to mimic fetal and utero-placental physiology, offering potential solutions to these challenges. This abstract reviews the history and components of artificial placenta systems, highlighting the importance of pumpless arterio-venous (AV) circuits, low-resistance oxygenators, umbilical access, and immersion in sterile fluid. The development of these components has led to improved survival rates and stability in experimental models. However, challenges such as cardiac afterload, optimization of circuit design, and prevention of infection and inflammation remain to be addressed. Promising artificial placenta models have been developed by research groups at the University of Michigan, Tohoku University (Sendai, Japan), and the University of Western Australia (Perth). These models have demonstrated increased survival times, stable hemodynamics, and successful organ maturation. The Philadelphia Children's Hospital model, known as EXTEND AW, has shown particular success, with lambs surviving up to 28 days and exhibiting normal organ development and neurological maturation. Despite these advancements, there are still challenges to overcome before artificial placenta technology can be implemented in clinical practice. These include reducing oxygenator surface area, improving hemocompatibility, optimizing nutrition and amniotic fluid composition, standardizing patient selection criteria, and developing efficient cannulation techniques. In conclusion, artificial placenta technology is a promising field with the potential to revolutionize neonatal care. With further advancements and research, artificial placenta systems may offer a solution to the challenges faced by extremely premature infants, improving their chances of survival and long-term health outcomes.

In this paper, we explore how members of the public invoke science fiction tropes and references in response to the topic of complete ectogenesis (where the entire development of a...

Artificial wombs represent a transformative frontier in medical technology, offering unprecedented possibilities in neonatal care and human reproduction. Known scientifically as ectogenesis, artificial womb technology aims to create a controlled, external environment that mimics the conditions of a natural womb, enabling fetal development outside a biological mothers body. While its primary focus has been on supporting extremely premature infants, artificial wombs also prompt fundamental questions about the future of reproduction, family dynamics, and child welfare. This review paper explores the current status of artificial womb technology, tracing its evolution from traditional neonatal care advancements to the latest breakthroughs. The paper examines the technical complexities involved in replicating the uterine environment, including challenges related to oxygenation, nutrient delivery, and waste removal. Furthermore, the limitations and ethical concerns surrounding artificial wombs are discussed. Looking to the future, the paper discusses potential developments necessary for artificial wombs to advance, including innovations in biomaterials, artificial intelligence, and long-term clinical trials to assess the safety and efficacy of artificial gestation in humans. Through a detailed examination of both technical and ethical dimensions, this paper provides a comprehensive overview of the promise and challenges surrounding artificial womb technology as it moves toward clinical reality.

Artificial placenta (AP) technology aims to maintain fetal circulation, while promoting the physiologic development of organs. Recent reports of experiments performed in sheep indicate the intrauterine environment can be recreated through the cannulation of umbilical vessels, replacement of the placenta with a low‐resistance membrane oxygenator, and incubation of the fetus in fluid. However, it remains to be seen whether animal fetuses similar in size to the extremely preterm human infant that have been proposed as a potential target for this technology can be supported in this way. Preterm Yucatan miniature piglets are similar in size to extremely preterm human infants and share similar umbilical cord anatomy, raising the possibility to serve as a good model to investigate the AP. To characterize fetal cardiovascular physiology, the carotid artery (n = 24) was cannulated in utero and umbilical vein (UV) and umbilical artery were sampled. Fetal UV flow was measured by MRI (n = 16). Piglets were delivered at 98 ± 4 days gestation (term = 115 days), cannulated, and supported on the AP (n = 12) for 684 ± 228 min (range 195–3077 min). UV flow was subphysiologic (p = .002), while heart rate was elevated on the AP compared with in utero controls (p = .0007). We observed an inverse relationship between heart rate and UV flow (r2 = .4527; p < .001) with progressive right ventricular enlargement that was associated with reduced contractility and ultimately hydrops and circulatory collapse. We attribute this to excessive afterload imposed by supraphysiologic circuit resistance and augmented sympathetic activity. We conclude that short‐term support of the preterm piglet on the AP is feasible, although we have not been able to attain normal fetal physiology. In the future, we propose to investigate the feasibility of an AP circuit that incorporates a centrifugal pump in our miniature pig model.

In 2017, a Philadelphia research team revealed the closest thing to an artificial womb (AW) the world had ever seen. The ‘biobag’, if as successful as early animal testing suggests,...

Clinical translation of the extracorporeal artificial placenta (AP) is impeded by the high risk for intracranial hemorrhage in extremely premature newborns. The Nitric Oxide Surface Anticoagulation (NOSA) system is a novel non-thrombogenic extracorporeal circuit. This study aims to test the NOSA system in the AP without systemic anticoagulation. Ten extremely premature lambs were delivered and connected to the AP. For the NOSA group, the circuit was coated with DBHD-N2O2/argatroban, 100 ppm nitric oxide was blended into the sweep gas, and no systemic anticoagulation was given. For the Heparin control group, a non-coated circuit was used and systemic anticoagulation was administered. Animals survived 6.8 ± 0.6 days with normal hemodynamics and gas exchange. Neither group had any hemorrhagic or thrombotic complications. ACT (194 ± 53 vs. 261 ± 86 s; p < 0.001) and aPTT (39 ± 7 vs. 69 ± 23 s; p < 0.001) were significantly lower in the NOSA group than the Heparin group. Platelet and leukocyte activation did not differ significantly from baseline in the NOSA group. Methemoglobin was 3.2 ± 1.1% in the NOSA group compared to 1.6 ± 0.6% in the Heparin group (p < 0.001). The AP with the NOSA system successfully supported extremely premature lambs for 7 days without significant bleeding or thrombosis. The Nitric Oxide Surface Anticoagulation (NOSA) system provides effective circuit-based anticoagulation in a fetal sheep model of the extracorporeal artificial placenta (AP) for 7 days. The NOSA system is the first non-thrombogenic circuit to consistently obviate the need for systemic anticoagulation in an extracorporeal circuit for up to 7 days. The NOSA system may allow the AP to be implemented clinically without systemic anticoagulation, thus greatly reducing the intracranial hemorrhage risk for extremely low gestational age newborns. The NOSA system could potentially be applied to any form of extracorporeal life support to reduce or avoid systemic anticoagulation.

According to the WHO, 15 million babies are born prematurely each year, of which 1 million die due to complications. The need to reduce neonatal mortality has culminated in the development of artificial amnion and placenta technology, commonly known as the ‘Artificial Womb’, which provides an environment for the ectogestation of the foetus. Ever since 1958, when Westin et al. developed the first artificial womb by cannulation of umbilical vessels, this technology has shown remarkable potential for improvement of clinical outcomes in critically preterm children. Currently, working models of the technology include EXTra-uterine Environment for Neonatal Development (EXTEND) by Children’s Hospital of Philadelphia, Ex-Vivo uterine Environment (EVE) by Tohoku University, and University of Western Australia1. The world’s first artificial womb facility – EctoLife – was launched on 9 December 2022 by a filmmaker and science communicator based in Berlin, Germany2. The ‘Womb’ has been designed to simulate all the necessary physiological mechanisms during gestation. Gaseous exchange is performed via extracorporeal membrane oxygenation. A pumpless arteriovenous circuit is deployed that drives blood exclusively from the foetal heart and is combined with a low-resistance oxygenator. Waste disposal is carried out through dialysis. A polyethylene film-based biobag is used, which is responsible for sterility, size adjustment, and fluid and space volume efficiency. It can be modified to mimic the dimensions and shape of the uterus with more accuracy, thus providing an analogous alternative to the real womb3. Considering the incidence and mortality rates of premature deliveries throughout the world, artificial womb technology (AWT) is no less than a boon. AWT provides the innate environment of a human womb, thereby reducing respiratory struggle incompatible with the premature lung of the foetus. The impervious, sealed design mimicking the amniotic cavity also reduces the risk of infection. It can be a suitable alternative in cases of placental insufficiency, which can lead to preterm labour and intrauterine growth retardation. The health benefits also extend to pregnant women, as this technology provides a safe alternative to high-risk pregnancies and will alleviate the risks of concluding a full-term pregnancy. Women frequently experience pregnancy-related concerns including anaemia, hypertension, mental health issues, and viral infections. Some of these may be fatal to both the mother and the child, but could be prevented with AWT. The benefits on the social front are also very uplifting. AWT enables infertile couples to conceive a child and become the real biological parents of their children. Moreover, it raises a good proportion of the responsibility of carrying a baby, which is otherwise entirely instilled upon the female. Allows both parents to share equal responsibilities even before the child is fully born, raising equity amongst both genders4. This will help women both physically and will mentally and be more independent. AWT is a helpful alternative to surrogacy for same-sex couples, females who have undergone hysterectomy or infertile women. However, there are still issues that need to be resolved. Technology currently aids in the development of the foetus only between 13 weeks and before complete gestation, that is, 38 weeks. As it cannot facilitate embryo to foetal development, it is bound to be preceded by a surgical extraction of the foetus, which may be associated with complications4. The models do not possess the natural ability of the placenta to reduce pulsatile flow from the umbilical artery to laminar flow in the umbilical vein5. Furthermore, there is no collective understanding of the long-term psychological and psychological effects of the womb on parents and future offspring, considering the change it will bring to the concept of ‘giving birth’. Given the multitude of possible applications, the AWT is not without ethical concerns. The main considerations for the foetus include the consequentialism of medical interventions and their legal status, while those for parents include the extent of their autonomy in decision-making on behalf of the infant, impact on maternal bonding, cost-effectiveness, and accessibility. Even societal arguments about the acceptability of ectogenesis and regulation of abortion pose a question that should be answered before the release of this technology. A potential, though remotely possible, application of the technology is ‘complete ectogenesis’ – complete gestation outside the human body. This will greatly affect the substantiated human involvement during gestation, making it an extracorporeal event and thus completely transforming the conventional notion of pregnancy. Ethical approval Not applicable. Sources of funding None. Author contribution The authors declare that they have no financial conflict of interest with regard to the content of this report. Conflicts of interest disclosure There are no conflicts of interest. Guarantor A. Neyazi. Data statement We have not collected any primary data for this research. The authors confirm that the data supporting the findings of this study are available within the article and/or its supplementary materials.

Throughout most of human history women have been defined by their biological role in reproduction, seen first and foremost as gestators, which has led to the reproductive system being subjected...

Development of an artificial placenta V: 70 h veno-venous extracorporeal life support after ventilatory failure in premature lambs

It is frequently claimed that artificial wombs (AWs) could alleviate the burdens placed exclusively on women in reproduction. In this article, I demonstrate how AWs used for the partial gestation of preterm neonates could introduce new choices for women by changing perceptions of tolerable risks in gestation. In light of advancing medical technology, it is necessary to consider whether the current legal framework in England and Wales would support increased choice for women about alternative forms of gestation. I examine the ill-defined offence of ‘unlawfully procuring miscarriage’ in the Offences Against the Person Act 1861 and demonstrate that different conclusions about the legal significance of ending a pregnancy are evident, depending on the analytical lens adopted in interpreting ambiguities. Furthermore, I demonstrate that the defences available to pregnancy termination under the Abortion Act 1967 are too narrow to support choices about alternative forms of gestation, even if they become physically and medically possible. Therefore, we should decriminalise termination of pregnancy, or, if it is assumed that gestation is the business of the criminal law, specific reforms to the legal framework are necessary. The offence of unlawfully procuring miscarriage is too uncertain and broad, and the defences available are too restrictive.

This article considers challenges for the European Union (EU) maternity and pregnancy rights framework when faced with advances in reproductive technology. Specifically, we consider how the introduction of the ‘artificial womb’ technology, an alternative to bodily gestation, would impact the availability of rights that exist under the maternity and discrimination framework. Employment rights in the EU context have already been confronted by the challenges of advancements in reproduction. We use the case law on in vitro fertilization (IVF) and surrogacy as a baseline for unpacking the challenges that ‘artificial wombs’ will bring. This analysis of the legal framework on maternity rights and sex discrimination will highlight potential avenues for integrating this technology and ensuring the continuation of rights for those opting for it. We advocate against the stratification of maternity and pregnancy rights based on the reproductive and gestational choices made by the pregnant person.

As suggested elsewhere [1] and also in this volume (see Chapter 13), the artificial womb (AW) and ectogenesis – a child brought to term outside a biological womb, might become a reality sooner than we may think. Novel research in disparate areas (such as neonatal care, assisted reproduction, embryology, fetal surgery, computer science and the human genome project) are converging to this end. Society is also pressing in this direction. Society, at large, aims at saving very premature newborns, and demands better outcomes in IVF. Because of this pressure, both sides of the gestation process, its beginning and its end (conception and birth), are presently experiencing a massive research effort. Indeed, while there is sill a huge gap between the first stages of gestation (by IVF) and the 22nd week of gestation (inside the womb), plausibly, this gap will be eventually overcome. Ectogenesis has been addressed in many scientific – philosophical writing [2–4] as well as in popular media. And while some medical sources avoid today discussion on this topic, others choose to address the advent of the artificial womb as a matter of fact [5]. The artificial womb, however, is not exactly welcomed: most countries ban research on human embryos beyond day 14th. Canada has explicitly prohibited any research designed to add to the knowledge of ectogenesis [6]. Still, since prematurely born babies spend less time in a woman’s womb, the question of why and for how long an embryo ‘should’ be required to be in a woman’s womb (nine months; six; five? two days?) cannot be easily answered. Moreover, if proved one day to be safe, ectogenesis, might be a solution to avoid the need of a surrogate for women, who want a biological baby, but lack a womb (for any reason); and possibly also for homosexual male couples. It might also appeal to women, who may need IVF to reproduce; women may save time, pain, depression and endless frustration (when embryos fail to implant for instance).

Clinical trials of artificial placentas are anticipated; however, debate continues over how to define an artificially gestated entity, and little empirical research has explored stakeholder perspectives on this issue. This article presents findings from the first study in England to engage with healthcare professionals’ perspectives. Healthcare professionals, as intermediaries between developers and patients, and clinical experts, are central to shaping technology integration into clinical practice. The analysis presented in this paper frames their views on the artificially gestated entity by different forms of ‘location’. This illustrates how they align the entity with either a newborn or a foetus or propose interim definitions. The lack of consensus amongst healthcare professionals is shown to derive from their reliance on existing legal and medical frameworks. The significance of this article therefore lies in the evidence it provides that the current legal framework in England does not adequately support a consistent definition of an artificially gestated entity. Further, engagement with this stakeholder group reveals the practical implications that ambiguous definitions could have for clinical settings. This article argues that stakeholder groups must collaborate to develop regulatory frameworks for artificial placenta technology that support clinical integration and account for the interplay between law and medical practice.

Lung immaturity remains a major cause of morbidity and mortality in extremely premature infants. Positive-pressure mechanical ventilation, the method of choice for respiratory support in premature infants, frequently promotes by itself lung injury and a negative impact in the circulatory function. Extracorporeal lung support has been proposed for more than 50 years as a potential alternative to mechanical ventilation in the treatment of severe respiratory failure of extremely premature infants. Recent advances in this field included the development of miniaturized centrifugal pumps and polymethylpentene oxygenators, as well as the successful use of pump-assisted veno-venous extracorporeal gas exchange systems in experimental artificial placenta models. This review, which includes studies published from 1958 to 2015, presents an update on the artificial placenta concept and its potential clinical applications. Special focus will be devoted to the milestones achieved so far and to the limitations that must be overcome before its clinical application. Notwithstanding, the artificial placenta stands as a promising alternative to mechanical ventilation in extremely premature infants. Pediatr Pulmonol. 2016;51:643-649. © 2016 Wiley Periodicals, Inc.

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