The path toward ectogenesis: looking beyond the technical challenges

Seppe Segers

doi:10.1186/s12910-021-00630-6

Abstract

BackgroundBreakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation.Main textThis paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis’ subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus.ConclusionsThe development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy.

Highlights

This paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial ethical issues that continued research into, and the clinical translation of, ectogenesis gives rise to
Close consideration should be given to whether ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures
Important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized

Summary

Main text

Ectogenesis: types and state of the art AWT interest first appeared at the turn of the nineteenth century in the writings of Haldane (who coined the term ‘ectogenesis’). Authors who are skeptical about the freedom and equality promoting argument assert that such considerations should at least take into account possible effects on the future child’s welfare, societal inequities and, in case of partial ectogenesis, the innate risks of preterm extraction of a fetus for ex utero gestation [17, 66, 73] For these reasons, it is argued that ExCG would be less acceptable for social considerations and for lesser discomforts, than for e.g. cases of dangerous pregnancy or as a form of neonatal intensive care [17]. An important consideration throughout these research phases, as well as when this technology becomes clinically available, is the question of liability for potential injuries during the gestation in the ectogenetic incubator [29, 47]

Conclusions

Background