At the end of September, the advisors of the US Food and Drug Administration (FDA) met to discuss the possibility of giving the green light to human clinical trials of an artificial uterus. These devices have been studied for years, with the goal of helping to more safely complete the development of premature babies. Their first major milestone came in 2017, when they managed to maintain fetal lambs born very prematurely for four weeks. It was even talked about in a chapter of Grey’s Anatomy.
Since then, more and more progress has been made., but never with humans. Until now, it had not been considered using a artificial uterus in premature babies. And, in fact, even if the FDA grants authorization, there would still be many steps to take before it becomes a reality.
However, the simple fact that they are considering it has given the starting signal to an intense discussion between defenders and detractors of this type of devices. It is true that it could bring many benefits on a medical level. But there is also talk of the ethical problems that could arise in a future in which artificial uteruses are a common practice in hospitals. Everything, both the good and the bad, will be what the FDA experts take into account. And, whatever your decision, you should continue considering it in the future, to put both extremes on a scale and decide which one weighs the most. Of course, saving the lives of babies who have come into the world prematurely seems like a good reason.
A baby is not the same as a fetus…
The artificial womb also known as extrauterine environment for neonatal development (EXTEND for its acronym in English), seeks precisely what this longer name says: to facilitate the development outside the womb of babies born very prematurely.
Babies born before week 37. This is something very common. In fact, it is considered that approximately 10% of babies They are born this way. According to figures from the World Health Organizationonly in 2020 were they born 13.4 million premature babies Worldwide.
But not everyone is born around week 37. By under 28 weeks They are classified as extremely premature. Of these, it is considered that, with the help of incubators, it is possible to keep babies born alive. from weeks 24 and 25. However, in these extreme cases, it is common for there to be consequences, such as respiratory, neurological or digestive problems. Additionally, they are more likely to get serious infections and mortality increases greatly.
…and should not be treated the same
For all this, alternatives to incubators have been investigated, such as the possibility of a artificial uterus. The big difference between these devices and an incubator is that, although in incubators newborns are treated as babies, in an artificial womb they continue to be kept as fetuses.
The big differences between a fetus in its most advanced stages and a baby are, to begin with, that fetuses do not breathe as such. What they actually do is oxygenate your blood. through the placenta. They also don’t have the same cardiovascular setup. As Elselijn Kingma and Suki Finn explain In a 2020 bioethics study, “the fetal heart functions as a single bomb, instead of a double, as in newborns.” Additionally, “the cardiovascular system in fetuses compared to newborns has multiple bypasses, different flow rates and blood pressures in different parts of the system.”
Artificial wombs, therefore, maintain the premature newborn even as a fetus would be maintained. in his mother’s womb. And for that, several considerations are taken into account.
This is how an artificial uterus works
In an artificial womb, the premature baby, or lamb, is kept in a fluid environmentwith some catheters attached to the navelwhich imitate the umbilical cord, and a external membrane oxygenator. In this way, they are supplied with all the necessary nutrients and gas exchange is promoted just as it would take place in the uterus.
As for the fluid chosen, it has the same properties as the amniotic fluid in which fetuses normally develop. With all this, it has been possible to maintain lambs equivalent to human fetuses for four weeks. 24-25 weeks of gestation. At the moment, there does not seem to be any intention or possibility of it being done below that time limit. However, bioethicists are already considering all the possibilities.
The advantages for which EXTEND technology was conceived
The use of an artificial uterus It is a form of complete ectogenesis. Any form of embryonic or fetal development is known as ectogenesis. outside the uterine environment. In vitro fertilization can be considered partial, after which the embryo is kept for a few days in the laboratory, before transferring it to the uterus. There are even those who consider neonatal incubation this way, since they are not babies born at 40 weeks.
But full ectogenesis is more drastic. These are fetuses that develop outside the uterus, but in conditions practically identical to those that would occur in it naturally.
This can be very beneficial on two levels. On the one hand, having the baby outside the womb would allow for better diagnoses or even easier intervention if necessary. But, above all, it is advantageous for premature babies, from everything we have seen so far. According to him he has explained to Hypertextual Ruben Rodriguez Rodriguez, a doctor specializing in obstetrics and gynecology at the Canary Islands Maternal and Child University Hospital, an artificial uterus “would help lengthen the gestation period, so the fetus would have more time to develop before being born.” As a consequence, “we would have fewer deaths and newborns with fewer short and long term complications”.
What are the disadvantages of the artificial uterus?
Detractors of the artificial uterus criticize it mainly on two levels. On the one hand, they believe it could be used to restrict women’s freedom over abortion. This, on the face of it, may seem strange. But it makes sense If we base ourselves on what is known as visual bioethics. In 2008, ethics professor Paul Lauritzen coined this term to refer to how what we see affects what we consider moral and what not.
This has an especially intense effect on reproduction. In fact, it is what many religious and conservative groups take advantage of to prevent some women from having abortions. They make them see ultrasounds of their fetuses so that they can visualize them as “living people” and they feel guilty when ending the pregnancy.
In an artificial uterus this effect would be even more intense. The fetus would be very visible and it would be much easier for the pregnant woman to see it as a person so alive and independent that she is capable of staying outside her womb.
Right now this It is something unfeasible. However, it is necessary to consider it for a future in which what seems like science fiction to us today can become something very everyday.
It is not easy to maintain the fetus for 9 months
Many of the detractors of the artificial uterus also argue that, little by little, it could be reduce the week of gestation to which they are used. There is even talk of maintaining for 9 months to the fetus and that the pregnancy took place completely externally.
However, currently this is science fiction. “With current knowledge, it is unlikely that an artificial uterus can maintain the entire pregnancy period,” says Rodríguez. “This is because a very specific environment would need to be simulated and difficult to recreate.”
Furthermore, the gynecologist points out that it would be very expensive to use these devices, since, at the beginning, specialized centers and professionals would be needed. “It would not be easy to extend throughout the world given the need to highly qualified staff and highly complex centers until in a second phase costs could be lowered and the training of professionals became generalized.”
It’s not about playing God, but it wouldn’t be beneficial either.
Let’s assume that an artificial uterus can be used for 9 months. Many will see it as playing God. But, leaving aside the religious implications, on a medical level it would not be beneficial either. It could be harmful to both the baby and the mother.
“For the baby, gestation occurring in an environment outside the uterus carries a greater risk of infection. Likewise, a lack of maternal stimulation could have an impact on its development in the long term. On the mother’s side, psychological problems such as stress, anxiety or depression due to separation from the baby could mainly be highlighted, in addition to the consequences of premature birth. However, more studies would be needed to further assess these shortcomings.”
Raúl Rodríguez Rodríguez, gynecologist at the Canary Islands maternal and child hospital.
After all, a pregnancy is possibly the strongest connection that exists between two people. Breaking those ties from their origin can bring many problems. Separating them ahead of time for the good of both parties is, without a doubt, one of those benefits for humanity for which science must work.