Like a Virgin by Prasad, Aarathi (recommended reading txt) 📕

An aquatic environment, an artificial womb, a synthetic placenta: these can surely keep premature babies alive. But could they be used to craft the future of all pregnancies?

Perhaps because of the ethical tangles involved, many scientists working in the field have not disseminated much of their research, or the possible applications of it. That includes scientists such as Hung-Ching Liu, an internationally respected researcher in reproductive biology who, at a conference in 2001, said that her ‘final goal is having a child in the laboratory’. And not through old-fashioned childbirth.

By that time, though, Liu had already managed to grow the lining for a human womb, using a sort of scaffolding over which cells, cultured from a woman’s womb, could multiply. This ‘womb’ was only a few sheets of cells in a Petri dish, not an entire organ. But when it was tested using fertilized eggs left over from IVF cycles, the eggs implanted in it at six days, just as they would in a real womb. Liu believes that this approach would ensure that the whole package – embryo and womb – would not be rejected by the immune system when inserted into the woman’s body to continue the long process of development.

In the lab, researchers currently are not allowed to grow human foetuses for more than fourteen days, because it is at this point that foetuses develop a neural tube – the precursor of the brain and nervous system. This meant that Liu’s experiment could not progress beyond eight days after implantation. Still, going ahead even for this scant time gave her an opportunity to study how the placenta grows, and to see whether she could develop a womb-like device that could remain viable outside of the mother. The device would need to be hooked up to a computer, which would regulate the delivery of liquid to nourish the foetus, the removal of waste products, and the control of the team of hormones that are so finely balanced in the real-life body of an expectant mother. If scientists could achieve this, a baby could conceivably be brought to full term in an artificial womb.

Liu’s vision is not fanciful, in terms of motivation or practicality, when you consider two issues. Women – even young women – without wombs are no small minority. In fact, ‘absolute uterine infertility’, which is defined as a woman’s infertility resulting from defective or absent wombs, affects millions throughout the world. In the United States alone, around five thousand hysterectomies are performed in women under the age of twenty-four; nearly nine million women of reproductive age have had a hysterectomy due to conditions including cervical cancer, endometriosis (where uterine cells grow elsewhere in the body, often on the ovaries), and Mayer-Rokitansky-Küster-Hauser syndrome (in which the uterus can be underdeveloped, shaped more like a cord than a sac, or even absent). Most women with uterine infertility have no chance of becoming a genetic mother, except by the use of another woman as a surrogate, and no prospect of ever carrying a pregnancy to term. Liu works with infertile women, many of whom have survived cancer but lost their wombs and reproductive potential to the disease. Her hope is to offer these patients the option of having their own children.

Second, the idea of creating a blood circuit that can serve as a placenta and work alongside an artificial womb and amniotic fluid is complex, seemingly too complex and too dangerous to use in anything outside of the great works of science fiction. But for premature babies, especially those who have difficulty breathing, the ideal situation would be to maintain them in a warm liquid bath, like the womb, attached to an artificial placenta rather than a lung-damaging ventilator. If the conditions in that bath could be set to match the environment of a natural womb, the baby might develop normally, without damage to the lungs and the oxygen-deprived brain. Recently, too, there has been progress in making liquid breathing a reality, through the development of a fluorocarbon liquid with the capacity to carry a large amount of dissolved oxygen and carbon dioxide. The liquid could be inserted into the lung, so that the lung sacs can expand at a much lower pressure, creating an intermediate developmental stage between the womb and life in the open air.

Liu and many other researchers in the field are confident that, despite the complications and difficulties, the technological perfection of an artificial womb is achievable. The French biologist Henri Atlan predicts that, within a hundred years, science will master the complete development of the human foetus from conception. In the meantime, Carlo Bulletti, a professor of reproductive biotechnology at the University of Bologna, says that partial ectogenesis – growing foetuses between fourteen and thirty-five weeks of pregnancy – is already within our reach if we were to use all of the knowledge and technology at our disposal.

What would it mean if a foetus could be gestated entirely outside of a woman’s body? Ectogenesis is clearly not an ethically easy path for starting or expanding a family. Hand in hand with the creation of a viable artificial womb, doctors and counsellors would have to create something to analyse a number of genetic defects carried by a fertilized egg or early-stage embryo that may not yet be recognized through pre-implantation genetic diagnosis. During in vitro fertilization, some embryos may fail to implant in the natural womb because of random or inherited genetic mutations or those that accumulate with age. With an artificial womb, that process would not work in the same way; the embryos would likely be attached by doctors to the synthetic placenta (or other filtration system that might provide nutrition) meaning that implantation would succeed where it would fail in a natural womb. And the embryo with potential abnormalities