The Moral Superiority of Bioengineered Wombs and Ectogenesis for Absolute Uterine Factor Infertility

Abstract

This paper argues that uterine transplants are a potentially dangerous distraction from the development of alternative methods of providing reproductive options for women with absolute uterine factor infertility (AUFI). We consider two alternatives in particular: the bioengineering of wombs using stem cells (which would carry fewer risks than uterine transplants) and ectogenesis (which would not require surgical intervention for either the prospective mother with AUFI or a womb donor). Whether biologically or mechanically engineered, these womb replacements could provide a way for women to have children, including genetically related offspring for those who would value this possibility. Most importantly, this alternative would avoid the challenge of sourcing wombs for transplant, a practice that we argue would likely be exploitative and unethical. Continued research into bioengineering and ectogenesis will therefore remain morally important despite the recent development of uterine transplantation, even if the procedure reaches routine clinical application.

Ethical, Translational, and Legal Issues Surrounding the Novel Adoption of Ectogestative Technologies

“…This includes reproductive use by persons with or without medical indications, both singles and couples, regardless of gender or sexual orientation. 44,[93][94][95][96][97] These perspectives either heavily rely on the less imminent perspective of "full ectogestation", or map onto the speculative outlook of employing AAPT to redress the physical, social, financial (or other practical) burdens associated with a complete pregnancy and childbirth (given our primary focus on translational and ethical issues in adopting ectogestative technology we refer for further reading to the overview presented in reference 14).…”

“…In normative terms, a major part of this debate effectively hinges on the idea that the technology could enable people to pursue their preferred parenthood project, including discretion about how to achieve it and potentially advance equality amongst people in terms of who carries the physical burdens of these reproductive choices. [94][95][96][97] Here as well, respecting autonomy to protect personal choice about reproductive projects should be balanced against other moral considerations like equity of access. 35,57 For our present purposes, it is most relevant to consider these (albeit speculative) perspectives through the lens of so-called "soft impacts" as part of a comprehensive technology assessment that includes awareness of wider concerns, such as how this emerging technology might affect existing practices, routines and norms.…”

The current and future state of surgery in reproductive endocrinology

“…Continued refinement of techniques (laparoscopic removal of uterus from the live donor, for example) and reduction of costs will further advance the field and make it accessible to more women. There are valid concerns that uterine transplant and its success will decrease efforts to develop bioengineered alternatives for the uterus from live or diseased donors [33]. This is a valid concern.…”