The path toward ectogenesis: looking beyond the technical challenges

Abstract

Background Breakthroughs 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 text 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 (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. Conclusions The 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.

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

“…17,18 For those that have the capacity for this process (at or beyond the viability threshold), mechanical ventilation does severe damage to the lungs and can cause longterm disability. 14,16 Both the EXTEND and the EVE protocol were designed expressly with the intention of circumventing these limitations not by improving existing methods but by better attempting to emulate gestation to allow for proper continued organ maturation. [5][6][7][8] Both studies have produced promising results that illustrate feasibility of extra-corporeal support of preterm fetal sheep and the associated progress that has been made in circuit configuration, oxygenator…”

Behavioral Intervention Technologies – Historical, Medical, Philosophical, and Ethical Perspectives

“…This "biobag" is currently used to continuing the development of premature babies as it behaves just like a mother's womb and provides oxygen, a substitute of amniotic fluid, water and all necessary nutrients. However, all these researches have triggered numerous pro-and con-discussions of an ethical and bioethical nature, focused on the clinical benefits, respectively saving premature babies, but also on disadvantages, among which more significant would be those in which the technique is used for non-medical purposes (Segers, 2021).…”

The Blurring of Boundaries in Bioscientific Discourse

“…the automation of decision-making processes) into some procedures related to assisted reproduction (Varghese and Charalampos 2019;Zaninovic and Rosenwaks 2020;Casciani et al 2021). It is also a fact that many research institutions are in the process of developing and refining procedures that would ensure the earliest and best possible extracorporeal development of foetuses (Partridge et al 2017;Bulletti and Simon 2019;Segers 2021). These technologies are now primarily used to modify animal reproduction (Wilkinson and Di Stefano 2020, 43).…”