Artificial Wombs, Coming Soon To A Hospital Near You?

(Blend Images — ERProductions Ltd/Getty Images)” class=”aligncenter size-full” />(Blend Images — ERProductions Ltd/Getty Images)

When Neo was told what the Matrix was, he was shown how evil robots incubated human embryos in what looked like big transparent orange eggs, picked like ripe fruit by mechanical behemoths when they were ready to be hooked up to their sinister virtual reality pods. That’s right, there was no spoiler warning because come on, that movie came out 18 years ago and by this point if you haven’t seen it, you only have yourself to blame. At any rate, the writers obviously thought this would look scary and advanced way beyond anything humanity has accomplished in terms of artificial wombs in which embryos could be brought to term. Yet here we are, potentially just a few steps away from something an awful lot like that being ready to save a premature baby in a hospital near you.

Researchers In Philadelphia successfully built a pouch filled with amniotic fluid in which lambs were able to grow and develop normally. The system uses a pump to circulate the fluid and an oxygenator to keep the embryo’s organs and tissues healthy and in a low stress environment as they grow. It provides a proof of concept for treating premature babies who still face an uphill battle to survive, and much higher risks of all sorts of future health and developmental problems when they pull through. Officially, the target for completing animal tests is two years from now. Three to five years later this system could be deployed at hospitals. Premature babies delivered by a C-section, after receiving a drug that momentarily suspends their breathing so their lungs can keep developing in the artificial womb, would be almost immediately enclosed in it and left to gestate for another month.

Ideally, this system targets babies born at 23 weeks so a month seems a bit too short. However, by 28 weeks, modern medicine can already help them avoid the worst possible outcomes and conventional methods could step in and help the baby mature a little further. Since the system has been tested for a month of continuous operation, the researchers and doctors wouldn’t want to push it far past that. However, should further testing prove that it can keep going and embryos are still developing normally for even longer, it’s probably not outlandish to think that some premature babies who still face long odds even at 28 weeks could be slowly kept in these mechanical wombs a little longer. In an perfect world, they could be carried to term by simple machines under medical observations and be extracted as healthy, happy babies with almost none of the risks of premature delivery.

Again, all of this will require a lot of work, testing, and careful peer review, but so far, the system looks extremely promising and we are learning more and more about fetal development. This may have been a fantasy a decade ago, but today, we have a viable way forward and a working prototype that seems safe and effective on actual living test subjects. This prompts three very important questions about its potential future applications. The first is whether this changes anything when it comes to the pro-live vs pro-choice debate since premature babies could be carried closer to term with risks to their quality of live significantly reduced. The second is whether it could be used even earlier during pregnancy and if so, what are the implications of artificially supported pregnancies. The third is who will pay for this.

First, if we assume this technology is successful, it doesn’t change anything for the controversy over abortion. It can only help premature babies which made it to 23 weeks and should have matured normally. When women are faced with terminating a pregnancy this late, it’s virtually always because the fetus would not have survived or had such severe abnormalities, there wouldn’t be much of a life expectancy to discuss after birth. Alternatively, continuing a pregnancy would’ve killed the mother either before birth, or during it. These are cases where this technology could really help because with it, expecting mothers could avoid making a tragic choice, and instead, have their babies gestate outside their wombs. However, keep in mind that this would be just a fraction of one percent of all abortions.

And this leads us into the second question. If this technology works so well that it becomes possible to incubate an embryo in an artificial egg much like the ones shown in The Matrix, would it make sense for women to forgo the risks and side-effects of pregnancy after 12 weeks? Any future, space-faring human society would certainly embrace this technology since having women out of commission in a potentially hostile alien environment for nine months at a time will be a huge risk. But before one develops, we’d need to answer a lot of key questions about pregnancy’s effects on the body as well as mental health because we haven’t updated our research into so many of them since the days that midwives’ guesses and anecdotes ended up being included in textbooks as if they were peer reviewed studies.

Finally, for the third and biggest question. It’s easy to imagine a price tag of more than a million dollars for artificial gestation and incubation of a very severely premature baby. Who would ultimately pay that? Certainly not the typical middle class, much less impoverished family. They don’t have seven figures in the bank for an emergency. Half of them don’t even have $400 in these situations. Insurance companies may balk at paying for “experimental treatments” such as this and kick the claim back to the hospital where social workers would have to figure out how to get at least some compensation for the time, effort, and resources involved. It’s unfortunate that when looking at a lifesaving innovation we have to plan for battles with insurers to cover its use during a medical crisis, but that’s the world we live in.

Thankfully the question of cost is solvable if we apply enough political will, technology, and compassion to the problem. The most important takeaway should be that scientists are on the verge of helping tens of thousands in a future coming soon to neonatal intensive care units, and this technology is far ahead of anything tried in the past thanks to more thorough research of embryonic and fetal development. Its potential, should it prove effective, is still an open question and we should wait until it starts saving real patients in real NICUs before we let our imaginations run away with ideas, but from everything demonstrated so far, all signs look promising. Here’s to hoping that it will be in clinical use sooner rather than later.