What is ectogenesis?

The term ‘ectogenesis’ describes the complete or partial gestation of a fetus outside of the human body. It is also referred to as ‘ectogestation’, ‘extra-corporeal gestation’ and ‘artificial womb technology’.

Complete ectogenesis is when the entire process of conception, embryonic development, and gestation takes place outside the human body; while partial ectogenesis is most often used to describe the transfer of a partially developed fetus from the human womb to an artificial womb to complete gestation.

What is happening in current scientific research?

Current scientific research is exploring the potential of partial ectogenesis. The stated aim of this research is to find more effective treatments for extremely premature babies. This research, which explores transferring fetuses from the maternal womb to an artificial womb environment, where they can continue to gestate, involves the use of lamb fetuses or simulation technology and not human fetuses. It should also be differentiated from the use of incubators for premature babies because it focuses on fetuses, rather than neonates, which have different physiological and physical characteristics.

In 2017, a team of scientists from The Children’s Hospital of Philadelphia reported the development of the Biobag, an artificial external gestation environment that closely reproduces the conditions of the womb. The Biobag is a sealable polyethene bag containing sterile, synthetic amniotic fluid, with catheters delivering nutrients and removing waste products.

In the Philadelphia study, eight extremely premature lamb fetuses were removed from the maternal womb by caesarean section and placed in Biobags. The blood vessels from the lambs’ umbilical cords were connected to a pumpless oxygenator that allowed the fetuses’ heartbeats to control circulation as they would in the womb. The lambs remained in Biobags for four weeks, all survived and showed evidence of being healthy and of having developed when they were delivered from the bags.

Also in 2017, scientists from Australia and Japan launched a similar device, called the EVE platform. Like the Biobag, the EVE platform is a sealed environment containing synthetic amniotic fluid and with an oxygenator and catheters. This version of the platform sustained lamb fetuses for a week. However, there was a higher instance of morbidity and mortality than in the Biobag study. In 2019, following a redesign of the EVE platform, the same group reported an improved survival rate, with lamb fetuses maintained outside of the maternal womb for five days.

A team of researchers in the Netherlands is also currently working on the development of a perinatal life support (PLS) system, or artificial womb, that will supply the fetus with oxygen and nutrients through the umbilical cord and an artificial placenta. Unlike the two earlier studies, which involved lambs, the PLS project will use breakthrough simulation technology and replicate the birth of an extremely premature infant using a manikin (a human simulation model used in medical research) and advanced computational monitoring and modelling.

Current research into partial ectogenesis represents a potentially significant advance in life-saving technologies for extremely premature babies and could have real-world impacts within the next decade. To date, no clinical trials have been carried out with human fetuses and such trials would only be justifiable under particular conditions. However, in September 2023, the first step toward clinical trials involving human fetuses was taken when US Food and Drug Administration (FDA) advisors met to discuss the ethics of moving research on artificial wombs from animals to humans.

In contrast, complete ectogenesis is mostly discussed speculatively in academic literature, and in fiction, and the possibility of human conception and gestation occurring wholly outside the human body remains a more distant prospect.

Nevertheless, it is important to carefully consider the ethical, social, and legal questions raised by possible future advances in ectogenesis-enabling technologies, whether partial or complete, in order to understand the potential benefits they may provide as well as any challenges and risks.

What issues/questions does ectogenesis raise?

• What legal and regulatory reforms will be needed to accommodate ectogenesis?
• What will (and what should) be the legal and/or moral status of the entity transferred to the artificial womb environment ? Should this differ from entities of similar gestational age within the woman’s body or neonatal incubators?
• If complete ectogenesis becomes possible, to what extent will changes in modes of reproduction alter prevailing social norms governing personal and sexual relationships?
• To what extent would complete ectogenesis radically disrupt or render obsolete existing concepts and language (ideas such as ‘birth’, pregnancy’, ‘mother’, and ‘child’)? And how will linguistic and conceptual change be exploited or resisted in public debates about human reproduction?
• What impact (if any) will ectogenesis have on the ethics and politics of abortion?