# Lentis/Artificial Wombs

An artificial womb is a synthetic reconstruction of a biological womb or uterus that allows for the gestation of an organism outside of a biological womb, or ectogenesis. Through in vitro fertilization (IVF) and an artificial womb, reproduction of animals that utilize uterus-based gestation could be completed without the use of a biological body. As of the early 21st century, the technological challenges facing the creation of a functional artificial womb remain formidable. Nevertheless, the numerous social implications that would come with the successful development of artificial wombs, identifies it as a controversial reproductive technology that should be discussed before it is adopted into common use.

## Artificial Womb Technology

For a human to develop entirely outside of a human body, both a synthetic uterus and a synthetic amniotic environment will be necessary. Dr. Helen Hung-Ching Liu, director of the Reproductive Endocrine Laboratory at Weill Cornell Medical College in NY, researches embryo implantation in an effort to improve IVF efficiency. In her pursuit to help women, who otherwise couldn't conceive, she has experimented with engineering a synthetic uterus. Using a technique she developed called co-culture in which both an embryo and uterine tissue are grown together in culture, Dr. Liu has successfully grown human embryos for up to ten days outside of a human body Although Hung-Ching Liu terminated the experiments with human embryos before the two week federal limit for human embryo research , the embryos would not be able to survive and develop indefinitely in a synthetic uterus without an amniotic environment.
Dr. Yoshinori Kuwabara at Juntendo University in Tokyo spearheaded the effort to create such an amniotic environment in the mid-to-late 1990s. His lab engineered an acrylic tank filled with synthetic amniotic fluid that serves as a womb. Using this technology, Kuwabara's team managed to sustain an premature 18 week old goat fetus for three weeks which allowed the goat to reach term.
According to Janet DiPietro, a developmental psychologist at Johns Hopkins University, "The fetal environment is more than just hormones." To synthesize a holistic womb, other researchers and scholars have proposed additional technologies needed to overcome the engineering challenges facing the creation of a viable artificial womb. These include breathable liquid, reserves of the mother-to-be's blood and hormones, and simulated sounds and movements. The integration of these technologies will hopefully allow a human embryo to be implanted into a synthetic uterus outside of a human body and then placed into an artificial womb-like environment that will allow the embryo to develop to term.
Readers interested in learning more about artificial womb technology are directed to the review article by Bulletti et al. and this article by io9.

## Living in an "Ecto Baby" World
### Human Reproduction and Sexuality

Artificial wombs would effectively de-sexualize reproduction; sex would no longer be a prerequisite for conception. The role of a man and woman in conception and pregnancy would gradually and permanently change. According to Professor Rosalyn Berne, "Every time we make a new technology like this, we have to redefine ourselves. It is always changing what it means to be human, to be pregnant, to be masculine or feminine." This ability to redefine gender roles has led many feminists to extensively study what ectogenesis would mean for society.
Feminist opinions are divided on the issue of artificial wombs. Depending on the framework of analysis, ectogenesis could add to preexisting inequities among genders or it could free women from the constraints of pregnancy. Some feminists praise this bodily liberation artificial wombs promise, a view commonly coupled with the pathologization of pregnancy. In this analysis, gender inequalities are largely due to different reproductive roles in conceiving and raising a child. Other groups view this technology as a loss of the female monopoly over reproduction and another sign of male control over the female body.

### Abortion

Roe v. Wade, the 1973 landmark court case on abortion, legalizes abortions up to 24 weeks into pregnancy, a decision based upon the concept of fetal viability. The decision defines viability as being "potentially able to live outside the mother's womb, albeit with artificial aid." By this definition, artificial wombs would make all fetuses viable. Artificial womb technology will force the government to, at the very least, redefine viability.
In 1987, the Vatican released the "Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation." This document laid out the opinions of the Roman Catholic Church on reproductive technology. It stated their disapproval of all technological interventions in human reproduction. Although the Vatican has not released an opinion specifically regarding artificial wombs, it is likely that their view on artificial wombs would follow the opinions stated in the 1987 document. However, some Catholics may be open to the idea of artificial wombs because of its potential to end the abortion debate, another highly contested issue in the catholic church.
Artificial womb technology has been identified as a potential scientific end to the abortion debate, as fetuses removed during an abortion could be transplanted to an artificial womb to be carried to term. However, the ability to transplant aborted fetuses carries with it the likelihood "that intensive care for such children could be massively expensive and lead to many new orphanages, foster care homes, and related services", especially considering that the number of potential adoptive children already exceeds the number of children adopted.

### Conservation and Husbandry

The first recorded instance of an artificial womb being used to successfully create an organism from embryo to term was the birth of six grey nurse shark pups using a series of tanks that functioned as an artificial womb. Since grey nurse sharks are endangered, the application of artificial wombs in this instance demonstrates its utility in conservation efforts and, potentially, in resurrecting extinct species.
The livestock industry may also welcome artificial womb technology as a boon. The ability to standardize the growth of livestock and do so without the restrictions, complications, and associated costs of natural livestock birth would help livestock businesses cut costs and increase efficiency. The livestock industry has readily adopted assisted reproduction technologies including artificial insemination, superovulation, IVF, and embryo transfer; as such, the livestock industry will likely adopt the artificial womb if it presents a cost-effective, profit-boosting tool.

## Existing Technologies with Implications for the Advent of Artificial Womb Technology
### Surrogacy

Laws that regulate such a controversial and unprecedented technology have yet to be created. When it comes to bio-technologies, particularly reproductive technologies, this is not uncommon. This 'catch-up' lawmaking can be seen in the rise of commercial surrogacy in the united states. Through the lens of commercial surrogacy, we can see how a reproductive technology or innovation, results in catch-up lawmaking.
One of the first high profile cases for commercial surrogacy is found in the case of Baby M. Mary Beth Whitehead, a surrogate mother, agreed to undergo traditional surrogacy for the Stern family. With her egg and the sperm of William Stern, Baby M was later born. After the birth of Baby M, Mary Beth demanded the child be returned to her and refused to abide by the surrogacy contract. Threatening her own suicide, Mary Beth was given the child.
In consequence the Stern family took Mary Beth Whitehead to court. The State Supreme court of New Jersey found the surrogacy contract invalid and against public policy. However, custody of the child was given to the Stern family. The conclusion of this case occurred almost 10 years after the commercialization of surrogacy began. The laws that regulated such an agreement were nonexistent before. Artificial wombs are likely to come into commercialization in a similar legal space. This 'catch-up' lawmaking will occur unless we consider the implications of artificial wombs beforehand.

### Cesarean Section

Because little is known about the technology of artificial wombs it is generally considered a taboo and controversial method. This is not unique to artificial wombs. Technology being disregarded when first brought up is common, especially in medical technologies. For example, in the movie The Artificial Uterus: Birth Without Bodies they claim that when IVF was first introduced the idea of separating reproduction from sexuality was "an outrageous thought, as outrageous as the artificial womb is today.” Overtime the acceptance of technology usually increases until it becomes commonplace. Insight about the possible acceptance of artificial wombs can be gathered by analyzing the trends seen in other related medical technologies.
The first data recorded about the number of C-sections in the U.S. was in 1965. At this time 4.5% of births in the U.S. were performed by C-section. Since then that number has significantly increased. Today 33% of babies are born by C-section in the U.S. This increase is not due to an increased medical need for C-sections. Instead, it is due to the increased general acceptance of a technology over time. Dr. Jeffrey Ecker, states that the increased number of c-sections is “like all practice in medicine, what you become used to becomes the standard.”

## Lessons We Can Learn from Artificial Wombs

As the narrator in the documentary, The Artificial Uterus: Birth Without Bodies, puts it:
"The artificial uterus is developing. Scientific discoveries are improving the technology and bringing it closer. But the artificial womb is also making progress elsewhere. It is overcoming our mental barrier against it. Birth outside the mother's body, it could be the ultimate outcome of the research that started in the 20th century with test tube babies. But do we really want it to happen?"
With the advent of assisted reproductive technologies (ART) such as IVF and commercial surrogacy, increased scrutiny has been placed on the field of technology and reproduction. Despite the initial controversies concerning the use of these technologies, they have been accepted and integrated into common practice. Five million babies have now been born through the use of IVF alone, and more are to come. The increase in the number of C-sections despite the lack of medical need may also serve as a model for the increased use of artificial wombs by women or couples who can conceive and bear a child without them.
These previous technologies give us the opportunity to discuss artificial womb technology (AWT) well in advance of its realization. As discussed in this chapter, there will be numerous large social implications in a world where babies can be born outside of a human body and without any sexual component. These implications range from changing definitions, responsibilities, expectations, privileges, and opportunities for humans of any gender or sexuality.
From AWT, we can learn that, with the adoption of new biotechnologies - reproductive technologies in particular - we must, as Professor Rosalyn Berne of the University of Virginia puts it "constantly redefine what it means to be human." Artificial wombs may initially be used only by those who cannot conceive the "natural" way; however, they may later be used as the primary means of human reproduction. We need to start the discussion now to consider what it is we need, or want, from technology.

## See also

A 2009 documentary on artificial wombs, The Artificial Uterus: Birth Without Bodies, explains the state-of-the-art of artificial womb technology and discusses the artificial womb's implications for sexuality, human development, child rearing, and abortion. It contains video footage of the research conducted at Kitasato University in Tokyo, a short interview with Dr. Helen Hung-Ching Liu, and interviews with French medical care providers and scholars addressing various aspects of the artificial womb. It is available free for University of Virginia students here.

## Future Research to Improve Chapter

Considering the similarity of proposed artificial womb technology (AWT) to current NICU technology - incubators in particular - would be interesting to explore.
A more in depth analysis of the potential effects of AWT on gender and sexuality, as well as on current conceptions of family would bolster this chapter's discussion of AWT's social implications.
Additions to the chapter concerning the role of science fiction and other popular conceptions of AWT would help to frame the discussion of AWT's social implications.
As always with rapidly developing new technologies, it will always help to keep the chapter up to date with any new advancements in technology that are relevant to the creation of a functional artificial womb. For example, this chapter does not discuss breathable liquids, which constitute a rapidly developing technology highly relevant to the development of AWT. Future editors are directed to the work of Thomas Shaffer for breathable liquid information.

## References

* 1 2 3 Reynolds, G. (2005). "Artificial Wommbs: Will we grow babies outside their mothers' bodies?" Popular Science.
* ↑ Kuwabara, Y., Okai, T., Imanishi, Y., Muronosono, E., Kozuma, S., Takeda, S., Baba, K., Mizuno, M. "Development of Extrauterine Fetal Incubation System Using Extracorporeal Membrane Oxygenator." Artificial Organs, 1987: 11(3):224-227.
* ↑ Unno, N., Kuwabara, Y., Okai, T., Kido, K., Nakayama, H., Kikuchi, A., Narumiya, Y.,..., Tamura, M. "Development of an Artificial Placenta: Survivial of Isolated Goat Fetuss for Three Weeks with Umbilical Arteriovenous Extracorporeal Membrane Oxygenation." Artificial Organs, 1993: 17(12):996-1003.
* ↑ Cook, M. (n.d.). Guest editorial: Reproductive technologies and the vatican. Retrieved from https://www.scu.edu/ethics/publications/iie/v1n3/
* ↑ Kaczor, C. (2005). "Could Artificial Wombs End the Abortion Debate?" Philosophy and Medicine, 85:105-121.
* ↑ Adoption and Foster Care Analysis and Reporting System FY 2012 data
* ↑ Chakravarthi, V. and Balaji, N.S. (2010). "Use of Assisted Reproductive Technologies for Livestock Development." Veterinary World, 3(5):238-240.
* ↑ Cesarean section. (2013). Retrieved from http://www.childbirthconnection.org/article.asp?ck=10456