The artificial womb has come of age. In Tokyo, researchers have developed a technique called EUFI — extra-uterine fetal incubation. What, essentially they did is taken goat fetuses, threaded catheters via the large vessels in the umbilical cord and supplied the fetuses with oxygenated blood while suspending them in incubators that contain artificial amniotic fluid heated to body temperature (Mind equals blown).
As one contemplates the goat fetuses as they lay primly suspended there without a care in the world, Aldous Huxley’s Brave New World, whose novel anticipates advancements in reproductive technology, psychological manipulation, among other things, not to mention a Centrally-Located Hatchery on a Dalek space-ship, if you are given to Dr.Who. I am always fascinated at these mind-boggling technological quantum leaps that prove us as humans to be something quite special. As a matter of factly, in recent decades, medicine has focused on the beginning and end stages of pregnancy, the crucial time inside the woman’s body has been reduced. However, we are still a long way from bridging those two points, from creating a completely artificial gestation. But we are at a moment when the fetus, during its obligatory time in the womb, is no longer inaccessible, no longer locked away from medical interventions (a common intervention being in-vitro hydrocephalic shunting).
The future of human reproductive medicine tracks along the speeding trajectories of several divergent technologies. There is neonatology, a sub-species of Pediatrics, accomplishes its miracles at the too-abrupt end of gestation (prematurely-born infants). There is fetal surgery, intervening dramatically during pregnancy to avert the anomalies that kill and cripple newborns. There is the technology of assisted reproduction, the in-vitro fertilization and gamete retrieval-and-transfer, technology of the last 20 years. And then, inevitably, there is genetics. All these technologies are essentially new, and with them come ethical questions so potent that the very inventors of these miracles seem half-afraid of where we may be heading. But, I believe Science should stand boldly before the Court of Morality to make its case; Morality should not impede the reality-tearing progress of Science, but rather should be a worthy guide.
Modern neonatology is a relatively short biography: a few decades of phenomenal advances and doctors who resuscitate infants born 16 or 17 weeks early, babies weighing less than a pound, et cetera. These very low-birth weight babies have a survival rate of about 10 percent. Experienced neonatologists are extremely hesitant about pushing the boundaries back any further; a lot of research now is aimed at reducing the severe morbidity of these extreme preemies who do survive.
“Liquid preserves the lung structure and function,” says Thomas Shaffer, professor of physiology and pediatrics at the School of Medicine at Temple University. This man has been working on liquid ventilation for almost 30 years, talk about dedication to the Natal-Advancements. The late sixties saw him looking for a way to use liquid ventilation to prevent decompression sickness in deep-sea divers. The technology he developed thereof was featured in the book”The Abyss,” and for the movie of that name, prompting Hollywood to build models of the devices Shaffer had envisioned. As a postdoctoral student in physiology, he began working with premature infants. Throughout gestation, the lungs are filled with the appropriately named fetal lung fluid. Interestingly, he thought, ventilating these babies with a liquid that held a lot of oxygen would offer a milder, gentler, safer way to take these immature lungs past the threshold toward the necessary goal of breathing air. Consequence- Barotraumas, which is damage done to the lungs by the forced air banging out of the ventilator, would thus be reduced or eliminated. Exquisite thinking, I’ll say.
Today, in Shaffer’s somewhat Daedalusian-structured laboratories in Philadelphia, chances are you’ll come across a ventilator with pressure settings that seem quizzically low; this machine is set at pressures that could never force air into stiff newborn lungs. On some obscure corner, there is the long bubbling cylinder where a special fluorocarbon liquid can be passed through oxygen, picking up and absorbing quantities of oxygen molecules. This machine fills the lungs with fluid that flows into the miniscule passageways and air sacs of a premature human lung. I would live in this lab!
There was a time when many people thought the whole idea was crazy (of course, how many great ideas aren’t)), when his was the only team working on filling human lungs with liquid. Today, liquid ventilation is cited by many neonatologists as the next large step in treating premature infants. In 1989 (the year I was ejected into this glaring reality that made me cry for the first time), the pioneering human studies were done, offering liquid ventilation to infants who were thought not to have any chance of survival through conventional therapy. The results were promising, and bigger trials are now under way to attempt to replicate them and then some; I can’t wait, so thoroughly excited. In fact, a pharmaceutical company has developed a fluorocarbon liquid that has the capacity to carry a great deal of dissolved oxygen and carbon dioxide — basically the fluorocarbon coefficient is every 100 milliliters holds 50 milliliters of oxygen, to put it in another way, the oxygen coefficient is 50ml/100ml of fluorocarbons. Shaffer and his colleagues argue that the lung sacs can be expanded at a much lower pressure by putting liquid into the lung.
“I wouldn’t want to push back the gestational age limit, I want to eliminate the damage,” he declares. Shaffer believes that this technology may become the standard. Pressed to speculate about the more distant future, he imagines a premature baby in a liquid-dwelling and a liquid-breathing intermediate stage between womb and air: Immersed in fluid that would eliminate insensible water loss you would need a sophisticated temperature-control unit, a ventilator to take care of the respiratory exchange part, better thermal control and skin care.
The notion that you could perform surgery on a fetus was pioneered by Michael Harrison at the University of California in San Francisco. Guided by an improved ultrasound technology, it was he who reported, in 1981, that surgical intervention to relieve a urinary tract obstruction in a fetus was possible.
”I was frustrated taking care of newborns,” says N. Scott Adzick, who trained with Harrison and is surgeon in chief at the Children’s Hospital of Philadelphia.
When children are born with malformations, damage is often done to the organ systems before birth; obstructive valves in the urinary system cause fluid to back up and damage the kidneys, or an opening in the diaphragm allows loops of intestine to move up into the chest and crowd out the lungs. ”It’s like a lot of things in medicine,” Adzick says,”if you’d only gotten there earlier on, you could have prevented the damage. I felt it might make sense to treat certain life-threatening malformations before birth.” Of course, it makes so much sense!
Eighteen years ago, in-vitro fertilization was tabloid news: test-tube babies! Now IVF is a standard therapy, an insurance wrangle, another medical term instantly understood by most lay people. Enormous advertisements in daily newspapers offer IVF, egg-donation programs, even the newer technique of ICSI intracytoplasmic sperm injection as consumer alternatives. It used to be, for women at least, that genetic and gestational motherhood were one and the same. It is now possible to have your own fertilized egg carried by a surrogate or, much more commonly, to go through a pregnancy carrying an embryo formed from someone else’s egg.
We ask, is it really very likely that any significant proportion of women would take advantage of an artificial womb? Could we ever reach a point where the desire to carry your own fetus in your own womb will seem a willful rejection of modern health and hygiene given the strong desire to be pregnant, which drives many women to request donor eggs and go through biological motherhood without a genetic connection to the fetus. Should Motherism fly in the face of Common Sense, with due regard to the fact that Common Sense is not so common (With the fact in mind that there are some mothers in a country that I will not name breast feed their children ‘til they are 4 years OLD)?
Ultimately, would you Oh women of Kenya and other African societies subscribe to motherhood gestationally without genetic attachment or with it (men you can say what you feel, too)? Will the African society give in to these things? Anyway, sometimes Science and Culture don’t have a meeting point. Personally, I look forward to more progress towards stranger-than-fiction technological realities in reproductive medicine. Here, here I say!
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