‘There was a group out of the Karolinska Institute in Sweden that published a paper in 1958 showing the use of this sort of platform with pre-viable human foetuses,’ he continues. ‘There were groups in Canada in the early 1960s that were doing short-term, twelve- and twenty-four-hour experiments with sheep using this system. As early as 1963, the Japanese did the most seminal work in the field. In the 1990s the Japanese were using goats and running them out to very similar or equal – to three weeks or whatever came out of Philadelphia. More recently, there’s a group in Michigan doing some work in this space. Anyone who tells you they’ve done this for the first time and what they’re doing is novel and new is being a little disingenuous.’ He doesn’t name any names.
There is no patent application for EVE (‘My view is that it’s not patentable,’ he says, exasperated. ‘This has all been in the public domain in various forms since 1958’) so Matt is happy to answer questions about it. I can’t come to his lab in Perth because he’s in Boston at the moment, studying business and leadership at Harvard Business School. We’re speaking on the phone during a break between his classes.
‘How come you’re studying business?’ I ask.
‘Well, because like most other things these days, science is a business,’ he says.
Today, Matt only wants to talk science. I ask him why he decided to name his artificial womb EVE, the name of the first woman and the mother of mankind, and it’s obvious he doesn’t want to get drawn into broad discussions about the symbolism of his work. ‘It was just a convenient way of describing it, I guess.’
Matt has been developing EVE since 2013, in collaboration with a team of researchers at Tohoku University Hospital in Sendai, Japan. No official images of EVE have ever been released, but I found a YouTube video uploaded to the official WIRF channel and watched it just before I rang him up. It looked like it wasn’t supposed to be online: it was clearly filmed on a phone and had had only fifty-six views in just over a year. Having only seen CHOP’s promotional video and the carefully sanitized images of the lambs they submitted with their paper, this forty-four-second clip made my jaw drop.
It begins with beeping monitors in a NICU. The even, regular trace of a healthy heartbeat thumps in red across a black screen. The camera pans down to the incubator beside it, and instead of a baby there is a lamb submerged in yellowish fluid in a transparent bag. Its chest rises and falls, its nostrils flare. The camera pans again, up from the lamb’s woolly abdomen to a mass of tubes protruding from the semi-open zip, like veins filled with blood. With its amateur camerawork and bright body fluids it’s far more visceral than the carefully considered footage released by CHOP. And it’s disturbing, uncomfortable viewing. This is what an artificial womb really looks like.
Still, the EVE therapy system looks like a biobag, and when Matt describes it, it sounds like one too. ‘Extremely preterm babies are not really small babies: they are more akin to a foetus. That’s the basis that we work on. We try and work with the anatomy and the physiology that they currently have, rather than trying to force them to adapt to life outside the uterus. That means making use of the umbilical cord and the foetal heart, and keeping these foetuses viable and protected under a layer of amniotic fluid, and hopefully allowing them to grow in the same way that they would otherwise.’
‘You call them foetuses rather than neonates,’ I say. ‘Does that mean you don’t consider the lambs to have been born when they are put into the system?’
‘We do not.’
‘So birth is opening the bag?’
‘Well, I would say birth is when you’ve cut and occluded the umbilical cord. That’s when you have agency as an individual person. My understanding is that until the cord is cut and clamped, then you are not born.’
Artificial womb technology is redefining birth: it’s no longer about being pushed or pulled out into the world, it’s about being separated from the life support that you rely on as a foetus. You can be separate from your mother and still be officially unborn.
Just like the vegan meat makers, Matt talks about his work like it is simple stuff – home brewing, rather than frankenscience.
‘How on earth are you able to plug in through the umbilical cord?’ I ask.
‘It’s not as tricky as you might think, once you’ve worked out how to do it.’
‘What’s in the amniotic fluid? How do you make it?’
‘It’s kind of like Gatorade, really. It’s a salt-protein-water mix.’ Just like Mike’s description of the medium they grow at Finless Foods.
WIRF’s collaboration with colleagues in Japan is going to give them the edge over the other teams making artificial wombs, he says. ‘Our competitive advantage is that we have a pretty big Japanese biotech company working to design the hardware for the things that we use. We need to be working with people who can run things to scale and potentially run them through an FDA pipeline. We’re working with a company down in Osaka called Nipro Corporation that’s a world leader. It gives us a very nice system to work with.’
But the big difference between WIRF’s work and CHOP’s research is that Matt’s team is putting far more premature lambs into EVE. The youngest lamb foetus put into the biobag was at 106 days’ gestation; Matt has been working with animals as premature as ninety-five days. He’s cautious about translating this into human terms, but it works out as somewhere between twenty-one and twenty-three weeks. No one else has ever reported working with foetuses this young. And while CHOP grew their lambs for several weeks and let some of them live after the experiment, Matt’s team chose only to keep them in the artificial womb for a week, and then killed all of them to analyse their organs. He says they could have easily kept them alive for longer, if they had wanted to. ‘These are very stable, very healthy animals at the end of their predetermined time point.’
Even in a week, the lambs change dramatically inside the artificial womb. ‘They grow, absolutely. They get bigger. Lambs at this gestation will put on about forty grams a day. They flex and extend and they swallow. I’ve never been pregnant, but my wife has been. Her view is that a foetus does those sort of movements: it kicks, it flexes its legs, it has a wee wiggle and it goes back to sleep for a while.’
I wonder if he has feelings about his invention as a father, as well as a researcher. ‘How does it feel to watch those kinds of changes if you’re going in there each day?’
‘It’s pretty remarkable stuff. From a basic science perspective, you’ve built a placental knockout model.’
I try again. ‘What about from a human perspective? Did you get attached to them?’
‘Yeah. You certainly do get attached to these little guys. You’re rooting for them.’
‘Did you name them?’
‘Yeah, they get named.’
‘What are they called?’
‘Oh, I can’t remember.’
I guess if your ambition is to put the tiniest children on earth into a plastic bag, it’s better not to be too overcome with paternal feelings towards them.
But clinical trials in human babies are a long way off. ‘Anyone who tells you that they’re going to be doing this in two years either has a wealth of data that is not in the public domain or they are being a bit sensationalist.’
‘Are you talking about anyone in particular, there?’
‘I am not. I am making a general comment,’ he says firmly. ‘All of the experiments that have been done to date are done on foetuses that come from pregnancies that are otherwise healthy and would be ongoing if they hadn’t been interfered with by the research team. That’s simply not the case for a twenty-one-, twenty-two-, twenty-three-week human foetus. These are not going to be healthy babies. There’s a reason why they are being born preterm.’ By creating a device to gestate such premature babies, both Matt’s team and CHOP have set themselves a task beyond simple ectogenesis.
‘The threshold barrier for getting this into clinical use is going to be incredibly difficult. If you’re going to create an a
rgument that an ethical committee will buy, you’ve got to have an odds-on chance of delivering an outcome that is several orders of magnitude better than the existing technology currently in use,’ he says. ‘What is the likely first demographic for this platform? I think we’re talking about a very sick twenty-one-week foetus that essentially has a zero chance of survival on anything we have existing.’
I wasn’t expecting him to say that. It completely floors me.
I lost a baby at twenty weeks – a son, who would have been my second child. There was nothing wrong with him. He was perfect. I got appendicitis when I was nearly nineteen weeks pregnant, although I didn’t know it then. I spent a week in hospital while obstetricians and gynaecologists scanned and poked and took my blood as they tried to work out why I was ill and what they should be doing about it. And then I went into labour. It happens: if you are pregnant, a serious infection can make your cervix open. In between contractions, the obstetrician told me that if I had been twenty-four weeks pregnant everything would have been different, but as I was at twenty weeks I should just let nature take its course. Even though the son I gave birth to was a proper baby who was wrapped up and given to me to hold and behold, he died while I was giving birth to him. A miscarriage, not a stillbirth.
This happened three years ago. Since then, I’ve had my appendix out, and I’ve had a baby daughter: the one who guzzles cows’ milk and shepherd’s pie. But, like anyone who has lost a baby, I will always be haunted by the memory of the child I never had, and what could have been done differently for him. If an artificial womb might save the life of a very sick twenty-one-week-old foetus, could it not also be used to save a twenty-week-old who was perfectly healthy, but unlucky enough to be inside a woman who was ill?
I swallow hard. ‘If the first time you put a human foetus in your system, it will be a foetus that is not going to be viable otherwise, can you see how questions are going to come up about pushing the boundaries of viability? Can’t you imagine parents of even more premature babies wanting their child to have any chance at all that an artificial womb might give them?’
‘I think this is actually a really easy question,’ he replies immediately. ‘This is a human – or this is a foetus, or this is a baby – that’s sick. If you had a three-year-old that was particularly unwell and somebody was developing a new therapy for it, would you have any qualms about that?’
‘Of course not.’
‘So there you go. From our perspective, this is no different.’
In other words, so long as they have a chance to save a baby’s life, they will try to do it. But there are limits to what they can do.
‘We don’t actually think we are shifting the border of viability further and further. The pragmatic reason for that is, if you can’t get a catheter into it, and the heart is not sufficiently developed to drive blood through the system, then it’s not going to work. So any concerns about harvesting eggs and putting them into these artificial devices are completely abrogated by that. It’s just not practically possible.’
* * *
While partial ectogenesis is likely to be with us within a few years, it’s certainly true that complete ectogenesis, from conception to live birth, is not yet practically possible. But as we get better at extending the lives of embryos outside the womb in the weeks following conception, and as we learn how to keep ever more premature babies alive, there will come a time when these two points meet – by accident, if not by design. We are getting closer to that point every year.
It used to be thought that human embryos could only be grown from conception outside the womb for a week, the time when they normally implant in the uterine lining. But in 2016, Professor Magdalena Zernicka-Goetz’s team at Cambridge University succeeded in keeping human embryos alive and intact outside the human body for thirteen days by bathing them in a special medium and incubating them. With the correct cocktail of growth factors, the embryos implanted onto the bottom of the dish and early placental cells developed.
Scientists will only keep human embryos conceived though IVF alive for fourteen days because of an ethical convention of halting research before the ‘primitive streak’ (a row of cells that marks the beginning of what will become the brain and spinal cord) appears on day fifteen. The Cambridge team’s embryos had to be killed because of this fourteen-day rule; it’s likely that they could have survived many more days, if they had been allowed to try. Since 2016 there’s been widespread debate about whether the limit should be extended to twenty-one or even twenty-eight days, because of the enormous scientific potential of being able to closely observe embryological development outside the human body. The fourteen-day deadline is a voluntary ethical limit only officially observed by seventeen countries. There is nothing to stop scientists in North Korea or Russia from growing human embryos for as long as they can.
In animal experiments, researchers have gone a lot further. In 2003, Dr Helen Hung-Ching Liu and her team at the Center for Reproductive Medicine and Infertility at Cornell University managed to grow a mouse embryo from conception almost to term using bioengineered womb tissue on an extrauterine scaffold. If R&D money continues to pour into the clean meat industry, our ability to culture tissue will make it even more likely that uterine tissue can be grown and used in this way.
Of course, the way an embryo develops is still a black box, and we have so much more to learn about what happens in the first and second trimesters of pregnancy. But by growing an embryo outside the human body for longer, the lid on the box begins to open. Reproductive medicine is driven by ambitious doctors and researchers, powered by a force as great as the human drive to reproduce, and funded by a customer base prepared to pay whatever it takes to fulfil that imperative. The more we understand, the more likely it is that full ectogenesis will become possible. There is too much pressure – scientific, medical but also commercial – for this not to happen. The obstacles will be ethical and legal, rather than technological.
IVF was once science fiction, then an ethical conundrum, then the cutting edge of assisted reproduction. Now it’s a normal part of making families, an acronym everyone understands, uncontroversial enough to be advertised on the Tube. The right to create a baby outside of the womb is recognized by the NHS, which covers the cost of couples having a chance to conceive their own biological children this way. Things that once seemed unnatural can easily become mundane.
Once bags and tubes can replace a womb, pregnancy and birth will be fundamentally redefined. If gestation no longer has to take place inside a woman’s body, it will no longer be female. Just like baby formula meant men were equally able to feed their babies, ectogenesis will mean bearing children no longer belongs to women. And the meaning of motherhood will also be changed, forever.
CHAPTER ELEVEN Immaculate Gestation
‘Pregnancy is barbaric,’ Dr Anna Smajdor declares. ‘If there were any disease that caused the same problems, we would regard it as a very serious disease indeed.’
I am sitting on Anna’s green sofa in her office on the campus of the University of Oslo, opposite a calendar featuring photos of her cats. She is swivelling from side to side on her chair, anchored by an elbow on her desk. There’s a green scrunchy on her wrist; her dark hair reaches to her chest. She is a bioethicist and Associate Professor of Practical Philosophy here, but her small frame, animated face and expressive eyes give her the air of a mischievous teenager.
‘The amount of women that suffer tears and incontinence and things that damage them for the rest of their lives is really high, yet it’s not adequately recognized in society,’ she continues. ‘This is all tied up with the strong value that we attach, not just to motherhood, but to giving birth. We expect women to joyfully go through this process. It’s worth talking about, just to shine a spotlight on what we expect women to go through for the production of new citizens.’
I’ve been eager to meet Anna ever since I read her two groundbreaking academic papers on artificial wombs: 2007’s ‘The Moral
Imperative for Ectogenesis’ and its sequel, 2012’s ‘In Defence of Ectogenesis’. The first paper set out how women bear the burden of society’s drive to reproduce, how ‘a man can currently use his wife or partner as a surrogate to carry his child’, and how the natural difference in reproductive capacity perpetuates the subjugation of women. ‘Pregnancy is a condition that causes pain and suffering, and that affects only women. The fact that men do not have to go through pregnancy to have a genetically related child, whereas women do, is a natural inequality,’ she wrote in the second paper. ‘There is a fundamental and inexorable conflict between the demands of gestation and childbirth and the social values we share as human beings: independence, equality of opportunity, autonomy, education, and career and relationship fulfilment […] Either we view women as baby carriers who must subjugate their other interests to the well-being of their children or we acknowledge that our social values and level of medical expertise are no longer compatible with “natural” reproduction.’
By anyone’s reckoning, gestation remains the most significant imbalance that exists between the sexes. The division of labour in family life begins with pregnancy and continues through birth, breastfeeding and parental leave, setting up a dynamic in which the gulf between maternal and paternal input is generally vast, no matter how progressive a society or how well intentioned and determined a father might be. From the beginning, women are more expert in meeting the needs of their kids. It starts with the placenta and breast milk, and ends with packed lunches.
Anna argues that ectogenesis would allow reproductive labour to be redistributed fairly in society in every sense, so there is a moral imperative for research that advances the development of artificial wombs. Published before any biobag or EVE system existed, her papers assume ‘perfect’ ectogenesis could exist: an artificial womb that functions just as well as a healthy female uterus, where there would be no technical issues to make it any more dangerous than a natural womb, in a society that upholds the rights of women.
Sex Robots and Vegan Meat Page 20