The artificial uterus: on the way to ectogenesis.

The inability to support the growth and development of a mature fetus up to delivery results in significant human suffering. Current available solutions include adoption, surrogacy, and uterus transplantation. However, these options are subject to several ethical, religious, economic, social, and medical concerns. Ectogenesis is the process in which an embryo develops in an artificial uterus from implantation through to the delivery of a live infant. This current narrative review summarizes the state of recent research focused on human ectogenesis. First, a literature search was performed to identify published reports of previous experiments and devices used for embryo implantation in an extracorporeally perfused human uterus. Furthermore, studies fitting that aim were selected and critically evaluated. Results were synthesized, interpreted, and used to design a prospective strategy for future research. Therefore, this study suggests that full ectogenesis might be obtained using a computer-controlled system with extracorporeal blood perfusion provided by a digitally controlled heart-lung-kidney system. From a clinical perspective, patients who will derive significant benefits from this technology are mainly those women diagnosed with anatomical abnormalities of the uterus and those who have undergone previous hysterectomies, numerous abortions, and experienced premature birth. Ectogenesis is the complete development of an embryo in an artificial uterus. It represents the solutions for millions of women suffering from premature deliveries, and the inability to supply growth and development of embryos/fetuses in the womb. In the future, ectogenesis might replace uterine transplantation and surrogacy.

The (Un)Ethical Womb: The Promises and Perils of Artificial Gestation.

The purpose of this article is to reflect on the changes that the implementation of artificial wombs would bring to society, the family, and the concept of motherhood and fatherhood through the lens of two recent books: Helen Sedgwick's The Growing Season and Rebecca Ann Smith's Baby X. Each of the two novels, set in a near future, follows the work of a scientist who develops artificial womb technology. Significantly, both women experience concerns about the technology and its long-term effects that make both of them leave their laboratories and rethink the technology they invented, while considering its many ethical implications. Both novels can be seen as feminist revisionary rewritings of Aldous Huxley's Brave New World, rejecting the vision of rows of mass-produced, anonymous babies in artificial wombs, stressing instead the closeness of the parents to their offspring. They nevertheless critically evaluate not only the many potential benefits for women of ectogenetic technology but also the possible disadvantages and pitfalls.

The Moral Superiority of Bioengineered Wombs and Ectogenesis for Absolute Uterine Factor Infertility.

This paper argues that uterine transplants are a potentially dangerous distraction from the development of alternative methods of providing reproductive options for women with absolute uterine factor infertility (AUFI). We consider two alternatives in particular: the bioengineering of wombs using stem cells (which would carry fewer risks than uterine transplants) and ectogenesis (which would not require surgical intervention for either the prospective mother with AUFI or a womb donor). Whether biologically or mechanically engineered, these womb replacements could provide a way for women to have children, including genetically related offspring for those who would value this possibility. Most importantly, this alternative would avoid the challenge of sourcing wombs for transplant, a practice that we argue would likely be exploitative and unethical. Continued research into bioengineering and ectogenesis will therefore remain morally important despite the recent development of uterine transplantation, even if the procedure reaches routine clinical application.

From the maternal uterus to the "uterus device"? Ethical and scientific considerations on partial ectogenesis.

The article aims to elaborate the progress made in partial ectogenesis research on sheep as well as human embryos. Since the ban on embryos experimentation after the 14-day window is a major roadblock in terms of partial ectogenesis research, the authors have weighed the possibility that such a ban could be reconsidered. In favor of easing such a restriction, it may be argued that: (a) unlike the Catholic approach, prevalent ethics precepts hold that the embryo's interest ought to be balanced against the interests of the other parties involved; (b) an extension of the 14-day deadline would no longer make ethically untenable practices acceptable; hence, the "slippery slope" argument, although generally worthy, would not conclusively apply to partial ectogenesis; (c) in mainstream embryo research efforts, there is a conflict between the lives of embryos and the health of individuals already born; as for partial ectogenesis, however, such a conflict would be between the lives of embryos and the lives of fetuses which would not survive otherwise. Still, in light of the embryo's status as a human being, the authors conclude that such research practices should only be allowed on supernumerary embryos.

Why bother the public? A critique of Leslie Cannold's empirical research on ectogenesis.

Can discussion with members of the public show philosophers where they have gone wrong? Leslie Cannold argues that it can in her 1995 paper 'Women, Ectogenesis and Ethical Theory', which investigates the ways in which women reason about abortion and ectogenesis (the gestation of foetuses in artificial wombs). In her study, Cannold interviewed female non-philosophers. She divided her participants into separate 'pro-life' and 'pro-choice' groups and asked them to consider whether the availability of ectogenesis would change their views about the morality of dealing with an unwanted pregnancy. The women in Cannold's study gave responses that did not map onto the dominant tropes in the philosophical literature. Yet Cannold did not attempt to reason with her participants, and her engagement with the philosophical literature is oddly limited, focussing only on the pro-choice perspective. In this paper, I explore the question of whether Cannold is correct that philosophers' reasoning about abortion is lacking in some way. I suggest that there are alternative conclusions to be drawn from the data she gathered and that a critical approach is necessary when attempting to undertake philosophy informed by empirical data.

Abortion Rights after Artificial Wombs: Why Decriminalisation is Needed Ahead of Ectogenesis.

Significant scientific progress has been made toward artificial womb technology, which would allow part of human gestation to occur outside the body. Bioethical and legal scholars have argued that artificial wombs will challenge defences of abortion based in arguments for protecting bodily autonomy, for a pregnant person could have the foetus transferred to an artificial womb instead of being terminated. Drawing on examples from the common law jurisdictions of Canada, the USA, and the UK, I assess three ways scholars have argued abortion might be defended after ectogenesis (through redefining foetal viability, through a property right, and through a right to avoid genetic parenthood). I argue that while each of these proposals has strategic merit, each has significant legal and ethical limitations. Taking the normative position that abortion will remain a vital healthcare resource, I make the case for protecting abortion rights from a challenge posed by ectogenesis by focusing on decriminalisation.

Gestación subrogada, trasplante de útero y útero artificial: aproximaciones desde el bioderecho / Surrogacy, uterus transplantation and artificial uterus: approaches from the biolaw

Han trascurrido más de cuarenta años desde el nacimiento del primer bebé mediante fecundación invitro y desde entonces las innovaciones técnicas en el campo de la reproducción humana no han hecho másque avanzar a un ritmo vertiginoso. Aquellos primeros recursos, han dado paso a prácticas que abren laspuertas a nuevas formas de reproducción que permiten superar los límites biológicos del ser humano. Losrecientes avances en edición genómica —en especial la tecnología CRISPR/Cas9— unidos al cada vez másamplio catálogo de técnicas reproductivas, han precipitado en los últimos años un intenso debate ético,social y jurídico sobre los límites de los nuevos modelos de reproducción humana, y sus posibles consecuen-cias. La diversidad de intereses jurídicos contrapuestos sugiere que la aplicación de estas técnicas deberíaoperar entre el respecto a la ley, la defensa de los derechos humanos de todos los agentes que intervienenen el proceso —o directamente son objeto de las mismas— y la libertad de investigación científica. Elpresente trabajo pretende abordar las diversas implicaciones éticas y los límites jurídicos de tres técnicasde reciente —o futura— irrupción en el panorama reproductivo, muy discutidas en los últimos tiempos:gestación subrogada, trasplante de útero y útero artificial.(AU)

More than forty years after the first baby´s birth through in vitro fertilization, innovations in the fieldof human reproduction have experienced a significant growth increase. Those first techniques have ledevolved to others that push the biological limits of reproduction. Recent developments in genomic editing— particularly, CRISPR/Cas9 technology— had leaded an intense ethical, social and legal discussion aboutthe boundaries limits of the new models of human reproduction, and their consequences in recent years.The number of conflicting legal interests suggests that the application of these techniques must combinethe respect for the law, the defense of the human rights of all the agents involved in the process, and thefreedom of scientific research. The present paper tries to deal with the diverse ethical implications andlegal limits of three of those techniques, recently developed or to be developed in the near future: surro-gacy, uterus transplantation and artificial uterus.(AU)

The path toward ectogenesis: looking beyond the technical challenges.

BACKGROUND: Breakthroughs in animal studies make the topic of human application of ectogenesis for medical and non-medical purposes more relevant than ever before. While current data do not yet demonstrate a reasonable expectation of clinical benefit soon, several groups are investigating the feasibility of artificial uteri for extracorporeal human gestation. MAIN TEXT: This paper offers the first comprehensive and up to date discussion of the most important pros and cons of human ectogenesis in light of clinical application, along with an examination of crucial ethical (and legal) issues that continued research into, and the clinical translation of, ectogenesis gives rise to. The expected benefits include advancing prenatal medicine, improving neonatal intensive care, and providing a novel pathway towards biological parenthood. This comes with important future challenges. Prior to human application, important questions have to be considered concerning translational research, experimental use of human fetuses and appropriate safety testing. Key questions are identified regarding risks to ectogenesis' subjects, and the physical impact on the pregnant person when transfer from the uterus to the artificial womb is required. Critical issues concerning proportionality have to be considered, also in terms of equity of access, relative to the envisaged application of ectogenesis. The advent of ectogenesis also comes with crucial issues surrounding abortion, extended fetal viability and moral status of the fetus. CONCLUSIONS: The development of human ectogenesis will have numerous implications for clinical practice. Prior to human testing, close consideration should be given to whether (and how) ectogenesis can be introduced as a continuation of existing neonatal care, with due attention to both safety risks to the fetus and pressures on pregnant persons to undergo experimental and/or invasive procedures. Equally important is the societal debate about the acceptable applications of ectogenesis and how access to these usages should be prioritized. It should be anticipated that clinical availability of ectogenesis, possibly first as a way to save extremely premature fetuses, may spark demand for non-medical purposes, like avoiding physical and social burdens of pregnancy.

Moving forwards: A problem for full ectogenesis.

Most existing literature on the ethics of full ectogenesis has proceeded under the presupposition that science will at some point produce sophisticated technologies for full-term gestation (from embryo to infant) outside the human womb, delivering neonate health outcomes comparable with (or even superior to) biological gestation. However, the development of this technology-as opposed to the support systems currently being advanced-would require human subject experiments in embryo-onwards development using ectogenic prototypes. Literature on ectogenic research ethics has so far focused on 'backwards' development of partial ectogenesis: incubation and ectogestation technologies that would allow the support of earlier and earlier neonates and foetuses. However, little has been said about the ethics of 'forwards' development of (partial or full) ectogenesis, involving the development of embryos and foetuses in prototype environments. Such a prototype might allow us to produce a gestateling or live neonate from a human embryo, but with poorer expected development and health outcomes than from biological gestation; it might also produce only gestatelings (healthy or otherwise) before the technology was developed to a stage where full-term gestation was achievable. This paper explicates some of the ethical issues that this raises for the development of 'full' ectogenesis, and presents prima facie reasons to consider this research problematic and therefore to require extensive further argument in its defence.

De onde vêm os bebês?: Útero artificial, bioética e direito:os possíveis impactos da ectogênese no campo da filiação - Uma análise a partir do contexto jurídico brasileiro / Where do babies come from?: Artificial womb, bioethics and law: the possible impacts of ectogenesis in the field of filiation - An analysis of the Brazilian legal context

Nos últimos tempos, os avanços biotecnológicos no campo da reprodução humana, sem dúvidas, acarretaram diversas alternativas procriativas para aqueles que buscam desempenhar um projeto parental através das chamadas técnicas de reprodução assistida. Desse modo, também nesse seguimento, pesquisas recentes vêm debruçando-se sobre o desenvolvimento da tecnologia do útero artificial, objetivando viabilizar a ectogênese, ou seja, o desenvolvimento de gestações extracorpóreas. Em razão disso, o presente artigo visou revisar, a partir do panorama jurídico brasileiro, os possíveis impactos que o desenvolvimento efetivo de tal ferramenta possa vir a causar na atribuição da filiação civil. Para tanto, a pesquisa pautou-se na técnica da revisão bibliográfica, no intuito de investigar quais seriam os parâmetros para estipulação dos vínculos filiatórios (AU)

En los últimos tiempos, los avances biotecnológicos en el campo de la reproducción humana han conducido a varias alternativas de procreación para aquellos que buscan iniciar un proyecto parental a través de las llamadas técnicas de reproducción asistida. En esta área, la investigación reciente se ha centrado en el desarrollo de la tecnología del útero artificial, con el objetivo de hacer viable la ectogénesis, es decir, el desarrollo de embarazos extracorpóreos. Como resultado, este artículo busca revisar, desde la perspectiva jurídica brasileña, los posibles impactos que el desarrollo efectivo de dicha herramienta puede causar en la atribución de filiación civil. Para este propósito, se realizó una investigación documental, a fin de recopilar información ya existente sobre el tema del establecimiento de la relación de filiación (AU)

In recent times, biotechnological advances in the field of human reproduction have led to several procreation alternatives for those seeking to initiate a parental project through so-called assisted reproductive techniques. In this area, recent research has focused on the development of artificial womb technology, with the aim of making ectogenesis viable, that is, the development of extracorporeal pregnancies. As a result, this article seeks to review, from the Brazilian legal perspective, the possible impacts that the effective development of this tool may have on the attribution of civil filiation. For this purpose, a bibliographic review was carried out in order to determine which would be the parameters for the assignment of filiation relationship (AU)

En els últims temps, els avanços biotecnològics en el camp de la reproducció humana han conduït a diverses alternatives de procreació per a aquells que busquen iniciar un projecte parental a través de les anomenades tècniques de reproducció assistida. En aquesta àrea, la recerca recent s'ha centrat en el desenvolupament de la tecnologia de l'úter artificial, amb l'objectiu de fer viable la ectogènesi, és a dir, el desenvolupament d'embarassos extracorporis. Com a resultat, aquest article busca revisar, des de la perspectiva jurídica brasilera, els possibles impactes que el desenvolupament efectiu d'aquesta eina pot causar en l'atribució de filiació civil. Per a aquest propòsit, es va realitzar una recerca documental, a fi de recopilar informació ja existent sobre el tema de l'establiment de la relació de filiació (AU)

Pregnant people, inseminators and tissues of human origin: how ectogenesis challenges the concept of abortion.

The potential benefits of an alternative to physical gestation are numerous. These include providing reproductive options for prospective parents who are unable to establish or maintain a physiological pregnancy, and saving the lives of some infants born prematurely. Ectogenesis could also promote sexual equality in reproduction, and represents a necessary option for women experiencing an unwanted pregnancy who are morally opposed to abortion. Despite these broad, and in some cases unique benefits, one major ethical concern is the potential impact of this emerging technology on abortion rights. This article will argue that ectogenesis poses a challenge to many common arguments in favour of a pregnant woman's right to choose, but only insomuch as it highlights that their underlying justifications for abortion are based on flawed conceptions of what the foetus and pregnancy actually are. By interrogating the various interests and relationships involved in a pregnancy, this article will demonstrate that the emergence of artificial gestation need not impact existing abortion rights or legislation, nor definitions of independent viability or moral status.

Ectogenesis and gender-based oppression: Resisting the ideal of assimilation.

In a recent article in this journal, Kathryn MacKay advances a defence of ectogenesis that is grounded in this technology's potential to end-or at least mitigate the effects of-gender-based oppression. MacKay raises important issues concerning the socialization of women as 'mothers', and the harms that this socialization causes. She also considers ectogenesis as an ethically preferable alternative to gestational surrogacy and uterine transplantation, one that is less harmful to women and less subject to being co-opted to further oppressive ends. In this article, I challenge some of the assumptions that underlie MacKay's case in favour of ectogenesis by questioning whether the relationship between women's capacity to gestate and birth children and gender-based oppression is as strong as MacKay makes it out to be. I subsequently argue that-even if MacKay's reading of this relationship is accurate-ectogenesis is not a desirable means to end gender-based oppression. It embodies a strategy that could be used to pursue liberating projects that follow what Iris Marion Young defines as 'the ideal of assimilation', but that must be resisted. I then concur with MacKay's contention that ectogenesis is better than gestational surrogacy and uterine transplantation. My argument is that many of the problematic issues that MacKay herself sees as features of these practices will not disappear with ectogenesis. Finally, I conclude that MacKay's narrow focus on women's biology and ectogenesis as a solution to gender-based oppression results in the overlooking of broader systemic issues that contribute to the upholding of oppressive norms.

Gender, gestation and ectogenesis: self-determination for pregnant people ahead of artificial wombs.

In this short response, I agree with Cavaliere's recent invitation to consider ectogenesis, the process of gestation occurring outside the body, as a political perspective and provocation to building a world in which reproductive and care labour are more justly distributed. But I argue that much of the literature Cavaliere addresses in which scholars argue that artificial wombs may produce greater gender equality has the limitation of taking a fixed, binary and biological approach to sex and gender. I argue that in taking steps toward the possibility of more just practices of caregiving and family making, we must look first not to artificial womb technologies but to addressing the ways that contemporary legal and social practices that enforce essentialising, binary ways of thinking about reproductive bodies inhibit this goal.

Neonatal incubator or artificial womb? Distinguishing ectogestation and ectogenesis using the metaphysics of pregnancy.

A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under-considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation-or metaphysics of pregnancy-(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate.

Willing mothers: ectogenesis and the role of gestational motherhood.

While artificial womb technology (ectogenesis) is currently being studied for the purpose of improving neonatal care, I contend that this technology ought to be pursued as a means to address the unprecedented rate of unintended pregnancies. But ectogenesis, alongside other emerging reproductive technologies, is problematic insofar as it threatens to disrupt the natural link between procreation and parenthood that is normally thought to generate rights and responsibilities for biological parents. I argue that there remains only one potentially viable account of parenthood: the voluntarist account, which construes parental rights as robust moral obligations that must be voluntarily undertaken. The problem is that this account mistakenly presumes a patriarchal divide between procreation and parenthood. I propose a reframing of procreation and parenthood from a feminist perspective that recognises gestational motherhood as involving robust moral obligations that ought to be voluntarily undertaken. If this were the case, all gestational mothers would be, by definition, willing mothers. To make this happen I argue that ectogenesis technology must be a widely available reproductive option.

Equitable access to ectogenesis for sexual and gender minorities.

As the technology for ectogenesis continues to advance, the ethical implications of such developments should be thoroughly and proactively explored. The possibility of full ectogenesis remains hypothetical at present, and myriad concerns regarding the safety and efficacy of the technology must be evaluated and addressed, while pressing moral considerations should be fully deliberated. However, it is conceivable that the technology may become sufficiently well established in the future and that eventually full ectogenesis might be deemed ethically acceptable as a reproductive alternative to gestation within a human womb under certain circumstances. If the safety and efficacy of full ectogenesis are established, if ethical dilemmas are sufficiently well addressed, and if the technology is offered as a reproductive option to cisgender heterosexual individuals or couples desiring to become parents, there is a moral obligation grounded in social justice to ensure that full ectogenesis be made available to individuals or couples identifying as members of sexual- or gender-minority groups who likewise seek to pursue parenthood. We examine the history of access to current family-building options, including assisted reproductive technology, surrogacy and adoption, for these populations and conclude that in the absence of robust empirical evidence suggesting an increased risk of harm to children of individuals and couples who identify as members of sexual- or gender-minority groups, equitable access to ectogenesis as a pathway to parenthood for sexual and gender minorities must be assured as a matter of reproductive justice.