“By 2035, 7500 extremely preterm human infants born in the US at 23 to 25 weeks gestation will have survived after being maintained beginning at birth in a fluid filled extrauterine device (artificial womb).”

In a 1923 lecture to the Heretics Club in Cambridge, JBS Haldane coined the term, ectogenesis, and predicted that within 150 years 70% of human “births” in England would take place outside of a woman’s body. That prediction is moving closer to reality. Hornick et al at Children’s Hospital of Philadelphia have now maintained extremely premature fetal lambs that are developmentally equivalent to the extreme premature human infant using a fluid filled, extra-uterine device and oxygenator circuit for up to 4 weeks achieving normal somatic growth, lung maturation and brain growth and myelination. (An extra-uterine system to physiologically support the extreme premature lamb. Nat Commun 8, 15112 (2017)). The authors suggest that the initial clinical target population for this therapy will likely be the 23–25-week extreme premature human infant. At the present time, the high morbidity and mortality in this population would seem to justify this technology if it were proven to dramatically improve outcomes in clinical trials. Prediction: By 2035, 7500 extremely preterm human infants born in the US at 23 to 25 weeks gestation will have survived after being maintained starting immediately after birth using an extrauterine device including an oxygenator and ‘amniotic fluid’ circuit that closely reproduces the environment of the womb (artificial womb). Justification: In 2018, there were 9,984 infants born in the US at 23 to 25 weeks gestation.(CDC Wonder, https://wonder.cdc.gov/natality-expanded-current.html). Assuming that human trials will begin in 2021 and that safety and efficacy will be demonstrated for this population by 2025, then if 10% of infants 23 to 25 weeks gestation (1000 infants per year) are treated with the artificial womb with a 75% survival rate (750 survivors per year), by 2035 a total of 7500 human infants treated with an artificial womb will have survived. This estimate does not include the other applications of artificial womb technology such as treatment of fetal growth retardation related to placental insufficiency, the salvage of preterm infants threatening to deliver after fetal surgery, and treatment of infants with congenital malformations. . The accuracy of the prediction will be assessed using results reported in the peer reviewed scientific literature or in patient registries including appropriate data on the population of interest. We are on the verge of clinical trials of the artificial womb for human fetuses at the border of viability. This will take us down the path that Haldane predicted in 1923 and about which Aldous Huxley warned in Brave New World. As artificial womb technology is perfected, traveling this path with its profound implications for society will become inevitable.