How Close are We to Becoming ‘The Pod Generation’ and How Would This Affect Queer Intended Dads?
There is a recently released movie titled ‘The Pod Generation’ (1), and it is set in a not so distant future where children can be developed completely outside a uterus, or in a ‘pod.’ As the movie has not yet been released in Sweden, I have not seen it yet, but I wanted to take this opportunity to discuss the science in this area, how this could affect rainbow family formation for queer dads-to-be, and the ethical considerations for a world in which this could be a reality.
For queer men, the options for becoming a parent include adoption and surrogacy. As I’ve written in a previous article (https://medium.com/@babymoonfamily/from-stonewall-to-surrogacy-the-lgbtq-community-and-family-planning-bc981cd27e47), surrogacy is becoming the preferred method for queer men to have children. However, surrogacy is not without controversy and under increasing political scrutiny, especially in deeply religious countries such as Italy (https://medium.com/@babymoonfamily/why-every-lgbtq-person-especially-intended-parents-ips-should-be-furious-at-italy-right-now-cfb8a4382532). Unfortunately, there are also instances, such as the recent scandal in Greece (https://medium.com/@babymoonfamily/the-surrogacy-crisis-in-greece-and-how-the-world-should-respond-d66f53eb0cc5), where surrogates, or gestation carriers (GCs), are not treated ethically and with the utmost respect that they deserve.
So what if there was another solution? One where a GC didn’t have to be involved? What if a child could be developed without a uterus?
The scientific research in this area is evolving, and the development of an ‘artificial womb’ has recently received attention from the U.S. Food and Drug Administration (FDA). In September 2023, the FDA held an independent advisory committee to discuss clinical trials for artificial wombs.
While this may sound like the technology is close to a reality, the truth is that the current discussions around an artificial womb are not about developing a human from conception to full term, or ‘ectogenesis’ as it is called, but rather to increase the survival of children who are born prematurely. According to the World Health Organization (WHO), an estimated 13.4 million babies were born preterm (before 37 completed weeks of gestation) in 2020. Preterm birth complications are the leading cause of death among children under 5 years of age, responsible for approximately 900,000 deaths in 2019. Across countries, the rate of preterm birth ranges from 4 to 16% of babies born in 2020 (2). In the United States, the issue disproportionately affects African Americans, who give birth prematurely at a rate that is 50% higher than those of White and Hispanic people (3).
However, the earlier an infant is born, the greater the risk of death. For example, only about 30% of infants born at 22 weeks survive, and just under 56% survive birth at 23 weeks (3). The time between 22 and 25 weeks is known as ‘peri-viability,’ as this is the time period when preterm children are most vulnerable and least likely to survive with current neonatal intensive care (4). Therefore, the current aim of artificial wombs and the planned clinical trials are to increase the survival and decrease the complications for children born between weeks 22 and 25, not to gestate a person from conception or even to medically intervene for children born less than 22 weeks given the development, size, and viability of fetuses at this stage.
So then, what exactly is an artificial womb in this current stage? The most advanced form has been developed by Alan Flake and Marcus Davey at the Children’s Hospital of Philadelphia, and it is called EXTEND, which is short for EXTrauterine Environment for Newborn Development. In 2017, they successfully conducted a preclinical experiment with a developing lamb, where the animal was kept alive for 28 days in a sterilized plastic bag filled with fluid. Tubes that delivered amniotic fluid, medicine and oxygen were connected to the lamb’s umbilical cord tissue. The team saw positive growth and development in the lambs’ lungs, brains, and gastrointestinal tracts (5). They have now conducted similar experiments on over 300 lamb fetuses with similar results (6).
Source: Nature Communications
The EXTEND technology is being further developed by Vitara Biomedical (7), and the fluid-filled environment is key to helping the fetus to continue developing their lungs. Neonatal intensive care units (NICUs) are regularly successful in saving premature babies, but there are significant complications with the ability of the lungs to finish developing or oxygenate sufficiently, even on a ventilator. The fluid’s ability to contain the fetus in this environment could potentially increase survival through improved lung development, oxygenation, and subsequent growth.
Source: Vitara Biomedical
While the Vitara Biomedical team is one of the most advanced, there are other researchers and companies around the world who are also hoping to initiate clinical trials after the FDA discussions. These include the University of Michigan (8), a joint venture between researchers in Australia and Japan (9), and the University of Toronto (10). All of these groups have been successful with various preclinical models in providing an extrauterine environment for gestation of animals such as lambs and pigs.
If approved, these clinical trials will likely focus on preterm children born between 22 and 23 weeks, as these are the most high risk preterms who still have some likelihood of survival. Even though the current technology is limited by a number of factors, such as the size of the fetus in order to manipulate and insert tubing into the umbilical cord, there are other limitations in terms of a lack of scientific understanding regarding earlier human development and the conditions that would need to be replicated for complete ectogenesis.
However, this research and FDA discussion comes soon after the announcement from the Weizmann Institute of Science in Israel that scientists had developed a ‘complete’ model of a human embryo in the lab with all the known features found in normal embryos around two weeks old. These stem cell-based embryo-like structures, or SEMs, were developed without using sperm, eggs, or a womb (11). Given this advancement at the earlier stages of human development, and the artificial womb technology working backwards from 28 weeks gestation, there is a possibility that in the future full ectogenesis of humans in ‘pods’ could become a reality.
If that were to be the case, how would this affect planning for queer intended dads? Obviously, this technology would not be limited to queer dads-to-be, but it would suddenly provide a solution to the challenges around surrogacy. However, a fully-functional artificial womb would certainly come with significant cost, something that can be the case with commercial surrogacy, but is less of a consideration with altruistic surrogacy. This could lead to further inequalities in terms of queer men who could afford the procedure.
Also, would there be a prejudice against ‘pod’ babies compared to ‘natural’ ones, leading to discrimination? Historically, there has been social stigma attached to IVF ‘test tube’ babies, but this has largely been attributed to the fertility issues associated with the parents, and less to the children themselves (12).
Also, what about the relationship between the GC and intended parents? This is often a deep and meaningful connection for the three people involved, and a lifelong bond can be formed among the adults as well as the child. What would happen if this were to be removed and replaced with an artificial womb?
While there is still time to ponder the ethical challenges that could arise with a ‘pod generation,’ I do believe it is exciting that the research and medical science continues to advance in this way. I truly believe a world in which rainbow families of all constellations of parents and children will make the world a better place (https://medium.com/@babymoonfamily/will-more-queer-parents-and-their-children-make-the-world-a-better-place-777056021564), and so any technology that makes this easier — as long as it is done ethically and humanely — is a step in the right direction.
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