1978, life begins as another child is born in Oldham general hospital. Baby Louise is the start of something new, her birth as the world’s first IVF baby [1] paves the way for scientific influence in reproduction.

Skipping forward to 2016 we see significant advances both in fertility medication and in stem cell research. Perhaps the most influential changes however, are due to happen in a quiet little ward called the NICU (neonatal intensive care unit). Here viability for premature births has dropped from 27 weeks to as low as 22 weeks old [2]. Current advances however have slowed, because amniotic fluid and the umbilical cord present a significantly gentler environment for growth than the air & peristalsis pumps of a hospital room.

The next logical step in neonatal (early birth) care, is the design of an artificial womb for protection until a suitable delivery date. This may seem like a sci-fi concept, but the technology isn’t so far from reality. The first ex vivo (outside the womb) human embryo test was run in 1989, ceased due to ethical concerns [3]. Today we see advancement from both ends of the process, with Cambridge University [4] culturing human embryos until the legal limit of 14 days (established in 1984 [5]) and the efficacy of Total liquid ventilation proven in lambs [6]. While the use in neonatal care is unlikely to face objection, it could be seen to pave the way for ectogenesis: "The development of embryos in artificial conditions outside the uterus” [7].

What will the future look like? Will ectogenesis paint the bleak picture once described by J.B.S. Haldane in his 1923 seminal essay “Daedalus, or, Science and the Future” [8]? Haldane envisaged the use of ectogenesis in sterilising generations, accelerating evolution by DNA selection. Some believe we are already on the road to this reality, as Sally Phillips argues in the recent BBC documentary [9], while considering the implications of genetic screening on termination rates.

Genetic screening was introduced in the 1960s to diagnose Phenylketonuria as a preventative measure [10]. Today screening is available for over 2,000 conditions, primarily taking the form of predictive, carrier, prenatal and pre-implantation screening [11]. All these determine the probability of future genetic disorders. The eradication of diseases such as Huntington’s might seem like a no brainer to some, but it’s the ethical “grey line” this creates that is leading to further controversies over the elimination of non-deteriorating disorders like Down’s Syndrome. Could you be next on nature’s un-natural chopping block? Many of us have had depression or anxiety during our lifetimes, and these could well be next to face the knife.

Screening of a foetus first occurs around 11-13 weeks [12], by which time many mothers will have become emotionally attached to the idea of their baby. The reason genetic screening is so closely linked to ectogenesis, is that, as with IVF, screening can occur before conception even begins. Thus, rather than terminating a foetus which has the chance of a disease, we will be selecting whether or not our child will be disabled in advance.

But what do we actually want from the future? Eugenics, ectogenesis and the age of the “designer baby” are all possibilities. To reduce overpopulation and unemployment rates, Governments could control breeding, creating a workforce suited to specific jobs. Maybe we will get rid of the “family” altogether. But this is only one potential, and before we eliminate the concept of ectogenesis for good, let’s look at the possible benefits. Whilst initial setup would be costly, the long-term savings are huge. The average cost of birth in the US is $8,802 [13] rising to $202,700 for premature birth [14]. Add to this the fact that 49% of US pregnancies are un-intentional costing $5Billion annually [15] and ectogenesis starts to look viable. But it’s not just the savings that makes ectogenesis so promising. Pregnancy is a dangerous occupation as Anna Smajdor acknowledges in her article “In defence of ectogenesis” [16]. Anna states that pregnancy and childbirth could be considered a ‘medical problem’ resulting in pain and mortality; pregnancy is in fact the sixth leading cause of death in women between 20 and 34 in the US [17]. Could ectogenesis provide the cure?

Some argue that pregnancy plays a vital role in the bonding between a child and mother [18], though with surrogacy both a father and mother may bond with their child even though neither carries the baby. Genderless pregnancy is perhaps the most interesting benefit, both in combating sexist prejudices surrounding neonatal care and in fostering gender equality. Not to mention the concept of looking in on your baby during its development, watching it form, being able to interact with it, could offer a far greater bonding experience, one already being explored by designer Melody Shiue in the PreVue: an e-textile showing you the baby beneath your skin [19]. The safety of the baby may also be improved. In the UK it is estimated that 1 in 6 women who are aware they are pregnant miscarry [20], perhaps with vital stats monitored throughout development, this risk could be reduced?

A benign future? Even assuming we chose to regulate screening selection and implement ectogenesis in a normative fashion, there are still great potentials for development. Perhaps children could begin to learn and kick-start their development before they are born as Annie Murphy Paul considers in her Ted talk entitled “What we learn before we're born”.

All this brings into question the reasoning for a 40 week pregnancy. Originally linked to the baby’s head size, it is now believed to be the mother’s maximum metabolic rate (2-2.5 times average), a burden that only increases as the foetus develops [21]. This means we are born altricial (immobile and requiring care) unlike many other animal species. It is foreseeable that with an artificial womb, we could develop to the point of adolescence in a relatively short period, being born precocial (mobile and self-sufficient).

This change to the nature of human development could alter us as a species, re-defining the human condition. So, where should design stop? Will you deny a baby of 22 weeks a water womb, because it enables ectogenesis? I think the benefits of continued development far outweigh the risks of corruption.