Like a Virgin (30 page)

Another point to consider is whether the only role of a mother’s womb is to house the developing embryo and provide what it needs to grow. We now know that a woman shapes
the genetics of her child through what is known as epigenetics, which refers to changes written over DNA that are environmental and potentially reversible. Epigenetics is the force involved in
genetic imprinting, when a chemical group sits on a stretch of DNA and influences whether and when the genes there work – or don’t. These influences can be good, neutral, or bad for a
child; epigenetics is agnostic when it comes to development.

The inheritance of characteristics through epigenetics is something that scientists have only quite recently started getting to grips with. But it seems that even from very early in life –
including when we are in our mother’s wombs – we can be
influenced by things that we previously thought had no impact, things like how much a woman eats and how
stressed she is. There are, for example, very clear epigenetic signatures that mark those whose mothers have lived through famine and poor socio-economic circumstances. One study of a small town in
Sweden found that having plenty of food had an interesting effect: the grandsons of men who ate well had a greater risk of diabetes than the granddaughters of women who did – meaning that the
sex chromosomes could be involved. A 2008 study of women who were diagnosed with depression in the third trimester found that their infant children reacted to stressful situations by releasing more
of the hormone cortisol, which increases blood sugar and helps with metabolism – getting a person ready for the quintessential fight-or-flight response. And it did not matter if the women
were receiving treatment for depression; the stress-response trait passed to the infant regardless. Epigenetic signatures have also been associated with being abused as a child, changing both that
person’s DNA – and possibly also her offspring’s.

There are sure to be other traits passed to a baby through the simple fact of being in one woman’s womb rather than another’s. And since epigenetics is about shaping genetics,
sharing genes with the child in your womb may not make a difference when it comes to these effects. It is possible, for instance, that through epigenetics surrogate mothers are influencing the way
a child’s genetics play out, including elements of the child’s personality – that is to say, how the child adapts to its outside environment. Of course, by the same token, an
artificial womb may throw no epigenetic influence on to the foetus growing within it. Whether that would be good, neutral or bad, it is far too early to know. Our knowledge of epigenetic influences
is too new for us to begin to contemplate what would happen if they were removed from the process.

What would undoubtedly be good for the foetus would be gestating removed from exposure to undesirable chemicals such as nicotine, alcohol, and other drugs that can be
absorbed via the placenta when a mother imbibes. During pregnancy, up to fifteen percent of women are believed to use alcohol, and about five percent use illegal drugs. The proportion of women
taking these substances decreases as they enter the later stages of pregnancy, but the effects on the foetus are often worse in the early stages of growth. And drug misuse, illegal or not, is known
to have potentially disastrous consequences for an unborn child. Heroin, or more specifically withdrawal between heroin use, can lead to spasm of the placental blood vessels, which reduces blood
flow to the placenta and lowers birth weight. Benzodiazapines, which are used to treat anxiety and insomnia among other things, but which are also often abused, slightly increase the risk that a
baby will be born with a cleft palate; they are also associated with low birth weight as well as premature birth, and can trigger withdrawal symptoms in the newborn. Cocaine is a powerful
constrictor of blood vessels; heavy use increases the risk of several serious conditions, including the placenta detaching from the womb, stunted brain growth, underdevelopment of organs and limbs,
and even foetal death. Tobacco causes a reduction in birth weight greater than that caused by heroin, and is a major factor in increasing the risk of Sudden Infant Death Syndrome (SIDS), or cot
death. Cannabis use does not seem to have a direct effect on pregnancy, but because the drug is frequently mixed with tobacco, the results can be the same as smoking during pregnancy.

Finally, there is humanity’s most accepted drug: alcohol. When consumed in large amounts, alcohol results in reduced birth weight. In the most extreme cases, a baby will suffer the effects
of so-called foetal alcohol syndrome (FAS): low birth weight, with general growth throughout life being stunted,
including the circumference of the head – and
consequently the size of the brain. Children with FAS will also exhibit dysfunctions in the central nervous system, including learning disabilities and certain, characteristic facial abnormalities,
known as the FAS face. Children with FAS are likely to have smaller head size and eye openings, an underdeveloped jaw, flattened mid-faces and nasal bridges, smooth philtrums (the slight groove
between the nose and upper lip will be absent), thin upper lips, and ear abnormalities.

Substance misuse is often associated with poverty and other social problems, with far-reaching effects on health. And a majority of drug-using women are in their childbearing years. It follows
that drug-using women may well be in poor general health before they become pregnant, making their wombs less conducive to a healthy pregnancy, even before ongoing drug use and other issues are
factored in. The alternative – a womb outside of your own body – may just be a more salubrious place in which to start life.

One alternative that is already making headlines is transplantation of a new womb, whether a donated organ or an artificially created womb-like structure, into a woman whose own
uterus is damaged or missing. While a womb transplant wouldn’t get around the inherent dangers to the mother of pregnancy and childbirth, or the dangers to the foetus from a mother ingesting
alcohol or other drugs, it would probably provide a healthier environment – especially given the limits that would be put on a woman’s behaviour after having undergone transplant
surgery to begin with. But although ovaries have successfully been transplanted in humans, womb transplants have only recently
been tried in humans, and early operations with
dogs in the 1970s proved unsuccessful.

In April 2000, Dr Wafa Fageeh, leading a medical team in Jeddah, Saudi Arabia (where surrogacy is illegal), became the first surgeon to attempt a womb transplant in a human. The recipient was a
twenty-six-year-old who had lost her womb six years earlier, after haemorrhaging during childbirth, and the donor was a forty-six-year-old who had been told she must have a hysterectomy because of
ovarian cysts. Fageeh’s work was innovative, and the transplant was not rejected by the recipient patient – in fact, she went on to have two natural menstrual cycles. This meant that
the graft had been properly done, and had been given a sufficient blood supply. But the transplanted womb had to be removed after ninety-nine days, when a clot developed in a blood vessel that was
surgically attached to it. Ultimately, the operation could only be regarded as unsuccessful, since it did not result in a pregnancy.

Within three years, however, scientists began to mark their first triumphs transplanting wombs in mammals. First, mice with donated wombs carried to term and gave birth to normal babies. In
2006, Giuseppe Del Priore, at New York Downtown Hospital, performed a womb transplant on a rhesus monkey; though he was able to establish blood flow between the donor organ and the monkey, the
animal was given an incorrect dose of anticoagulants and the experiment had to be terminated within a day. Then, in 2009, a team led by Richard Smith, a consultant gynaecologist at London’s
Hammersmith Hospital, managed to transplant not just the womb, but also major blood vessels including the aorta, in rabbits. Once the transplant surgeries were completed, the rabbits were placed on
immunosuppressant drugs, which helped to prevent the donated womb from being rejected. Alas, despite being mated, none of the rabbits became pregnant. On this occasion, it seemed that the trouble
lay with the Fallopian tube, which became blocked and could not carry the fertilized egg to the womb.

These early successes have led to some speculation about the possibility of implanting an embryo into a man. One possibility, in the near term, would be to insert the embryo in the abdomen, the
equivalent of an ectopic pregnancy – when an embryo attaches to tissue outside the womb, yet continues to develop. Ectopic pregnancies are dangerous – they can lead to haemorrhaging and
death – but a handful of cases in women have been taken to a healthy, live delivery via laparotomy, a form of Caesarean section. In 2008, for instance, a British woman, Jayne Jones, gave
birth to a son at twenty-eight weeks gestation; the pregnancy had not terminated earlier because the embryo had attached to a fatty portion of the mother’s large bowel, ensuring a good source
of nutrition, and the foetus was removed as soon as it was discovered to be outside the womb. This was the first successful delivery in the UK of its sort – and thirty-six medical staff
attended.

The eminent fertility expert Lord Robert Winston has commented that ‘male pregnancy would certainly be possible, and would be the same as when a woman has an ectopic pregnancy... although
to sustain it, you’d have to give the man lots of female hormones’. In such a case, the foetus would be implanted inside a hormone-packed man’s abdomen, with an artificial
placenta attached to an internal organ – such as the bowel. But apart from all the hormones the procedure would necessitate, the problems associated with ectopic pregnancy would not make it
an attractive prospect to anyone. To prevent haemorrhaging at birth, for instance, the placenta would probably have to stay intact, attached to his insides, after delivery. This would be risky for
his health – the tissue would either grow, almost like a tumour, or detach or rupture and become lethal when it haemorrhages. If men were to carry embryos to term in this
manner, they would, by definition, be experiencing an ectopic pregnancy – which is known to be dangerous to women, and tends to be terminated as soon as it is discovered.

Womb transplantation would be a different prospect entirely – particularly in women. The womb, of course, is a defined space provided for the foetus; as we’ve seen, it is where the
placenta embeds itself, offering a line of communication between the mother and the foetus, not just resource management. And while there are several major hurdles to overcome before the procedure
could be considered ready for regular trials in humans, optimism reigns. In 2011, for example, Eva Ottosson, a fifty-six-year old mother of two from Nottingham, England began proceedings to have
her womb transplanted into her twenty-five-year-old daughter, Sara. Sara was born lacking a uterus and some parts of the vagina, yet wanted to experience pregnancy and childbirth. In an interview
with the
Telegraph
newspaper, Sara expressed no uneasiness about receiving the womb that had carried her to term. ‘I’m a biology teacher, and it’s just an organ like any
other organ,’ she said. Eva had asked, ‘Isn’t it weird?’ – but her daughter had answered with an unequivocal no. On the other hand, many people undergoing organ
transplants later report feeling as though something about them has changed – not just that a physical bit has been grafted into them, or that they have recovered their health, but that they
have acquired new tastes, behaviours, or personality traits, which they usually link to the donor. It might be that the womb, because it has been viewed historically as a vessel for another life,
doesn’t trigger the same feelings in transplant recipients. But if it does, there may be some odd feelings after the procedure, despite Sara’s sure answer.

In any case, the surgery, scheduled for 2012, is not something that the mother and daughter take lightly. Sara noted that she was ‘more worried that my mum is going to have a big
operation.’ Indeed, Mats Brännström, the surgeon planning the groundbreaking transplant, has been working on the procedure for years. He is convinced that it will be
more technically demanding than a kidney, liver, or heart transplant. He is especially focused on the complicated connections between the womb and the blood supply and between the womb and the
vagina. Will these surgically created connections be strong enough to survive the strain of pregnancy?