Womb with a View
Ectopic pregnancy is a sad and tragic outcome for about 2% of all pregnancies, or 1 in 50 (1). In an ectopic pregnancy, the fertilized ovum, instead of making its intended trip down the fallopian tube to implant in the uterus, implants elsewhere, usually in the fallopian tube itself (although implantation into the abdomen outside of the uterus and the cervix are also possible, but much rarer). The fallopian tube cannot maintain the growing child, as it does not expand to accommodate its size, and may rupture. A ruptured ectopic pregnancy is usually a surgical emergency, as it may result in life-threatening bleeding, pain and infection. If diagnosed early and the tube has not ruptured, an ectopic pregnancy can be medically treated with a drug named methotrexate, which stops further development of the embryo, resulting in its death and reabsorption or elimination from the body of the mother.
As we have often discussed, language can be manipulated for ulterior motives. In this way, an ectopic pregnancy is a kind of miscarriage, although no one, either in medicine or in the common parlance, refers to ectopic pregnancies as miscarriages. Similarly, before the death of the embryo, an ectopic pregnancy can be classified as an inevitable abortion, or, after rupture, a spontaneous or incomplete abortion, but again, no one in medicine uses those terms as it is not an accurate descriptor of the pathologic process at hand. The accurate description is, as we have just said, ectopic pregnancy. Everyone knows what that means. The technically accurate, but confusing and unused other terms are prominently put forth by the pro-abortion cheerleaders as reasons for permitting unrestricted abortion on demand. Because they equate treatment of a life-threatening ectopic pregnancy with elective abortion, their dishonest scare tactic becomes, “Banning abortion will kill women by preventing treatment of ectopic pregnancies.” A corollary to this is the abortion cheerleaders’ position that banning abortion also results in women not receiving treatment for miscarriages. This is another very dishonest scare tactic, which we discussed in detail last week (2). Bottom line, not one of the state abortion regulations or restrictions prohibits the medical or surgical management of either ectopic pregnancies or miscarriages – not one. Anyone who says otherwise is simply lying to facilitate the murder of children for convenience and irresponsibility. As we pointed out in last week’s column, even the most restrictive abortion regulations make detailed and specific exceptions for the treatment of ectopic pregnancies and miscarriages (2). It is an unfortunate truth, however, that treatment of an ectopic pregnancy, either medically or surgically, will result in the death of the growing child. Whether in Catholic or secular doctrine, this is an unavoidable outcome of providing care for the mother and is acceptable, albeit tragic. Suffering an ectopic pregnancy is just as traumatic as a miscarriage, as the hopes and dreams for the unborn child are dashed away. Regardless of one’s desire for a child, continuing an ectopic pregnancy is simply not an available choice. If not treated early, the fallopian tube will rupture and the child will die, along with, possibly, the mother and it is fortunate that medical science has developed to a point where this can be avoided.
A logical question that was recently asked of me is, “Why can’t the doctors save the child by moving the ectopic pregnancy to the uterus?” This is not an unreasonable thought. After all, we have seen what can be accomplished with in-vitro fertilization (IVF) and the implantation of developing embryos into uteri. Recently, I came across marketing material for a uterine transplant program at Baylor Scott & White Health in Dallas (3), apparently the largest uterine transplant program in the world. In this procedure, a uterus from either a living or deceased donor is transplanted into a woman who desires to carry a pregnancy to term in her uterus, but for various reasons, is unable to do so in the uterus with which she was born. Most commonly, this is because the uterus was previously removed in a hysterectomy for reasons like congenital absence/malformation, cancer or traumatic injury. The first uterine transplant took place in Saudi Arabia in 2000 (4). The donor was a 40-year-old woman who was having a hysterectomy and oophorectomy for ovarian cysts and the recipient was a 26-year-old woman who had previously had her uterus removed during an emergency C-section to manage uncontrollable bleeding (5). In this case, the transplant was successful for a period of time and the transplanted uterus underwent two spontaneous menstrual cycles before blood flow failed and it had to be removed (4). (It is a topic for another day, regarding the ethical conduct of research, but there is a fascinating discussion of the ethical controversy regarding this first uterine transplant here: https://forbetterscience.com/2022/05/16/the-first-uterus-transplant-or-how-lancet-apologised-to-saudis/ (6). Interesting reading and touches on an upcoming topic of the intersection of politics and science.)
The first child actually born to a transplanted uterus was reported in Gothenburg, Sweden in 2014 (7). Since then, there have been over 70 uterine transplants worldwide and 33 in the United States (8,9). Most of the uterus transplant recipients in the US had a congenitally-absent uterus and 64% received the organ from a living donor (9). Through October 2021, 19 of the 33 US recipients (58%) had delivered 21 live-born children (9). What they are not broadcasting here is that uterine transplantation is a vanity procedure. It treats no pathologic condition and subjects the recipient to acute and chronic risks. Acutely, there are the usual risks of anesthesia and surgery (bleeding, infection, etc.) and the longer-term risks of immunosuppressive medications and implantation of an organ that is a source of highly-aggressive cancers. Indeed, many hysterectomies are done to treat or prevent cancer in susceptible patients. Because uterine transplants are uncommon, they have not been well-studied and validated as safe. We have very serious concerns about a source for cancer implanted in the setting of immunosuppression, and we are not alone in those concerns (4). Again, this is a vanity procedure, intended to give women the ability to gestate a pregnancy in “their own uterus.” As the ovaries and fallopian tubes are not transplanted, the only way for this uterus to gestate a “natural” pregnancy is by the implantation of an embryo (or embryos, that is, children), created via IVF.
We have previously discussed IVF at length and it is our strong opinion that the process is immoral and evil, a sin under the magisterium of the church and, for other secular reasons, should be illegal (10). Additionally, as an unnecessary procedure, uterine transplant is not covered by insurance and is provided by hospitals as a cash-up-front service, that is, a source of revenue. I suppose medical ethics, patient risk, use of medical resources, and strain on an overburdened medical system are less important considerations when there is money to be made. (To quote some hospital administrators, “We could do really well if it wasn’t for all the sick patients, doctors and nurses.”) Perhaps it is harsh to call uterine transplants evil, but they perpetuate evil technology, IVF, for reasons of vanity, so, if the shoe fits… Of course, you all know what comes next, right? It follows logically that uteri will be transplanted into men who believe they are women (trans-women) so that they can be “fulfilled” and carry a child! Frankly, I am surprised that this has not yet become a booming business in California, the land of social surrogates and IVF for same-sex couples. Honestly, I am shocked that the trans cheerleaders and Gavin Newsom have not yet mandated uterine transplants for trans-couples and put up billboards advertising California as a sanctuary for trans-transplants! (If this indeed does happen within the next 2 years, you owe me a Coke.) (As an aside, I was recently boarding a plane out of Los Angeles and saw a sign in the jet bridge stating something to the effect of the area being subject to fumes that may cause harm to pregnancy. Ironic, I thought California was all about harm to pregnancy?) Before you think this is all hyperbole, there is, indeed, a New Delhi surgeon saying that he plans to do just that in the near future (11) and reputable medical journals are now trumpeting the idea of uterine transplants as a way to, “improve quality of life in transgender women, alleviate dysphoric symptoms, and enhance feelings of femininity”(12). We suppose this is just taking gender reassignment surgery to its extreme (and logical) conclusion. Taking the stand that gender identity disorder is a psychiatric condition (as it was until recently) if gender reassignment surgery is like offering liposuction to an anorexic, a uterine transplant would be like adding gastric bypass to that liposuction!
So, back to the question of ectopic pregnancy, given what has gone on with uterine transplants, it is entirely reasonable to ask, why not move the developing fetus from the fallopian tube to the uterus, an embryonic transplant, so to speak? After all, the entire IVF industry revolves around embryonic transfer to a uterus. Wouldn’t moving a developing embryo from a fallopian tube to a uterus be even simpler? Additionally, wouldn’t this be ethically cleaner? One is taking a developing child from a place where death is certain to a place where it can grow and, eventually, be born. This also alleviates the trauma of losing the child for the parents. It seems that “rescue” therapy for ectopic pregnancies should be an area of active investigation.
If you think that, you are wrong.
In researching rescue therapy for ectopic pregnancies, the only results that come up are “rescue” of the pregnant woman. The goal in the studies published is to eliminate the ectopic pregnancy as soon as possible. The motivation, ostensibly, is to protect the health and future fertility of the mother. Laudable goals, of course, but what of the ectopic child? A tragic victim of circumstance? In this era, yes.
As we have frequently discussed, in our culture of death unborn children simply don’t count. It is a bizarre and ironic comment on American culture that the most liberal abortion laws (abortion at any age and for any reason) co-exist in California, with the most liberal IVF and surrogacy laws in the world. Perhaps it is less surprising, however, when one considers children a commodity or property, rather than human beings. One can sell, buy, barter and discard property at will, so it actually makes sense that California sanctions all this, since the unborn is not recognized as human in that state. If a same-sex couple wants to pay for IVF, create a designer accessory (baby) and then pay a surrogate to carry that child, it makes sense that one could also get an abortion at 32 weeks because it is hurting their career as a B-movie actress and maybe whip up a batch of embryos to save for later. Brave new world, indeed.
If one, however, takes the position of the Catholic Church, that every human life is equal and worthy, created in the image and likeness of God, from the moment of conception to natural death, medical science should be researching ways to rescue ectopic children with the same vigor that they research treatment for cancer, stroke and heart attack. We believe that ectopic rescue can be done. In fact, it has been reported sporadically in the medical literature, as well as anecdotally. This actual literature is hard to find, but there is a case report of one successful uterine re-implantation of an ectopic pregnancy in 1917, one in 1996, and one in 2011 (13). A study was also done that demonstrated numerous successful abdominal pregnancies being carried to viability, in the case of uterine rupture and abdominal implantation of the originally intrauterine pregnancy (14). Thus, in most of these cases, the pregnancy accidentally ended up in the abdomen and came to viability. These were messy affairs, with complicated surgeries and significant blood loss. In the two cases of intentional uterine reimplantation of tubal ectopic pregnancy, the details are unavailable. We are not sure what a publication from 1917, or even a case report from 1996 means. It does not count as data. Antai Hospital, in Singapore, also reports that they have successfully rescued ectopic pregnancies by reimplanting the child in the uterus (15). On the one hand, this is web marketing and similarly does not count as data. On the other, Singapore has a highly sophisticated and regulated medical system. That doesn’t make the claims true, but it is, in every way, a first-world medical standard that competes favorably with anywhere in the world, including the US.
In 2019, Ohio put forward a very restrictive abortion bill that mandated physicians attempt to reimplant viable ectopic pregnancies into the uterus, lest they be charged with abortion murder. Predictably, the pro-abortion drive-by media went crazy, decrying the Ohio legislature for proposing a technology that didn’t exist as a way to purposefully kill women with ectopic pregnancies (21). It is odd, admittedly, that legislation was written requiring a non-existent procedure, but the lay public, including legislators and their aids, does not usually access or understand the medical literature and has to rely on the usually uninformed interpretations of the drive-by media. The unfortunate side effect is that what someone thought was a clever add-on to the bill, weakened the pro-life cause and may have been among the reasons that the bill eventually died in committee. (One of the roles of our proposed Saint Padre Pio School of Osteopathic Medicine will be a public policy think tank and resource, to aid and advise legislators on working through complicated medical issues from a Catholic and pro-life, pro-family context.)
We believe that rescue and uterine reimplantation of ectopic pregnancies should be studied. Clearly, however, the animal models are very difficult to achieve and the procedures are hard, requiring sophisticated microsurgical techniques. It is a lot easier to simply cut out the ectopic pregnancy, or use methotrexate, and start over. This is similar to the philosophy of pediatric care in China. When I was a visiting professor of anesthesiology in Shanghai, during the one-child policy, I wondered why, in a city of nearly 30 million people, there was only one smallish children’s hospital. I thought that, given the limitation on having children, pediatric care would be highly valued and prioritized. Silly me, with those Judeo-Christian values. As was explained to me when I asked why, they said, “Since you can only have one child, why spend money on one who is sick, when, if he dies, you can start over?” Wow. In China, it’s cheaper and easier to let the child die (especially if she’s a girl), rather than do complicated and costly medical treatment. Just like, why try to rescue the ectopic, when you can just discard the child and start over? As we have said in the past, when you are on the same side of a moral argument as China, you should probably reevaluate your position, (and take a shower).
Along these same lines, currently, there is no technology that allows extrauterine rescue of extremely premature infants. The lower limit of viable gestational age is around 22 weeks, and that requires extraordinary medical care. Currently, there is no feasible extrauterine treatment for a child at 6-12 weeks of gestation, when most ectopic pregnancies are diagnosed. But, that does not mean it can’t eventually be developed. In fact, it almost certainly will be.
There was a lot of talk in the popular press recently about artificial wombs. Hashem Al-Ghaili is a self-described “science communicator,” a social media influencer of sorts, who puts together YouTube videos about science, technology, and “the future” (by unsurprising coincidence, he also writes science fiction novels). Recently, Mr. Al-Ghaili put together a video about an imagined enterprise, Ecto-Life, that would be an artificial womb facility for gestating babies from fertilization to birth (16). It is well done, with high production values, and worth your 8 minutes to watch here: https://www.youtube.com/watch?v=O2RIvJ1U7RE.
In fact, it was so slick, that the media exploded with consternation over this artificial baby factory, gestating 30,000 children and using (of course) renewable energy. Ecto-Life, however, doesn’t exist and it seems that Mr. Al-Ghaili’s goal was to create media buzz and get his name in lights. Mission accomplished. The potential for artificial wombs, however, is very real and it is not hyperbole to anticipate that we may see this in our lifetime. Artificial womb technology is an active area of legitimate scientific study and it is not unreasonable to believe this may be available within a decade (17). In my recent discussion about ectopic rescue, bioethicists considering the question strongly felt that an artificial womb was not licit and would be forbidden in the view of the Catholic Church. This is not entirely accurate. An artificial womb is, in itself, neither licit nor illicit. It is the use of this technology that decides whether or not it would be permissible under the magisterium of the Church (18). As a rescue “incubator” for an extremely premature infant, it should be perfectly acceptable to preserve the life of the child. An infant born, say, at 22 weeks, requires extraordinary means of life support. He/she will need to be tracheally intubated and placed on a ventilator. Commonly, the child will require considerable pharmacologic support, artificial nutrition, and hydration and will often require the use of extra-corporeal membrane oxygenation (ECMO). This is probably the most extraordinary means of artificial life support, a sort of heart-lung machine, that takes the blood out of the body, removes carbon dioxide, provides oxygen, and then returns the blood to the body and circulates it. ECMO replaces the heart and lungs, giving them time to grow, so that they may function naturally at an appropriate time. It is far more extraordinary and aggressive than even an artificial heart and was used with varying degrees of success, to support the lives of persons, including pregnant women, suffering from severe COVID-19 infection during the recent pandemic. Thus, an artificial womb is simply a more advanced ECMO/incubator and would be of great benefit in saving the lives of extremely premature infants, including those in ectopic pregnancies.
The problem with this is Paris Hilton.
Paris Hilton is nearly a self-parody, as someone who is famous because of a family background or pedigree. A great-granddaughter of Conrad Hilton, who founded Hilton Hotels, Ms. Hilton first caught the media’s attention in the 1990s, when, at age 19, she was modeling and on the New York social circuit. I suppose the late 1990s/early 2000s was an era of silly reality television, particularly on the MTV network, which abandoned the quite creative and enjoyable music videos of the 1980s to concentrate on truly reprehensible, stupid, and IQ-lowering shows like Jersey Shore, Flavor of Love, Beavis and Butthead and, The Simple Life starring Paris Hilton. Ms. Hilton has gone on to make a few forgettable movies and other shows, none of which most people have ever seen. She follows the Hollywood trend of fame for leaked sex tapes, pool parties and “brand” merchandising. Like others of the archetype, she occasionally surfaces when she needs a cash infusion and has recently been in the news as a side effect of marketing her latest book.
Consider the following, from People Magazine, discussing Ms. Hilton becoming a mother:
“Nicky Hilton Says Sister Paris ‘Is on Cloud Nine’ as First-Time Mom to Son Phoenix Barron”
“She is such an incredible mother,” said Nicky Hilton Rothschild of her sister Paris, who welcomed her first child via surrogate in January with husband Carter Reum.
Paris Hilton has taken to motherhood like a pro.
At Friday’s 16th Women in Film Oscars Party in Los Angeles, her sister Nicky Hilton Rothschild told PEOPLE that the Paris in Love star is “great” as a first-time mom to her and husband Carter Reum’s 2-month-old son, Phoenix Barron.”
“She is on cloud nine. She is such an incredible mother,” added Nicky, 39. “She was born to do this, and I’m just so happy for her.”
Paris told PEOPLE that she and Reum, 42, welcomed their first child via surrogate in January.
“It’s always been my dream to be a mother, and I’m so happy that Carter and I found each other,” she said at the time. “We are so excited to start our family together and our hearts are exploding with love for our baby boy.”
Paris previously told Glamour UK that she and Reum have frozen 20 embryos, “all boys,” noting that they’re trying for a girl. “I just went through the process again a month ago, so I’m waiting for the results to see if there’s any girls,” she said last month (19).”
“She is such an incredible mother.” We wonder if the writer who put this piece together was drunk at the time he wrote it. We further wonder who actually believes this nonsense, aside from California voters who keep Gavin Newsom in office and hope for a second Biden term. In more Paris Hilton news, USA Today recently called Ms. Hilton’s memoir a “must-read book” and published the following excerpt:
“Paris shares her story of choosing to get an abortion in 2003, when she was 22.
“It was like waking up on the ledge outside a 40th-floor window. I was terrified and heartsick. The hormones sent my ADHD symptoms spiraling,” Hilton writes. “Everything I knew about myself was at war with everything I’d been raised to believe about abortion. No one can ever know how hard it is to face this impossible choice unless she’s faced it herself.”
Hilton continues, “Choosing to have an abortion can be an intensely private agony that’s impossible to explain. The only reason I’m talking about it now is that so many women are facing it, and they feel so alone and judged and abandoned. I want them to know that they’re not alone, and they don’t owe anyone an explanation (20).””
If only people were pro-choice before engaging in irresponsible and selfish behavior for a few seconds of pleasure. They don’t make that choice. They only choose to kill the humans they created afterward. (Note to Planned Parenthood, when your spokespeople are Paris Hilton and The Satanic Temple, you may want to reevaluate your marketing strategy.)
I have to think that Osama Bin Laden, reading USA Today in hell’s rec room (where the only reading material is USA Today and the TV only gets Entertainment Tonight, CSPAN and MSNBC) jumps out of his chair and yells at Hitler, “You see Adolph! You see!? This is why death to America!” And throws his slipper at Timothy McVeigh, who sits in a corner playing solitaire, since no one ever talks to him (even people in hell have standards).
Hence the problem with artificial wombs. It is clear that, immediately on their development, they will be used by the same people who today use social surrogates to carry designer babies to birth. Given what we know about what is going on in California, this should not be in the least surprising and I can already see the IVF profiteers revising their proformas to reflect the cost saving from not having to use a surrogate. If one takes this thought experiment a little further, it is very easy to see that some designer babies will be accessories for vapid celebrities, while others may be engineered by the Department of Defense to be super-soldiers, some may be custom tailored to do yard work and gardening for the Hilton family and still, others may be put on reserve for organ harvesting, just like in The Matrix. I suppose we are going there anyway. We had thought it was illegal to treat persons as property since about 1865 in this country, but apparently, California didn’t get the memo.
As it always is, the Catholic Church is absolutely clear on this fundamental issue. People are created in the image and likeness of God and are all equally worthy and valued from the moment of conception to natural death. Holding that as a fundamental tenet easily solves the question of whether or not things like artificial wombs are ethical. Just as in the case of the children created and frozen by the evil of IVF, just as in the case of children conceived in rape, just as in the case of children exterminated by oral contraceptives, the circumstance of one’s creation does not change his/her basic humanity, all life should be preserved, and the methods of preserving such life are ethical, even if extraordinary, as long as these methods do not compromise another life; that is, one person should not be killed to save the life of another.
Aldous Huxley would say, “I told you so.”
W Fageeh, H Raffa, H Jabbad, A Marzouki, Transplantation of the human uterusInt J Gynecology & Obstetrics (2002) doi: 1016/S0020-7292(01)00597-5