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Honoring the Giants of IVF

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a blog by David Kreiner, M.D., F.A.C.O.G.

My first day of fellowship training in Reproductive Endocrinology at the Jones Institute was the day the Institute moved from the old quarters at the medical school to their new location at Hoffheimer Hall. Movers carried boxes laden heavy with text books and the physician giants of IVF I had up until now only read about were picking up odds and ends from their recently departed offices. On that auspicious day, Howard and Georgeanna Jones looked to me like someone’s old grandparents rather than the father and mother of IVF. I feared that I had come too late, that they were way past their prime and I would not be able to learn from them. It was, after all, 1985 and they had been leaders in infertility since the 1960’s. Dr. Howard was let go from Johns Hopkins Hospital almost seven years earlier for reaching the retirement age.

They had planned to settle on the Maryland shore and spend time on their second love after fertility, sailing. Instead, an old friend of theirs from Johns Hopkins from the 1960’s, Mason Andrews, helped found a new medical school in Norfolk, Virginia and wanted their help to build the division of reproductive endocrinology, infertility (REI). Eastern Virginia Medical School which later changed its name to the Medical College of Hampton Roads was new and barely known by anyone outside of Virginia at that time. Mason, a southern gentleman in his 60’s, soft spoken with a sharp wit and former Mayor of Norfolk, was successful in talking them into spending a few more years teaching. They bought a cozy house on the Elizabeth River 10 minutes from the school.

The Joneses hadn’t finished unpacking when the greatest fertility event of all time hit the news. Patrick Steptoe and Robert Edwards had succeeded in Great Britain with creating a new life through a process known as In Vitro Fertilization. Journalists interviewed the Jonses’ about the event. Dr. Howard talked about Professor Edwards’ genius and how he was not surprised that he achieved success. Almost as an afterthought at the end of the interview, Dr. Jones was asked if IVF could be performed successfully in Norfolk. In his pinpoint precision fashion and with his classic radio announcer voice, he confidently proclaimed that they could develop a successful IVF program at Eastern Virginia Medical School. (the videotapes of Dr. Howard talking about this moment conjures up images of Babe Ruth promising to hit a homerun for the sick boy in the hospital then pointing to the fence just prior to him knocking one out of the park.)

Well, the Joneses hit the homerun as predicted and gave birth to IVF on this side of the Atlantic and, by the time I arrived in 1985, Norfolk was the center of the IVF universe. Experts worldwide travelled to Norfolk to train and to teach. Prior to the time the Joneses entered the IVF playing field, the world averaged one baby a year from IVF. Dr. Georgeanna introduced the concept of stimulating a woman’s ovaries with gonadotropin hormones in order to produce multiple eggs, thereby increasing the odds of retrieving healthy mature eggs, getting them fertilized and creating embryos that had good pregnancy potential. Patients came to Norfolk from Asia, Europe, Africa and South America to have their IVF where the success rate, in 1985, was a world-leading 15%.

IVF was terribly inefficient in those early days. We routinely transferred six embryos in order to achieve a 15% pregnancy rate. Sometimes patients would try up to four times before conceiving and then would occasionally conceive with a high order multiple pregnancy.

One of my first patients with was one such patient. She conceived quadruplets, and after spending two months in the hospital, delivered four tiny premies at 31 weeks, all of whom required close attention in the neonatal intensive care unit. The babies had pulmonary problems, including difficulty getting off the respirator, various emergencies and surgery. What started out as a wonderful miracle proved to be a tremendous burden for my patient and her husband that was complicated by dealing with a roller coaster of emotions as the new parents encountered numerous obstacles to appreciating their newly-created family.

Howard Jones was not blind to the problems some of our patients were having with high order multiple pregnancies. He had been involved in the development of ethical standard for reproductive technologies and was a past chair of the American Fertility Society Ethics Committee on Reproductive Technology. He and his wife were the only American gynecologists invited by the Vatican to participate on a panel to advise the Pope concerning assisted reproduction.

Jones has pushed for regulation to prevent high-order multiple pregnancies, writing, ”there are probably several reasons why voluntary guidelines are ineffective.”

Here’s why:

  • First, most patients undergoing ART have an intense desire to become pregnant and may ignore or downplay information about the risks of multiple pregnancy.
  • Second, the medical profession seems unwilling to emphasize sufficiently to the patient the dangers involved.
  • At a minimum, the physician must be sure that the informed consent signed by the patient is clear and sufficiently detailed as to the risks of multiple pregnancy.

  • Third, there is competition among ART programs in the U.S. to achieve a high pregnancy rate.
  • Reporting specific pregnancy rates by the Centers for Disease Control and Prevention is misleading and needs to be revised or eliminated. A revision must factor in the multiple pregnancy rates of individual clinics as a negative factor.

  • Fourth, the scientific advances that we cherish are a subtle factor that cause multiple pregnancy.
  • Programs must acknowledge these advances and adjust the number of embryos transferred on an individual basis.

  • Finally, lack of universal insurance coverage in the United States mandates that the number of attempts to achieve pregnancy be kept to a minimum.
  • Universal insurance coverage may mitigate this difficulty.”

Jones believed that if the medical profession could not control the number of embryos transferred and the subsequent risk of multiple pregnancy, the legislative process might (as might litigation). “It is time for our leading medical societies to act by providing and enforcing guidelines.”

I was extremely lucky to have trained with Howard and Georgeanna Jones and to work with them as their Assistant Professor. Dr. Georgeanna was the endocrinologist expert of the team. She was also the heart of Norfolk. She empathized with her patients and would go out of her way for them to help her patients achieve their dream of building a family. Dr. Howard was the surgeon, the geneticist and the spokesman in addition to being the leader. He was able to motivate and direct like a general leading his troops to battle. Everyone on his team was critical to their ultimate success. He loved to say, “a chain is only as strong as its weakest link.” He did what he could to ensure the integrity of each link.

Despite being into his 70’s, Dr. Howard exercised regularly, was in excellent shape and, in my mind, was the original Macho Man. I remember observing him operate, not always delicate, but experienced in fertility surgery like few others. He was never intimidated and, if the job called for raw muscle, he was eager and willing to provide whatever the job called for.

In 1988, I returned home and started the first successful IVF program on Long Island dedicated to the Jones who through their time, efforts and knowledge trained me and in so doing passed the baton of successful family building through the miracle of IVF.

Today, we remember these giants of IVF who started it all. Mason Andrews and Dr. Georgeanna have since passed on. Dr. Howard, now in his 90’s, is still occasionally involved in trying to make IVF safer and more accessible. They were erudite medical pioneers who are responsible for the hundreds of thousands of babies who have been born through the technology that they helped create and promote. They were the original teachers of IVF who selflessly shared their knowledge with others in order to help their patients conceive.

Today, their job is yet complete as we work to eliminate the risk of these dangerous multiple pregnancies that remain a blight on the great miracle of IVF.

Dr. David Kreiner is the Director of East Coast Fertility, a multi-office practice on Long Island, New York. You can learn more about Dr. Kreiner and his practice here.

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