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. Howard and Georgeanna Jones looked to me on that auspicious day like someone’s old grandparents rather than the father and mother of IVF. Dr. Georgeanna, as she liked to be called, reminded me of my own grandmother. 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 7 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 now wanted their help to build the division of reproductive endocrinology, infertility (REI). Eastern Virginia Medical 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 so 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. The Joneses had worked with Professor Edwards years ago and were themselves well known in the field so it was natural that journalists came to their home to interview the erudite couple. Dr. Howard talked about the genius of Professor Edwards 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 Dr. Howard’s pinpoint precision fashion and with his classic radio announcer voice, proclaimed that they certainly could develop IVF and with sufficient funds they could even create a successful program in Norfolk. I have seen videotapes of Dr. Howard talking about this moment and it 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 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 Joneses entering the playing field of IVF, 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 travelled from all over to have their IVF at Norfolk where the success rate, in 1985, was a world leading 15%.
I was excited beyond belief that this was my world now. I arrived early that first day of my fellowship dressed in a brand new shirt and tie eager to learn and impress. I managed to be accepted to this most competitive fellowship in part because I had been reading reproductive endocrinology for over 5 years. I went through my ob gyn residency with the intention of specializing in REI and IVF. In 1980 I began my training in REI mentored by Zev Rosenwaks, who convinced me that I could not possibly learn as much in any other residency as I would with him in Stony Brook. So, I joined Zev, who had trained with the Joneses at Johns Hopkins, and he helped me start a residency clinic in REI at StonyBrook where I trained until 1985. Those five years I had been preparing for this moment in July 1985, to do my fellowship with Howard and Georgeanna Jones at the world famous Jones Institute in Norfolk, Virginia.
That first day, during office hours, I was following Dr, Georgeanna who was seeing her private patients. Training begins. She asked, do I know about the two cell theory to the luteal phase? I was dumbfounded. I had never come across such a concept in any of my reading. Little did I know, Dr. Georgeanna had a knowledge base and theories in reproductive endocrinology that few others could rival. She explained about the large cell and small cell and how the small cell is activated 10 days after ovulation by the pregnancy hormone, hcg. In its absence the large cell dies, progesterone decreases and a woman menstruates. In its presence the activated small cells continue to pump out progesterone and support the pregnancy. How exciting! I realized that I would spend every possible free moment talking reproductive endocrinology with Dr. Georgeanna. She knew all the REI secrets. She 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, and that dream was to build their 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 in his view 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 his age which was into his 70’s, 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 it himself.
I completed my two year fellowship in 1987, having learned an enormous amount of information and prepared to start my own IVF program. However, the Joneses asked me to stay on as an assistant professor, to help start an embryo cryopreservation program and direct the donor egg program. How could I refuse such an opportunity? I saw patients next door to Dr. Georgeanna and around the corner from Dr. Howard. Zev Rosenwaks was down the hall. I could present every patient to whomever I thought would know the most about my patient’s problems. This became an even better learning experience than my fellowship. There were four of us in the IVF rotation, Zev Rosenwaks, myself, Suheil Muasher, a fellow who was two years ahead of me in training and Anibal Acosta, the Howard Jones of Argentina. Rosenwaks and Acosta were often lecturing so Suheil and I performed more of the IVF that year. It was an exciting time. We started doing retrievals transvaginally instead of laparoscopically. We were experimenting with lupron and pregnancy rates were exceeding 25%. I was doing my life’s dream working in IVF, helping women in need of help with conception achieve their dream of making their family.
Times were changing. Successful IVF programs were springing up throughout the nation. It was the spring of 1988 when I returned home and started the first successful IVF program on Long Island dedicated to Howard and Georgeanna 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 and how he describes it as late in the 9th inning is still occasionally involved in trying to make IVF more accessible to the public. 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 so that they also may help their patients conceive. I am eternally thankful for the opportunities and training I received there from them, from Zev Rosenwaks, Suheil Muasher and from others at the Institute.