Medical History

Innovation and imagination: Howard W. Jones, Jr, MD, discusses the experiences and coincidences that shaped his career

Professor Emeritus of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, Professor Emeritus of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland

Executive Director, American Society for Reproductive Medicine, Birmingham, Alabama

Howard W. Jones, Jr, MD, has been a leader in the field of infertility for nearly 60 years. In partnership with his wife, Georgeanna Seegar Jones, MD (1912-2005), he performed the first successful in vitro fertilization (IVF) procedure in the United States. In a recent conversation with Robert W. Rebar, MD, Dr Jones shared his perspectives on key developments in this field.

RWR: What caused you to become interested in the field of infertility?

HWJ: I became involved largely because of my wife, Georgeanna Seegar Jones. We were sweethearts in medical school, and when we married in 1940 I was in general surgery and she was in obstetrics and gynecology. She was especially interested in the endocrinological aspects, and she actually started the first division of what we now call reproductive medicine at Johns Hopkins, at the request of Richard TeLinde, in 1939. During World War II, I went to war as a general surgeon, but it became important to both of us that we be in the same field. So when I came back, I took a second residency in gynecology.

RWR: You collaborated with your wife over almost a 60-year career, then.

HWJ: Anything that I was able to do I did better, and maybe only, because of my wife. We formed a special team. She was full of ideas. We always rode home from the hospital in one car, and that was the time when we discussed things. What ever we did, we did as a pair.

RWR: What was the field of infertility like at the time that you began your career?

HWJ: Infertility was seen as largely an anatomical problem. Donor sperm were used for male infertility soon after I entered the field, but on the female side there was no thought of endocrinological disorders affecting fertility and, of course, no therapy as we know it today. Almost from the first, as our practices filled, my wife would have patients with anatomical problems that needed surgical correction; so I became involved in the field of reparative surgery.

RWR: Looking back, what do you think were your greatest contributions in the surgical field?

HWJ: We developed operations to correct serious abnormalities of the external genitalia in patients with developmental her maphroditism, or intersexuality as we now call it. Lawson Wilkins, the pioneering pediatric endocrinologist at Hopkins, had discovered how to treat congenital virilizing adrenal hyperplasia by using cortisone. This reversed the masculinization endocrinologically, but of course it didn’t alter the masculine genitalia caused by the condition. We were able to reconstruct genitalia from the male to the female side, and we were really on the ground floor of that.

Then there was the matter of the double uterus. We had a young girl with an obstruction of one side of a septate uterus; we did a laparotomy and discovered that she had a blind horn. The question was what to do with it. We were able to anastomose one side to the other by removing the septum surgically. After that we operated on many patients with similar conditions.

RWR: Those were innovative operations.

HWJ: I think my war experience came into play, although I didn’t realize it at the time. During the war I had been chief of a surgical team, operating on seriously wounded individuals. Every case was different, and to solve the problem before me I had to do things that I ordinarily didn’t door hadn’t read about. The experience stood me in good stead later. Some of the surgeries that I performed later were the result of being willing to undertake things that hadn’t been described.

RWR: Turning back to infertility, what has been the greatest advance in that field during your career?

HWJ: In vitro fertilization, without a doubt.

RWR: Patrick Steptoe and Robert Edwards achieved the first successful term birth with IVF in 1978, with the birth of Louise Brown. You had collaborated with Dr Edwards on research prior to that, correct?

HWJ: Bob Edwards, the embryologist of the team, worked with me during a fellowship at Johns Hopkins in 1965. In retrospect I believe that human eggs were fertilized in vitro for the first time as part of our work, although we didn’t publish that claim.¹ Bob felt that fertilization could be proved only if the sperm tail was visible on an egg under a microscope, and we couldn’t see the tail on any of the eggs. However, 2 micrographs published with our original article show eggs with pronuclei; by today’s standards they would be considered fertilized.

RWR: How did your own program at Norfolk get started?

HWJ: We moved to Norfolk in 1978; it happened that the day we arrived was the day Louise Brown was born in England. A reporter from the Norfolk newspaper wanted a story on the birth and came out to our house to interview us amidst unpacked boxes. She asked if the procedure could be done in Norfolk, and I said, “Sure,” without thinking much about it. She asked what it would it take, and I said it would take some money.

A patient who lived in Norfolk but had been referred to us in Baltimore read those remarks and called me. She asked me a question I’ve never been asked before or since: “How much money do you want?” That led to a meeting the next day, at which we decided to start an IVF program at the Eastern Virginia Medical School. We had not thought of it at all 24 hours before.

RWR: How much time passed before the first birth in Norfolk?

HWJ: The first baby was born in 1981. Bob Edwards had taken 15 years to get his IVF pregnancy, and a pregnancy in Australia had taken 7 years. But we had the benefit of knowing Bob and his group; they told us everything they knew. We stood on their shoulders and were able to cut down the time involved.

RWR: What has been your greatest contribution to the field of infertility?

HWJ: I think we made IVF a practical clinical procedure. The procedures in Great Britain and Australia were successful but extremely, and unnecessarily, complicated. For example, they used nitrogen to distend the abdomen during laparoscopy because of concerns about changing the pH. I was unwilling to do that and risk an air embolism, particularly because we were very much in the public eye and certain groups were opposed to our work. Instead, we showed that carbon dioxide—the standard gas for laparoscopy—could be used. After resolving several similar problems, we were able to convert the procedure into one that could be done any where.

RWR: If you could effect one improvement in IVF today, what would it be?

HWJ: Tremendous benefits would result if we could identify, in a noninvasive way, the fertilized eggs with pregnancy potential. Human reproduction is inefficient—only about 1 in every 4 or 5 fertilized eggs has pregnancy potential. The others are defective in one way or another, and under the microscope we simply can’t be sure which one has the white hat. I believe there are avenues that might allow us to do this, perhaps within the next decade. It would make IVF far more efficient, and it would eliminate some complications, such as multiple pregnancies.

RWR: Looking further ahead, what other advances might we see?

HWJ: We may find ways to derive substitutes for germ cells from somatic cells, rendering sperm and eggs unnecessary. It won’t happen within the decade, but I wouldn’t be surprised if 50 years from now it were possible to develop a mammal from somatic cells cultured in the proper way.

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