ROBERT WOOD JOHNSON MEDICAL SCHOOL RETIRED FACULTY ASSOCIATION NEWSLETTER JANUARY 2017 VOLUME X, NO. 1 UPCOMING RFA MEETING IN VITRO FERTILIZATION: AN EMBRYONIC HISTORY “A Robot’s View of Our Ocean Planet” By Eckhard Kemmann, MD When I started my training in Obstetrics- Gynecology at SUNY Downstate-Kings County Hospital in Brooklyn almost five decades ago, infertility was encountered by ten percent of couples, and treatment options were limited and primarily surgical. My teachers and mentors at the institution represented different aspects of the presently evolving field of reproductive medicine. Dr. A. Siegler was a pioneer in tubal surgery and laparoscopy – in the 80s he would introduce laparoscopy to China. Dr. J. R. Jones was an early expert in reproductive hormone research, and Dr. A. Gemzell had come from Sweden where he faced mandatory retirement at the age of 65 and brought his expertise to the United States in the use of ovulation induction. Dr. Gemzell was the first to isolate and use (continued on page 2) Josh Kohut, Ph.D. Associate Professor, Department of Marine TABLE OF CONTENTS PAGE and Coastal Science, Rutgers University Upcoming Meeting 1 InT Vitro Fertilization: An Embryonic History Friday, March 3, 2017 by Eckhard Kemmann, MD 1 Noon – 1:30 p.m. Dean’s Conference Room I See You by Elliot Sultanik, MD, Class of 2016 4 Rutgers Robert Wood Johnson Medical School RWJMS RFA Election Results 5 Piscataway, New Jersey Retired RWJMS Faculty Program to Mentor Medical Students 5 All current and retired faculty, staff, and students Faculty Transition to Retirement Program 6 are welcome to attend. Lunch will be available, and contributions for the lunch may be made at In Memoriam: Sidney Pestka, MD the meeting. from Sherine E. Gabriel, MD, MSc 7 Global Health Fellowship Fund 8 Attendees may park without a parking permit in RFA Membership 8 general parking in lots A, B, and C located next to the medical school from 9 a.m. to 5 p.m. Membership Application and Donation Form 9 RETIRED FACULTY ASSOCIATION IVF Pregnancy RWJMS RETIRED FACULTY ASSOCIATION The United States was prominent in early IVF pregnancy research. In the 1940s, Drs. Rock Officers and Menkin in Boston attempted fertilization of Michael Gochfeld, MD, PhD, President oocytes obtained from fresh surgical specimens. David Seiden, PhD, Vice President In 1959, Dr. M. C. Chang demonstrated Paul Lehrer, PhD, Treasurer successful mammalian IVF fertilization with David Riley, MD, Secretary healthy offspring in rabbits and rodents. His research indicated the need for sperm Election and Membership Committee capacitation, a required step in the maturation of David Seiden, PhD, Chair mammalian spermatozoa to render them Mordechai Bermann, MD competent to fertilize an oocyte. In the 60s, Drs. Norma Greenfield, PhD Howard and Georgianna Jones from Johns John Lenard, PhD Hopkins reported that early embryos could be obtained by IVF, but they were not able to Program Committee achieve a pregnancy. Gordon Schochet, PhD, Chair In the early 70s, a race was on in various Eckhard Kemmann, MD countries – USA, Australia, United Kingdom – to Joseph Lieberman, MD attain the first successful IVF pregnancy. Among Sandra Moss, MD the researchers was Dr. Shettles from New York Mary Swigar, MD who attempted an IVF procedure in 1973. Oocytes from his patient were obtained by RFA Newsletter Editor laparoscopy and brought to Columbia Michael Gochfeld, MD, PhD Presbyterian Hospital by her husband via taxi. At RFA Website: the hospital Dr. Shettles attempted to fertilize http://rwjms.rutgers.edu/faculty/index.html# these with the capacitated sperm of the husband. Dr. Shettles had not informed the institution about his doings. When the chair of the department learned of it, he immediately shut the experiment down. The patient couple In Vitro Fertilization sued, and both husband and wife were awarded (continued from page 1) money for their distress five years later, she $50,000 and he $3. Dr. Shettles had to resign human gonadotropins to achieve pregnancy in and went to Las Vegas to open a cloning clinic humans. Initially, he had used cadaver pituitary (not successful). Importantly, the U.S. glands, an unfortunate choice as later some of Government issued a moratorium on all IVF his patients died from Creutzfeld - Jakob activities. disease. By the 70s, due to the work by Dr. Dr. Robert Edwards, from the United Kingdom, Donini in Italy, the source of human had been at Johns Hopkins and worked with the gonadotropins to induce ovulation had been Joneses on human fertilization. Upon his return switched to urine collected at convents from to Cambridge, he looked for ways to obtain menopausal, elderly nuns. The urinary oocytes and met Dr. Steptoe. Dr. Steptoe had purification process was commercialized, and been trained in laparoscopy by Drs. Raol Palmer the Serono company was founded and marketed (France) and Hans Frangenheim (Germany) and urinary FSH as Pergonal. published the first book on gynecologic Thus, important preconditions were met to laparoscopy in the English language in 1967. explore in vitro fertilization which was fully Shortly thereafter, he received a call from Dr. recognized as a promising approach to Edwards with an invitation to collaborate on the overcome specifically tubal infertility problems. IVF project. Dr. Steptoe would recover oocytes However, in 1973 a moratorium had been issued from infertile patients at a small hospital in in the United States, stopping all IVF work. How Oldham, and Dr. Edwards would attempt the could it come to that? fertilization process to get the embryos for a (continued on page 3) 2 RETIRED FACULTY ASSOCIATION In Vitro Fertilization (continued from page 2) transfer into the patient’s womb. The government rejected funding for the project, and the work was funded by patients’ support. After some failures (miscarriage, ectopic pregnancy) Drs. Edwards and Steptoe announced the birth of the first IVF baby, Louise Brown, on July 25, 1978. This advance hinged on a single case. The obstetrician remarked that if, by chance, the baby would have been not normal, the whole IVF process would have been discredited. Dr. Edwards, later to receive the Nobel Prize in Medicine in 2010, remarked that opposition to IVF at that time was fierce and sometimes Dr. Eckhard Kemmann (left side of the photo) vicious. and Dr. Robert Shelden in the IVF Laboratory Five months after the event in England, a girl (photo taken about 1989) was born in Kolkata, India, her name “Durga.” Dr. S. Mukherjee had performed the IVF that resulted in her birth, but was denied recognition. Dr. Shelden had a small fertilization laboratory The local government declared the event bogus, adjacent to the room. Several years later, when forbade him to travel, and transferred him to the we had outgrown the space, we moved to new ophthalmology department. He committed facilities on George Street in New Brunswick. suicide in 1981. Later investigations of his Improvements and extensions followed quickly records gave him posthumous recognition for his during a golden decade of IVF inventions. achievement. Cryopreservation of embryos was described in 1983 (Trounson), followed by oocyte Over 5 Million IVF Births cryopreservation three years later. Dellenbach After the birth in England, IVF births were introduced vaginal oocyte retrieval in 1984 and reported in Australia in 1980 and in the USA in visited us soon thereafter to demonstrate his 1981. The U.S. program had been set up in technique that made laparoscopic retrieval Norfolk by the Joneses, husband and wife superfluous. Palermo introduced ICSI physicians formerly at Johns Hopkins, and had (intracytoplasmic sperm injection) in 1992, to overcome initial objections and greatly improving the chances to achieve demonstrations. Once successful, the Joneses fertilization if sperm counts were abnormal. Even invited interested specialists to a conference to men with azoospermia could now become discuss their expertise and help spread fathers if sperm could be recovered surgically knowledge of IVF. Dr. Robert Shelden, a from the testes. Embryo testing was introduced colleague of mine at Rutgers Medical School, by using FISH (Munne, 1993) and the and I attended that conference in 1982. The first polymerase chain reaction (Handyside, 1992). program in the northeast was at Yale (1982). Much was learned about better patient selection. The first IVF program in New Jersey opened in While initially only patients received IVF as a last 1983 at Rutgers (then UMDNJ) in New resort treatment, it was recognized that age was Brunswick. At the fall meeting of the NY Ob a critical factor, and women over 40 had only Society, three programs reported successful very limited chances of success. Now patients pregnancies by IVF, Rutgers among them. are younger and go to IVF relatively quickly. Three decades later more than 5 million births Third party reproduction took off in the 1980s had been achieved worldwide using IVF. with the use of donor oocytes, donor sperm, and surrogate gestation. Improvements in When the IVF program at then Middlesex medication resulted in better control of the General Hospital was set up, we used a surplus ovulation stimulation. delivery room for egg retrievals, and (continued on page 4) 3 RETIRED FACULTY ASSOCIATION In Vitro Fertilization pregnancy, making single embryo transfer (and (continued from page 3) freezing surplus embryos) a reasonable approach to reduce the multiple pregnancy During these years, a number of missteps problem IVF children tend to have such as lower achieved notoriety. For example, a physician in weight and a higher risk of prematurity and New York was jailed for miscoding and fraud as malformation; it is unclear if this relates to he tried to help patients with insurance patient or procedural factors. Another problem of reimbursements; IVF was usually not covered by IVF treatment is ovarian hyperstimulation; here insurance at that time.