Doctors here are awaiting the birth of the nation's first test-tube baby, probably sometime between Dec. 28 and Jan. 9.
"All systems are go," Dr. Howard Jones of the young Eastern Virginia Medical School here said today of the pregnancy.
He would not name the parents until the child is born, but the mother and fetus seem healthy and the birth should pose no more than the normal risks of any childbirth.
This, and the fact that perhaps six more such pregnancies have been achieved in a city not previously noted for medical wonders, is one of the most remarkable recent developments in American medicine.
Three doctors, all in their 60s or 70s, are mainly responsible.
Two are a husband and wife, Drs. Howard and Georgeanna Jones. He is a gynecological surgeon. She is a gynecological endocrinologist, a specialist in the hormones that make pregnancy possible. Both have spent their long careers attacking infertility, which they still find terribly frustrating both for would-be parents and their physicians.
The third, courtly Dr. Mason Andrews, 62, is both an obstetrician and organizer and, currently, a Norfolk city councilman and vice mayor. More than anyone else, he is responsible for the creation in just eight years of a medical school with a skilled faculty in a modest-sized city with a faltering economy.
It is so capable a faculty that they, and not doctors at Harvard or Yale, have become the world's third medical team to achieve successful "in vitro fertilization"--joining male sperm and a female egg cell in the laboratory to begin human conception.
Andrews played no role in the laboratory work but he was crucial to its development. In Howard Jones' words, "he gave it the go-ahead."
Andrews in the 1960s was a civic-minded doctor involved in Norfolk redevelopment. When redevelopment reached Norfolk General Hospital, it became obvious that not just a new building but a new concept was needed.
He argued for "a medical school," because "medical education does not just attract good doctors and scientists--it gives a community better care." The local medical society at first was cool. Then Andrews became its president, and in 1973 he finally presided over the opening of the school, as part of a larger "medical authority" with many functions.
As young men, Andrews and Howard Jones were fellow residents at Johns Hopkins Hospital. Howard and Georgeanna Jones remained in Baltimore and become widely known for their work in infertility. In 1978 he was 67, she was 65, and they were about to retire. Andrews enlisted them.
"We had no idea whatsoever of getting into in vitro fertilization," says Howard Jones.
"But on the day we arrived, July 25, 1978, Louise Brown the world's first test-tube baby was born in England. A local reporter called and said, 'Could this be done here?' I said, 'Why not? . . . All it would take would be a little money.' "
A former patient read this and phoned to offer a $5,000 start-up fund. "Strangely," Jones says, "not much more was needed because a good medical center has most of the equipment, and the patients pay the rest of the costs."
But the effort required a "certificate of need" from the area health planning agency. Public hearings drew opponents who accused the medical school of "genetic engineering" and of planning to wash unsuitable babies "down the sink."
The Joneses said they had no such plans and only wanted to help couples have babies. They got strong backing from Mason Andrews.
"He had to be ready, willing and able," says Jones, not only to back the program administratively but to deal with the foes.
Andrews says he did so with clear conscience: "When we had a confluence of the physicians and scientists to make such an effort, it seemed to me almost immoral not to try."
By March, 1980, the Jones and cooperating scientists were ready for patients. They had 30 patients in 1980 and 30 failures.
A "serious reappraisal," some "major changes" and attention to a thousand details has led the Joneses and colleagues--Drs. Edward Wortham, George Wright, Anibal Acosta, Jairo Garcia and others--to the following protocol:
* They give the intended mother a fertility-inducing drug, both to make her ovulate at a fixed time and to produce, usually, two or more ova or egg cells rather than the single ovum of the usual female cycle.
* They monitor her hormonal level meticulously to "catch" the ripening ova at the right time, then "harvest" them through a long, telescope-like instrument inserted into the abdomen.
* The eggs, formerly joined promptly with the husband's sperm, are placed in a warm, moist incubator for six to eight hours to approximate the time they would continue to develop in nature while awaiting the migrating sperm.
* The egg or eggs and the sperm are finally joined in the central well of a clear plastic dish. In more than nine cases in 10 now they successfully marry. Within 42 to 46 hours they grow into a four to six-celled clump of cells which are then inserted into the mother's womb.
In about two cases in 10, still a discouragingly low number, the embryonic infant implants itself in the womb and there is a pregnancy. The pregnancy is still subject to the possibility of spontaneous abortion or miscarriage, though no more so, apparently, than in natural fertilization.
When the mother yields more than one egg and more than one are successfully fertilized, all are placed in the womb. In England and Australia, the two other sites of successful in vitro fertilization, twins have developed as a result.
Science, one scientist has said, knows more about the moon than it does about the human egg cell and sperm.
"That's almost true," Jones agrees. But with 50 patients this year "we are finally becoming as successful in this procedure as we are with some types of fertility surgery." Some Blue Cross plans indicate they soon may be willing to pay for the effort.
Up to now, the Joneses have not charged for their many hours but starting Jan. l each couple must pay up to $1,400 in doctors' fees and $3,450 in laboratory and hospital charges for a completed pregnancy.
So far there have been no federal contributions. A Carter administration ethics advisory board said the government should at least finance laboratory research. Federal health officials have largely greeted this recommendation with silence.
"Any doctor who deals with infertility," says Howard Jones, "develops a very great reverence for life. And great frustration at not being able to solve the infertility problem.
"If the federal government is interested in solving it, it would be irrational, to say the least, not to support this research."