First 'Test-Tube' Baby Born in U.S., Joining Successes Around World

First 'Test-Tube' Baby Born in U.S., Joining Successes Around World
By WALTER SULLIVAN

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For the first time, a ''test-tube'' baby, conceived in a laboratory dish, has been born in an American hospital. Elizabeth Jordan Carr, weighing 5 pounds 12 ounces and described as ''perfectly healthy,'' was delivered yesterday morning at Norfolk General Hospital in Norfolk, Va.

The birth, which came two weeks ahead of schedule, brings to at least 15 the number of babies born in this manner. The rest were in Britain and Australia, although one was born to American parents in England. About 100 women have become pregnant through the same procedure, five of them in the United States.

At least five American clinics are treating infertile women in this way, but so far with meager success. Nevertheless, reliability seems to be improving rapidly. The time when it becomes standard treatment for several causes of infertility may be drawing near.

The Dec. 5 issue of the British medical journal Lancet suggests editorially that the procedure may become simple and reliable enough to be handled as a ''day-care and outpatient service.''

The parents of the newborn baby are Judith Carr, a 28-year-old schoolteacher, and her husband, Roger Carr, 30, of Westminster, Mass. The technique, known medically as in vitro (''in glass'') fertilization and called colloquially, ''test tube'' conception, was conducted at Eastern Virginia Medical School in Norfolk by Dr. Howard Jones and his colleagues, who were the first to try it in the United States.

An egg cell removed from Mrs. Carr was fertilized in a laboratory dish with sperm from her husband. The resulting embryo was then inserted into her womb for normal gestation and birth.

The procedure is designed to overcome the inability of some women's Fallopian tubes to transport to the uterus the egg cell released each month from one ovary. Fertilization normally occurs en route, as sperm and egg meet in the tube. As many as half a million American women are believed sterile because of this condition.

To bypass this impediment an almost mature egg cell is removed surgically and incubated for five or six hours in a special fluid. Then sperm from the husband are added and, after 12 to 23 hours, the egg is examined. If fertilization has occurred, the resulting embryo is cultured for a number of hours - typically 40 to 50, by which time it has subdivided into four or eight microscopic cells.

The embryo is then blown into the womb via a tube inserted through the cervix in the hope that it will attach itself to the wall of the womb and develop normally.

The first successful birth by this procedure, that of Louise Brown in England on July 25, 1978, was a triumph for Dr. Robert Edwards, a specialist in female physiology at Cambridge University, and Dr. Patrick Steptoe, an obstetrician who had developed the egg-removal procedure. As in yesterday's birth, delivery was by Caesarian section.

The parents, John and Lesley Brown, are expecting a second child by the same method. Dr. Steptoe has recently reported that 70 pregnancies have been achieved in Britain, although six did not progress beyond the stage of preliminary hormonal changes. A few weeks ago a sixth in vitro child was born in his clinic. In Australia 20 to 30 pregnancies have been achieved.

In Norfolk Dr. Jones has reported four pregnancies, including the one ending in yesterday's birth and another that may produce twins. At the Los Angeles County-University of Southern California Hospital, a birth is expected in June after some 30 attempted embryo insertions by Dr. Richard Marrs.

According to Dr. Alan H. DeCherney of the Yale University Medical School in New Haven, 11 embryo inserts had been performed there when the project was suspended last fall for a move to new quarters.

The Yale physicians followed the procedure that led to the early successes of Drs. Steptoe and Edwards, monitoring the approach of egg cell maturation by repeatedly analyzing the woman's urine for luteinizing hormone. Its level typically surges 24 to 28 hours before the egg is ready. None of the embryos in New Haven took hold.

When the project is resumed in February it is planned to follow a procedure favored in Australia. The woman is first treated with a substance that induces maturation of more than one egg cell. A hormone from the urine of pregnant women (human chorionic gonadotropin) is then administered to control the time, 32 hours later, when the eggs are ready for removal.

Such precise timing makes it possible to have a full medical staff in readiness. The egg removal takes only a few minutes. A hollow needle is inserted through the abdominal wall and the egg cell sucked from its nest, or follicle, on the surface of the ovary. Timing is critical. If the egg becomes fully ripe and is ejected before removal, it is lost. When taken too early, it does not mature.

If, in response to drug treatment, more than one egg is produced, retrieved, fertilized and inserted, the chances are greater that at least one will attach itself and mature. Several pregnancies have involved twins.

The group at U.S.C. is using hormone control, as are physicians at the University of Texas Medical Center in Houston where two groups are trying embryo inserts. A third team is doing so at the University of Texas in San Antonio as are groups in London and in Melbourne and Sydney, Australia.

Some American medical centers conducting or planning the procedure are reportedly avoiding publicity. Last week it was announced that plans to establish a clinic at the Erie County Medical Center in Buffalo, N.Y., had been canceled because, a hospital spokesman said, of ''ethical and pragmatic considerations.''

A few days earlier, press reports had quoted Bishop Edward D. Head of the Roman Catholic diocese of Buffalo as opposing the procedure as ''depersonalizing.'' The project was to have been directed by Dr. Jack Lippes, a professor of obstetrics and gynecology at the State University of New York in Buffalo. He said last week 85 patients had applied for the treatment.

The procedure is controversial also because only embryos that appear to be developing normally are inserted. The rest are discarded, a procedure equivalent to abortion in the eyes of some opponents.

Defenders of the procedure argue that three-quarters of naturally conceived embryos are aborted, half of them ''silently'' when swept out with the first monthly discharge. They propose that physicians, if it is within their power, should enable sterile couples to bear their own children.

According to the Lancet editorial, one normal birth is now being achieved for every 10 to 15 embryo transfers. It predicts a substantial improvement in this success rate and points out that the procedure can also be used to overcome sterility where the husband's sperm count is low or the woman's reproductive tract is hostile to his sperm.

Dr. Edwards recently reported that at present between one-quarter and two-fifths of the implanted fetuses die in the womb. In one case, such a naturally aborted fetus was found to be carrying a triplet of chromosomes instead of the normal pair. Such genetic defects most often arise, he said, from the egg being fertilized by two sperm. This, it is widely agreed, should occur rarely from in vitro fertilization, where the number of sperm given access to the egg can be limited.

Nevertheless, Dr. Edwards recommended that in all in vitro pregnancies, fluid should be withdrawn from the womb to be tested for genetic defects. An international registry has been established for pooling information gained from in vitro efforts.

In the Journal of the American Medical Association of Aug. 9, Dr. Gary D. Hodgen, chief of the Pregnancy Research Branch of the National Institute of Child Health and Human Development, cited some of the difficulties still to be overcome. Embryos, he pointed out, develop more slowly in vitro than in their natural environment. As a result the mother's womb reaches the proper stage of receptivity before the embryo is ready for insertion.

Dr. Hodgen told of efforts in his institute, using monkeys, to find more ''natural'' alternatives that also eliminate the lag in embryo growth. One simulates a situation, found in some sterile women, in which the upper part of the Fallopian tube is blocked but the lower part is intact. An egg cell is extracted and inserted into the lower part of the tube for normal fertilization. Dr. Hodgen reported an encouraging 16 percent success rate.

In another technique the egg, after removal and fertilization, is placed in a tiny capsule for insertion into the body cavity. The capsule permits body fluids there to penetrate and reach the embryo. It has been discovered, Dr. Hodgen said, that these fluids promote normal growth of the embryo whereas the chemical environment of the uterus is hostile to the newly fertilized embryo. The Australians have reported achieving a pregnancy by inserting an embryo at only the two-cell stage. If their experience is repeatable, the timing problem might be resolved.

On the other hand, if the chemical hostility of the uterus could be neutralized, it might be possible to insert an egg cell immediately after extraction and allow it to be fertilized normally.

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