In early January 1986 — four years after the first “test-tube” baby was born in the U.S. — news broke in the Upper Valley that Dartmouth Hitchcock Medical Center was starting its own in vitro fertilization program.

“There was a real need for this service,” Paul Gardent, the hospital’s then-vice president of operations, said in a Valley News interview at the time. “It fit within our mission of being a resource to this area.”

Less than 20 months later, the first IVF baby was born at Mary Hitchcock Hospital, which back then was still located in Hanover. It was the first hospital in northern New England to report a successful IVF pregnancy.

Dartmouth’s medical school hailed the birth of the baby girl, the daughter of sheep farmers from Poultney, Vt., on Aug. 31, 1987, as a “significant advancement in reproductive medicine for the region.”

Over the next three decades, hundreds of couples who previously couldn’t conceive were able to bring babies home, thanks to the infertility clinic at DHMC.

But in early May 2017, in what could only be viewed as a step backward for reproductive medicine for the region, DHMC announced it was shuttering the clinic.

By the end of that month, DHMC had closed its entire reproductive endocrinology and infertility division. More than 120 women with a wide range of reproductive hormonal and infertility issues found themselves having to travel to Burlington or Boston for care.

The center also treated men with reproductive hormonal issues along with, among other things, providing fertility preservation which involved freezing sperm for males with cancer and immune disorders.

How could a program that brought hundreds of babies into the world, improved people’s health and, by DHMC’s own acknowledgment, remained “marginally profitable” suddenly be discarded?

The decision to stop providing services around reproductive endocrinology and infertility, or REI, stemmed from difficulty in finding the “right amount of staffing,” Dr. Edward J. Merrens, DHMC’s chief clinical officer, told the Valley News when the announcement was made. “We were concerned that we just could not keep the program going, given staffing and resource issues.”

Now, nearly eight years later?

It’s clear that a lot more was going on behind the scenes back then than leaders at what is now Dartmouth Health, the nonprofit medical center’s parent organization, were willing to share with the public.

A nursing shortage was only the last “straw,” Merrens testified during his deposition in a wrongful termination lawsuit filed by one of the clinic’s former fertility specialists.

Another DHMC administrator under oath described the REI program in its final years as “totally dysfunctional.”

Internal DHMC emails that are part of the federal court file show that Merrens and other administrators in 2017 quickly went into damage control mode.

While DHMC was “pinning the dissolution of our reproductive endocrinology program on our failure to maintain and recruit nurses for this work, it is ultimately the dysfunction of the physicians who worked in this area for years (as well as recent hires) and ultimately a failure of leadership,” Merrens wrote in an email to Aimee Giglio, DHMC’s head of human resources.

The fact that “we’ll be referring patients to a similar, rural academic REI center in Burlington, Vt., will make our explanation to the public, patients and the media, well, rather thin,” Merrens added.

“I appreciate your candor and recognition of the issues,” Giglio responded in an email to Merrens. “PR here is very sensitive — goes without saying. We will need to manage internal vs. external messaging and issues.”

The lawsuit — filed by Dr. Misty Blanchette Porter, of Norwich — also includes allegations of medical wrongdoing.

Some of her colleagues in recent years performed procedures without obtaining proper patient consent, Blanchette Porter said her deposition. Two REI physicians “were ordering and performing unnecessary testing and … they were billing for that unnecessary testing,” testified Blanchette Porter, who began working as a staff physician in the REI program in 1996.

Porter v. Dartmouth-Hitchcock Medical Center is scheduled to be heard in U.S. District Court, starting in late March. The trial at the federal courthouse in Burlington is expected to last up to three weeks.

Dartmouth Health declined to answer specific questions about the case or make administrators available for interviews with the Valley News.

“Our policy is not to comment on ongoing litigation,” Audra Burns, a DH spokeswoman, said in an email.

Conception

Let’s start at the beginning.

In December 1978, a young doctor and his wife flew into Lebanon from Augusta, Ga. Greeting them at the small airport was Dr. Barry Smith, the head of obstetrics and gynecology at Mary Hitchcock Memorial Hospital.

Paul and Wendy Manganiello were given a room at the Hanover Inn, which was within walking distance of the hospital.

It was the first visit to the Upper Valley for Paul Manganiello, who grew up in a working-class neighborhood in Jersey City, N.J. After graduating from Seton Hall University in his home state, Manganiello enrolled in medical school in Philadelphia, where he met his future wife, a nursing student.

After finishing his obstetrics and gynecology residency in Philadelphia, Manganiello headed to the Medical College of Georgia, where he’d been offered a fellowship in REI.

With the three-year fellowship nearing an end, Manganiello’s mentor — Paul McDonough, a well-known infertility and genetics specialist — told him about a job opening at the hospital in Hanover.

With their first child on the way, Manganiellos were leaning toward moving to Philadelphia or Boston, where he could join a more lucrative private practice than what Hanover offered.

But the opportunity to work at a teaching hospital affiliated with an Ivy League medical school was too tempting.

In the late 1970s, obstetrics and gynecology wasn’t yet a stand-alone department at DHMC, but with Smith at the helm it was headed in that direction. IVF was also still in its infancy. (The first IVF baby was born at a British hospital in July 1978.)

As exciting a breakthrough as it was, Manganiello maintained a healthy skepticism about the future of IVF. “I couldn’t imagine a woman putting herself through this, realizing it often doesn’t work,” he told me in a recent interview.

In 1985, just before DHMC started its program, the chances of IVF resulting in a successful pregnancy was around 10%, according to the U.S. Centers for Disease Control and Prevention.

At DHMC, Manganiello’s patients included a broad spectrum of women. “REI doesn’t do just infertility,” he said. “Anything to do with hormones, we got.”

It took a few years to launch the infertility clinic. Along with Manganiello, the clinic needed a lab director.

Judy Stern, who had a doctorate in zoology, was finishing up a postdoctoral fellowship at Dartmouth in 1985 when she was hired to join Manganiello at DHMC’s Fertility Center.

With the hospital still located in Hanover next to the medical school, “we had no space” for the clinic, said Smith, who served as head of obstetrics and gynecology from 1976 to 2004.

Manganiello recalled turning an exam room into the clinic’s lab.

“It was actually a closet, I think, at the end of a hall,” said Stern, who now lives in Clarendon, Vt.

The running joke, Stern said, was “why do you need more space? Eggs are very small.”

Leading edge

In its announcement, DHMC said its IVF clinic would be open only to married couples, using their own eggs and sperm.

Even with the restriction (which was later lifted), a DHMC feasibility study estimated between 50 and 150 couples a year experiencing difficulties with fertility would have the financial means to cover the $4,000 or so in costs not covered by private insurance.

Manganiello and Stern “worked very hard” to make it work, Smith said. “The program grew, and patients loved it.”

The same couldn’t be said for all of DHMC’s doctors. Some of his colleagues didn’t “look at infertility as a disease,” Manganiello said. “There was a lot of push back. Some physicians thought it was superfluous.”

The retrieval of a wife’s eggs and immediately mixing them with her husband’s sperm required the use of an operating room, where the woman underwent general anesthesia.

Taking precious — and revenue generating — OR time from other surgeons to perform a procedure lacking a proven track record didn’t win the fertility clinic friends inside the hospital.

“There’s no question there were people who were very unhappy about it,” Stern said.

Objections went beyond medicine. The Catholic Church, from the pope on down, opposed IVF on moral grounds because it involved discarding some embryos. IVF also was not a “natural process,” church leaders argued back then (and still do).

Some Catholics in DHMC’s administration were “against the program, but somehow they got voted down,” Manganiello said.

It helped that Jim Varnum, the hospital president, was “very supportive,” he said.

Manganiello traveled to Sweden to learn a cutting-edge way of harvesting eggs that used ultrasound technology to guide a surgeon during the procedure. The technique developed by Scandinavian doctors was a game changer, Manganiello said.

DHMC became the first IVF center in New Hampshire to use ultrasound in harvesting eggs, which allowed it to become an outpatient procedure.

Still, the chances of a successful pregnancy remained remote.

Manganiello recalled a conversation that he had with a husband of an IVF patient. “I know this isn’t going to work,” the husband said. “I’m doing it for her.”

“I couldn’t think of anything to say back, except that I really appreciated them doing this,” Manganiello told me.

The couple?

The sheep farmers from Poultney, Vt., whose daughter became the first IVF success story at DHMC in 1987.

While the story raised DHMC’s profile, the IVF program “in the beginning wasn’t profitable,” Manganiello said. “It took a long time to get up the numbers.”

Today, more than 2% of all newborns in the U.S. are conceived using assisted reproductive technology, of which IVF is the most usual, The New York Times reported last year. Since the first IVF birth in 1978, 12 million or more babies have been born worldwide using the procedure, according to the National Committee for Monitoring Assisted Reproductive Technologies.

As for DHMC’s decision to suddenly shutter its REI program in May 2017, terminating Porter and two other reproductive endocrinologists, Manganiello, who retired in 2012, said he didn’t see it coming.

“It’s pretty much unheard of to have an academic medical center, and not have a department of reproductive endocrinology,” he said.

Next weekend: What led to DHMC’s decision and the repercussions.

Jim Kenyon can be reached at jkenyon@vnews.com.