DISCLAIMER: Today’s episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free, to you! Here, the Advertiser has editorial control. Feature sponsorship is not an endorsement, and does not necessarily reflect the views of Inside Reproductive Health.
Scalable and solvable questions.
According to Dr. James Grifo, Chief Executive Physician for [Inception Fertility (TM)], that’s what REI’s need to bring to the table to advance fertility medicine over the next 30 years.
In this week’s episode we look back at Dr. Grifo’s fertility legacy and look forward to the new opportunities REIs have to create their own.
Tune in as Dr. Grifo talks about:
Your biggest opportunities in the years to come (From egg retrievals to streamlining ovulation induction)
How to bring patient education into the culture
Non-Selection Studies and how you may be leading them
The unique opportunities the Prelude Network offers (Like pioneering research at the Prelude Research Institute)
How one legacy career leads to another: Yours.
Dr. James Grifo
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Prelude Fertility
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Transcript
[00:00:00] Dr. James Grifo: There's going to be more and more need for assisted reproduction. If the trends of age at first birth in these last 30 years, we went from 19 to 37 in New York city and, and, you know, 2021, it was 30 for the whole United States. It's a matter of time where we're having our whole families in late 30s, early 40s.
And we're going to be using assisted reproduction as the safest way to get there.
[00:00:23] Sponsor: This episode was made possible by our feature sponsor, the Prelude Network, where top REI physicians find their calling. Join us and leverage state of the art technology. Collaborate with the best physicians in fertility.
And be part of a network that's redefining fertility care across North America. At Prelude, your expertise helps turn dreams into reality. Discover more at rei.preludefertility.com. That's rei.preludefertility.com.
Announcer: Today's episode is paid content from our feature sponsor, who helps Inside Reproductive Health to deliver information for free to you.
Here the advertiser has editorial control. Feature sponsorship is not an endorsement and does not necessarily reflect the views of Inside Reproductive Health.
[00:01:18] Griffin Jones: Scalable, solvable questions. That's what critical thinking REIs need to bring to the table to advance this field of medicine over the next 30 years, according to today's guest. If you're at the beginning of your career as an REI, How do you contribute and leave a legacy like my guest has? How do you collaborate with your colleagues?
How do you make things dramatically better for your suffering patients and maybe, just maybe, also be lucky enough to get an angry phone call from the FDA? My guest is Dr. Jamie Grifo. You might know him from NYU Langone. You might know him as the chief executive physician for [Inception Fertility (TM)]. He's a combined MD PhD.
We weave through time in this episode. I'm interested in Dr. Grifo's history. Because he's one of the pioneers of fertility preservation. NYU's First Egg Free's baby was born in July, 2005. So we go back 19 82, 19 92, 2005, 2016, and look at this tremendous progress that Dr. Grifo and his team made, and we use that as a look and glass into your career.
What do you accomplish in 2030? In 2040? In 2050? How do you as an REI embarking upon your legacy? Bring patient education into the culture. We talk about the unique opportunities that the Prelude Network has, like their Physician Advisory Board, like their Physician Summit. How are all these REIs that are on the inside collaborating with each other?
And the opportunities for pioneering research through the Prelude Research Institute, and what Dr. Grifo sees might be your biggest opportunities. Research in non invasive egg retrievals, in streamlining ovulation induction. in advancing egg freezing and the mission that might be close to you, avoiding miscarriage.
Dr. Grifo talks about how you might be involved in these non selection studies, how you might lead them, and how scalable, solvable questions are necessary from critical thinking REIs. I hope you enjoy this conversation about how one legacy career leads to another, yours. Dr. Grifo, Jamie, welcome to the Inside Reproductive Health podcast.
[00:03:15] Dr. James Grifo: Thanks, Griffin. It's great to speak with you today.
[00:03:18] Griffin Jones: I've had a lot of shows and a lot of content for young REIs and talking about career paths, but it's mostly been about the initial career trajectory. It's been about how you think about partnerships and if you go work for an academic. practice or, you know, what you should consider having in contracts and that sort of thing.
It hasn't really been, I'm trying to think if, if I've done an episode or two where we really go through a career and when you and I spoke recently and you were talking about what you've done with fertility preservation, egg freezing, I was like, this would be cool to do, to, to think about how you actually.
You know, go through a career and present young doctors with not just here's the job that you can get now, but what do you want the next two or three decades to look like? And so I look forward to going into the past with you a little bit, into the present, into the future, weaving through the three of those.
Let's start with. with your own history with fertility preservation, because I think, I think you and I have only met in person once and we had a 10 minute conversation and it, and it was about this, this practice passion of yours. And, and so how did that develop?
[00:04:44] Dr. James Grifo: So, I mean, it started before medical school.
You know, I didn't know a lot of the things I knew. Going into it, but I, I was very interested in science. I didn't know if I wanted to do just science. I was very interested in medicine and, you know, because of that, I ended up doing both. And same with college. I didn't, you know, I, I majored in biology and chemistry 'cause I couldn't make a decision.
So I, I did both and then, you know, I realized that college I want, I wanted to go. It's a medical school, but I still wanted to keep the science doors open. So I applied to MD PhD programs, uh, knowing that if I got the extra chaining with the PhD, no matter what I did, that would benefit me. And if I was going strictly science, I was prepared.
And if I was going medicine, that would only make me better. And, and so I, I went and did a combined degree at a time when they were just starting those programs and I was very fortunate to go to Case Western Reserve and then during medical school, you know, it even started the first day. It was like, all right, what am I going to do?
Like what, what, what field is gonna be the field I want to go into? And, you know, the first two years of medical school was all didactic. And during that time I was doing my, my PhD. Coursework at the same time as medical school and it was pretty streamlined and I was able to do that and I started my research, you know, during the summers and then once I finished the first two years of medical school, I went to the lab and did some pretty fun, interesting molecular biology research that actually led to about 10 publications and one of them actually was foundational for one of the drugs that is now being used.
And in a very indirect way, so it was kind of cool to make that impact, but when I went back to medical school and I started doing the clinical rotations, every rotation I did I loved. It was like, all right, I'm going to be a surgeon. All right, I'm going to be a pediatrician. All right, I'm going to be an internist.
And in fact, what I did was I deferred OBGYN until my fourth year because there was a chief resident who said, look, you can be my sub I, sub intern, your last month of third year, even though you're not supposed to do it until fourth year, because I'll be gone. And I got permission to delay my OBGYN until my fourth year, which no one.
It was really allowed to do at that point, but they accommodated me. And after a month on those wards with the MD PhD training, the kind of thought was I would go into cancer biology and cancer treatment and go to the NIH and that's how, and after a month on the medicine wards, I thought, you know, this really isn't exactly what I want to do.
Seeing these patients with chronic illnesses, it seemed like we were just. You know, not really curing them. And, and then I did the OB rotation. That was so positive. There was a lot of surgery that there was happy moments. And, you know, then there was this fertility thing that came out of nowhere, you know, back in 1984, it was when I graduated, it was 19.
82 that I was doing my clinical rotations and the average age of first birth for a woman was 19. It's pretty remarkable because you think about where we are now, just to give you kind of the sideline of that, in 2016, average age of first birth of 19 in the whole United States became 26. And in two thousand twenty one it became thirty new york city last year it was thirty seven and say wow that's eighteen years in the last thirty five years which is even more remarkable because three hundred thousand years ago when we first hit this planet as a species we we were.
Having our babies at 14, we were dead by 25. And if you think about the system, I'm always, I'm a little bit nerdy that way. I like to think about like, how did this evolve and what was the purpose? Purpose of reproduction in the early days was keep us on this earth evolution. We had to adapt to our environment.
So we had to make a lot of embryos that didn't quite make sense unless there was something they adapted to and kept us. As a species on this earth and then what about how efficient, you know, we always think of, you know, that sex ed class way back when in fourth grade where they said have sex one time you'll be pregnant and get five sexually transmitted diseases all in the same night, which is, you know, a little bit remarkable.
They wanted to scare us. They don't want us to make any bad decisions, but reproduction is nowhere near that efficient. A 14 year old 300, 000 years ago in our lifetime released 100 to 120 or 7 million eggs. Yeah. And had three babies and that was the goal, not too many, not too few, if we had too few, we'd be trit and be extinct.
If we had too many, we would overpopulate, get disease and famine and be gone. So, it was never designed to be that efficient and then, you know, 300, 000 years later, it's 1984, we're 19 having, having babies and a woman has 12 eggs a year and 240 eggs in a lifetime to build a family of three or four or whatever.
You know, fertility issues were less of a problem than they are now, because our biggest problem is just the age at which we're having babies. This system was never designed for that.
[00:09:41] Griffin Jones: So I want to make sure I understand. So you're saying in 1982, the average age of first birth per American woman was 19?
That's in 1982?
[00:09:51] Dr. James Grifo: Yeah, 82 84.
[00:09:52] Griffin Jones: And then when did it rise? You said at some point it rose to 26. What, what year was that?
[00:09:58] Dr. James Grifo: 2016. But we, we saw that happening even before. We saw that in the 90s when I first started practicing in, you know, in IVF, that our patients were getting older and older. And just as a remark to that, I remember on my rotations going through, you know, the OB wards and this young female, high risk OB, head of department, high risk OB said, all right, now we're going to see something that you, you probably are going to be seeing more of in your career. And well, what's that? Well, we're going to go in and see this geriatric pregnancy. And I'm like, first of all, that's an awful term.
Why would you use that term? Like I have six sisters. I don't think they would like that. Um, and I didn't say that cause you know, you weren't like that back then in medical school and you just said, yes, yes, yes. And so we go in this room and there's a 32 year old woman having her first baby. And like that was considered a geriatric pregnancy.
That was 1983. You know, so just to give you a perspective last year, I mean, in New York City, 37 was the average age of first birth, not not second, not third. And we're having families. And really, if you look at the clock for women, it's never really been described to them well, you know, pretty much age 42, it ends.
So if you're starting at 37, you got five years and about 60 eggs to have a family. And you say, well, that's plenty of eggs. Not when they're 37 year old eggs. It's not so it's not such a straight shot. But back in 1984, you know, you were 19 and you had a lot of opportunity. And I guess the analogy I always like to use is like you ever see a farmer go out in the One seed in the ground and go home and eat dinner saying the crop's coming.
No, they throw a hundred seeds down knowing they're getting, getting 10 plants and embryos are just like that. And no one thinks of it like that, but I always did from the beginning. Bottom line is during that OB rotation, it was pretty clear to me with my molecular biology training and IVF just starting to happen.
That we had a whole future ahead of us because during my medical school training, I spent time with a friend of mine on the cystic fibrosis ward with all these young people born with this awful disease that couldn't be diagnosed before they were born and their lives were really hampered. They died young, they were infertile, they had miserable lives, they were in the hospital a lot, they had chronic pneumonias and it was like, we couldn't do anything about it.
We couldn't cure them, we got better. But, you know. With, with my molecular biology training, thinking about IVF and what we could do, we could prevent those diseases. And that, that was really my initial focus of IVF is like. We could use this technology to eliminate genetic disease by only putting back embryos that don't have genetic disease.
And essentially, you could wipe out all genetic diseases. Now, fast forward. Here we are today. Our patients come in. We check them for 566 recessive genes and see if they carry any one of those recessive genes, which is not a problem if they do, but if their partner carries the same one, like cystic fibrosis, The 25 percent of their embryos will have cystic fibrosis, and the baby will have a disease that we now can prevent, and in our clinic, because we screen everybody who is willing, and most are, we don't make babies with genetic disease anymore.
We've eliminated that, which is, like, that's happened in a 30 year span. It's remarkable. So, I mean, I didn't see that, that happening that fast or even in my career, but that was kind of the focus when IVF started. It was like, all right, during my fellowship, I started biopsying mouse embryos so I could learn how to do this technology to diagnose embryos and prevent genetic disease.
And that led to them. The one, the first one that I did was in 1992 when I was at Cornell, and we literally waited four years for permission to do it. The Brits did it first. They had permission. We didn't. Once the Brits had success, it was Alan Handyside and Mark Hughes, who's from the U. S., but he helped.
He did a lot of the genetics. We were waiting in line. I had a patient lined up. She needed IVF. We had done the mouse studies. I'd gotten permission. It worked. And she said, look, I want to be your first patient. My brother died of hemophilia. I'm 25, 25 percent of my babies will have it. I'm willing to be your experiment.
And she was, and her child is 32 years old now and doesn't have hemophilia. So that, that, that technology was born. I started my IVF career at Cornell in 1990. I trained at Yale and during my Yale fellowship, I was where I pioneered a lot of these technologies. We were, you know, there were several investigators.
I was one of them working on these methods of embryo biopsy and that led to the first United States successful embryo biopsy. In 1992, we were the second in the world to do that. And you know, that led to the next thing, you know, older women miscarry 40 year old woman miscarries 40 percent of the time, she'll have a down syndrome pregnancy one to 2 percent of the time, you know, we were seeing our patients get older, we were seeing them failing to get pregnant, we were seeing them miscarry more, you know, 25, percent of the time, you have a down syndrome risk of one in 500.
Well, as our patients were getting older, because You know, even in 1990, our average age patient in IVF was like 33, 34. And we were not having very good success with the older patients. And what was clear was so obvious. Embryos being chromosomally abnormal was the cause of age related decline in fertility.
Now, we knew that thesis in the 90s. We didn't publish the paper until 2010 because it took us that long to get the data. But it was also, not only could we prevent genetic disease, we could find the embryo that makes the baby. We could eliminate Down syndrome if patients don't want to have a baby with Down syndrome or Turner syndrome or Edwards syndrome, those chromosomal abnormalities.
But mainly what we could do is eliminate. Not completely, but to a great extent, miscarriage risk, because there's nothing worse than doing IVF and getting a miscarriage. Except getting the 16 weeks pregnant and having a down syndrome pregnancy, which we were making routinely in the years before we were using PGT a routinely, which is only recently, relatively recently.
[00:16:11] Griffin Jones: Let's go back to 1992 for a second, because I'm seeing the, this trajectory from 1982 to 1992, where you're, you're learning about molecular biology, you're going through medical school, you're seeing the demographic changes in terms of first pregnancy, which leads you to the implant. Implications of of what used to be called geriatric pregnancy and but then how do you get to the point in to take that first step to where you were among the first people to biopsy an embryo in 1992.
I see how you got the interest, but what was the actual step that you took to become a part of that team and and be able to actually bring that into your career?
[00:16:56] Dr. James Grifo: So, you know, during my fellowship, I, I said this was going to be my career. I'm going to biopsy embryos is going to be the future. It's going to help us with so many things that the initial focus was genetic disease.
When I went to Cornell in 1990, uh, Rosenwax was in charge of that program. And the goal was for me to. Developed an embryo testing program and we started initially with genetic disease, but Santiago Mune joined us and he was going to study reactive to oxygen species and sperm. And I sat him down. I said, Santi, like the future is not studying sperm.
The future is genetics. And he, he agreed. And he did a pivot, complete pivot and said, all right, I'm going to work on methods that we can diagnose the embryo. And so And we had research protocols at the time, embryos that weren't being transferred that patients donated for research embryos that were tested for genetic disease and had genetic disease patients donated for research.
And we started asking, can we count chromosomes and that's where fluorescent in situ hybridization, a way to like, look at the cells of the embryo and see if they have the right number of chromosomes we showed in 1994. Think about this. That 20 percent of embryos were mosaic and no one knew what to do with it.
It took us three times submitting it to journals to publish it. No one thought it was real. They thought it was an artifact. And here we are 2016, how many years later now you have next generation sequencing as a technology to diagnose embryos, and now we're finding that there's mosaic embryos that we were transferring for all those years unknowingly.
And, and not believing our original research in 1992. And what have we learned? Mosaic embryos make babies. They make healthy babies, depending on the extent of mosaicism. It's either they are very low chance of making a baby or they have a high chance of making a baby. They don't perform as well as euploid embryos that have the right number of chromosomes.
So we started the foundational research in the early 90s. And at first, we started with five chromosomes because accounting for most miscarriages. And you know, it took us how many years to get to a stage where we can now screen for all chromosomal abnormalities. And now we have the most sophisticated technology in the world doing that.
You know, the, the labs like Cooper and. And you know, there's, there's tons of them. There's really good labs out there. I worked mostly with Santi who sold his lab to Cooper. And so I've done most of my research with them. I have no financial interest in them. I benefit not at all by using them, except I know it's a product that I've, I've helped develop.
And so I could, I trust it. I think now the whole field is going in the direction of routinely screening all embryos. It's still controversial. It's still, there's still issues with it. There's a lot that has to happen, but you know, when you've spent 30 years doing it, And your embryologists have the quality of your product is going to be better than someone who starts, you know, last year or five years ago.
So, you know, part of the reasons it doesn't work as well in some labs, they just haven't put in the time and the training to get there.
[00:19:56] Griffin Jones: So you persuaded Dr. Mouneh to get on board with this and say, listen, the future is in genetics. It's not, it's not here and just analyzing the sperm. And so you had a small team in the beginning, but 30 years ago, there wasn't.
A prelude network. There wasn't the networks that we have today. And if you were a 33-year-old REI or a 30 5-year-old REI, that was doing the equivalent of whatever the pioneering, uh, the next, uh, phase of segment of this field of medicine is, what would you do differently having the network that you have now?
[00:20:35] Dr. James Grifo: Don't know that I would have done it much differently because, you know, it would have take someone with a vision to do a high risk investment in something that, you know, sounded like a crazy idea that actually 30 years later turned into a really good idea, you know, mainly through not just my work, but there were hundreds of other people at different centers, you know, we all saw the same vision and we collaborated even though we were competing and, and really this field pulled itself up by its bootstraps.
Most of us did it with. With clinical money, like I, I never had research grants, you couldn't get embryo, embryo research grants, it was politically charged. I had a patient who was incredible to me, she has five kids from our efforts, and she's very wealthy and she supported us. You know, with annual grants that we use that money, we use clinical dollars.
We did a lot of stuff for free. My first, you know, five years of embryo vibes who've never charged for it. We just, because we, we, we didn't charge for anything until we had a, had a product. And so, you know, we saw that. PGTA was going to be the future. And we started focusing on that in the nineties. When I came to NYU, that became our, our prime focus.
But as in the nineties, we were watching our patients get older and it was very clear and we were seeing more and more patients needing egg donor, and that was. a problem because not everybody could get there. So a lot of women in their forties who wanted their first or second or whatever child, they were past that age and they needed egg donor.
Many of them didn't have that baby because they just couldn't get there with egg donor. And so that's where, you know, I spent With John Zhang, as my first fellow, we spent years trying to fix old eggs by taking the nucleus out of them, putting them in young eggs, and we got to a whole lot of trouble. I almost got, I almost got in trouble, you know, with this technology.
And, you know, 16 years later, it actually turned out to work and it actually turned out to be safe. But at the time that there wasn't a lot of appetite for that. I got shut down. I mean, I can tell you stories. I got a personal letter from the assistant surgeon general of, of. I got a phone call and she called me up and she said, what the hell do you think you're doing up there?
As we published something at SRM, it was a prize paper. We took old eggs, took the nucleus out of the old eggs, put them in young eggs and made embryos. And by the way, we did all this stuff in mice first and showed that it worked. So the babies were born were healthy and we got IRB approval to do this.
But once this happened and people thought it was cloning because we were doing nuclear transfer, it wasn't cloning, but they didn't understand the science even, she called me up and said, what the hell do you think you're doing up there? This is a, I said, excuse me, is this a personal call? Or is this like, no, no, you know who I am and you know why I'm calling.
And then the next week I got a letter from the FDA which said, We regulate you, you have to stop your work, you need to file an investigational new drug application if you're going to keep doing that work. I don't want to get too bogged down in this story, it was five years and a lot of clinical capital and money that we spent on a project that never took off, and you know, again, high risk capital, that turned out to actually be a good idea and could work and does work.
It will never take off. But you know what? There's always for every crisis. There's always opportunity. It kind of forced us to say, you know what? This is never gonna fly. No one's gonna have an appetite for it. Let's let's start freezing eggs. And so in 1999 2000, we started freezing mouse eggs, thinking that that would be the cure for egg donor.
We could let patients be their own egg donor by freezing their eggs. And we spent four years, a lot of money, again, personal money and, and donated money. Because again, it was hard to get, you couldn't get grants and, you know, would, would these big networks invest money now in such high risk stuff? I don't know.
Probably now there's, you know, there's, it's a whole different science world. I don't know. Certainly the opportunity is there. The bottom line is we, we got really good at making baby mice to the point where like, okay, it's 2002. We can do this, but you know, we haven't done it in human. We've done some frozen egg donors, but you know, we always do everything in our lab.
We do it in the animal first. We show that we can do it. We then move to the clinic. We do it for free. So now we had to design an experiment, which we paid for, and it was a lot of money. We did 23 free cycles of. egg freezing in patients who needed IVF, and back in, you know, 2000, most patients didn't have insurance for IVF.
A lot of them didn't do it because they couldn't afford it. So we had a natural group of patients that we wanted to help, and we had a need. Our need was to see how good we were at freezing eggs, because our mouse data said we would be as good as IVF. But we needed the data. So we did 23 free cycles of egg freezing in patients who needed IVF, waited a few months, thawed their eggs, made embryos, put back the best looking embryo, just like they had an IVF cycle.
And we said to them, you know, we think this is going to be as good as IVF. We don't know. Because we don't know, and because it's new, we'll pay for it. And we paid for their drug, their anesthesia, their whole process. And 23 women went through 13 of them had a baby from it. We had a 57 percent baby rate. We expected this group of women who they were 27 to 37 mean age was 33.
We expected to get 50%. We got 57 percent our first baby from that study. I got my annual picture from mom every year. I just got the first year at college picture this year. Uh, she's 18 and just started college. It's pretty incredible how much even just an experiment changed the trajectory of that family's life.
They never would have had a baby had they not been part of that experiment. I would call that life changing.
[00:26:20] Griffin Jones: So now you have now NYU has a, an REI fellowship program. Is that right? Yeah. You have a fellowship. And you also have a lot of young docs throughout the prelude network. How do you involve them in what you're working on now?
[00:26:35] Dr. James Grifo: I don't have to, they're, they're like in there figuring it out and they're doing their own stuff and they're You know, using the basis and foundation of things we've done, they're an incredible group. They know, they see the future and they're, they're working on it. Really now we're at the stage of just refining egg freezing and getting better at IVF and get better at the testing and, and, you know, trying to make the patient experience better.
And that, that is one thing where, you know, Prelude Network has been really big on is just trying to make the patient experience better. Cause there's so many opportunities there for streamlining and, and also making things efficient. And, you know, that's where our, our, you know, medical advisory board meetings, physician advisory board meetings, we, we all get together and we talk about possibilities of how to be better and try and as much as you can standardize things to make consistency and that makes less errors and that makes for, you know, better process for patients.
And, you know, we at NYU, one of the things our fellows do, which is, I think, with our best experience, is we every, you know, a couple times a year, we ask specific clinical questions. Hey, we do this this way. Find out what the rest of the world is doing. Get all the papers. Let's talk about it. Let's come to a consensus between the doctors.
How are we going to do frozen embryo transfer now? What's the best protocol? And so we sit down and we review the literature and we come up with a consistent strategy we all use for many things, like all these new tests that come about and, and so it's made us better doctors, but then that gets trans translated to the network.
So then it's made a whole team of people better, and it's all about cooperation and being on the same team. And in the old days, we were all competing programs, although I got to say in our field, we have amazing people. And despite fierce competitiveness. We cooperated. I mean, Richard Scott, my fiercest competitor, we, we collaborated in so many, he made me so much better and I helped him get better.
Same with Schoolcraft. I mean, we, we, we were cooperative, but now in these networks, you could be a lot more cooperative and, and, and translate that into, you know, scalable stuff that benefits patients and benefits process and streamlines and makes things more efficient. So yeah, a lot of that stuff's happened, but our fellows, yeah.
See a heavy dose of all that. And then they're, they're out in their career. I mean, we've hired the best of our best fellows is our, our practice. And, you know, our, our practice are filled with. You know, five incredible young women who are, you know, have bright futures and they're doing the next generation of studies.
We had like 30 some odd abstracts at ASRM last year. One of them was we were part of the prize paper at ASRM for mosaic embryo transfer. I mean, we did one of the earliest mosaic embryo transfers in 2016. So you know, we're, we're always trying to move the needle and get better, not just. Not just in the science, but in it actually, how you conduct yourself and, you know, present to your patient and how you can make their lives better.
Many of us have been patients. I personally have gone through multiple failed IVF cycles. So I kind of know what it's like a little too well. And so that's influenced us as well. And we have a group of people here who are, who are, you know, many you have as well. So that's made us better, but you know, so the egg freezing thing.
Now it's 2005. We've had our first baby from it. And now it's like, all right. And PGT is starting to take off. And now it's like, my view is any principle that works well in IVF, we should apply to embryos that we get from frozen eggs. So we started doing some of the first studies with frozen eggs when we started thawing them of, Hey, our patients who showed up initially for egg freezing, who do you think they were?
They weren't 25 year old saying, Hey, I'm going to protect my future. That no one had a knowledge of any of this stuff. Egg freezing was an experiment. No insurance covered it. The 43 year old, the 42 year old, the 41 year old, the 40 year old showed up and said, you know, I'm like one year away from needing egg donor.
Like, why don't I at least put something in the freezer and see, and take a flyer on this. 88 women did from 2005 to 2009. The first five years of it, I mean more, more frozen than that, but 88 of 'em came back and used their eggs, and these were women who had a mean age of 39 40, knowing that the majority of their embryos are gonna be chromosomally abnormal.
We said to them, look, we're doing this in IVF. There's no reason why we shouldn't do this with frozen eggs. Let's thaw your eggs, make embryos not transfer them. Let's biopsy them and find the euploid embryos. You know, you're going to have a 30 percent miscarriage risk or 40 percent miscarriage risk and a 2 percent down syndrome risk if we just put back the best looking embryos.
And so we had some of the first frozen thawed eggs that were biopsied as embryos, frozen again and then transferred as single embryos. And I'll give you my last tweak, what I ran into. Patient of mine, I met her at 34, she's 46 now, she showed up at 42 having had two batches of frozen eggs from 36, she was 41 and a half.
With the guy, we made embryos, she had three euclid embryos, we put one back, she had a baby at 43, she now just came back at 40, you know, 45 and a half, and we put back her second embryo, and she's going to have her whole family from a batch of frozen eggs. We have over 30 patients who that's been their way of family building.
This is happening so fast. And, you know, it's happened sooner in the coast because that's kind of the, what's happened, you know, women are older in the cities having babies. They are having careers. They are delaying. And, and now this technology is coming to help us. This, this egg freezing is starting to take off.
You know, our average age of freezing eggs till about two years ago was like 38 and older. Now we're freezing eggs in 30 year olds who are like, yeah, I get this. This is important. Or we're banking embryos in couples who are 32 and they're on their career path of partners in a law firm and they don't want to have a baby now and they know they're going to be 40 before they get around to it and they're making their embryos now to have their family later, knowing that they'll put back a single embryo.
Whereas if you're 40 years old, the chance you get a single euploid embryo from one retrieval. Half the patients don't get one, and average is one, and one only gives you a 65 percent chance of a baby. You're not going to have a very good chance doing 40, you know, starting at 40 to build a family. You know, you do your retrieval at 30, you're going to have a chance to have enough embryos that you can build your whole family, and you can even Make sure you have enough by doing enough cycles to do that.
That's something that's happening. I mean, this is kind of like under the radar. People don't know this, but this is every day here now in our, our center, because that's just where we're at and our patients are at in our little microcosm.
[00:33:28] Griffin Jones: Now it's become established and you've worked on this with other docs and now younger docs are working on their own initiatives.
And you talked about the Physician Advisory Board. I'm curious as to what that is and how somebody gets on that. Is that just any doc in the network?
[00:33:47] Dr. James Grifo: No, so there are two year terms. You know, because I'm the Chief Executive Physician, I'm always there. And, you know, we go out to, to Napa Valley, TJ has a bunch of friends out there.
They let us use their space and, you know, we, we do fun things in interspersed with lots of lectures and discussions and planning and task management of what we're going to do next year. So people get nominated to be on, on the board. We try and get a good geographic exposure of our programs and, you know, people rotate in and off of that.
It's only been happening about four years now, I think, or maybe five, four, I think. And so it's a relatively new thing. We're still learning. We're still, but it's also just the chance to talk to other people from different places who are doing things a little different from you. And, you know, you find out what you thought was optimal, maybe they're doing it better.
So I better adopt it. We're making each other better. And then we're looking at. Globally more what, what kind of network kind of projects can we do? What kind of network research projects can we do where streamlining data? We're trying to get big data and pool all our data and doing a lot of things to improve, you know, the medical record and the data that we get from it.
And also streamline that some of it is even business oriented in terms of, you know, making us more efficient so we can, you know, lower the costs and not have to raise our prices. Things like that. So there's so many positive, good things about it and, you know, the docs want to be part of it.
[00:35:16] Griffin Jones: And, and they are, how many docs are on the advisory board?
[00:35:20] Dr. James Grifo: Don't, yeah, I should know this number. It's about 10. We do have a physician summit, which is a bigger group. And a lot of the similar things are done. So we have annually a physician summit and annually a physician advisory board. But the Visition Summit is, you know, up to 20 docs and we all meet in one location and have meetings and, and fun too.
There's some social aspects to it just to kind of learn about each other and all the stuff that we're doing. And those are heavy science oriented and clinically, you know, clinical practice oriented. You know, a lot of sharing it, and it's the thing that's unique about it is when you're under the same umbrella, it's not like you're at srm with all your competitors, you know, you don't work, you don't try and keep, you know, some people are very secretive about things.
We have no reason to be, we're all partners, so, so the level of dialogue is more productive, it's a better feel for, you know, talking to your colleagues. You know, you're not threatened. And, you know, we share things that, you know, look, we had this really terrible thing happen. Here's how we handle it. What do you think?
And, and, and they learn from our mistakes, so they won't make the same mistake. You know, it was incredible. So we're, we're sharing things that you wouldn't normally talk about. And that's making us better. Programs and better, you know, managers and doctors and, you know, patient care people.
[00:36:43] Griffin Jones: It's so how is that different in your view from just rounding with your colleagues inside the clinic?
[00:36:50] Dr. James Grifo: Well, because we're very focused and very narrow. I mean, we, we, you know, every, every place has its own way and thinks their way is the best way. And you know what? It's humbling because you go and you hear, man, maybe that idea that we're doing this way, maybe it's not the best way to do it. Maybe we should try it that way.
We do that with our clinical consensus meetings, but we do that at those two meetings as well. And, you know, we share. And so now the network gets more uniform in quality and that's good for patients. It's good for us. And it also allows us to get more data to see if we can refine further. But, you know, these kind of efforts take years and years of effort.
They don't bear fruit in one meeting. But you can see over four years how much we've improved. And, you know, we go to work every day wanting to get better because we know our patients depend on that. Our futures depend on that. And it's kind of the passion of behind everything we do. We want to get better.
You know, we see the failures, we see the patients who don't succeed. We want everybody to succeed. And we want to try and get as many people on that success train as possible. And so it motivates us. It keeps us. honest, it keeps us, you know, going forward, moving the ball, moving the needle, getting better, doing things better, thinking about the patient, thinking about their experience.
How do you put all those things into a better outcome and a better product? And then that will help because there's going to be more and more need for assisted reproduction. If the trends Of age at first birth in these last 30 years, we went from 19 to 37 in New York City and, and, you know, 2021, it was 30 for the whole United States.
It's a matter of time where we're having our whole families in late thirties, early forties, and we're going to be using assisted reproduction as the safest way to get there. And also the most preventative, because now we can eliminate genetic disease. We can eliminate. Babies being born with down syndrome, Turner syndrome, Edward syndrome, the things that you terminate pregnancies at 16 weeks for.
And you only find that out because you didn't test the embryo. And I remember the days when we were putting back just good looking blastocyst and getting the call of the patient saying, doc, I just got my results from my amnio, that picture that's sitting on my freezer that you told me was a beautiful embryo.
As down syndrome, like it's the worst phone call you get. And as you know, multiply that by a million, cause that's how the patient feels and I know how bad it feels to get that call. So I can only imagine what it's like to be the patient, although I've had too much experience that way too. So, you know, it's human suffering that we can prevent it's human, it's futures, it's health, it's so many things that we're going to influence with this technology.
And at some point, if the trend continues of being this old, we're already below zero population growth. At some point, we reach a point where we start declining in population and then it becomes a threat to survival. And I don't, this is not going to be in my lifetime, although I don't know, I didn't think we'd be here at this point in time.
And here we are, we're going to be at a point where this is going to keep us from being extinct. Because biology and evolution will not fix it. We are stuck with a 300, 000 year old biologic system designed for a different species of Homo sapiens. And it hasn't changed and it's not going to change because until we're threatened with extinction, there's no even selective gene pressure for that to happen.
So we're going to be the fix. We're going to be the adaptation. The system reproduction is going to save the species at some point.
[00:40:30] Griffin Jones: This isn't a question that I was planning to ask. And so if it's too personal, feel free to decline. But you mentioned the struggle that you went through personally with IVF and you have a number of colleagues at your own practice at NYU, you have 10 or so other physicians on on the Physician Advisory Board, you have 20, 30 physicians that you're, that you're seeing at the Physician Summit throughout, across this whole network.
Does that ever come up with them? You know, like, just that perspective as a patient, do you ever say, no, I know that this isn't the right way, or I know that this is more important than we're weighting it presently because, um, Because I've been on the other side. Do you ever bring that into?
[00:41:17] Dr. James Grifo: Oh, we talk about that all the time, all the time.
And in fact, TJ, that's his whole demo about, you know, why he got into this company. You know, he was in radiation oncology and, you know, he then, you know, went through assisted reproduction. He's very public about it and, and he didn't have a great experience. And so his main focus is to give a better patient experience.
And the way you do that is you make sure your workers have a good experience because they're the ones who are on the, on the, You know, front lines and we have to show them and respect them. And this is a big topic of discussion at these meetings. It's not just the science it's like we have to treat our, the people working for us in the best possible way, because they're the ones representing us.
And we're only as good as the, as the people that are part of us. And so we have 160 people in our program. We have to make sure they're doing their best, make sure they understand what it feels like to be a patient and how to be empathetic to them and meet their needs and help them have a good experience because that's just as good, just as important as getting them pregnant.
And, you know, every clinic has patients who feel like we did a bad job in that arena, but we have patients who failed multiple cycles and had really terrible, awful outcomes who still to this day are so grateful how we treated them. Like they say, they sent me a note, even though I didn't have a baby.
Thank you so much. You know, you guys did such a great job helping me through all this stuff. It's a really important piece of it. And it's a really hard thing to do and do well. So yeah, that comes up a lot. And yes, because most of us, look, we're all delaying childbearing. That's how I ended up needing assisted reproduction.
It was a second marriage, but we were much older and it wasn't going to work. And it didn't. So we, I, you know, I learned firsthand what it's like to fail IVF cycles, what it's like to have your transfer fail. And you know, it just is what it is. It was my best teacher.
[00:43:11] Griffin Jones: So can other, can younger docs contribute in the same way?
Like can, can a doc that's only been practicing for a year or so even join the physician advisory board or do they have to be practicing?
[00:43:23] Dr. James Grifo: They come to the summits. Anybody is a, uh, a, a prelude physician. Is eligible to get on the board and you know so the process i'm not really clear completely of the details they get nominated and then you know pretty much headquarters decides you know who to take because they want they want to make sure that network is represented they want to have.
You know adequate voices they want to have you know no gender bias they want to know. They want us to be a really good, cohesive and diverse group of people with different experiences and different clinical experiences. So it's a work in progress, and we're trying to learn how to do it better. And, you know, we get feedback every year from the docs who are part of it, and then we try and address that in the next year.
So that that in itself is a whole other project to learn how to do that better, because that's going to benefit. I mean, face it, consolidation is happening in our industry. There's going to be three or four players that, you know, control most of the IVF. Um, it, I've been watching that train, you can see it in 2015, you know, it was probably under 10 percent and now it's, I don't know the number, but it's, it's getting close to over, over 50 percent where, you know, 50 percent of the IVF cycles are being done by, you know, networks.
And it's going to go there because just the. The capital costs and all that make, make it that you can do it better as, as a network. So that's one of the benefits of all these networks is to streamline process to, you know, cut costs by having, you know, more centralized management part of, of. You know, back office type stuff that you can make it less expensive and more efficient and have it streamlined with technology and, you know, medical records.
So those are other aspects of focus of trying to make us better and also streamline the process to eliminate errors and, and. you know, make, make tracking of things more easy so that we can do studies with data that will show us what's better and then make changes. So, yeah, I mean, it's a really exciting time.
It's a really exhausting time because our patient load has just like boomed. I mean, just here at NYU, we've gone from doing about 16 to 1800 retrievals a year this year, we're going to do 4, 200 retrievals. We moved into a new space and, and egg freezing has really blossomed because now it's being covered by insurance.
Now it's got traction. We just published the world's largest study of 15 years of patients with eggs in the freezer. The first 15 years of our, you know, from 2005 to 2019, what happens to those eggs? How many babies do we get? What, what can we learn from it? And you know, we showed several things, very obvious conclusions, but we have data to prove it.
Now, the more eggs you get, the better the chance. The younger you freeze your eggs, the better the chance if you do more than one cycle, you have better chance. And we showed that if you are under 38, when you froze your eggs, and in this study, they would mean each was 36 of the under 38. Most of the patients were older and you have, you have 18 eggs in the freezer.
70 percent of those patients got a baby, which, you know, the New York times, when they wrote their article said sobering statistics from freezing eggs, because Our study was an honest study. We took all the patients in those 15 years, 40 percent of whom were over the age of 39, not the age you should be freezing eggs at.
And we included it in the data. And it's incredibly remarkable that even though 40 percent of the patients who froze eggs were over the age of 39, we still had a 40 percent baby rate. That was not expected at all. It was stunning. Under age 38. Anybody who did at least one retrieval had over 50 percent baby rate.
If they had 20 eggs or more, it's 70 percent baby rate. And if patients did two cycles, they dramatically improved their chances. And now that data is, is real. Some of it is published. We're still trying to get more specifics of it published. Peer review process is brutal. It's been rejected two times. We have data that really needs to get out there.
I just give it to my patients because I can't wait for peer review. We have a grid of if you're this age, you froze this many eggs. You did one cycle, here's your baby rate. You did two cycles, here's your baby rate. Because we have the data now. We've been doing it that long. We have big data, and it's significant.
Although, you know, the peer review says, Oh, it's not a big enough data set. It's only 612 patients who thawed eggs. It's only 300 babies that were born. It's the biggest data set in the world. Publish it, because people can use it. It's helpful data. But we haven't gotten it published yet. But I use it on every consult.
And, and say to patients, and so now our patients are doing two cycles of egg freezing because they see that there's a benefit. And you know, now we have patients building their families from frozen eggs only. I mean, that's become a big part of our practice. So It's, it's transformative.
[00:48:23] Griffin Jones: What still needs to be done to advance fertility preservation?
When you think of, okay, we started thinking about this and in the eighties and we started working on it in the nineties and I'll maybe make an assumption that you're not going to be practicing for another 30 years.
[00:48:38] Dr. James Grifo: Hopefully. I could be. I could be. I'm not that old.
[00:48:41] Griffin Jones: Well, that, that, well, I mean, I
[00:48:43] Dr. James Grifo: guess I went to Howard Jones's hundredth birthday party.
[00:48:47] Griffin Jones: Fair enough. So maybe you will, and let's pretend for a moment that you're not and you, that you have to turn over the reins.
[00:48:56] Dr. James Grifo: Oh, I will.
[00:48:58] Griffin Jones: The people that are listening now might still be in fellowship. They might be, they might be out of fellowship, but they're only like a year or two in and they're thinking about where they want to work next.
And let's pretend it's not someone that already works for you and not somebody that already works in your network, but someone that is at the very beginning of their career, what would you want them to take over? Or not even what would you want them to take over, but what is their For them to to take over that they're going to be doing over the next 30 years
[00:49:30] Dr. James Grifo: So making this more accessible is, is, would be great.
And the only way to do that is to make it more efficient and scalable. And so there's a whole focus on automating the lab. And there was lots of research going on and a lot of venture capital doing that. That's going to happen. I don't know when or how long it's going to take, but that's going to be a big, a big element.
You know, being more efficient at egg freezing education is a big piece. Like I I'll tell you a story. It's, it's pretty scary. I was president of SART somewhere around 2000. I don't remember the exact year because I don't keep these things in my head, but. Phil McNamee was, and David Adamson were, you know, either president, president elect and, you know, moving through the, you go through three years to become the president.
And during that term, when I was on that three year track, we as a group, the SART group, using our own money, put forth a, an educational public service, hey, patients are getting older, you need to know what it does to your fertility. And so we did it in a very, you know, thought out way. We thought we were being smart.
And just to say, Hey, do you know what your age does to your fertility? And, you know, the longer you wait, the harder it's going to be. And you need to have, be thinking about this and planning your, your family and your future. And so we spent a lot of money on this thing the first week that it went out.
The National Organization for Women was publicly accusing us of scaring women and trying to tell them to come to our office and be treated. And we were just trying to educate them. We weren't, we weren't looking for patients. We were busy enough, but we were seeing our patients get older and we wanted to get the message out.
And, you know, it's so mad, uh, maddening how, um, uh, uh, a message. Shoot the messenger always can take over and it gets, goes viral, you know, the way media handles things now and we don't have common sense anymore. And it gets so political and it was awful. It was awful. Here we did this well meaning thing that we paid for out of our own pockets to try and educate.
Education is the most important thing. Kids need to learn this in college and high school. Women need especially to know what happens to them fertility wise. They need to see the lecture I give to every egg freeze patient to understand what the clock truly is and what it isn't. You know, most women think it's just bad luck that you have infertility.
Most women think it's something they did in college or high school, that they harmed their eggs, or they did something, they were doing something wrong now, or they're stressed and they should quit their job, or all these magical thinking things that have nothing to do with this biology being 300, 000 years old and not designed for us to be having babies in our 30s.
And so that's why we're so busy and we're just getting busier. Why? Because more and more people are delaying for good reasons. It's a social thing that's happened. There's so many good reasons to be older, starting your family. There's so many reasons to be, you know, financially stable and have a career as a woman before you start your family.
And yet this biologic system is not designed for that. And so we're the fix. And so education is a big piece of it. You know, making, streamlining the process, finding more non invasive ways to do the things that we currently do, finding ways to safely get more eggs without, you know, hyper stimulation.
There's so many opportunities, streamlining technology of the tools that we use in our day to day. I've watched ultrasound get so much better. It's helped us with embryo transfer and having better, more effective embryo transfers. I mean, there's so many opportunities. What I would say to someone just starting out, find your passion.
Find the thing you want to fix. Find the problem that you think we could do better and then find a way to make it happen because you can
[00:53:15] Griffin Jones: so it sounds like two different spheres one is the education piece, which I would say is more than just education. It's like bringing it into the culture. That's something that the up and coming generation of docs is doing somewhat, but, but neat, that that is part of the ethos of what they need to do. It's not just educating the patient that's in front of you. It's bringing the awareness into the culture. And the second piece is some of the things that might be, have to do with the network research projects, the maybe, maybe that's what you're talking about with more noninvasive ways to do retrievals or to, to safely get more eggs.
Tell me about what. What research projects are either underway that you'd love to see people be a part of, or what research projects that you think are not underway yet that you would love to see this up and coming generation take up?
[00:54:07] Dr. James Grifo: So, I mean, one of the focuses here is streamlining ovulation induction and making that more efficient and more effective and safer, getting more eggs and less hyperstimulation.
That's a focus. You know, getting better at egg freezing, that's more in the lab, using PGT in a more effective way and making better, I mean, one, one project that was done, one of our residents now fellow happens to be the daughter of Dr. Lecharty, one of our partners. She helped use artificial intelligence with the Cooper platform to select embryos better for transfer that were PG, PGTA tested to be euploid.
And we, we could improve the, the pregnancy rate. Using artificial intelligence, using our data and training their assay, knowing our outcomes, I mean, that, that was a little, a little win, but every little win adds up to a lot of wins over, over time, you know, there's now improvement in the technology of accuracy of PGT testing, you know, we've done a lot of studying of mosaic embryos and we'll continue to do that and finding the ones that Are worthwhile transferring to get good outcomes and maybe there are some that the risk is too high, for instance, you know, if you have a high level whole chromosome mosaic where you know more than 60 percent of the cells are.
have an extra or missing whole chromosome, you know, those embryos do poorly. They make babies, but you know, only about 15 percent of them do and they miscarry about 60 percent of the time. Having that data empowers patients to say, you know what, I'm willing to take that risk. It's my only embryo. I'm going to do it.
Or you know what, I'm just going to do another retrieval. That's just not worth it. That 60 percent miscarriage risk for a 16 percent chance of a baby. I don't want to be, I don't want to be that miscarriage. You know, we have that data now because we're doing PGT on these patients. Most other clinics, they're just transferring that embryo, not knowing because they didn't test it.
And so the patient takes an unknown risk is never counseled for it. The doctor is not responsible because they don't know. And so that's inferior technology. That's inferior treatment. You know, and it's a big debate whether we should be doing PGT on everybody. It's such a useful tool if you have the data and we spent 30 years at NYU getting it, and now it's our network has it.
It's avoiding miscarriage is our biggest goal now. And PGT is the way to get there. Avoiding we still have a 15 percent triplet rate. We have to 30 percent twin rate. I haven't seen triplets in, in, I don't know, 14 years. Um, we put one embryo back and 98 percent of our transfers and we still have a good pregnancy rate.
Why? Because when you're putting back, you put embryos, you don't need to put back more embryos. We sometimes put back two because patients want to, and we still let them make some of those decisions, but they're counseled. We still don't have very many twins because those are the patients whose embryos aren't that good of quality.
They're euploid and they don't have a good, as good a chance. And we say, all right, you can put two, mostly we put one at a time because you get there anyway. You know, and I haven't had to counsel somebody at 16 weeks with a bad amnio since 2012 when we were only doing about 60 percent PGT, you know, where patients would get pregnant and get to 16 weeks with untested embryos.
I haven't had that call.
[00:57:27] Griffin Jones: Because of the advancements and we've weaved through the past, present and future, the advancements to come. I'd like to conclude with what skills or not, not even skills, what qualities would you want to see docs that are sitting on your physician advisory board three or four years from now?
Let's pretend that they're not. People that you already work with. These are not prelude docs. There, there may be, there may be just finishing up fellowship. Maybe they're working for somebody else right now, but they, so it's, it's not somebody that you've met yet. What qualities do you want them to bring?
[00:58:07] Dr. James Grifo: Well, they have to be critical thinkers. They have to be well versed in science. And they have to know how to ask good clinical questions that we can get a scientific answer for. Design a study that will get us the answer, you know, and what's the question you want to ask. You know, for instance, like frozen embryo transfer protocols, there's two different ones.
You can use a program cycle where we give Natural estrogen, natural progesterone. It has a lot of advantages. It's three visits. It's easy. And you don't have a lot of canceled cycles because patients don't ovulate because they're not ovulating through it. You do natural cycle, more visits, they ovulate naturally.
They're transferred. We get the same baby rate, but you know, can we make, can we do better? Is there a better protocol than either of those two that, that, you know, design a study? Let's figure this out. Let's, let's get better. We're getting there. So the, the, you know, being able to ask a scalable, solvable question and not, not just a, a, a theoretic ideologic question, you really just need to look at the problems in front of us and say, how do I solve that problem?
And then let me use good science to figure it out and let me design a study to figure it out. And it's really hard to do that. The best thing now are non selection studies where you test your test. So, for instance, Richard Scott did one of the best ones. He did PGTA on all the embryos that were collected.
They were all frozen. He did the first transfer just by morphology, looking at the embryo, not knowing the results of PGTA. And then after the babies were born, and he got the patients to do it. He said, look, we'll do the PGTA for free. You'll get it on your second cycle. The first cycle you get your best embryos.
Pretty good pregnancy rate. What do you got to lose? And patient said, yes, sign me up. And what he showed was that 0 percent of the aneuploid embryos made a baby, meaning that's a pretty good test. If we know 100 percent of those embryos aren't making a baby and they make a lot of miscarriages, there's no reason a patient should get those transferred.
There's no benefit to them. He showed that 65 percent of the euploid embryos made a baby, and he only put back one embryo, so we're making singletons. And the miscarriage risk at a 40 year old went from 40 percent down to 10%. So he showed that his test, and the same test we're using, could improve the quality of outcome and, and life for the patients.
Avoiding miscarriage is a really big thing. Seeing, I used to see so many miscarriages, we used to do so many more DNCs. I don't miss them. I don't miss them. And we still see them because we can't eliminate them completely. You know, those patients often give up, they quit treatment. So I mean, that's a non selection study that proved that his technology works and our technology works.
You can't argue it. And yet people still do. I don't know why. Well, that's a whole other topic. That's a whole other discussion. But those are the kind of studies we need to be doing. We shouldn't just do, like, for instance, the ERA test has caused so much heartache because, you know, the initial studies suggested that it was very helpful and now recent studies show that it doesn't really offer that much.
And so it was never tested properly. You got to do a non selection study. Um, you know, all the things that we do, we did a non selection study looking at endometritis. We learned that endometritis Is not as big of a threat as we thought, although there's a small sub subset of patients where it is and we treat them only and not everybody that was a non selection study that changed the way we treat.
We need to do more of those studies and patients need to help us so that we can help their care get better and everybody else's in the future's care get better.
[01:01:49] Griffin Jones: I know that Prelude has a form that docs can fill out to get in touch, and we'll link to that. But if people wanted to continue this conversation directly with you, if they were interested in maybe collaborating with you in the future, would you be against them reaching out to you individually on No, not at all.
We can include your LinkedIn in the show notes, or if people want to email me for me to make an introduction, I'd be happy to do that if you're also open to that.
[01:02:19] Dr. James Grifo: Yeah, I'm open. I'm open to anything.
[01:02:21] Griffin Jones: Dr. Jamie Grifo, it's been a pleasure. I look forward to having you back on the show. It's probably been too long for this to be the first time we've had you.
So I look forward to it being not as long when we have you on again. And thank you so much for coming on the Inside Reproductive Health podcast.
[01:02:37] Dr. James Grifo: Thank you so much. Thank you for doing this because educating our, our, our own is really great and we appreciate this.
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