If you or someone you know has experienced a failed implantation during IVF, you know how devastating it can be. Dr. Jenna Turocy published an article titled Novel Therapeutic Options for Treatment of Recurrent Implantation Failure a few years back, and I knew the moment I saw it that I had to bring her on the show. She’s joining me today to share her knowledge and expertise with all of us.
She and I have very similar approaches to patient care. We both want our patients to know about every available option to them in this day and age, where technology is advanced enough to give us an edge in fertility.
Dr. Turocy shared some incredible insights about up-and-coming tech advances in fertility, where they factor into instances of recurrent implantation failure, and how you can apply them in your own fertility journey. I’m thrilled to share this conversation with you!
Full Transcript:
Dr. Aimee: I am beyond delighted to have Dr. Jenna Turocy on today. Thank you so much for your time today.
Dr. Jenna Turocy: It’s so good to be here. Thank you for having me.
Dr. Aimee: It sounds like we have so much in common, how we approach patient care and our interest in incorporating new technologies into the work we do with patients. Share with us, why did you become a fertility doctor, what drew you to this field?
Dr. Jenna Turocy: Before becoming a fertility doctor, I was actually a biomedical engineer, what feels like a lifetime ago. That’s where I saw how we can use technology to help and transform people’s lives.
In medicine, I find the science and the miracle behind reproduction absolutely fascinating. The research behind fertility and technology and what we’re able to offer our patients today is constantly evolving. I love that I get to use the latest research and technology to help patients conceive. I think you’ll agree with me that it’s probably the most rewarding career out there.
Dr. Aimee: I would have to agree. I couldn’t do anything else.
During your fellowship, I want to talk a little bit about that, you did some amazing research, cutting-edge, on genomic medicine and assisted reproduction. Can you explain what genomic medicine is and how it can impact fertility care?
Dr. Jenna Turocy: Genomic medicine is using a patient’s own genes, their own genomic information, information about their genome to make clinical decisions.
We are practicing genomic medicine now every day. When we look at things like your expanded carrier screening, we’re looking to see are couples carrying any of the same genes that if they had a child could potentially make that child at risk for a genetic disease. Some patients who are undergoing IVF might choose to genetically test their embryo to look for certain genes or look for chromosomes. That’s genomic medicine.
Dr. Aimee: What technologies did you look at in your research?
Dr. Jenna Turocy: In my research, I was looking at gene editing technologies. Right now, we have the ability through IVF and preimplantation genetic testing, PGT, to screen embryos for genetic diseases, things like Cystic Fibrosis or Huntington’s. A patient might go through IVF, they make an embryo, and you could screen that embryo to see if they have the disease. If they don’t, they transfer it. If they do have the disease, they don’t do anything.
These new technologies in the research laboratory, we’re looking at ways that we could potentially not just screen an embryo, but also potentially fix a gene. These technologies include CRISPR, base or prime editing.
It’s important to realize that just because we potentially could do something doesn’t mean that we always should. I think there are a lot of ethical considerations. I was most concerned about the negative impacts or the unintended consequences of these technologies. Specifically, I was looking at CRISPR and what happens to the entire chromosome.
I found that if you inject CRISPR into an embryo and you’re trying to fix the gene, sometimes you actually lose that entire chromosome. Approximately one-third of the embryo has lost an entire chromosome after being injected with CRISPR. That’s not compatible with life. So, this reaffirms our understanding that the CRISPR and other gene editing technologies are not ready yet to be used clinically. This type of bench laboratory research is so important before we actually ever introduce this clinically.
Dr. Aimee: I get questions about CRISPR all the time because patients think that we might be able to use it very soon. When, if ever, do you think CRISPR will be ready for prime time?
Dr. Jenna Turocy: I think ‘if’ is the correct term to use, because I’m not sure it ever will be something that we’ll offer patients. I really love the fact that we’re talking about it because I think patients need to be informed about what the technology is, doctors need to know what it is, researchers should know what it is. Politicians should know about it, too, because I think we all need to have a conversation about it before it’s something that is ever clinically offered.
Dr. Aimee: How do you approach getting to know a patient or a couple as you begin care, and how does genomic medicine play a role in this?
Dr. Jenna Turocy: Sure. Each patient and couple are unique, they have their own story. Before starting, I like to take a step back and really get to know the patient as a couple and as an individual, and kind of seeing what they’ve been through. This helps me tailor my therapy or care to that individual.
Dr. Aimee: I just appreciate all the work that you’ve done. I’m so glad you’re doing this genomic medicine work. The reason is I’ve had patients who have seen me that haven’t even had a basic carrier screen. For patients to hear that this is stuff that we do, will help someone hopefully advocate for themselves to say, “Have you applied genomic medicine to my case?” Obviously, that doesn’t mean CRISPR, but things like a carrier screen or chromosome analysis if indicated.
Now let’s get into the novel therapeutic options for treatment of recurrent implantation failure, which was published in Fertility and Sterility. For those who are watching and listening, what is recurrent implantation failure? Other than a really silly name. I hate the word failure. Don’t you agree?
Dr. Jenna Turocy: I definitely agree. It’s the same about miscarriage, I hate that term, too. You didn’t miscarry anything. It’s a pregnancy loss, is what it is. I hate using the words failure or miscarry. People get so stressed out and they individualize everything, and they think they did something, when really it’s not something they did. It’s a disease. Infertility is a disease.
What recurrent implantation failure is specifically, when we use that kind of term, what we’re talking about is when a woman undergoes an embryo transfer and the embryo fails to stick and you don’t get pregnant.
Dr. Aimee: What drew you to this topic?
Dr. Jenna Turocy: Unfortunately, not everyone is going to get pregnant in their first embryo transfer. Sometimes it can take several tries. As their doctor, I get to become a part of these couple’s lives. You weather the storm with a couple. When they finally are successful, and I truly believe that most patients will be successful, and they finally get that baby that they’ve always wanted, I don’t think there is anything more rewarding as a doctor.
Dr. Aimee: I’m getting a little emotional. Thank you for saying that.
Dr. Jenna Turocy: Tears for everybody.
Dr. Aimee: I know. Okay. I’ll gather my thoughts and dry my tears.
So, your paper looked at three treatments. I want you to walk through each one. Let’s start with immune therapies such as peripheral blood mononuclear cells. What are they?
Dr. Jenna Turocy: They are a mouthful to say. Peripheral blood mononuclear cells, these are your blood cells. Mononuclear, meaning one nucleus. Specifically, they are immune blood cells, your B and T lymphocytes.
Dr. Aimee: Awesome. What happens in a situation where they’re not acting normally, what happens within the uterine lining?
Dr. Jenna Turocy: Typically, if you have something foreign or something different that comes into your body, think of a virus or bacteria, your body is supposed to attack it. This is your immune system working to prevent you from getting sick. When you’re pregnant, this is also something foreign, something different. The mother’s uterus needs to know not to attack the pregnancy. When I think about it, I think it’s actually miraculous that pregnancies even happen.
When you’re pregnant, the body needs to have special cells, like your T cells, that lessen and suppress the immune response. It’s hypothesized that for some women with recurrent implantation failure that they’re unable to recruit these special T cells and they can’t actually suppress their immune response.
Dr. Aimee: Have you found that the intrauterine administration of these cells does improve chances for implantation in these women?
Dr. Jenna Turocy: It’s exciting that there are these now small randomized control trials that have shown better success when we have patients that have inserted their own peripheral blood. This is your own blood, we’re just putting it in the uterus before a transfer.
Dr. Aimee: Exciting. I’ve also talked before on this show about intrauterine platelet rich plasma. I’ve been using it in my practice now more recently. What is it, for those unfamiliar with the term?
Dr. Jenna Turocy: PRP stands for platelet rich plasma. Plasma is the liquid portion of your blood. What happens is you get your blood drawn, they centrifuge that blood, so they spin it really fast, and with that spinning it will separate the blood into the different components. What they’re taking is the component that has the most platelets, that’s your platelet rich plasma.
Then in the fertility setting what we’re doing is placing that PRP inside of the uterus. PRP is being used in a lot of different areas of medicine these days, too. Some people might be familiar with it from cosmetics, what they call the vampire facial. It’s also very popular in orthopedics for joint injuries as well.
Dr. Aimee: It stimulates cellular processes involved in endometrial regeneration. What does that mean in plain terms?
Dr. Jenna Turocy: I tell patients to think of it like growth factors. What the platelets are doing is stimulating growth factors to help tissue grow and rejuvenate.
Dr. Aimee: Which patients do you think are the best candidates for this?
Dr. Jenna Turocy: Right now, I am offering PRP to my patients who have a very thin lining. Sometimes before the embryo transfer when we’re measuring the lining of the uterus, if it’s thin, there are studies that have shown by inserting PRP, the patient’s own plasma, growth factors, so it helps that lining grow.
Also, patients with recurrent implantation failure. These patients who have undergone multiple transfers and not gotten pregnant, if we place the PRP before their transfer, these patients have also had better success rates.
Dr. Aimee: The third technology that you looked at was subcutaneous granulocyte-colony stimulating factor. Say that after three shots of tequila. This is also for treating thin endometrium. How does a thin endometrium impact an embryo’s ability to implant?
Dr. Jenna Turocy: We think of endometrial thickness as a marker for endometrial receptivity. When we transfer an embryo, the uterus and the embryo need to talk to each other. The uterus needs to be receptive, aka receptivity, to that embryo. Studies have shown that when your endometrial thickness is thin, this is associated with lower pregnancy rates.
I try to describe it to patients as the embryo wants a nice thick pillow of endometrium to implant in.
Dr. Aimee: That’s a lovely analogy. I might be using that in the very near future.
Does the subcutaneous GCSF actually improve the thickness of the lining, and how the heck does it do that?
Dr. Jenna Turocy: There are studies that have shown a thicker lining after injection with a GCSF. The idea is GCSF is itself a growth factor, so again we’re stimulating growth.
Dr. Aimee: What about intrauterine? I’ve heard so much more about intrauterine GCSF infusion, not as much about subcutaneous. What about intrauterine administration?
Dr. Jenna Turocy: I think for GCSF the jury is still out about the outcomes for it. There have been studies that have looked at, just like you’re saying, intrauterine or subcutaneous. So, do we insert into the uterus, or do you do it as a shot underneath the skin? The studies when you’re looking specifically, not just at the thickness of the endometrial lining, but for patients that have had an implantation failure, your patient’s lining may or may not be thick, they may have perfect lining, but still they don’t get pregnant. When they have done studies to look to see does the intrauterine, putting it right into the uterus before a transfer, does that help? The studies say no, actually.
The studies have shown that GCSF in the uterus doesn’t really help. They look at, then, what about subcutaneous, what about injecting it, does that help? There are some small RCTs that show an increase in implantation and pregnancy rates with that.
The next follow up question then should be why is that, how does that happen? For right now, we still don’t really know. I think we still need more research, bigger trials, more evidence about why it works and how it works before we really offer it to all of our patients.
Dr. Aimee: That’s why you’re here to talk to us about all of this research. We can’t wait to hear more about what you learn over the next many years.
If someone is suffering from recurrent implantation failure, how do they advocate for themselves and ask for some of these treatments?
Dr. Jenna Turocy: It’s really difficult to be a patient sometimes. Keeping up to date is really hard, but when you’ve heard things like this, don’t ever feel bad about talking to your doctor about it. You should feel comfortable with your doctor, you can ask questions. Ask if they’ve heard about PRP, what their experience is, and if they’re offering it. If not, then feel free to get a second opinion with someone who maybe is.
Dr. Aimee: I imagine there are patients out there listening to this and saying, “I really want to talk to Dr. Turocy about my case and maybe incorporate some of these things.” How can they find you and reach out to you?
Dr. Jenna Turocy: I practice at Columbia University Fertility Center here in New York City. The nice thing is in this field of telehealth and Zoom, you don’t need to be in the New York City area. I’m happy to talk to you. You can always call my office. I’m happy to set up a Zoom appointment, and I could act as the second opinion, primary opinion, whatever it is. When you’ve had multiple transfers before, it is so heartbreaking, and I really do think you deserve specialized care, and sometimes it’s nice to hear from somebody that is specifically looking at this and doing the latest research to see what works and what doesn’t.
Dr. Aimee: I would like to invite you on every time you publish an article. I’m going to have PubMed alerts on to send me what you’re publishing so that you can come and talk to us again because this has been so incredibly helpful.
Is there anything else you’d like to share with our audience before we end our show?
Dr. Jenna Turocy: No. Thank you so much for having me. I’ve really enjoyed it and I’m planning on being back.
Dr. Aimee: Thank you, Jenna.
