Dr. Carol Curchoe, ART Compass director and reproductive physiologist and embryologist, speaks with Griffin Jones about the future of artificial intelligence in the IVF lab, shares her thoughts on how it could be the solution to the ever-present threat of embryologist burnout, and what technologies could take the place of old school, antiquated monitoring systems.
Listen to the full episode to hear:
What will happen when the big names in IVF labs retire (soon), and who will be (or won’t be) replacing them.
Why the idea that technology hasn't advanced in the IVF lab is a myth
What solutions AI presents for IVF lab quality control, and how we universally implement them.
How the tech gaps in IVF lab management are overburdening embryologists everywhere, and how this can, and should, be solved.
Dr. Carol Curchoe’s Information:
Linkedin: https://www.linkedin.com/in/carol-lynn-curchoe/
Website: https://artcompass.io/
Inside Reproductive Health is sponsored by EngagedMD. For technology that educates your patients with true informed consent, visit engagedmd.com/IRH for 25% off your implementation fee.
Transcript
[00:01:00] Griffin Jones: There's a massive wave of retirement coming from IVF lab directors and different techniques in the lab are helping or harming IVF success rates. And we often don't know which is which, or by how much, because we need artificial intelligence to integrate into a single system.
This is at least according to my guests, Dr. Carol Curchoe we talk about these concepts as well as the idea that technology hasn't the idea that technology has an advanced in the IVF lab is. The tech needs to be adopted to light and workload because embryologists are burning out and they're leaving the lab and even trying to work for people like me.
And we also talk about venture capital and the lack of funding in the IVF space and, and especially for female founders. And we talk about all of these points and I hope you enjoy this because I am doing more content about the lab. Like I promised you that I would please enjoy today's episode of inside reproductive health Dr. Carol Curchoe.
Dr. Curchoe Carol welcome to Inside Reproductive hHealth.
[00:02:04] Dr. Carol Curchoe: Thank you so much for having me.
[00:02:06] Griffin Jones: You've been up to a lot recently. I saw you at PCRs recently, you had some data about things going on with lab staff and quality testing. And maybe even before we get into that, maybe give us just a little State of The Union of, of how you're seeing the IVF lab nowadays.
And what do you really want to talk about?
[00:02:30] Dr. Carol Curchoe: Yeah, so my main focus in life is on brain new technologies to the IVF lab. So we are at a pivotal moment in IVF technology where we have. The first generation of embryologists slated to retire. And this is what I call the great gray rhino in the room. So this is the threat that is lurking in the room, that is mostly going by unnoticed. Although I think now this is what everybody's talking about. So the brain drain that's coming to the IVF industry is imminent. And one of the ways that we bridge the gap between first generation embryologists and second or third generation now, maybe fourth generation embryologists, we're getting on 40 years in IVF, right?
And each decade sort of brings us a new wave of fresh graduates and fresh people. Who've trained up under different methodologies and protocols and ideas and ways of thinking in the IVF lab. The best way to bridge this and to really translate the knowledge from the first generation of embryologists all the way to the brand new generation is through the use of technology.
So that is my main focus these days, other than making expensive science babies for infertile couples.
[00:03:53] Griffin Jones: I was just bragging to you before we started recording that I've included more embryologist lab staff lab topics this year, I think, than in the previous three years of doing the show combined. And then I realized, as you're talking about this brain drain, like I haven't thought about.
Second about, I just did an entire generational grid. That was part of my talk at PCRs about the changing of, I talk about the donors, the patients, the retiring partners, the fellows. I didn't say anything about the lab. So here I am being like, oh yeah, I got way more lab stuff than I ever did before. And then meanwhile, totally neglecting.
[00:04:33] Dr. Carol Curchoe: Yeah.
[00:04:33] Griffin Jones: Thinking about the lab on either side of this coin that apparently you and I are both thinking about. So let's talk a little bit about the, the brain drain. And do you have like any kind of numbers or when is this waterfall gonna start hitting? Like, is it already hitting, are we seeing the embryologist retire now?
Or are they about to retire as, are we going to see a peak? What's that like?
[00:04:53] Dr. Carol Curchoe: Yeah. Yeah. So the peak retirement is coming, but what we're seeing now is that they're anywhere from five to 10% of baby boomer generation embryologists are already past the retirement age and they're hanging in the industry either because of lack of somebody to take over their lab or the multiple successive economic failures that the us has had over the past 15 years, which has drained everybody's retirement savings, maybe they're not capable of retiring yet, but the people who are retiring direct multiple IVF labs, and I can think of several big name, IVF lab directors who are directing at least five labs piece who are going to be retiring. So it's not just a sheer numbers game of people who are directly retiring, but each one of those people are going to be directing multiple IVF labs. So if you can think of five big name IVF lab directors who will be retiring in the next five years, they are each directing five IVF labs. So that is going to be 25 openings that are coming onto the market.
And when I see the numbers of people who are getting new HCLDs, which is the certificate that you would need to direct an IVF lab, right? I'm not seeing the same number of HCLD lab directors being produced each year as what we will need to fill the market.
[00:06:34] Griffin Jones: So if nothing changes, if there's no intervention than what's going to happen, if there's no intervention to increase the number HCLDs then what are we looking at happening in the next five or so years?
[00:06:48] Dr. Carol Curchoe: Yeah, so I think what we're seeing is in the industry in general is kind of a tendency to become more corporate and for bespoke IVF lab practices to be all gathered under one sort of corporate umbrella. And then I think from what I'm seeing is there are brand new IVF lab directors who go to work for these large corporate networks.
And then as brand new IVF lab directors, they're being asked to oversee more than one lab in the network. And so I think that can kind of be a problem for brand new IVF lab directors who don't really have the experience of many years of, of IVF lab directing. And then the other possibility that I'm seeing a lot is the, the rise in offsite lab directorship.
And when we're talking about quality in the IVF lab, a certain amount of oversight that is necessary for the quality to remain high across the industry, or even increase if we're talking about quality improvement and doing even better than we've done before. And I believe we are going to need to do that because of the rise in demand for IVF and the number of IVF cycles is increasing incredibly.
[00:08:13] Griffin Jones: Yeah. Are you worried about the quality from one, either someone who's not experienced enough overseeing too many IVF labs or from one like somebody having to do it remotely from so many different sites, what are the quality implications?
[00:08:34] Dr. Carol Curchoe: Yeah. And I think that you can open the news, almost any day of the week, it seems like now, and to see some kind of horrific news story coming out of the IVF lab at PCRs, there was actually a talk.
[00:08:46] Griffin Jones: One a week?
[00:08:47] Dr. Carol Curchoe: Once I hear it, it seems like it's happening so frequently nowadays, right?
[00:08:53] Griffin Jones: That maybe I'm not reading the right news sources that once a week seems like a lot, but what you were about to say an example.
[00:09:00] Dr. Carol Curchoe: That's an exaggeration, but PCRs there was that amazing talk about risk management and the IVF lab. And this speaker was very careful to point out that the majority of the risk in the practice is actually coming from the IVF lab.
So four times the amount of risk is coming from the IVF lab than anywhere else in, into the practice. And IVF it's one of those things that you really, there is no room for error. You really do have to always get it right of every single time. And so when we're talking about scaling the number of cycles in the US one of my favorite people who has some very compelling, logic and numbers around how many cycles we are doing and how many we're going to do is David Sable.
And he talks for example, a lot about how you could come up with different name combinations in various states, all over the country, name and birthday combinations, and then how they could be the same. And when we're talking about embryos and eggs that are shipping all over the country, just for example, having a unified system of patient identification where each patient has an established unique identifier that everybody else agrees to, kind of like a car driver's license, right? Like when I cross state lines, that license is going to be my identification, no matter what state I'm in, and it's going to be respected and unique and uniquely identify me in a bigger system that someday, I hope I never make it into that system of them being able to tell if I have a ticket in a various state, but.
[00:10:45] Griffin Jones: We are a couple of short analogy. They're going to know all the crap about you and me and everybody listening and going to be in a credit score and you'll all want it. Everybody, you'll all want it because it will be traded for something that's valuable to you.
Either being able to purchase things more quickly or get services tailored more accustomed to you, or whatever it might be be appearing to be a better citizen. You'll all get that we're digressing. This is like the second time in two months that I've got that I've gone on this, this like futuristic time I did it on Dr. Bruno Gaston’s episode, too. But you are talking about something like, so you're in my understanding correctly, you're proposing a kind of solution that helps identify quality across the field..
[00:11:35] Dr. Carol Curchoe: Right. And so that there and there are many people proposing different solutions. So there's the IVF open group proposing the patient ID identification solution.
There's the Tomorrow Robot who is proposing the cryo storage solution of the future. And there are many people, many different groups working in artificial intelligence and within my role in artificial intelligence. So we have a lot of very loosely structured data and IVF, and mostly it's all sitting in on paper documents in binders, hundreds of binders in every different IVF lab.
And, my platform, our compass was created to basically have data, stop going onto paper and start going into the computer where it's structured and can be interacted with by artificial intelligence systems. So my platform does a lot of different things along the quality assurance spectrum, including an embryo embryologist training competency and staff related quality assurance.
It's also very helpful for brand new IVF lab directors, because it's bridging that knowledge gap between the baby boomer generation and brand new lab directors or brand new embryologists.
[00:12:57] Griffin Jones: So I'll ask some questions, which is either born from being devil's advocate or ignorance. And the audience might not know the difference between the two.
I don't know the difference between the two half the time I'm asking you something because I want to poke at it, or because I really don't understand it in this case. It's probably a little bit of both. Why not the EMR in this instance, what is insufficient about the EMR for storing that data there?
[00:13:21] Dr. Carol Curchoe: Yeah and it's a really good question. So EMR, generally electronic medical record system most of the EMR on the market were created 30 or more years ago, and they have been kind of tasked with keeping up with this ever changing landscape of the IVF lab. And they have mainly been created to manage the clinical side of an IVF practice. So they do things like handle insurance and patient calendaring and appointments, the physicians appointments with the patients, so that, physician and staff will have a calendar of what is going on that day with the patients. And also the medication ordering from the pharmacy.
So none of those things have to do with the IVF lab. So on top of the IVF lab cycle management at the heart of every IVF lab practice really is the quality control and quality assurance. It's sort of what elevated IVF from being an art to being more of a science that we know exactly what's going to happen if we do exactly these defined things in the IVF lab, and we can make it predictable, reliable, robust, and effective for the patients. So there's a whole suite of quality management items that overlay everything that happens in the IVF lab. And that's going to be everything from training and competency.
To what happens with your instrumentation or your environment on any given day? We know a lot more now than we know in the beginning of IVF. So we know for example, that using alcohol based hand sanitizers are not good for embryos in the lab. We have to remove those VOCs from the air in the lab.
And so tracking things like how many times our IVF lab door opens and closes and how the pressure in the IVF lab changed and how many times the incubators were open and closed. All of those environmental parameters add up to impacts various impacts on IVF cycles.
And then it goes all the way through.
[00:15:31] Griffin Jones: How do you track all of those?
[00:15:32] Dr. Carol Curchoe: Exactly.
[00:15:33] Griffin Jones: I could see like the alcohol sanitizers on the hands it's. How would you even know to hypothesize about that? To look for something like that? And so I'm like, how do you decide what to track to? How do you track it?
[00:15:49] Dr. Carol Curchoe: Yeah. And it's really, really difficult because there are as many different ways and things to track in an IVF lab as there are embryologists in the United States or in the world.
And so if you compare what any two labs are tracking, and there was a really nice publication a couple of years ago that did this, they looked at 36 different labs and the instruments that were being quality controlled, and it was highly variable. Nobody knows what to track or if it's significant or how many times a day, for example, do you monitor it? So whenever you can go into the lab and you do quality control, you might do it once a day, or maybe every time you walk by an instrument, you might glance at the sensor and see that it's within range. But a lot of these things could be done much, much better if we take the power of computer science and artificial intelligence, I can see a web of smart sensors throughout the IVF lab that are collecting data all the time. Then you combine that with the inputs from the embryo incubators and the , for example, the cryo storage tanks that the tomorrow robot is creating with many, many thousands of data points of continuous monitoring.
So all of that is going to be much, much better than what an embryologist can do. And honestly, embryologists are overburdened with the amount of work that we have. We really need computers and sensors and AI to start taking some of the workload and actually doing it much better than we ever could. So there's no way we can continuously monitor what's happening in the embryo incubator at most, that can only be done a few times a day.
[00:17:32] Griffin Jones: What's impeding technology taking over that workload right now. Is it the technology itself? It's not there yet. Is it regulation? Is it like adoption? What's stopping it from happening now?
[00:17:47] Dr. Carol Curchoe: Yeah, and I think there are solutions that are coming out onto the market where we've seen a really great innovation has been in the electronic witnessing space.
And like different electronic witnessing systems that are watching every step of the process and making sure that, for example, we're not mixing eggs and sperm from two different couples that don't go together or that when we thought the embryo from this patient, we're putting it into that same patient's dish before it gets transferred to the, that patient.
So that whole process now is starting to be electronically witnessed, but these technologies are definitely maturing. I wouldn't say that there are all the way in maturity yet. There are kind of gaps with each one of them. And then I really think one of the biggest things is how does everything integrate together into a single system right now, most manufacturers don't want to play well with each other.
So you might have alarm systems for your tanks. You might have alarm systems for your incubators. And all kinds of various other monitoring systems, but they're all separate logins and they don't talk to each other and they don't share the data. So one of the things that I like to think about is when you log into your Gmail and you click in the upper right-hand corner, you get all of the apps that Google has, you get your drive, you get your calendar, you get any apps that you yourself have, have integrated into that little platform and really that's what IVF labs need. So the EMR is just one small part of the data management in an IVF lab. And then particularly you have technologies that go all the way through the patient management side.
So managing the patient journey, the patient consents the patient calendars patient education and how do you deliver the results of your IVF lab cycle to the patient.
[00:19:51] Griffin Jones: Well, that analogy that you used is also self descriptive of why so many of these companies don't want to integrate with each other because they all want to be the Google in this instance that you used, Google is the perfect example to use because it's Google maps, Google drive, Google docs, Gmail, all of these things that Google assistant, all of these different apps that are within the Google ecosystem.
And, and so people are like, well, we, we want to, we want to be the Google. So before we talk about how to integrate into a single system, I want to ask you more about like the gaps. So you were saying that witnessing is something that has advanced a lot, and the technology is a little bit more mature there than maybe in some of the other w where are the gaps.
[00:20:43] Dr. Carol Curchoe: Yeah. So I think from my perspective, a lot of the gaps are coming from the management of IVF cycle data. It is mostly still done on paper. And for example, when the PGT company gives the genetic testing results to you, that will come to you in a PDF. And so when data is generated, it tends to be static.
It can't be interacted with, and it's very sloppy and unstructured. The thing I like to talk about is for example, like when I want to order something off of Amazon, I just opened my app. And I know that like paper towels in my house are running low because I have this subscribe and save feature and the Amazon app, and then it's, one-click ordering right. Or it's set up to automatically be delivered.
So that's another experience in the IVF lab that is being mainly handled manually. You have an IVF lab supervisor who kind of calculates in their head, how many cycles we're doing, how many cycles we're going to do this month? And then the volume and the amount of reagents that will be needed to not run out of anything.
And that's a process that is very time-consuming. It creates a lot of friction and it could be as simple as one-click ordering an inventory. If there were some smart products that could step in and fill that gap.
[00:22:16] Griffin Jones: So, how do you envision all of this being integrated? Tell us Larry Page, how does, how does the Google drive and the Google docs and the Google calendar and Gmail and everything else from the lab world integrate in one single system?
[00:22:34] Dr. Carol Curchoe: So I think google didn't, I'm not sure they really developed all of that, or if they went out and bought a best in class solution and then slotted.
[00:22:42] Griffin Jones: Did plenty of both Carol.
[00:22:44] Dr. Carol Curchoe: Plenty of both. Right?
[00:22:45] Griffin Jones: Plenty of both.
[00:22:46] Dr. Carol Curchoe: So we could be just waiting for that one person to take the vision and really execute it. But one of the other things that I find compelling when David Sable talks about what is IVF going to look like in the next 20 years? He talks a lot about building the IVF super highway. And so right now, the number of IVF clinics that there are they kind of liken it to the old system of country roads, right, where now we have all these country roads and they need to connect into what is really the IVF super highway.
And it's a brand new system that is built for high volume and high capacity in with these best in class solutions. And so, I know that there has been a tendency in the industry right now to be attracting a lot of private equity and building these new sort of forward-thinking networks.
Right. IVF labs that are brand new. So obviously kind body is a good example here and then her fertility and in the UK. So it's definitely going to be very interesting to see, like ultimately what happened with the super highway project is you had a president who put together a, a package at the federal level to build it because it's bigger than what one state could do by itself.
And so how this Federation of IVF labs and the industry of IVF itself is going to continue to be pushed forward without a federal level project or federal level support. I'm not sure, but.
[00:24:32] Griffin Jones: Well, let's stick with it. I love sticking with people's metaphors. I love using people's own metaphors to like, tweak in and ask these questions.
So, one president that president being Dwight D Eisenhower coming up with the interstate program, late forties, early fifties connected the United States together, advanced mobility, like we had never seen before on the planet. Some cons that came from that, including demolishing entire cities and neighborhoods, including those, like in places where I came from.
And so what are some of the, the doubt? What are some of the risks and dangers that could come from this?
[00:25:10] Dr. Carol Curchoe: Yeah, and I absolutely hear that. I think so one of the risks and dangers is that the IVF process could actually stagnate because you have these, this sort of way that things are done. And then maybe from it because there are investors and everybody needs to make money and it has to happen this specific way. So it can kind of curtail your scientific freedom, right. To be in these, in these large corporate networks. And that's an argument that I've, I've heard a lot that embryologists nowadays are very much just kind of like technologists, right?
They're given the protocol and they're told what to do and they have to come in and do it the same way every day. And that can be seen in a negative way, or it can be seen in a positive way, right? On the patient side. The patient is assured of what they're getting because the corporate network does things in a certain way.
You're not going to get experimentation directly on humans in many IVF labs. Now. And I think everyone would agree. That's probably a good thing. In the early days of IVF, we were literally experimenting directly on people and embryos for what could happen. And so things are different now. And I think everybody agrees that that, that aspect of it is probably good.
I think there's just in the management of people, that aspect can kind of get lost when you do a huge corporate network. It becomes very difficult to manage staff the further away from the nucleus of the company that you get. And I think you start to get the communication is a little unclear and the path to your career path.
For example, it can be a little unclear in a big network like that where you might have a lot of potential in a very small clinic to rise very quickly and become the lab director and maybe even become a partner in the clinic. And that kind of thing is not going to happen in a corporate setting. Right?
[00:27:24] Griffin Jones: You might be making some decisions about what you want to implement for your practice. And I'll give something for you to consider. You may have been thinking about EngagedMD for a while. You may now be among the minority of practices that are not using EngagedMD. But think about losing even one of your linchpins on your staff, even just one of them, because they've had it, they're too burnt out.
That's what I'm seeing as a hiring manager in this marketplace, people from your clinics, embryologists nurses, mid-level providers, even. Are applying to companies like mine because they want to get the heck out of the clinic and they want to get the heck out of the lab. They're burnt out. There's only so much that you can do.
You're trying everything to hire more people. You're also, you want to lower their workload, but you have such a high patient. All we can do is implement technological solutions. In many cases, to lighten the workload. And some technological solutions are really, really proven. One that's really, really proven is EngagedMD, ask anybody that uses EngagedMD.
You don't have to take my word for it. Ask anyone that uses EngagedMD, and that's probably going to influence your decision, but still mention that you heard it on the. Well, you heard it from Griffin Jones because you'll get 25% off of your implementation fee. If you do go to engagemd.com/irh, but in any event, don't do it for me do, it because we're all in danger of losing the linchpins on our staff right now.
And if there's something that you could have done about it, you're going to be kicking yourself. And one thing that you can do about it, if you haven't done already is to look into EngagedMD. EngagedMD.com/irh. Now back to the show.
One of the things that you got my attention with when we were emailing about this episode was that I do hear people say a lot that technology hasn't advanced and some in one breath, I hear people say technology has advanced incredibly. And then another routes I hear people say, we've been doing the same thing for 40 years.
And so when something is reduced to one sentence, it can become a platitude that could be used for, to support one point or another. Right. You don't actually know what it means until, until you describe it. But I do hear people say it on the side of technology has not advanced. And you feel like, it doesn't have where else is it going to go?
And you said like it's advancing a ton and so can you talk a little bit.
[00:30:09] Dr. Carol Curchoe: So I think one of the things is like in the early days of IVF, right, we didn't know how to make cultural media. We didn't know humongous things. We didn't know how to incubate embryos. There were these like really big buckets that got figured out early.
And since then, it's been a process of refining all of these steps and there have been huge step changes in the field of IVF where seemingly everything changed overnight. I mean, of course that that's not actually how it went. It was a lot of small discoveries and small labs putting it into practice and people slowly doing it.
And then it seemed like the industry changed overnight. So the couple of things I can think of where that happened, where cultured a blastocyst which is sort of it's been adopted, I think by most IVF labs. Now you might still get ahold out few hold outs here and there that are only culturing to day three.
[00:31:07] Griffin Jones: Seems like everybody is doing that so.
[00:31:07] Dr. Carol Curchoe: Everyone's doing, yeah, they, at least they have five, six, and now the newest thing is day seven embryo culture. So that has been hotly debated. And it's been, the body of literature has been growing over the past five years to other day seven culture is valuable for patients. I think now we're all starting to agree that it is, you can get normal embryos that implant on day seven.
And so that is a change that like when you talk about experimenting directly on people with no oversight, Right. The decision to go from culturing today, six to extending the culture one more day to day seven, that's kind of an easier decision to make. And there are a lot of things like that that have happened in the IVF lab.
So for example, one of the things that I can think of is the decision of when to hatch an embryo. We're getting all kinds of new technologies like Embryoscope and single-step media, and we're taking the embryos added incubator much less. And so people are starting to get rid of hatching on day three, which was kind of the industry standard for the last however many years since we stopped doing biopsy on day three and shifted it to day five and the wind started hatching on day three and doing biopsy on day five.
But what we've seen with success rates for embryos that are fully hatched is that by and large. They're a little bit lower than embryos that are frozen with Arizona. And so what people have started to do is leave the embryo totally alone and hatchet on day five when they do the biopsy. And so that entails them actually breaching the zona with the whole biopsy pipette and pulling the embryo across to the opening that you've made.
And none of those interventions are, have been properly tested. Right. We just decided to start doing that with patient embryos. And so we have no idea what the effect of tugging on the embryo that much or creating a larger hole in the zona is. But I think everybody sort of agrees that. We want there to be less fully hatched embryos on day six.
And the way to do that is not to hatch it on day three. When you make a hatch on day three, the embryo likes to grow out of that and it fully hatch out by day six. So maybe by doing that overall, we can increase the efficiency rates of IVF by five or 10%. If the whole field stops doing hatching on day three and starts doing it at the time of the biopsy.
And so IVF success rates are pretty good, , and then if we. Increasing them slowly by five or 10% through the use of these kind of lab developed techniques that spread from lab to lab. It's very hard to do any kind of a control trial for these lab developed techniques, any sort of a randomization or a control trial.
So RCTs in the US are extremely expensive. And so being able to test whether this intervention is more effective or less effective, it's very, very difficult. And so I think also one of the best tools we have at our disposal are these longitudinal databases, like the SART CORSdatabase. So everybody loves to hate on the SART CORSdatabase, but it actually acts as a very good post-market surveillance tool for the entire industry.
For these interventions that are, we can kind of point to a time period and say, okay, around this time, almost everybody adopted blastocyst culture around this time, almost everybody started hatching on day three for PGT. And so in a much larger sense, larger than any clinical trial could ever give us.
We can sort of monitor the success of the industry through these longitudinal databases.
[00:35:17] Griffin Jones: And so this is about the growth of the umbrella, right? So it's not like I'm trying to think of how you would do an RCT like this and you wouldn't. I was thinking, well, this could be something for like this could be something that you use with embryos that you're going to discard, but we're talking about making the umbrella.
So that's not an option. And so what, what needs to happen in order for this to be something that can be standardized across the field.
[00:35:44] Dr. Carol Curchoe: Yeah. So I think that's why there, there is no mechanism like that that exists. The CLIA regulations basically give us leeway to make and validate a lab developed test in our own labs.
So we will verify and validate that the test is working. And we do that in kind of a step wise procedure, but then what happens is we publish those results at a scientific meeting. And then the lab next to us says, I also want to implement this lab developed test or procedure in my lab. And so then they also go through a process of verifying it and validating it in their own lab.
And so there's a whole bunch of other different innovations that I can think of that fall under that category. Like everybody's doing the flick biopsy now. And that's a method of breaking the cells off of the embryo that obviously can't go through a randomized clinical trial.
There are ultra fast ultra fast thought and freezing protocols that are being developed. And we saw a jaw dropping talk at the recent PCRs meeting about an ultra fast thought protocol that had been developed in a lab. And I personally know, 10 embryologists who are going back to their own lab and trying to verify that work. And then way that the presenter presented it. And so yeah, I think that lake basically, embryo hatching, embryo biopsy technique, even the ICSI needle technique, itself. Has gone through some evolution. So there are some people who insert the ICSI needle and pierce the Oolemma very slowly and very carefully. And there are some people who scrape the Oolemma and stretch it until it breaks.
And then most recently I saw a pipette that sort of sucks back on the Oolemma membrane and makes it taut so that when you puncture it, there's no invagination of the Oolemma into the OS site. And so if you think about what's happening inside the egg, the egg has a cytoskeleton and a structure of its own. And when we pierce it with the ICSI needle and suck the cytoplasm out, we are doing some disruption of the egg membrane and the cytoplasm and the cytoskeletal structure inside the egg.
And so, again, those are all things that are very difficult to do any kind of an RCT on and where we always have to be asking ourselves the question, is our intervention helping? Or is it harming? Is it causing it?
[00:38:20] Griffin Jones: And we don't know the answer to that is what you're saying right now. We don't know the answer to how much, that you're saying, if it is damaging, we don't know how much it is.
And so that's why we need the artificial intelligence for, to collect all of the data points
[00:38:36] Dr. Carol Curchoe: And so many other things too, right? Like that just the existence of these longitudinal databases themselves are very important for the industry. But yeah, AI analysis of all of that data especially because humans, aren't very good at synthesizing large amounts of data and analyzing it.
Computers are better suited to that task than we are. So just giving, like tons of parameters different things that you think may or may not be helping or impacting, or even having a negative effect on an IVF cycle, right? AI, a computers are going to do that much better, but getting the data into a database where it's usable and accessible is the most important part of that.
So how do you collect all this data and not rely on people to do it?
[00:39:25] Griffin Jones: Yeah. What will the role of experiments be, once we have data points for everything? I wonder about that. Like, when you have an artificial intelligence, when, when you have data points for everything, and eventually we will, as you, every breath that we take, everything that we purchase, everything we've made will, will be tracked.
And so what is the role of experiments once you have every possible variable accountable, because the entire point of an experiment is to control for variables. Right and so.
[00:39:58] Dr. Carol Curchoe: Yeah and really defends the hypothesis, right.
[00:40:02] Griffin Jones: But do you need the experiment to test the hypothesis if you have every data point from forever?
[00:40:08] Dr. Carol Curchoe: Yeah.
Yeah. You definitely do. Because the, what you can do is, you can make a prediction. Based on all of those data points. So for example, what is your genetic background? Where did your grandparents grow up? Did they go through a famine and the country that they were living in before they migrated to the U S has there been, incredible stress in your life?
Are the sensors outside at your street light detecting a lot of pollution? Like you live in a heavily polluted area with a lot of car traffic. And so we're using environmental sensors in, in a much broader sense. But the role of experimentation, I think, after you collect all that data and have a data point for everything is then you're constantly testing interventions.
So by intervention, I mean, for example, like a treatment, a drug for endometriosis, for PCOS, for, let's say you have childhood cancers. And so there are different treatments that are impacting fertility later on down the line. There are a lot of STDs that directly cause infertility or STI that directly cause infertility.
So being able to intervene on these different aspects in a much larger way could be very helpful for people. It could be helpful to direct policy can be helpful to direct like public health policy, basically. But yeah, I think the role of experimentation will always be relevant. We're never going to solve all these problems.
[00:41:47] Griffin Jones: Okay, where does our compass figure into this IVF superhighway?
[00:41:57] Dr. Carol Curchoe: Yeah. So we are just basically a new way to have a database that structures data in order for artificial intelligence to interact with it. So we're just a new way of, of storing and accessing data for AI systems and then providing the forward-looking statement on this, right?
All the AI technologies are in development. The first step is collecting the data. The second step is creating the AI validating it. So developing it, validating it, and then actually making predictions or prognosis. The low-hanging fruit we like to say is whether an embryo is viable or not. So just using embryo images instead of performing an invasive perfected or biopsy, and then waiting two to three weeks for the genetic testing results to come back, we could look at an embryo image and give a score right away for whether that embryo will be viable or not.
So those kinds of advances will be very good for patients. They'll cut down on like an entire cycle time between the time of the retrieval. And then the time you get the genetic testing results back and prepare the uterus for transfer of one of those embryos, it'll also be really good for patients because I think we are going to sort of solve one of the dilemmas of PGTA, which is that.
It really decreases the number of embryos that are available for transfer. And we probably are discarding some embryos that would have been viable. So patients are probably going to get more embryos in the end, more chances to try with those embryos that they've made. And yeah, so it's eventually it becomes diagnosis, prognosis and making predictions.
So business intelligence, even for running your clinic.
[00:43:50] Griffin Jones: Do you want to share a little bit of what your abstract was about at PCRs because that I've found so interesting of that, of talking about of grading embryologists or their responses. Do you want to talk a little bit about that?
[00:44:05] Dr. Carol Curchoe: Yeah.
So if you ask 10 different embryologists ,the same question. You're probably going to get it back. At least 60% of the responses will vary. So a lot of what we do in embryology is, is very subjective. And it's based on your experience and what you have seen. It's not objective and it can be a challenge because so many other things are based on what the embryologist looks at and sees in the dish.
And then what they say about those embryos. So whether an embryo gets biopsied that day, whether it gets frozen that day, whether it gets frozen in the cycle at all of those things have an impact on the number of blastocysts that the patient has at the end of an IVF cycle. And so for embryologist, we need to be really consistent in our judgment and our grading of the embryos.
And it's just, the variability is just completely wild. And so the abstract that I presented at PCRs we basically just did a small survey to see whether the terminology that embryologists were using for early blastocyst development was consistent. It wasn't, and whether we could kind of trick embryologist into picking a fake term, that's not actually in use.
And that term was picked many times.
So it just.
[00:45:33] Griffin Jones: What was it again? I don't remember the name of it.
[00:45:36] Dr. Carol Curchoe: It was cleaving morchella which is not a real embryo grade. And so it was just kind of interesting, but we've had a couple of surveys that we've published at ASRM and ESHREand shows what we know all along that the consistency and objectivity of embryologist is low.
I mean, we are human. It could vary depending on whether you've just eaten lunch or whether you've already graded 10 patients before this patient. And you're running out of time to do your body. I've seen freezing for the day. And so just being able to rely more on computers, to take some of that routine, manual subjective and highly variable labor off of our plates is probably a good idea.
[00:46:21] Griffin Jones: So once we do, then what is the embryologist going to do once that is off the plates? What are they going to do?
[00:46:28] Dr. Carol Curchoe: The important work, right? Making sure the embryos get frozen correctly and that your patient doesn't end up having a boy when they asked for a girl, which was a news article that just came out last week.
There is so much more that embryologists needed to do. And some of the most important work that often gets, not a lot of time for is the quality assurance and the training of the next generation of embryologists. So just being able to invest more, even in the, the people and their techniques and it's there's plenty of work to be done outside of embryo grading.
[00:47:08] Griffin Jones: So before we close, I want to go on a little bit of a tangential topic, but it's related to how we opened the show, which is about the soon to be mass Exodus of senior embryologist and HCLDs is, and how there are fewer HCLD candidates in the pipeline right now. And this is totally anecdotal, Carol, but I wonder if you're seeing it too, is I'm seeing a lot of younger embryologists trying to get the hell out of the lab at a time were they've never been more desired. They've never been more in demand. And like everybody's trying to get their hands on embryologists and, and I'm seeing, so I've got a couple open positions for my business development and creative firm, nothing to do with the lab. And embryologists are applying for jobs at my firm.
I get at least once a week, at least one a week, and then I'll talk to them and it typically comes down to, they don't physically want to be in the lab all day. They hate that. And then they don't like the burning the midnight oil been burning the midnight hour, that whatever hours. Yeah.
And so I don't have any data on younger people trying to get out of the lab, but Canary in the coal mine. That's what I'm seeing. What do you see?
[00:48:31] Dr. Carol Curchoe: Yeah.
So I can think of that is partially accurate there the profession itself is very difficult. A lot of times so you have a very high pressure situation where you can't make any mistakes.
It's highly likely that the other people you work with in lab have a certain amount of a certain level of OCD, and that they're going to be correcting you nonstop all the time for your first five years until you become a senior embryologist. Even among senior embryologist, they're going to be correcting each other and picking out each other all day to do things the right way and to document all of these little small details.
And you have high pressure situation long work hours, a lot of times weekends and holidays are required. Because the IVF lab they say it can never stop. And so a lot of those things are management decisions that what it comes down to is you are choosing to run this many cycles with this number of staff and have your clinic be open on all these days and to do retrievals every day of the week.
And on holidays, you could choose a different way to manage your practice. But what I think is the most compelling part is we have to get to an agreement where the number of cycles can scale and really treat the number of patients that need IVF in the country, which we're only treating a fraction of, but that the management of the cycles within the clinic has to somehow get more better for people, more family friendly, more friendly for the embryologists. And so again, I think a lot of that is going to have to do with technology. A lot of healthcare burnout comes from continuous documentation of, of items is that you don't even know why are we doing this?
It has no, it's never going to have any impact on any cycle. It just gets filed away in a binder and put it in the closet for the next 10 years. And so there are just, I think there are just different things that every step of the way that kind of need to be looked at. I also think training more male embryologists in the field would be very helpful.
But I think what happens now is, is maybe a lot of male embryologists start off in embryology. And then they're like, I'm not going to take this. I'm going to go find a better job for better pay and less stress. And I think if we were to do that and get more male embryologists, maybe that can help to actually raise the standard for all embryologists.
And it could also smooth out some of those real big dips that happen when with a lot of maternity leaves and different things that happen in different practices. But for the female embryologist, I know many of them have been asked to return to work within four weeks of having their baby or less, because they're the only embryologist who knows what they're doing in the lab or in that area and.
[00:51:52] Griffin Jones: Technology is really, it has to be a part of it though, because right now we're in a chicken and egg, and this is all across the marketplace. It's not just the fertility field. It's not just an IVF lab. It's happening everywhere. That tension I'm talking about is between employee needs, wants customer needs wants.
And in our case, staff member, provider embryologist needs wants versus the patient needs, want, patients wanting to get pregnant and they want to be seen, and they don't want to wait eight and a half weeks, 10 weeks, 12 weeks for any IVF cycle. And so I can empathize with both sides here, which is like, we're trying to help these patients here.
And so we're trying to put more people through on the other hand, we're burning people out and then, so they're quitting and then that puts the, makes the burden even heavier for those that remain. And so. We have to have technology. We have to adapt what ever technology that we can to be able to reduce this burden, because otherwise we're just going to be stuck on until, until some other economic force, like a recession or something comes in and makes one side of the teeter-totter go up in one go down.
But until that happens, like we're all. And even then it will be temporary. Like we need this technology in order to break that chicken in the egg.
[00:53:21] Dr. Carol Curchoe: Yeah,
absolutely. And I just think, we need to responsibly scale cycles so that it, so that it doesn't break the backs of the workers, but it also, we scale the industry to serve as many patients as possible because people really need this life altering life saving, really technology that we have that.
We need to be able to make it available to everyone who needs it.
[00:53:46] Griffin Jones: I'm going to selfishly give a little plug for something that I want to see., and then I want you to conclude with the way that you want to conclude. But what I selfishly want to see is a story to tell the importance of the different parts of the lab and the, and the clinic like meet like the hero's journey of the embryologist, the hero's journey of the fertility nurse, because everybody's going through burnout.
People like yourself and others are doing what they can to bring technological solutions as quickly as possible. In the meantime, for being able to carry the burden, it really helps to know to tie into. This greater purpose, this story that you see, or this drama playing out that you see yourself as a part of and creative really helps to do that.
So when I came into the field seven or eight years ago, Carol, it was about new patient acquisition. That was my value prop. And then for a few years, it's still was that most clinics don't need that right now don't need new patients, a couple profiles do then there, it was about converting more to treatment of, okay, you're bringing enough new patients in the door, but you need to help converting them to treatment.
Even now, most people are like, well, it doesn't matter if we convert more because we're at capacity at the lab. And so what we're trying to use creative for is like, use it in such a way that get your people and your patients to be able to understand go through and be a part of like, what's really important for getting this done on the patient side.
It's very often about resetting expectations and on the staff side, nurses, embryologist, it's about seeing like how like really important this is. And you might, you might say like, oh, well, like of course we see it. We see it every day because we're living it. No, there's something about the story allows you to see how you play into it.
I used to volunteer at an orphanage of, of a network of orphanages called new Esther spontaneous or miles. And I was there and I did it like every, I lived there. I did it every day. I'm telling you Carol, that when I watched the YouTube videos of like, of like the family at large and would see like how we played into the bigger.
I was like, yes, this is what I'm doing it for. So I want to see that. I want to see it for the embryologist. I want to see it for fertility nurses. And there's so many different ways to tell this story. And if you're listening, talk to me about that because I'm not talking about just getting new patients in the door, I'm talking about, about using creative to solve challenges, like best, but I'm going to let you conclude that was, that was selfishly for what I want to see.
What do you want to see happen in the field? How would you like to conclude with our audience about the future of, of the lab as you see it?
[00:56:55] Dr. Carol Curchoe: Yeah, so I think we need funding to make these innovations happen. So I'm in a very small group. A very small segment of the population who ever becomes an embryologist and then creates a technology and makes a startup.
I'm a female founder. And I didn't go to Stanford. I don't have a pedigree. And so the funding, I think for a person like me and the avenues to funding are it's extremely difficult, less than 2% of all female founders nationwide ever get funded. Right? So its ambition, a small market, and we need just more funding.
I know everyone's talking about fem tech nowadays and getting more funding into these technologies. And so that's great. I think that that just needs to go rise more and more and more, but if you're an average everyday embryologist and you have a good idea that needs to be commercialized, and you're the one who's working with these technologies every day and what could make your life better and easier?
How would you commercialize? How would you even go about how would you, what would be your first step to commercialize the technology? And I think it's just not talked about a lot ever. And so having just like the education, the startup education and the mindset of being able to drop a blueprint with an engineer, get a patent together try to raise funding and build a company.
How to do that should be a little bit clearer and a little bit easier for people to do so that we can continue to innovate basically
[00:58:44] Griffin Jones: Dr. Carol Curchoe of art compass and CCRM Orange County. Thank you so much for coming onto the show.
[00:58:51] Dr. Carol Curchoe: Thanks for having me.