Nodal Q&A with Reproductive Biologist Dr. Carol Curchoe

‍Carol Lynn Curchoe, Ph.D., TS (ABB), is the Director of Medical Affairs at AIVF and Founder of ART Compass, a software that is revolutionizing paperless IVF management. She's also a Senior Clinical Embryologist Board Certified in Embryology. Dr. Curchoe is the author of The Thin Pink Line , a critical exploration of historical perspectives and controversial topics in modern gynecology from birth control to sterilization, to episiotomies and the “husband stitch,” to “educational” pelvic exams to gender-affirming surgery, human embryo research, assisted reproduction, and more.‍

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We are so excited to feature Dr. Curchoe today.

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Caroline: Hi, Dr. Carol! Let’s start with a big question: What are some of the biggest misconceptions about infertility? 

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Dr. Carol Curchoe: That it's the woman’s job to solve. That only women want babies. That a young person can't be infertile. That a woman ate/drank/ slept/was stressed/or did something—anything—to cause infertility or miscarriage.

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And also? That no one wants to hear about your struggle or that you should hide your meds and treatments. One of the biggest misconceptions is that it is ever “too early” to announce your pregnancy. It's OK to say, “I finally have a positive test, it’s very early, and this is only the first step in a long road.” I want to know. For me, I want to be there for you, especially if you lose your embryo or early pregnancy. I will grieve that loss with you, too, no matter how early. It is not a burden to me to hear details about your trying, treatment plans, or what you are trying next.

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Caroline: Are there any areas of infertility that are under-discussed? If so, what and in what ways could we better shine a light on them?

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Dr. Carol Curchoe: I am a reproductive biologist, and so some of the things that I want to say might seem shocking to some people, but to me, they are just everyday facts. 

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There is a horrific sexually transmitted infections (STIs) epidemic in the United States that is linked to our sexual health education policies and access to healthcare. The rates of chlamydia, gonorrhea, and syphilis have reached all-time highs and show no sign of slowing. We must reverse this trend if we are ever to lower the rate of infertility in our country. 

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In the course of trying to conceive, the population of patients we see needing to have non-viable pregnancy tissue removed is even higher than in the general population (obviously, we see infertile people who cannot maintain a pregnancy for whatever reason), and medically that is termed “abortion,” no matter if it's spontaneous or therapeutic abortion. Having a miscarriage or being treated to expel non-viable tissue is very similar to active labor, including contractions, pain, and blood. After a miscarriage has physically completed, the pregnancy hormones must be “followed down,” and that can take a long time, sometimes more than three cycles. Occasionally, placental tissue is retained, which is why the hormones stay high, and a dilation and curettage (D&C)—a procedure to remove tissue from inside your uterus—is needed. In states that are restricting women's access to healthcare, even (and especially) people trying to conceive will be affected by these policies and laws. 

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Related: Nodal Q&A with Intended Parent and Fertility Consultant Ashley Gildin Spitzer

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Caroline: Regarding under-discussed aspects of infertility, I’m just starting to learn about anovulatory infertility. Can you tell me more? 

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Dr. Carol Curchoe: I suffered from this. Anovulatory infertility is when you don't ovulate an egg. No one really knows why it happens. In my case, the suggestion was that it was a PCOS-related problem in what must be a spectrum of disorders that seem to hinge around insulin processing. (Just like how in the old days they just said “cancer,” but now we know breast cancer can stem from many genes, it is not one single etiology (cause)). I had almost no other symptoms, was lean, and didn't have unexpected hair growth. I did all the hormone testing, and my androgens were not high, and everything else was normal. But still, I stopped eating carbs, especially drinking wine each night, and getting very regular exercise. 

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The only symptoms I displayed (other than anovulation) were lack of a period and deep under my skin, painful cystic acne that appeared and went haywire when I came off my birth control pills. When I finally ovulated the one good egg that would become my daughter, I practically had a six-pack! Her implantation must have been delayed because my first test was negative. I thought for sure I must be in full-blown menopause. A week later, I had the first and only positive test I have ever had in my life. My miracle baby is six years old now. 

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Caroline: Tell me about the app you founded, ART Compass. How does the software work to refine the IVF process?

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Dr. Carol Curchoe: Clinical Laboratories do the actual science and testing that underlies every physician's clinical decision. There are a set of federal regulations that control how clinical laboratories are run (it’s called CLIA 88). This law was created to ensure quality and consistency in patient care. 

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Unfortunately, despite these regulations, clinical lab errors still occur. In IVF, an error can be much worse than death. You can cause someone to be born who shouldn't have. That kind of error tears families apart and reverberates through the generations. It inflicts a type of reproductive trauma. And CLIA88 is not the only set of rules we follow. There are also FDA (Food and Drug Administration), HIPAA (Health Insurance Portability and Accountability Act), OSHA (Occupational Safety and Health Administration), and many other regulations.

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ART Compass is what we call a laboratory information management system (LIMS for short) that ensures we keep our labs in line with all those rules. It takes orders from the physician, so there are no mistakes in what procedures are ordered, when they will happen, whose gametes will be used, and what embryo to thaw and transfer. Then the lab generates all kinds of data, like how many eggs, how many embryos are frozen, what are the genetics (Preimplantation Genetic Testing (PGT) results), what was thawed for transfer, and what actually happened. For instance, did the embryo survive? Did we thaw another? ART Compass organizes all that data and passes it to the physician for review and the patient app for updates. 

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Of course, all of that is really not sexy or exciting at all. For the folks reading this, the most exciting part is that intended parents (IPs) can see each of their embryos!

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Related: What to Expect for Embryo Transfer as a Surrogate

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Caroline: It’s the year 2033—in your wildest dreams, what does the infertility landscape look like to you?

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Dr. Carol Curchoe: Most of “infertility” is solved. Infertility due to tubal scarring or STDs is unheard of. Eggs and sperm are frozen at any time for young folks, as commonly as graduating high school is. Family planning and fertility education are openly discussed from the earliest ages. All babies are planned for and wanted, and foster care and adoption are nearly unheard of. 

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Infertility treatment is as common as going to Lens Crafters at the mall and getting eyeglasses. Anyone can and does afford it, and insurers widely cover it. Nevertheless, it is also affordable even without insurance. 

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Needing a tissue donor (e.g., egg, sperm, or embryo donor) and donating those cells is seen just as any other living tissue donor, and vast public banks exist akin to the Red Cross. Think about it: When you give blood, you get stickers to wear, you get to be proud to be a blood/plasma/bone marrow/kidney (or whatever) donor, and how no one has to be ashamed to receive those tissues from another human.

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In my wildest dreams, hormones are administered through simple patches on the skin and micro dart technology. Better yet, eggs are matured in the lab from the smallest follicles, and no hormones need to be administered to produce mature eggs. Pessaries or progesterone in oil (PIO) are laughable things of the past, like the dark ages of infertility medicine. We will laugh at the memory as if we were talking about leeches or humors to cure infertility!

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Lastly, Artificial Intelligence (AI) technologies and robotics perform the majority of all lab-based tasks, and not only have success rates risen to 90 percent or better through this technology, but it’s also capable of ensuring that embryos of “unplanned parentage” are never created, or the wrong embryo is never transferred.