December 10, 2025 • 44 mins
Months after the shutdown, patients finally hope to reclaim their embryos. But as auditors begin comparing records to what’s actually in storage, they uncover widespread inconsistencies — raising new fears about what may have happened inside the clinic.
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Episode Transcript
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Speaker 1 (00:01):
It's late April twenty twenty four. The Center for Reproductive
Health is closed. The clinic itself is dark, the door
is locked. Doctor Vazkaz is no longer allowed to handle
patient records or anything else involving the clinic.
Speaker 2 (00:17):
The state has taken.
Speaker 1 (00:18):
Over CRH, and a receiver, a third party appointed by
the courts, takes responsibility for what's left behind. The first
priority is the cryogenic tanks. The clinic has five of them,
filled with frozen embryos, eggs, and sperm, what the fertility
industry refers to as genetic material. The receiver hires an
(00:42):
embryologist to come to the shuttered CRH several times a
week just to monitor the tanks and make sure there's
enough liquid nitrogen in them. That is, until the receiver
can find another clinic willing to take in all of
this genetic material.
Speaker 2 (00:58):
But this isn't a simple task. Digging into the.
Speaker 1 (01:02):
Files, the receiver discovers how truly disorganized they are. The
Center for Reproductive Health kept three separate inventory systems, one
on paper and two electronic, and none of them match
up perfectly. Meanwhile, patients are desperately waiting for news.
Speaker 2 (01:22):
In May they get a.
Speaker 1 (01:23):
Letter from the receiver reassuring them that the tanks are
being cared for, but there's no timeline for moving them,
no concrete path forward at all. All they can do
is wait. May June July, Nashville shifts from spring to summer.
(01:44):
The receiver files monthly reports, all with the same information
about the genetic material. We're still trying to move the embryos,
Thanks for your patients, etc. The air outside grows heavy
and humid. Finally, in August, around four months after the
Center for Reproductive Health shuts down, the receiver finds a
(02:06):
clinic willing to accept the genetic material, the Tennessee Fertility
Institute or TFI. This is the news patients have been
waiting for the chance to start again.
Speaker 3 (02:18):
Precious genetic material that was at the Center for Reproductive
Health moved down I sixty five to Franklin last week.
The fertility clinic that accepted that tissue. From what I've learned,
still has their work cut out for them.
Speaker 1 (02:30):
But any excitement is quickly dampened because the records are
such a mess. A full audit is required. Every embryo,
egg and vile of sperm needs a paper trail showing
who it belongs to, how it was created, and how
it's been stored. The Tennessee Fertility Institute has to comb
through crch's record keeping systems and verify that everything is
(02:55):
properly linked to the right patient before anything can be released.
This won't be easy. In total, there's almost twelve hundred
embryos to sort and identify. So the patients wait again.
They hope the audit will finally bring clarity. Instead, it
exposes just how unstable crch's operations really were and how
(03:19):
much trust had already been broken. I'm Melissa Jelson from
School of Humans and iHeart Podcasts. This is what happened
in Nashville episode for the audit.
Speaker 4 (03:44):
Great anxiously waiting this letter the day on This is
October second, twenty twenty four, and you know the SICH
closed in April, so this is a long time coming.
Speaker 1 (03:56):
This is Kristen Wall. She and her wife Diana are
both for more patients of the Center for Reproductive Health.
When the clinic closed, they were new parents to a
baby conceived through IVF, one of the two thousand children.
Doctor Vaskaz boasted of bringing into the world.
Speaker 5 (04:14):
We just had our baby.
Speaker 4 (04:15):
We were enjoying it soaking that in and we had
her embryos frozen at CRCH.
Speaker 5 (04:22):
We hadn't even.
Speaker 4 (04:23):
Talked about our thought about starting to grow our family again,
just because we were very much in the throes of
a newborn baby, and so it really wasn't even a
blip on our radar at the time. And then I
saw that news article and my immediate thought was, our embryos.
They're not viable like they are.
Speaker 5 (04:43):
Something's happened to them, and I was terrified.
Speaker 1 (04:47):
The information trickling out doesn't ease those fears. First, there's
the report after the state inspection where authorities described observing
a dirty lab and Vaska's A currently struggling to service
the tanks. Then news breaks that Ferrera Dyer isn't a
licensed doctor. Kristin and her wife are stunned.
Speaker 4 (05:10):
He was our first contact point at ERH. He introduced
us as doctor Dyer. Everyone referred to him as doctor Dyer.
He had a white coat on, brought us in to
his office.
Speaker 1 (05:21):
They had met with dire as they navigated fertility treatments
at the clinic, although he didn't perform IVF procedures at
RH such as egg retrievals or embryo transfers. He was
the one who they said, reviewed test results with them, and,
as far as they could tell, seemed to come up
with their treatment plan. Kristin and Diana had picked the
(05:43):
Center for Reproductive Health because it offered reciprocal IVF, a
process that allows both women to participate in the experience,
one by donating the eggs, the other by carrying the baby.
In their case, Diana underwent an egg retrieval and Kristin
planned to carry. Their first embryo transfer resulted in a miscarriage.
(06:06):
On the second attempt, Doctor Vazki has transferred two embryos
to Kristin's uterus, both implanted until one stopped developing.
Speaker 5 (06:16):
I became pregnant with twins.
Speaker 6 (06:18):
Wow.
Speaker 4 (06:19):
Yeah, And as you probably know IVF, pregnancy with twins
is definitely a very high risk pregnancy, and unfortunately I
lost one of the twins, so I miss carry one
of them. I have what's called vanishing twin syndrome, and
(06:40):
it was awful and I'm still, you know, kind of
dealing with it today. But on the good side, I
did carry the other one to full term and we
do have a child, which is wonderful, but I am
still really reeling from that because I had worked through
(07:03):
my own emotions around it, and then when this CRCH
thing happened, it just threw me right back to it.
I immediately just started questioning everything. And when Kristin and Diana
finally get their medical records from the clinic, they become
even more alarmed by the state of things. In Diana's file,
(07:23):
they find information that shouldn't be there. I was scrolling
and all of a sudden, I see another woman's name,
and I'm.
Speaker 5 (07:32):
Like, who is this.
Speaker 4 (07:34):
This is a woman that had an ank retrieval at CRCH,
and I looked at the date and she had it
the day after my wife did, and it's lumped right
in the middle of my wife.
Speaker 1 (07:45):
Kristin's own records are no better. She says, there's no
documentation of her second embryo transfer, the one where Vazka
has transferred to embryos and which resulted in the birth
of their child.
Speaker 4 (07:59):
My record had absolutely no indication or record that I
had to transfer with two embryos. I just felt really
invalidating because it felt like I didn't even go through
that process.
Speaker 5 (08:13):
I just I I was like.
Speaker 4 (08:16):
You couldn't even take the time to document it or
put that in my records.
Speaker 1 (08:20):
Other patients are also receiving their medical records and sharing
their reactions on the Facebook page Sydney created. It turns
out the inconsistencies that Kristen and Diana discovered aren't unique.
Patients report missing test results, entire procedures omitted. Each discrepancy
(08:41):
adds to a growing sense of panic. If the paperwork
is wrong, what else might be.
Speaker 4 (08:48):
The more information we found out, just the less hopeful
we got. It was just like a blow every single
time we found out new information.
Speaker 1 (08:56):
The receiver releases regular status reports to update patients on
what's happening behind the scenes. Kristin, like many patients, carefully
reads through each report, and some of the details she
learns are shocking.
Speaker 4 (09:12):
I read the receiver discovered evidence that at least two
patients received the incorrect embryos for their frozen embryo transfer procedures,
and I immediately was like, holy shit, Like this is
that is my biggest fear.
Speaker 1 (09:26):
The report does add that neither of these embryo transfers
led to a pregnancy, but that doesn't help quash Kristen's fear.
That maybe she'd received an embryo that wasn't made from
her wife's egg, but from some other woman's instead. Kristin
and all the other patients must now wait for the
official embryo audit by the Tennessee Fertility Institute, the one
(09:49):
that requires going through three sets of incomplete records to
understand more.
Speaker 4 (09:56):
That same week, we get our letter in the mail
and it says you have been identified as a former
patient of the Center for Reproductive Health with cryogenically stored
genetic material. And then they said they did a physical
inventory audit and says please see below for the results,
and it says you have ten of ten embryos identified
(10:16):
in the inventory audit of the CICH doers. The account
of your genetic material matches your ch patient record.
Speaker 1 (10:24):
This might seem like reassuring news ten out of ten
embryos identified everything with its own matching record, but it's not.
Speaker 5 (10:33):
What we should have is eight.
Speaker 4 (10:35):
So I'm reading in a receiver's report that they're talking
about women receiving the wrong embryos. And then I get
this letter that says we have ten and we're only
supposed to have eight.
Speaker 1 (10:46):
The couple originally had eleven. Embryos. They transferred three, which
means they should have had eight left, but the letter
says they have ten embryos in the tanks. This is
exactly what what Kristin had been worried about.
Speaker 5 (11:02):
I mean, I about shut down.
Speaker 4 (11:05):
My immediate thought was, we have two embryos that aren't ours,
or you transferred somebody else's embryos to me.
Speaker 1 (11:15):
Kristin and her wife reach out to a lawyer who
contacts the receiver, and after an additional review, the couple
gets another letter retracting the original count. Actually there are
only eight embryos in storage. The receiver doesn't explain why
the mix up happened. Was it because of corh's messy
(11:36):
record keeping? Was it a miscommunication? It doesn't make Kristin
feel any better.
Speaker 4 (11:43):
So they were like, sorry, clerical air. And I'm like, well, okay,
so you have a clerical air. How am I supposed
to trust that the audit, the full audit you did,
was accurate. Then these receivers reports, You're just naming all
these discrepancies in the record. So I just had zero
trust that this was right.
Speaker 1 (12:05):
Kristin isn't alone. The audit uncovers widespread problems According to
a report filed by the receiver, out of a total
of six hundred and sixty four patients, one hundred and
fifty four had genetic material in storage that did not
match up with their records. That's nearly twenty five percent.
Some women like Kristin are told they have more embryos
(12:28):
than they thought, others fewer. One woman who believed she
had none discovers she has three. And then there are
other issues eighty seven patients with genetic material in storage
but no mailing address on file, and twelve specimens with
missing or indecipherable labels, which means there's no way to
(12:51):
verify who they belonged to. I asked the receiver for
more information on the audit, including details on the two
instances where patients received the wrong embryos during a transfer.
The receiver clarified that the two embryo transfers use the
correct person's genetic material, just not the intended embryo for
(13:15):
the transfer, but they declined to provide more details about
the other inconsistencies the audit discovered for patients. The audit
results are deeply unsettling, and I can understand why, speaking
from experience. When you put embryos in storage a service
it's worth noting you pay for you expect meticulous care,
(13:38):
every label confirmed, every detail exact, every record air tight.
Speaker 4 (13:44):
My wife and I both agreed that if we couldn't
be one hundred percent certain that these embryos are ours,
we would not feel comfortable using them. I was angry, honestly,
and frustrated.
Speaker 1 (13:55):
The whole audit and how the results are communicated leaves
patients like Kristen and Diana feeling abandoned.
Speaker 4 (14:03):
I felt like we deserved a phone call from somebody.
Speaker 5 (14:07):
I just felt like we deserved more.
Speaker 4 (14:10):
It's already just an emotionally hard process, and for a
lot of people, they're not coming to IVF because they've
had success.
Speaker 5 (14:19):
In getting pregnant.
Speaker 4 (14:21):
These people just don't seem to understand or care, or
they're just trying to cover their.
Speaker 1 (14:26):
Butts covering the fallout from the Center for Reproductive Health's closure,
and going through infertility myself, I keep coming back to
the same theme time with fertility. It's always a race
(14:48):
against time.
Speaker 7 (14:49):
Probably one of the better predictors of how likely a
treatment is to be successful is the age the woman
is when the procedure is performed.
Speaker 1 (14:58):
This is doctor Allan Penzius, a reproductive endocrinologist an associate
professor at Harvard Medical School, just.
Speaker 7 (15:05):
A biological fact that as women get older, reproductive capacity
goes down.
Speaker 1 (15:13):
The numbers tell the story. If you go through IVF
when you're under thirty five, you have a more than
fifty percent chance of having a baby after just one
egg retrieval. Those are great odds, But the older you get,
the lower your chances. Forty percent when you're thirty five
to thirty seven, twenty six percent between ages thirty eight
(15:37):
and forty, thirteen percent in your early forties, and once
you're over forty two, you have just a four percent
chance of having a baby after a single egg retrieval.
So biology sets the clock, that often money sets the ceiling.
(15:57):
Each cycle can cost tens of thousands of dollars, and
most insurance doesn't cover it. Every failed round isn't just
another heartbreak, it's another bill or series of bills. This
is the cruel math of infertility. Biology, time and money
all working against you at once. And that's what made
(16:21):
crh's closure so catastrophic. It didn't just delay treatment, it
robbed patients of time they could never get back and
drained the limited resources they had, Wasted time, wasted money.
This isn't supposed to happen. Fertility clinics, like other medical practices,
(16:43):
are expected to have protocols in place if they need
to close, whether for retirement, emergencies or natural disasters.
Speaker 7 (16:53):
We know that hurricanes sometimes happen, and if there's a
hurricane that's threatening to go past where an ivy F center,
sometimes it's necessary to take precautions to lock things down
and to make sure that the tanks are toped of.
Speaker 1 (17:06):
In addition to treating patients at Boston IVF, doctor Allan
Penzius is also a former board member of the American
Society for Reproductive Medicine or ASRM, an organization dedicated to
the advancement of the science and practice of reproductive medicine.
Speaker 7 (17:24):
Sometimes you have to actually move the embryos from one
location to another to keep them safe. So those are
all the obligation of the fertility center to make sure
that they've been entrusted with these very important biological materials,
to make sure that we take care of them properly.
Speaker 1 (17:39):
There are roughly five hundred fertility clinics in the US.
Doctor Penzius notes that when one has to close, which
happens from time to time, there's a well established protocol
to follow.
Speaker 7 (17:52):
So in the case of a program that knows they
might be closing for one reason or another, Let's say
a solo practice has had a great practice, it's going
to retire, and they know that in six months they're
going to be closing the practice. What do they do?
Will they notify all their patients in advance. They make
sure that anybody who has stored materials knows that they
(18:14):
can have the right to use them, or that they
can tell them where they're going to be sent to.
Maybe they've even made an arrangement with another fertility program
to transfer anything that's left over for long term story
and notified those patients to the abst of their ability.
Speaker 1 (18:33):
And this isn't unique to fertility treatment. Continuity of care,
meaning there's no interruption in your access to medical treatment,
is one of the core obligations of medicine. In fact,
Tennessee law requires physicians to notify patients if they're retiring.
Anyone seen in the past three years must be contacted,
(18:54):
urged to find a new provider, and told how to
obtain their medical records.
Speaker 7 (18:59):
Those are all the kind of things that would happen
under a normal circumstance where a clinic knows that they're
going to close and is obligated to ethically as a
practitioner or do no harm. Make sure you're transparent, make
sure you notify people, and it's very important stuff. That
would be very unusual for somebody to all of a
(19:19):
sudden have a problem that arose overnight that would require
just the door to be padlocked and nobody be available
that I can't imagine a circumstance where that would be reasonable.
Speaker 1 (19:31):
When your dentist office closes, it's inconvenient, maybe you put
off a filling, live with a toothache for a while
until you can find a new provider. But when a
fertility clinic shuts down overnight, there can be much bigger consequences.
In addition to precious time lost, there's the psychological and
(19:51):
emotional toll of not knowing when.
Speaker 2 (19:54):
Or if you'll ever.
Speaker 5 (19:55):
Be able to have children.
Speaker 8 (19:59):
Yeah.
Speaker 9 (20:00):
One thing that is interesting is that the American Medical
Association only recognized infertility as a disease of the reproductive
system in twenty seventeen, So that's really quite recent.
Speaker 1 (20:13):
This is Maria Polyyakova, an economist and associate professor of
health policy at Stanford School of Medicine. She studies the
impacts of infertility on patients.
Speaker 9 (20:24):
What we were curious about is what happens to people
who go through this process in other areas of the
life and in the londrun. I think we underestimate the
psychological aspects of this experience.
Speaker 1 (20:38):
Much of the impact of infertility remains hidden. People going
through it don't always talk about it publicly, and even
understanding how common it is isn't simple. The US doesn't
really have a system that tracks who undergoes fertility treatment
or what happens afterward, but Sweden does. In a study
(20:59):
released in twenty two twenty four by the National Bureau
of Economic Research, Polyakova and her colleagues used nationwide health
and pharmacy records to follow one point eight million Swedish
women of child bearing age, offering a rare window into
how widespread infertility is and how profoundly it shapes people's lives.
Speaker 9 (21:21):
We found that basically one in eight women have some
sort of interaction with you know, in fertility treatment. That's
as common as breast cancer in the US, and we
don't have the data for the US, but I don't
think there is any reason that that wouldn't be applicable
to the US.
Speaker 1 (21:37):
And while many infertility journeys do end with a child,
not everyone is so fortunate. When Professor Polyakova dug into
the data, she found that among women who started fertility treatment,
about three quarters had a child within eight years, but
even after all that time, nearly a quarter didn't. For
(21:59):
women who remain childless after treatment, Polyakova found they are
also likely to experience other harmful effects.
Speaker 9 (22:08):
They're much more likely to be taking various mental health medications, antidepressants,
anxiety drugs. They are more likely to experience separations the
family partnership falls apart. Basically in fertility experience itself results
in poor mental health.
Speaker 1 (22:25):
Polya Covi's theory is that it isn't the medical procedures
themselves that leave such deep scars, but the uncertainty of
not knowing what, if anything, will work.
Speaker 9 (22:36):
My guess, so this is not data, This is just
purely my guess is that it's not like the actual
medical intervention. If someone told these women, look, you're going
to have to take these drugs. It will be super painful,
and we can guarantee that you come out after three
months with a child. I think that experience of treatment
per se would not necessarily have long run effects on
(22:57):
people's health. It's this experience of coping and then hopes
not being realized, and this uncertainty.
Speaker 1 (23:05):
Her words resonated deeply with me. Even though my infertility
journey would be, by most accounts, considered easy, it left
a mark. While making this podcast, I went through three
embryo transfers trying for my second child. The first failure
was a gut punch. I spun in circles, wondering what
(23:28):
I'd done wrong. Was it something as small as getting
caught in the rain and coming home chilled, or the
fact that I had cried at my embryo transfer instead
of remaining calm. I knew this was unlikely, illogical even
but the urge to make sense of what happened was powerful.
The second failure hit even harder. I sank into a fog,
(23:52):
found a new therapist, kept myself busy with friends so
I didn't spiral into negativity. There was no reason and
why the first two transfers didn't work. My embryos were
genetically tested and highly rated. It was just a roll
of the dice. But after back to back failures, it
felt like my luck.
Speaker 2 (24:12):
Had run out.
Speaker 1 (24:14):
I only had one more embryo, one more chance. At
the age of forty one, I wasn't sure I'd be
able to go through IVF again. In the weeks leading
up to my final transfer, I mentally prepared for another failure.
I downloaded an app to journal about gratitude as a
(24:37):
reminder of what I already had as a thought experiment.
I've pictured in great detail what the future would look
like with only one biological child, and I allowed myself
to grieve the life I had envisioned. Amazingly, that third
transfer worked. I'm actually pregnant now as I record this.
(24:59):
Still the the whole experience leaves scars, the endless appointments,
the injections, the anxiety and uncertainty, and the quiet anguish
of nothing working. It wears you down, which is why
I feel so much empathy for patients like Mary, the
veterinary technician whose embryo transfer was canceled when CRCH shut down.
Speaker 10 (25:23):
No matter where I'm at in this journey, I mean,
I've been on for forever, and I'm always an en
up somehow back at square one, and it's it's like
you're at some point you have to start and think like, Okay,
the universe is literally trying to tell you something.
Speaker 6 (25:37):
Right.
Speaker 1 (25:37):
As the months go by, I talk with Mary on
the phone a few times. She's worried about a lot
of things, like if she and her husband will have
enough money to start again at a new clinic. She's
worried about their embryos, which she still doesn't have access to,
but she's especially worried about time.
Speaker 10 (25:58):
So now we are at the mercy of the courts.
I think we're just trying to hold out hope that
the embryos have been maintained in a tank properly and
that they are viable, and that one day we're going
to get them out and we're going to transfer and
we're going to be a family.
Speaker 1 (26:16):
Mary has spent five years trying to get pregnant. Her
insurance is gone, she doesn't have enough money to pay
out of pocket either. She's banking on the two embryos
she has in storage to take her from being childless
to finally becoming a mother. But as the months drag on,
with no word from the receiver on when her embryos
(26:37):
will be available, Mary feels hopeless.
Speaker 6 (26:41):
It feels like.
Speaker 8 (26:41):
I just keep getting older and my embryos keep sitting
in a tank.
Speaker 1 (26:45):
Her biggest fear is ending up in that twenty five
percent of women who pour years into fertility treatment only
to walk away with nothing. And then another option appears,
one that seems like it might all her problems. Out
of the blue, another local couple reaches out.
Speaker 8 (27:05):
They had heard of our story, they had seen us
on the news.
Speaker 1 (27:09):
They heard about Mary's traumatic experience at the Center for
Reproductive Health and offered a gift Mary and her husband.
They're leftover embryos.
Speaker 8 (27:18):
The family that owned the embryos they were older and
they didn't want them to just sit in a tank
or go to science.
Speaker 1 (27:26):
The two embryos being offered to Mary and her husband
are from an older couple who aren't planning to get
pregnant again. Genetic testing shows the embryos are what's called mosaic,
made up of both normal and abnormal sels, which means
there's less of a chance they'll result in a healthy pregnancy.
(27:47):
But Mary is desperate.
Speaker 8 (27:48):
We didn't know if we would have our embryos, like
when they were going to be released and we had
this opportunity, and it was like do we keep waiting around?
I think at that point, I like, I didn't know
how else I was going to hit more rock bottom.
Speaker 1 (28:06):
So she transfers them both and takes the chance. It
feels like the only one she has, Like, if.
Speaker 8 (28:13):
This doesn't work, then yes, I'll be devastated, but I've
been devastated for five years with results. Infertility is a
lot of hating rock bottom and picking yourself back up.
Speaker 1 (28:28):
In November twenty twenty four, seven months after the Center
for Reproductive Health suddenly closes, patients finally have access to
their embryos again. Now they have to decide what to
do with them. Many choose to establish care at the
Tennessee Fertility Institute or TFI, the clinic now holding the embryos.
(28:50):
It's the simplest option. Moving such fragile material again would
carry an additional fee and additional risk. Some women restart
treatment right away and over the next few months. There
are success stories on the Facebook support group. A handful
celebrate positive pregnancy tests.
Speaker 3 (29:10):
Currently thirteen weeks Because of TFI and doctor Miller.
Speaker 1 (29:14):
We transferred November fifth at TFI and it was a success.
Speaker 5 (29:19):
Fingers crossed, it will be the same for you.
Speaker 6 (29:21):
Just tested positive today.
Speaker 4 (29:23):
I can't believe it.
Speaker 1 (29:25):
It's been a crazy year sending baby dusk to all.
Speaker 2 (29:29):
Don't give up hope.
Speaker 1 (29:31):
But others run into unexpected issues. One woman told me
when she went in for a transfer at TFI, the
embryologist thawed the vial holding her embryo and found it
was empty. The next day, she emailed the lab asking
if her embryo had ever been there at all. The
answer it was impossible to know. She did have another embryo,
(29:55):
which they used and it was successful. Her baby was
born this past summer, but still an empty vial means
a missing embryo, and the audit hadn't even caught that mistake.
As I reported this story, I was shocked to learn
about the depth of the disarray behind the scenes at CRH.
(30:15):
This is every patient's worst nightmare. But I also began
to wonder how unique is this case really? If you
pulled back the curtain at any given fertility clinic in
the US, would you see similar problems? I asked of Fox,
a national expert on health law and bioethics.
Speaker 11 (30:35):
IVF today in the United States is far less regulated
than virtually any comparable part of medical practice, or as
compared with assisted reproduction regulation in other parts of the
developed world.
Speaker 1 (30:52):
Fox walked me through how IVF is overseen.
Speaker 2 (30:55):
In the US.
Speaker 1 (30:57):
Clinics are required to self report their success rates every
year to the CDC, which then makes the numbers public.
You can even go online look up your clinic and
see how it stacks up against others across the country.
The FDA plays a smaller role, inspecting storage facilities and
making sure donor eggs and sperm are tested for infectious diseases.
(31:20):
States may also do routine inspections, so from the outside
it looks like a web of oversight the CDC, the
FDA state regulators. In addition, IVF labs can choose to
be accredited by the College of American Pathologists or CAP,
a professional organization that evaluates laboratory quality and safety. And
(31:43):
then there are also organizations that develop guidelines for clinics
to follow, like ASRM and its affiliate, the Society for
Assisted Reproductive Technology aka SART. SART states its goal is
to establish and maintain standards so that patients received the
highest level of care. In twenty twenty one, sixty six
(32:04):
percent of IVF clinics in the United States were members
of SART, including the Center for Reproductive Health. We reached
out to both ASRM and SART for comment, but they
passed and opted not to talk to us.
Speaker 11 (32:19):
You've got these professional organizations like the American Society for
Reproductive Medicine that sets forth these industry standards or best practices,
at least for the clinics that are members of their program.
But again that's completely voluntary, and they're routinely ignored. Professional
(32:41):
self regulation has a lot of limits. We would just
never accept this in other areas of medicine.
Speaker 1 (32:48):
Fox explained that in the absence of robust federal oversight,
there's no built in quality control. What happens behind the
doors of most fertility clinics remains largely unknown.
Speaker 11 (33:01):
In other areas of healthcare, states make hospitals monitor and
report major avoidable errors, so things like mismatched blood transfusion
surgery on the wrong body part or the wrong patient.
We call these things never events because they're things that
(33:23):
just should never happen, and so states require investigations and
record keeping and preventative measures in assisted reproduction. There's no
agency or authority that tracks or polices this kind of
substantial and needless error in the US when it comes
(33:45):
to things like you know, fertility freezer failures or donor switches,
the buck stops nowhere.
Speaker 1 (33:54):
Clinics aren't required to report these incidents to federal or
state agencies, and no national database tracks them. So these errors,
including more serious never events, often go unnoticed. They only
really come to the surface when there's an obvious mistake,
like one say, a white couple unexpectedly gives birth to
(34:16):
a baby of another race. These mistakes involving mismatched race
are more easily detected for obvious reasons, but Fox thinks
there are far more that go under the radar.
Speaker 12 (34:29):
You don't see very many of at all, where like
the kids look kind of similar, they're just not the
person that was supposed to be used. Wow, all the
switches just happen to involve you know, a white person
for a black person, or an Indian person for an
Italian person or whatever. No, I think probably those are
the ones that people notice and learn about or whatever
(34:50):
that come out in the news, and probably it happens
more often there are just so many question marks. We
don't even know how frequent these errors are.
Speaker 1 (35:00):
The audit at CRH didn't reveal the kind of headline
grabbing mixups Fox describes, but with records this chaotic, no
one can say with confidence they never happened. And for
the patients, the disorganization undermines the trust they had in
their care and in their genetic material. It also creates
(35:22):
significant obstacles for patients, especially those who want to move
their embryos to healthcare providers other than TFI. As the
receiver documents in a report, many fertility clinics are hesitant
to take embryos that had originated at CRH because they
couldn't verify basic records such as how they were created,
(35:43):
cared for, or even what testing had been done. By
the end of November, only seventeen patients managed to relocate
their embryos out of TFI. By late January twenty twenty five,
that number creeps up to just thirty nine. One patient
still looking for a new home for her embryos is
(36:05):
Aaron Meyer.
Speaker 6 (36:07):
I'm Erin and we live in North Carolina. May have
a small farm and we grow flowers.
Speaker 1 (36:13):
Aaron and her husband, Gregor, begin researching alternative pathways to
parenthood after they learned they were both genetic carriers of
the same rare condition.
Speaker 13 (36:24):
There was a twenty five percent chance that we have
a child with severe publications from this genetic condition.
Speaker 1 (36:31):
They decide not to have a genetically related child, but
they still want to become parents. While searching online, they
discover the American Embryo Adoption Agency or AEAA. That again,
is a program run by doctor Vasquez, which offers patients
donated eggs and embryos, often the ones left over after
(36:53):
another couple has completed their fertility care. Even though doctor
Vasquez's facilities are local in Tennessee, not North Carolina, Aaron
and her husband feel like this is a new way forward.
Speaker 6 (37:07):
I was approaching forty, starting to feel the pressure a
little bit more and trying to say, Okay, what is
the fastest roots and to some degrade the cheapest route
right because it's still very expensive, and so adoption of
an embryo seem like a good route to go.
Speaker 1 (37:23):
In August twenty twenty two, Aaron and Gregor start working
with the American Embryo Adoption Agency. They buy three embryos
for eighteen thousand dollars. According to the paperwork provided, the
embryos are highly graded. Their cell structure looks robust, but
they haven't been genetically tested, which is not that unusual.
(37:45):
Not all couples decide to test their embryos, but Aaron
and Gregor choose to, hoping to identify the strongest embryo
to transfer first. They're stune to learn that all of
them are genetically abnormal, none are suitable to use. Eighteen
thousand dollars down the drain as a constellation, AEAA offers
(38:10):
them an additional genetically tested.
Speaker 2 (38:12):
Embryo for free.
Speaker 1 (38:14):
Aarin is eager to do an embryo transfer, so she
and her husband drive the ten hours to the Center
for Reproductive Health for the procedure.
Speaker 2 (38:23):
The transfer doesn't work.
Speaker 6 (38:26):
After that failure, we couldn't for a year, really, because
I had to really rally again. I had no emotional
reserves left. I was a heap, unable to function, unable.
Speaker 5 (38:38):
To get out of bed.
Speaker 6 (38:39):
Eventually went and got depression medications to help pull me
through this time.
Speaker 1 (38:44):
Still, Aaron and Gregor don't want to give up, and
so when they're ready, they turn once more to doctor
Vazquez's Embryo agency to see what's available.
Speaker 6 (38:55):
So we had gone back to them. Really I felt
the pressure of time at this point. So I was
forty one, about to turn forty two, really frustrated at
being slowed down. My mother had, I think, felt uneasy
about this clinic and had encouraged me to look at
other clinics. But I knew that that meant establishing care
(39:16):
with them, and that it just the time. Really was
the pressure that I was feeling the most.
Speaker 1 (39:21):
In February twenty twenty four, the couple decides to purchase
more embryos.
Speaker 2 (39:26):
We hadn't pulled the trigger.
Speaker 6 (39:28):
Everything in IDF is a gamble, and so you know, uh,
we took this gamble.
Speaker 1 (39:34):
Because that exhausted their options for loans, and their health
insurance doesn't pay for this. They make the difficult decision
to withdraw money out of their retirement fund.
Speaker 5 (39:44):
It this is a one time thing.
Speaker 6 (39:46):
This is the last time we're going to try. We're
going to take a chunk of money out of retirement
to be able to adopt new embryos and two embryos
and try at least once, maybe twice to cover the medications.
But this is a one time thing, because now we're
going to threaten our future.
Speaker 1 (40:06):
The couple paid eleven thousand dollars for two embryos. The
plan was for Aaron to begin taking medications for the
embryo transfer in April twenty twenty four.
Speaker 2 (40:17):
I had tried calling the clinic.
Speaker 5 (40:19):
Nobody was answering.
Speaker 13 (40:20):
The answering services. Well, I don't know.
Speaker 6 (40:22):
They're out today, They're going to be back tomorrow, okay,
And I put a message through the portal saying I
have tried to reach you guys multiple ways. I don't
understand what's happening. I'm a little concerned, but I'm not
getting a response back. At that point, the message bounced
on the message portal.
Speaker 1 (40:38):
That's when she learns the clinic is closed for good.
Speaker 2 (40:43):
I mean my heart sank and.
Speaker 6 (40:47):
Panic set in because this is these were our last
this was our last chance, Like.
Speaker 5 (40:53):
This was all the money on the table that we
were going to be able.
Speaker 6 (40:56):
To put and to see a clinic closed after we
had paid all of this money and had embryos sitting there,
the dream was over.
Speaker 1 (41:10):
In November, Aaron and Gregor are finally notified that they
are able to access their two embryos now stored at TFI.
These are the same ones they used retirement funds to purchase.
They try to find a clinic to move the embryos to,
preferably not in Tennessee.
Speaker 13 (41:28):
Going back to Tennessee is not my is not at
the top of my list, Like I don't trust the
state of Tennessee.
Speaker 5 (41:34):
Can we handle my health care?
Speaker 1 (41:36):
But moving the embryos is harder than they thought. They
don't have all the required paperwork, and the clinic they
want to use won't accept the embryos due to their
poor quality. This comes as a surprise to the couple.
Speaker 13 (41:50):
My cynical viewpoint was that doctor Vasquez, any American embryo
adoption agency was taking any embryos the rejects other programs
were not allowing into their system.
Speaker 5 (42:04):
They were accepting embryos that were not considered the.
Speaker 13 (42:06):
Highest grade or the most valuable, and ones that were
best for their patience.
Speaker 1 (42:12):
I asked doctor Vaskez's attorney about these claims, but haven't
received a response. Erin is now involved in the state's
consumer protection case against the clinic.
Speaker 5 (42:23):
You know, we certainly haven't gotten any of the money bag.
Speaker 2 (42:26):
I don't know what we're going to do yet.
Speaker 1 (42:30):
Aaron's fertility journey moving forward is uncertain. She's not sure
what to do with the two embryos in Tennessee at TFI.
She and her husband are out of money and can't
buy more embryos, and every day that goes by, she's
getting older.
Speaker 2 (42:48):
Dasquez took our last chance to try and have children
next time.
Speaker 1 (43:03):
On What Happened in Nashville, Long before the clinic's abrupt closure,
cracks were already forming.
Speaker 2 (43:11):
A patient who sued the Center for.
Speaker 1 (43:13):
Reproductive Health a year before it shut down shares their story.
Speaker 11 (43:18):
It's been the wildest of experiences of feeling isolated and
disregarded and then learning that we're not.
Speaker 7 (43:28):
The only ones and they have their own horror stories.
Speaker 1 (43:32):
Plus newly uncovered FDA reports revealed just how deep the
problems ran.
Speaker 5 (43:38):
It was like, okay, like there's not going to be
anybody left to hold this clinic up, Like it's going
to fall. We could see it coming.
Speaker 1 (43:48):
What Happened in Nashville is a production of School of
Humans and iHeart podcasts, written, reported, and hosted by me
Melissa Chelson. Our producer is Etaly's perez Ing. Your producer
is Amelia Brock, with additional production by Emily Seiner and
Carl Catle. Theme song by Jesse nice Swanger, Sound design,
(44:09):
scoring and mixing by Jeremy Thal and Jesse nice Swanger.
Fact checking by Savannah Hugh Lee and Austin Thompson. Our
production manager is Daisy Church. Voice acting by Grace Walker,
Nicky Speak and Daisy Church. Executive producers are Jason English,
Virginia Prescott, Brandon Barr, and Elsie Crowley.
Speaker 2 (44:31):
If you're enjoying the show, tell everyone you know.
Speaker 1 (44:33):
And don't forget to leave a rating in your favorite
podcast app. Tune in again next week for what happened
in Nashville
It's late April twenty twenty four. The Center for Reproductive
Health is closed. The clinic itself is dark, the door
is locked. Doctor Vazkaz is no longer allowed to handle
patient records or anything else involving the clinic.
Speaker 2 (00:17):
The state has taken.
Speaker 1 (00:18):
Over CRH, and a receiver, a third party appointed by
the courts, takes responsibility for what's left behind. The first
priority is the cryogenic tanks. The clinic has five of them,
filled with frozen embryos, eggs, and sperm, what the fertility
industry refers to as genetic material. The receiver hires an
(00:42):
embryologist to come to the shuttered CRH several times a
week just to monitor the tanks and make sure there's
enough liquid nitrogen in them. That is, until the receiver
can find another clinic willing to take in all of
this genetic material.
Speaker 2 (00:58):
But this isn't a simple task. Digging into the.
Speaker 1 (01:02):
Files, the receiver discovers how truly disorganized they are. The
Center for Reproductive Health kept three separate inventory systems, one
on paper and two electronic, and none of them match
up perfectly. Meanwhile, patients are desperately waiting for news.
Speaker 2 (01:22):
In May they get a.
Speaker 1 (01:23):
Letter from the receiver reassuring them that the tanks are
being cared for, but there's no timeline for moving them,
no concrete path forward at all. All they can do
is wait. May June July, Nashville shifts from spring to summer.
(01:44):
The receiver files monthly reports, all with the same information
about the genetic material. We're still trying to move the embryos,
Thanks for your patients, etc. The air outside grows heavy
and humid. Finally, in August, around four months after the
Center for Reproductive Health shuts down, the receiver finds a
(02:06):
clinic willing to accept the genetic material, the Tennessee Fertility
Institute or TFI. This is the news patients have been
waiting for the chance to start again.
Speaker 3 (02:18):
Precious genetic material that was at the Center for Reproductive
Health moved down I sixty five to Franklin last week.
The fertility clinic that accepted that tissue. From what I've learned,
still has their work cut out for them.
Speaker 1 (02:30):
But any excitement is quickly dampened because the records are
such a mess. A full audit is required. Every embryo,
egg and vile of sperm needs a paper trail showing
who it belongs to, how it was created, and how
it's been stored. The Tennessee Fertility Institute has to comb
through crch's record keeping systems and verify that everything is
(02:55):
properly linked to the right patient before anything can be released.
This won't be easy. In total, there's almost twelve hundred
embryos to sort and identify. So the patients wait again.
They hope the audit will finally bring clarity. Instead, it
exposes just how unstable crch's operations really were and how
(03:19):
much trust had already been broken. I'm Melissa Jelson from
School of Humans and iHeart Podcasts. This is what happened
in Nashville episode for the audit.
Speaker 4 (03:44):
Great anxiously waiting this letter the day on This is
October second, twenty twenty four, and you know the SICH
closed in April, so this is a long time coming.
Speaker 1 (03:56):
This is Kristen Wall. She and her wife Diana are
both for more patients of the Center for Reproductive Health.
When the clinic closed, they were new parents to a
baby conceived through IVF, one of the two thousand children.
Doctor Vaskaz boasted of bringing into the world.
Speaker 5 (04:14):
We just had our baby.
Speaker 4 (04:15):
We were enjoying it soaking that in and we had
her embryos frozen at CRCH.
Speaker 5 (04:22):
We hadn't even.
Speaker 4 (04:23):
Talked about our thought about starting to grow our family again,
just because we were very much in the throes of
a newborn baby, and so it really wasn't even a
blip on our radar at the time. And then I
saw that news article and my immediate thought was, our embryos.
They're not viable like they are.
Speaker 5 (04:43):
Something's happened to them, and I was terrified.
Speaker 1 (04:47):
The information trickling out doesn't ease those fears. First, there's
the report after the state inspection where authorities described observing
a dirty lab and Vaska's A currently struggling to service
the tanks. Then news breaks that Ferrera Dyer isn't a
licensed doctor. Kristin and her wife are stunned.
Speaker 4 (05:10):
He was our first contact point at ERH. He introduced
us as doctor Dyer. Everyone referred to him as doctor Dyer.
He had a white coat on, brought us in to
his office.
Speaker 1 (05:21):
They had met with dire as they navigated fertility treatments
at the clinic, although he didn't perform IVF procedures at
RH such as egg retrievals or embryo transfers. He was
the one who they said, reviewed test results with them, and,
as far as they could tell, seemed to come up
with their treatment plan. Kristin and Diana had picked the
(05:43):
Center for Reproductive Health because it offered reciprocal IVF, a
process that allows both women to participate in the experience,
one by donating the eggs, the other by carrying the baby.
In their case, Diana underwent an egg retrieval and Kristin
planned to carry. Their first embryo transfer resulted in a miscarriage.
(06:06):
On the second attempt, Doctor Vazki has transferred two embryos
to Kristin's uterus, both implanted until one stopped developing.
Speaker 5 (06:16):
I became pregnant with twins.
Speaker 6 (06:18):
Wow.
Speaker 4 (06:19):
Yeah, And as you probably know IVF, pregnancy with twins
is definitely a very high risk pregnancy, and unfortunately I
lost one of the twins, so I miss carry one
of them. I have what's called vanishing twin syndrome, and
(06:40):
it was awful and I'm still, you know, kind of
dealing with it today. But on the good side, I
did carry the other one to full term and we
do have a child, which is wonderful, but I am
still really reeling from that because I had worked through
(07:03):
my own emotions around it, and then when this CRCH
thing happened, it just threw me right back to it.
I immediately just started questioning everything. And when Kristin and Diana
finally get their medical records from the clinic, they become
even more alarmed by the state of things. In Diana's file,
(07:23):
they find information that shouldn't be there. I was scrolling
and all of a sudden, I see another woman's name,
and I'm.
Speaker 5 (07:32):
Like, who is this.
Speaker 4 (07:34):
This is a woman that had an ank retrieval at CRCH,
and I looked at the date and she had it
the day after my wife did, and it's lumped right
in the middle of my wife.
Speaker 1 (07:45):
Kristin's own records are no better. She says, there's no
documentation of her second embryo transfer, the one where Vazka
has transferred to embryos and which resulted in the birth
of their child.
Speaker 4 (07:59):
My record had absolutely no indication or record that I
had to transfer with two embryos. I just felt really
invalidating because it felt like I didn't even go through
that process.
Speaker 5 (08:13):
I just I I was like.
Speaker 4 (08:16):
You couldn't even take the time to document it or
put that in my records.
Speaker 1 (08:20):
Other patients are also receiving their medical records and sharing
their reactions on the Facebook page Sydney created. It turns
out the inconsistencies that Kristen and Diana discovered aren't unique.
Patients report missing test results, entire procedures omitted. Each discrepancy
(08:41):
adds to a growing sense of panic. If the paperwork
is wrong, what else might be.
Speaker 4 (08:48):
The more information we found out, just the less hopeful
we got. It was just like a blow every single
time we found out new information.
Speaker 1 (08:56):
The receiver releases regular status reports to update patients on
what's happening behind the scenes. Kristin, like many patients, carefully
reads through each report, and some of the details she
learns are shocking.
Speaker 4 (09:12):
I read the receiver discovered evidence that at least two
patients received the incorrect embryos for their frozen embryo transfer procedures,
and I immediately was like, holy shit, Like this is
that is my biggest fear.
Speaker 1 (09:26):
The report does add that neither of these embryo transfers
led to a pregnancy, but that doesn't help quash Kristen's fear.
That maybe she'd received an embryo that wasn't made from
her wife's egg, but from some other woman's instead. Kristin
and all the other patients must now wait for the
official embryo audit by the Tennessee Fertility Institute, the one
(09:49):
that requires going through three sets of incomplete records to
understand more.
Speaker 4 (09:56):
That same week, we get our letter in the mail
and it says you have been identified as a former
patient of the Center for Reproductive Health with cryogenically stored
genetic material. And then they said they did a physical
inventory audit and says please see below for the results,
and it says you have ten of ten embryos identified
(10:16):
in the inventory audit of the CICH doers. The account
of your genetic material matches your ch patient record.
Speaker 1 (10:24):
This might seem like reassuring news ten out of ten
embryos identified everything with its own matching record, but it's not.
Speaker 5 (10:33):
What we should have is eight.
Speaker 4 (10:35):
So I'm reading in a receiver's report that they're talking
about women receiving the wrong embryos. And then I get
this letter that says we have ten and we're only
supposed to have eight.
Speaker 1 (10:46):
The couple originally had eleven. Embryos. They transferred three, which
means they should have had eight left, but the letter
says they have ten embryos in the tanks. This is
exactly what what Kristin had been worried about.
Speaker 5 (11:02):
I mean, I about shut down.
Speaker 4 (11:05):
My immediate thought was, we have two embryos that aren't ours,
or you transferred somebody else's embryos to me.
Speaker 1 (11:15):
Kristin and her wife reach out to a lawyer who
contacts the receiver, and after an additional review, the couple
gets another letter retracting the original count. Actually there are
only eight embryos in storage. The receiver doesn't explain why
the mix up happened. Was it because of corh's messy
(11:36):
record keeping? Was it a miscommunication? It doesn't make Kristin
feel any better.
Speaker 4 (11:43):
So they were like, sorry, clerical air. And I'm like, well, okay,
so you have a clerical air. How am I supposed
to trust that the audit, the full audit you did,
was accurate. Then these receivers reports, You're just naming all
these discrepancies in the record. So I just had zero
trust that this was right.
Speaker 1 (12:05):
Kristin isn't alone. The audit uncovers widespread problems According to
a report filed by the receiver, out of a total
of six hundred and sixty four patients, one hundred and
fifty four had genetic material in storage that did not
match up with their records. That's nearly twenty five percent.
Some women like Kristin are told they have more embryos
(12:28):
than they thought, others fewer. One woman who believed she
had none discovers she has three. And then there are
other issues eighty seven patients with genetic material in storage
but no mailing address on file, and twelve specimens with
missing or indecipherable labels, which means there's no way to
(12:51):
verify who they belonged to. I asked the receiver for
more information on the audit, including details on the two
instances where patients received the wrong embryos during a transfer.
The receiver clarified that the two embryo transfers use the
correct person's genetic material, just not the intended embryo for
(13:15):
the transfer, but they declined to provide more details about
the other inconsistencies the audit discovered for patients. The audit
results are deeply unsettling, and I can understand why, speaking
from experience. When you put embryos in storage a service
it's worth noting you pay for you expect meticulous care,
(13:38):
every label confirmed, every detail exact, every record air tight.
Speaker 4 (13:44):
My wife and I both agreed that if we couldn't
be one hundred percent certain that these embryos are ours,
we would not feel comfortable using them. I was angry, honestly,
and frustrated.
Speaker 1 (13:55):
The whole audit and how the results are communicated leaves
patients like Kristen and Diana feeling abandoned.
Speaker 4 (14:03):
I felt like we deserved a phone call from somebody.
Speaker 5 (14:07):
I just felt like we deserved more.
Speaker 4 (14:10):
It's already just an emotionally hard process, and for a
lot of people, they're not coming to IVF because they've
had success.
Speaker 5 (14:19):
In getting pregnant.
Speaker 4 (14:21):
These people just don't seem to understand or care, or
they're just trying to cover their.
Speaker 1 (14:26):
Butts covering the fallout from the Center for Reproductive Health's closure,
and going through infertility myself, I keep coming back to
the same theme time with fertility. It's always a race
(14:48):
against time.
Speaker 7 (14:49):
Probably one of the better predictors of how likely a
treatment is to be successful is the age the woman
is when the procedure is performed.
Speaker 1 (14:58):
This is doctor Allan Penzius, a reproductive endocrinologist an associate
professor at Harvard Medical School, just.
Speaker 7 (15:05):
A biological fact that as women get older, reproductive capacity
goes down.
Speaker 1 (15:13):
The numbers tell the story. If you go through IVF
when you're under thirty five, you have a more than
fifty percent chance of having a baby after just one
egg retrieval. Those are great odds, But the older you get,
the lower your chances. Forty percent when you're thirty five
to thirty seven, twenty six percent between ages thirty eight
(15:37):
and forty, thirteen percent in your early forties, and once
you're over forty two, you have just a four percent
chance of having a baby after a single egg retrieval.
So biology sets the clock, that often money sets the ceiling.
(15:57):
Each cycle can cost tens of thousands of dollars, and
most insurance doesn't cover it. Every failed round isn't just
another heartbreak, it's another bill or series of bills. This
is the cruel math of infertility. Biology, time and money
all working against you at once. And that's what made
(16:21):
crh's closure so catastrophic. It didn't just delay treatment, it
robbed patients of time they could never get back and
drained the limited resources they had, Wasted time, wasted money.
This isn't supposed to happen. Fertility clinics, like other medical practices,
(16:43):
are expected to have protocols in place if they need
to close, whether for retirement, emergencies or natural disasters.
Speaker 7 (16:53):
We know that hurricanes sometimes happen, and if there's a
hurricane that's threatening to go past where an ivy F center,
sometimes it's necessary to take precautions to lock things down
and to make sure that the tanks are toped of.
Speaker 1 (17:06):
In addition to treating patients at Boston IVF, doctor Allan
Penzius is also a former board member of the American
Society for Reproductive Medicine or ASRM, an organization dedicated to
the advancement of the science and practice of reproductive medicine.
Speaker 7 (17:24):
Sometimes you have to actually move the embryos from one
location to another to keep them safe. So those are
all the obligation of the fertility center to make sure
that they've been entrusted with these very important biological materials,
to make sure that we take care of them properly.
Speaker 1 (17:39):
There are roughly five hundred fertility clinics in the US.
Doctor Penzius notes that when one has to close, which
happens from time to time, there's a well established protocol
to follow.
Speaker 7 (17:52):
So in the case of a program that knows they
might be closing for one reason or another, Let's say
a solo practice has had a great practice, it's going
to retire, and they know that in six months they're
going to be closing the practice. What do they do?
Will they notify all their patients in advance. They make
sure that anybody who has stored materials knows that they
(18:14):
can have the right to use them, or that they
can tell them where they're going to be sent to.
Maybe they've even made an arrangement with another fertility program
to transfer anything that's left over for long term story
and notified those patients to the abst of their ability.
Speaker 1 (18:33):
And this isn't unique to fertility treatment. Continuity of care,
meaning there's no interruption in your access to medical treatment,
is one of the core obligations of medicine. In fact,
Tennessee law requires physicians to notify patients if they're retiring.
Anyone seen in the past three years must be contacted,
(18:54):
urged to find a new provider, and told how to
obtain their medical records.
Speaker 7 (18:59):
Those are all the kind of things that would happen
under a normal circumstance where a clinic knows that they're
going to close and is obligated to ethically as a
practitioner or do no harm. Make sure you're transparent, make
sure you notify people, and it's very important stuff. That
would be very unusual for somebody to all of a
(19:19):
sudden have a problem that arose overnight that would require
just the door to be padlocked and nobody be available
that I can't imagine a circumstance where that would be reasonable.
Speaker 1 (19:31):
When your dentist office closes, it's inconvenient, maybe you put
off a filling, live with a toothache for a while
until you can find a new provider. But when a
fertility clinic shuts down overnight, there can be much bigger consequences.
In addition to precious time lost, there's the psychological and
(19:51):
emotional toll of not knowing when.
Speaker 2 (19:54):
Or if you'll ever.
Speaker 5 (19:55):
Be able to have children.
Speaker 8 (19:59):
Yeah.
Speaker 9 (20:00):
One thing that is interesting is that the American Medical
Association only recognized infertility as a disease of the reproductive
system in twenty seventeen, So that's really quite recent.
Speaker 1 (20:13):
This is Maria Polyyakova, an economist and associate professor of
health policy at Stanford School of Medicine. She studies the
impacts of infertility on patients.
Speaker 9 (20:24):
What we were curious about is what happens to people
who go through this process in other areas of the
life and in the londrun. I think we underestimate the
psychological aspects of this experience.
Speaker 1 (20:38):
Much of the impact of infertility remains hidden. People going
through it don't always talk about it publicly, and even
understanding how common it is isn't simple. The US doesn't
really have a system that tracks who undergoes fertility treatment
or what happens afterward, but Sweden does. In a study
(20:59):
released in twenty two twenty four by the National Bureau
of Economic Research, Polyakova and her colleagues used nationwide health
and pharmacy records to follow one point eight million Swedish
women of child bearing age, offering a rare window into
how widespread infertility is and how profoundly it shapes people's lives.
Speaker 9 (21:21):
We found that basically one in eight women have some
sort of interaction with you know, in fertility treatment. That's
as common as breast cancer in the US, and we
don't have the data for the US, but I don't
think there is any reason that that wouldn't be applicable
to the US.
Speaker 1 (21:37):
And while many infertility journeys do end with a child,
not everyone is so fortunate. When Professor Polyakova dug into
the data, she found that among women who started fertility treatment,
about three quarters had a child within eight years, but
even after all that time, nearly a quarter didn't. For
(21:59):
women who remain childless after treatment, Polyakova found they are
also likely to experience other harmful effects.
Speaker 9 (22:08):
They're much more likely to be taking various mental health medications, antidepressants,
anxiety drugs. They are more likely to experience separations the
family partnership falls apart. Basically in fertility experience itself results
in poor mental health.
Speaker 1 (22:25):
Polya Covi's theory is that it isn't the medical procedures
themselves that leave such deep scars, but the uncertainty of
not knowing what, if anything, will work.
Speaker 9 (22:36):
My guess, so this is not data, This is just
purely my guess is that it's not like the actual
medical intervention. If someone told these women, look, you're going
to have to take these drugs. It will be super painful,
and we can guarantee that you come out after three
months with a child. I think that experience of treatment
per se would not necessarily have long run effects on
(22:57):
people's health. It's this experience of coping and then hopes
not being realized, and this uncertainty.
Speaker 1 (23:05):
Her words resonated deeply with me. Even though my infertility
journey would be, by most accounts, considered easy, it left
a mark. While making this podcast, I went through three
embryo transfers trying for my second child. The first failure
was a gut punch. I spun in circles, wondering what
(23:28):
I'd done wrong. Was it something as small as getting
caught in the rain and coming home chilled, or the
fact that I had cried at my embryo transfer instead
of remaining calm. I knew this was unlikely, illogical even
but the urge to make sense of what happened was powerful.
The second failure hit even harder. I sank into a fog,
(23:52):
found a new therapist, kept myself busy with friends so
I didn't spiral into negativity. There was no reason and
why the first two transfers didn't work. My embryos were
genetically tested and highly rated. It was just a roll
of the dice. But after back to back failures, it
felt like my luck.
Speaker 2 (24:12):
Had run out.
Speaker 1 (24:14):
I only had one more embryo, one more chance. At
the age of forty one, I wasn't sure I'd be
able to go through IVF again. In the weeks leading
up to my final transfer, I mentally prepared for another failure.
I downloaded an app to journal about gratitude as a
(24:37):
reminder of what I already had as a thought experiment.
I've pictured in great detail what the future would look
like with only one biological child, and I allowed myself
to grieve the life I had envisioned. Amazingly, that third
transfer worked. I'm actually pregnant now as I record this.
(24:59):
Still the the whole experience leaves scars, the endless appointments,
the injections, the anxiety and uncertainty, and the quiet anguish
of nothing working. It wears you down, which is why
I feel so much empathy for patients like Mary, the
veterinary technician whose embryo transfer was canceled when CRCH shut down.
Speaker 10 (25:23):
No matter where I'm at in this journey, I mean,
I've been on for forever, and I'm always an en
up somehow back at square one, and it's it's like
you're at some point you have to start and think like, Okay,
the universe is literally trying to tell you something.
Speaker 6 (25:37):
Right.
Speaker 1 (25:37):
As the months go by, I talk with Mary on
the phone a few times. She's worried about a lot
of things, like if she and her husband will have
enough money to start again at a new clinic. She's
worried about their embryos, which she still doesn't have access to,
but she's especially worried about time.
Speaker 10 (25:58):
So now we are at the mercy of the courts.
I think we're just trying to hold out hope that
the embryos have been maintained in a tank properly and
that they are viable, and that one day we're going
to get them out and we're going to transfer and
we're going to be a family.
Speaker 1 (26:16):
Mary has spent five years trying to get pregnant. Her
insurance is gone, she doesn't have enough money to pay
out of pocket either. She's banking on the two embryos
she has in storage to take her from being childless
to finally becoming a mother. But as the months drag on,
with no word from the receiver on when her embryos
(26:37):
will be available, Mary feels hopeless.
Speaker 6 (26:41):
It feels like.
Speaker 8 (26:41):
I just keep getting older and my embryos keep sitting
in a tank.
Speaker 1 (26:45):
Her biggest fear is ending up in that twenty five
percent of women who pour years into fertility treatment only
to walk away with nothing. And then another option appears,
one that seems like it might all her problems. Out
of the blue, another local couple reaches out.
Speaker 8 (27:05):
They had heard of our story, they had seen us
on the news.
Speaker 1 (27:09):
They heard about Mary's traumatic experience at the Center for
Reproductive Health and offered a gift Mary and her husband.
They're leftover embryos.
Speaker 8 (27:18):
The family that owned the embryos they were older and
they didn't want them to just sit in a tank
or go to science.
Speaker 1 (27:26):
The two embryos being offered to Mary and her husband
are from an older couple who aren't planning to get
pregnant again. Genetic testing shows the embryos are what's called mosaic,
made up of both normal and abnormal sels, which means
there's less of a chance they'll result in a healthy pregnancy.
(27:47):
But Mary is desperate.
Speaker 8 (27:48):
We didn't know if we would have our embryos, like
when they were going to be released and we had
this opportunity, and it was like do we keep waiting around?
I think at that point, I like, I didn't know
how else I was going to hit more rock bottom.
Speaker 1 (28:06):
So she transfers them both and takes the chance. It
feels like the only one she has, Like, if.
Speaker 8 (28:13):
This doesn't work, then yes, I'll be devastated, but I've
been devastated for five years with results. Infertility is a
lot of hating rock bottom and picking yourself back up.
Speaker 1 (28:28):
In November twenty twenty four, seven months after the Center
for Reproductive Health suddenly closes, patients finally have access to
their embryos again. Now they have to decide what to
do with them. Many choose to establish care at the
Tennessee Fertility Institute or TFI, the clinic now holding the embryos.
(28:50):
It's the simplest option. Moving such fragile material again would
carry an additional fee and additional risk. Some women restart
treatment right away and over the next few months. There
are success stories on the Facebook support group. A handful
celebrate positive pregnancy tests.
Speaker 3 (29:10):
Currently thirteen weeks Because of TFI and doctor Miller.
Speaker 1 (29:14):
We transferred November fifth at TFI and it was a success.
Speaker 5 (29:19):
Fingers crossed, it will be the same for you.
Speaker 6 (29:21):
Just tested positive today.
Speaker 4 (29:23):
I can't believe it.
Speaker 1 (29:25):
It's been a crazy year sending baby dusk to all.
Speaker 2 (29:29):
Don't give up hope.
Speaker 1 (29:31):
But others run into unexpected issues. One woman told me
when she went in for a transfer at TFI, the
embryologist thawed the vial holding her embryo and found it
was empty. The next day, she emailed the lab asking
if her embryo had ever been there at all. The
answer it was impossible to know. She did have another embryo,
(29:55):
which they used and it was successful. Her baby was
born this past summer, but still an empty vial means
a missing embryo, and the audit hadn't even caught that mistake.
As I reported this story, I was shocked to learn
about the depth of the disarray behind the scenes at CRH.
(30:15):
This is every patient's worst nightmare. But I also began
to wonder how unique is this case really? If you
pulled back the curtain at any given fertility clinic in
the US, would you see similar problems? I asked of Fox,
a national expert on health law and bioethics.
Speaker 11 (30:35):
IVF today in the United States is far less regulated
than virtually any comparable part of medical practice, or as
compared with assisted reproduction regulation in other parts of the
developed world.
Speaker 1 (30:52):
Fox walked me through how IVF is overseen.
Speaker 2 (30:55):
In the US.
Speaker 1 (30:57):
Clinics are required to self report their success rates every
year to the CDC, which then makes the numbers public.
You can even go online look up your clinic and
see how it stacks up against others across the country.
The FDA plays a smaller role, inspecting storage facilities and
making sure donor eggs and sperm are tested for infectious diseases.
(31:20):
States may also do routine inspections, so from the outside
it looks like a web of oversight the CDC, the
FDA state regulators. In addition, IVF labs can choose to
be accredited by the College of American Pathologists or CAP,
a professional organization that evaluates laboratory quality and safety. And
(31:43):
then there are also organizations that develop guidelines for clinics
to follow, like ASRM and its affiliate, the Society for
Assisted Reproductive Technology aka SART. SART states its goal is
to establish and maintain standards so that patients received the
highest level of care. In twenty twenty one, sixty six
(32:04):
percent of IVF clinics in the United States were members
of SART, including the Center for Reproductive Health. We reached
out to both ASRM and SART for comment, but they
passed and opted not to talk to us.
Speaker 11 (32:19):
You've got these professional organizations like the American Society for
Reproductive Medicine that sets forth these industry standards or best practices,
at least for the clinics that are members of their program.
But again that's completely voluntary, and they're routinely ignored. Professional
(32:41):
self regulation has a lot of limits. We would just
never accept this in other areas of medicine.
Speaker 1 (32:48):
Fox explained that in the absence of robust federal oversight,
there's no built in quality control. What happens behind the
doors of most fertility clinics remains largely unknown.
Speaker 11 (33:01):
In other areas of healthcare, states make hospitals monitor and
report major avoidable errors, so things like mismatched blood transfusion
surgery on the wrong body part or the wrong patient.
We call these things never events because they're things that
(33:23):
just should never happen, and so states require investigations and
record keeping and preventative measures in assisted reproduction. There's no
agency or authority that tracks or polices this kind of
substantial and needless error in the US when it comes
(33:45):
to things like you know, fertility freezer failures or donor switches,
the buck stops nowhere.
Speaker 1 (33:54):
Clinics aren't required to report these incidents to federal or
state agencies, and no national database tracks them. So these errors,
including more serious never events, often go unnoticed. They only
really come to the surface when there's an obvious mistake,
like one say, a white couple unexpectedly gives birth to
(34:16):
a baby of another race. These mistakes involving mismatched race
are more easily detected for obvious reasons, but Fox thinks
there are far more that go under the radar.
Speaker 12 (34:29):
You don't see very many of at all, where like
the kids look kind of similar, they're just not the
person that was supposed to be used. Wow, all the
switches just happen to involve you know, a white person
for a black person, or an Indian person for an
Italian person or whatever. No, I think probably those are
the ones that people notice and learn about or whatever
(34:50):
that come out in the news, and probably it happens
more often there are just so many question marks. We
don't even know how frequent these errors are.
Speaker 1 (35:00):
The audit at CRH didn't reveal the kind of headline
grabbing mixups Fox describes, but with records this chaotic, no
one can say with confidence they never happened. And for
the patients, the disorganization undermines the trust they had in
their care and in their genetic material. It also creates
(35:22):
significant obstacles for patients, especially those who want to move
their embryos to healthcare providers other than TFI. As the
receiver documents in a report, many fertility clinics are hesitant
to take embryos that had originated at CRH because they
couldn't verify basic records such as how they were created,
(35:43):
cared for, or even what testing had been done. By
the end of November, only seventeen patients managed to relocate
their embryos out of TFI. By late January twenty twenty five,
that number creeps up to just thirty nine. One patient
still looking for a new home for her embryos is
(36:05):
Aaron Meyer.
Speaker 6 (36:07):
I'm Erin and we live in North Carolina. May have
a small farm and we grow flowers.
Speaker 1 (36:13):
Aaron and her husband, Gregor, begin researching alternative pathways to
parenthood after they learned they were both genetic carriers of
the same rare condition.
Speaker 13 (36:24):
There was a twenty five percent chance that we have
a child with severe publications from this genetic condition.
Speaker 1 (36:31):
They decide not to have a genetically related child, but
they still want to become parents. While searching online, they
discover the American Embryo Adoption Agency or AEAA. That again,
is a program run by doctor Vasquez, which offers patients
donated eggs and embryos, often the ones left over after
(36:53):
another couple has completed their fertility care. Even though doctor
Vasquez's facilities are local in Tennessee, not North Carolina, Aaron
and her husband feel like this is a new way forward.
Speaker 6 (37:07):
I was approaching forty, starting to feel the pressure a
little bit more and trying to say, Okay, what is
the fastest roots and to some degrade the cheapest route
right because it's still very expensive, and so adoption of
an embryo seem like a good route to go.
Speaker 1 (37:23):
In August twenty twenty two, Aaron and Gregor start working
with the American Embryo Adoption Agency. They buy three embryos
for eighteen thousand dollars. According to the paperwork provided, the
embryos are highly graded. Their cell structure looks robust, but
they haven't been genetically tested, which is not that unusual.
(37:45):
Not all couples decide to test their embryos, but Aaron
and Gregor choose to, hoping to identify the strongest embryo
to transfer first. They're stune to learn that all of
them are genetically abnormal, none are suitable to use. Eighteen
thousand dollars down the drain as a constellation, AEAA offers
(38:10):
them an additional genetically tested.
Speaker 2 (38:12):
Embryo for free.
Speaker 1 (38:14):
Aarin is eager to do an embryo transfer, so she
and her husband drive the ten hours to the Center
for Reproductive Health for the procedure.
Speaker 2 (38:23):
The transfer doesn't work.
Speaker 6 (38:26):
After that failure, we couldn't for a year, really, because
I had to really rally again. I had no emotional
reserves left. I was a heap, unable to function, unable.
Speaker 5 (38:38):
To get out of bed.
Speaker 6 (38:39):
Eventually went and got depression medications to help pull me
through this time.
Speaker 1 (38:44):
Still, Aaron and Gregor don't want to give up, and
so when they're ready, they turn once more to doctor
Vazquez's Embryo agency to see what's available.
Speaker 6 (38:55):
So we had gone back to them. Really I felt
the pressure of time at this point. So I was
forty one, about to turn forty two, really frustrated at
being slowed down. My mother had, I think, felt uneasy
about this clinic and had encouraged me to look at
other clinics. But I knew that that meant establishing care
(39:16):
with them, and that it just the time. Really was
the pressure that I was feeling the most.
Speaker 1 (39:21):
In February twenty twenty four, the couple decides to purchase
more embryos.
Speaker 2 (39:26):
We hadn't pulled the trigger.
Speaker 6 (39:28):
Everything in IDF is a gamble, and so you know, uh,
we took this gamble.
Speaker 1 (39:34):
Because that exhausted their options for loans, and their health
insurance doesn't pay for this. They make the difficult decision
to withdraw money out of their retirement fund.
Speaker 5 (39:44):
It this is a one time thing.
Speaker 6 (39:46):
This is the last time we're going to try. We're
going to take a chunk of money out of retirement
to be able to adopt new embryos and two embryos
and try at least once, maybe twice to cover the medications.
But this is a one time thing, because now we're
going to threaten our future.
Speaker 1 (40:06):
The couple paid eleven thousand dollars for two embryos. The
plan was for Aaron to begin taking medications for the
embryo transfer in April twenty twenty four.
Speaker 2 (40:17):
I had tried calling the clinic.
Speaker 5 (40:19):
Nobody was answering.
Speaker 13 (40:20):
The answering services. Well, I don't know.
Speaker 6 (40:22):
They're out today, They're going to be back tomorrow, okay,
And I put a message through the portal saying I
have tried to reach you guys multiple ways. I don't
understand what's happening. I'm a little concerned, but I'm not
getting a response back. At that point, the message bounced
on the message portal.
Speaker 1 (40:38):
That's when she learns the clinic is closed for good.
Speaker 2 (40:43):
I mean my heart sank and.
Speaker 6 (40:47):
Panic set in because this is these were our last
this was our last chance, Like.
Speaker 5 (40:53):
This was all the money on the table that we
were going to be able.
Speaker 6 (40:56):
To put and to see a clinic closed after we
had paid all of this money and had embryos sitting there,
the dream was over.
Speaker 1 (41:10):
In November, Aaron and Gregor are finally notified that they
are able to access their two embryos now stored at TFI.
These are the same ones they used retirement funds to purchase.
They try to find a clinic to move the embryos to,
preferably not in Tennessee.
Speaker 13 (41:28):
Going back to Tennessee is not my is not at
the top of my list, Like I don't trust the
state of Tennessee.
Speaker 5 (41:34):
Can we handle my health care?
Speaker 1 (41:36):
But moving the embryos is harder than they thought. They
don't have all the required paperwork, and the clinic they
want to use won't accept the embryos due to their
poor quality. This comes as a surprise to the couple.
Speaker 13 (41:50):
My cynical viewpoint was that doctor Vasquez, any American embryo
adoption agency was taking any embryos the rejects other programs
were not allowing into their system.
Speaker 5 (42:04):
They were accepting embryos that were not considered the.
Speaker 13 (42:06):
Highest grade or the most valuable, and ones that were
best for their patience.
Speaker 1 (42:12):
I asked doctor Vaskez's attorney about these claims, but haven't
received a response. Erin is now involved in the state's
consumer protection case against the clinic.
Speaker 5 (42:23):
You know, we certainly haven't gotten any of the money bag.
Speaker 2 (42:26):
I don't know what we're going to do yet.
Speaker 1 (42:30):
Aaron's fertility journey moving forward is uncertain. She's not sure
what to do with the two embryos in Tennessee at TFI.
She and her husband are out of money and can't
buy more embryos, and every day that goes by, she's
getting older.
Speaker 2 (42:48):
Dasquez took our last chance to try and have children
next time.
Speaker 1 (43:03):
On What Happened in Nashville, Long before the clinic's abrupt closure,
cracks were already forming.
Speaker 2 (43:11):
A patient who sued the Center for.
Speaker 1 (43:13):
Reproductive Health a year before it shut down shares their story.
Speaker 11 (43:18):
It's been the wildest of experiences of feeling isolated and
disregarded and then learning that we're not.
Speaker 7 (43:28):
The only ones and they have their own horror stories.
Speaker 1 (43:32):
Plus newly uncovered FDA reports revealed just how deep the
problems ran.
Speaker 5 (43:38):
It was like, okay, like there's not going to be
anybody left to hold this clinic up, Like it's going
to fall. We could see it coming.
Speaker 1 (43:48):
What Happened in Nashville is a production of School of
Humans and iHeart podcasts, written, reported, and hosted by me
Melissa Chelson. Our producer is Etaly's perez Ing. Your producer
is Amelia Brock, with additional production by Emily Seiner and
Carl Catle. Theme song by Jesse nice Swanger, Sound design,
(44:09):
scoring and mixing by Jeremy Thal and Jesse nice Swanger.
Fact checking by Savannah Hugh Lee and Austin Thompson. Our
production manager is Daisy Church. Voice acting by Grace Walker,
Nicky Speak and Daisy Church. Executive producers are Jason English,
Virginia Prescott, Brandon Barr, and Elsie Crowley.
Speaker 2 (44:31):
If you're enjoying the show, tell everyone you know.
Speaker 1 (44:33):
And don't forget to leave a rating in your favorite
podcast app. Tune in again next week for what happened
in Nashville
Host
Melissa Jeltsen
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