What Happened in Nashville

The Audit — Nashville E4

45 min
Dec 10, 20254 months ago
Listen to Episode
Summary

Episode 4 of 'What Happened in Nashville' examines the audit of frozen embryos at the shuttered Center for Reproductive Health, revealing widespread record-keeping failures affecting 664 patients. The episode explores how 154 patients (23%) discovered mismatches between their stored genetic material and clinic records, and investigates broader regulatory gaps in the U.S. fertility industry.

Insights
  • Fertility clinic closures create cascading crises beyond medical care—patients lose irreplaceable time in their reproductive window, draining limited financial resources with no regulatory requirement for advance notice or continuity planning
  • The U.S. fertility industry operates with minimal federal oversight compared to other developed nations; clinics self-report success rates but aren't required to report critical errors like embryo switches or freezer failures to any authority
  • Record-keeping chaos at CRH (three incompatible inventory systems) prevented detection of serious errors; an empty vial containing a missing embryo wasn't caught by the audit, suggesting systemic failures go undetected across the industry
  • Patients bear psychological and financial burden of uncertainty; infertility treatment's impact stems less from medical procedures than from prolonged hope-and-failure cycles, with 25% of women remaining childless after years of treatment
  • Embryo adoption and third-party genetic material markets lack transparency; patients purchasing embryos from Dr. Vasquez's agency received low-quality genetic material without adequate disclosure, suggesting predatory practices in unregulated segments
Trends
Regulatory arbitrage in fertility medicine: U.S. clinics operate with voluntary compliance frameworks while other developed nations enforce mandatory oversight, creating quality disparitiesPsychological toll of infertility underestimated: Research shows 1-in-8 women undergo fertility treatment; untreated uncertainty drives mental health crises, family dissolution, and long-term medication dependenceEmbryo transfer errors likely underreported: Mismatches involving visibly different races surface publicly, but same-race switches likely go undetected due to lack of mandatory reporting or national tracking databaseTime scarcity as market vulnerability: Aging patients facing biological clocks become susceptible to predatory pricing and low-quality services; fertility clinics exploit urgency without accountabilityMedical record fragmentation enables patient harm: Multiple incompatible record systems at single clinic create liability gaps; no federal standard for fertility clinic data management or interoperabilityEmbryo custody and access barriers: Even after clinic closure, patients struggle to relocate embryos due to incomplete records; only 39 of 664 patients relocated embryos by late January 2025, trapping them at successor clinicsProfessional self-regulation failure: ASRM and SART membership is voluntary and non-binding; organizations decline transparency requests, suggesting industry resistance to external accountabilityGenetic material valuation disconnect: Patients pay tens of thousands for embryos without genetic testing; low-quality embryos sold as 'highly graded' indicates information asymmetry and fraud in adoption markets
Topics
Fertility clinic regulation and oversight gaps in the United StatesEmbryo storage and cryogenic preservation protocols and failuresMedical record-keeping standards in reproductive medicinePatient notification and continuity of care obligations for clinic closuresEmbryo transfer errors and genetic material mismatchesInfertility treatment outcomes and psychological impact on patientsEmbryo adoption and third-party genetic material marketsFDA and CDC oversight of fertility clinics and donor screeningState-level medical licensing and physician notification requirementsASRM and SART industry standards and voluntary complianceReceiver-appointed court oversight of clinic asset liquidationGenetic testing of embryos and mosaic embryo viabilityInsurance coverage gaps for fertility treatmentBiological age and reproductive capacity decline in women over 35Never events in assisted reproduction and error reporting
Companies
Center for Reproductive Health (CRH)
Nashville fertility clinic that abruptly closed in April 2024, triggering state receivership and audit of 664 patient...
Tennessee Fertility Institute (TFI)
Franklin-based clinic that accepted CRH's 1,200 frozen embryos in August 2024 and conducted the audit revealing 154 p...
American Embryo Adoption Agency (AEAA)
Dr. Vasquez-operated program selling donated embryos to patients; sold low-quality, untested embryos to Erin Meyer fo...
Boston IVF
Fertility clinic where Dr. Alan Penzias practices and serves as former board member of ASRM, providing expert comment...
American Society for Reproductive Medicine (ASRM)
Professional organization setting industry standards and guidelines for fertility clinics; declined to comment on epi...
Society for Assisted Reproductive Technology (SART)
ASRM affiliate organization claiming to establish standards for patient care; 66% of U.S. IVF clinics were members in...
College of American Pathologists (CAP)
Professional organization offering optional accreditation for IVF labs to evaluate laboratory quality and safety stan...
iHeartRadio
Podcast distribution platform and production company producing 'What Happened in Nashville' series through School of ...
People
Dr. Vasquez
Owner of Center for Reproductive Health; unlicensed staff member Ferrer Dyer presented as 'Dr. Dyer'; clinic closed A...
Ferrer Dyer
Unlicensed individual at CRH who presented himself as 'Dr. Dyer' to patients, reviewed test results and treatment pla...
Kristen Wall
Former CRH patient whose audit letter initially showed 10 embryos instead of 8, then retracted as 'clerical error'; e...
Diana
Kristen Wall's wife and CRH patient; found another woman's medical information in her clinic file, indicating severe ...
Mary
Veterinary technician and CRH patient; spent 5 years trying to conceive; embryo transfer canceled when clinic closed;...
Erin Meyer
North Carolina patient who purchased embryos from AEAA for $18,000; all three were genetically abnormal; withdrew ret...
Gregor
Erin Meyer's husband; genetic carrier of rare condition; couple pursued embryo adoption through AEAA and faced financ...
Dr. Alan Penzias
Reproductive endocrinologist at Boston IVF and former ASRM board member; expert on IVF protocols, success rates by ag...
Maria Polyakova
Health policy economist at Stanford; studied 1.8M Swedish women to show 1-in-8 undergo fertility treatment and psycho...
Dove Fox
National expert on health law and bioethics; explained U.S. IVF regulatory gaps compared to other developed nations a...
Melissa Jeltsin
Host and reporter of 'What Happened in Nashville' podcast; personally experienced three embryo transfers while report...
Sydney
CRH patient who created Facebook support group where patients shared medical record discrepancies and coordinated res...
Quotes
"I read the receiver discovered evidence that at least two patients received incorrect embryos for their frozen embryo transfer procedures. And I immediately was like, holy shit, like this is, that is my biggest fear."
Kristen Wall
"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 10 and we're only supposed to have eight."
Kristen Wall
"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."
Dove Fox
"In assisted reproduction, there's no agency or authority that tracks or polices this kind of substantial and needless error. In the U.S., when it comes to things like, you know, fertility freezer failures or donor switches, the buck stops nowhere."
Dove Fox
"It's this experience of, like, hoping and then hopes not being realized and this uncertainty. That's what leaves such deep scars."
Maria Polyakova
"Dasquez took our last chance to try and have children."
Erin Meyer
Full Transcript
I'm Nancy Glass, host of the Burden of Guilt Season 2 podcast. This is a story about a horrendous lie that destroyed two families. Late one night, Bobby Gumpwright became the victim of a random crime. The perpetrator was sentenced to 99 years until a confession changed everything. I was a monster. Listen to Burden of Guilt Season 2 on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. When segregation was a law, one mysterious Black club owner, Charlie Fitzgerald, had his own rules. Segregation in the day, integration at night. It was like stepping on another world. Was he a businessman? A criminal? A hero? Charlie was an example of power. They had to crush him. Charlie's Place, from Atlas Obscura and Visit Myrtle Beach. Listen to Charlie's Place on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is the biggest night in podcasting. The countdown is on to our 2026 iHeart Podcast Awards. Live from South by Southwest, March 16th, we'll honor the very best in podcasting from the past year and celebrate the most innovative, talented creators in the industry. It's truly a who's who of the podcasting world. Creativity, knowledge, and passion will all be on full display. And the winner of the iHeart Podcast Award is... See all the nominees now at iHeart.com slash podcast awards. Audible is a proud sponsor of the Audible Audio Pioneer Award. Explore the best selection of audiobooks, podcasts, and originals all in one easy app. Audible. There's more to imagine when you listen. Sign up for a free trial at audible.com. Hey everyone, it's Emily Simpson and Shane Simpson from the Legally Brunette Podcast. Each week, we're bringing you true crime through a legal lens. Whether you want all the facts on the disappearance of Nancy Guthrie, or you still need to wrap your head around the ditty verdict, we're breaking it all down step by step. And we're not just lawyers, we're also husband and wife. It makes for some pretty entertaining episodes. Listen to Legally Brunette on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Saturday, May 2nd, country's biggest stars will be in Austin, Texas, at our 2026 iHeart Country Festival presented by Capital One. See Kane Brown, Parker McCollum, Riley Green, Shabuzi, Dylan Scott, Russell Dickerson, Gretchen Wilson, Chase Matthew, Lauren Alaina. Tickets are on sale now. Get yours before they sell out at Ticketmaster.com. It's late April 2024. The Center for Reproductive Health is closed. The clinic itself is dark. The door is locked. Dr. Vasquez is no longer allowed to handle patient records or anything else involving the clinic. The state has taken 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 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. But this isn't a simple task. Digging into the 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. In May, they get a 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. 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 patience, 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 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. Precious genetic material that was at the Center for Reproductive Health moved down I-65 to Franklin last week. The fertility clinic that accepted that tissue from what I've learned still has their work cut out for them. But any excitement is quickly dampened. Because the records are such a mess, a full audit is required. Every embryo, egg, and vial 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 CRH's record-keeping systems and verify that everything is properly linked to the right patient before anything can be released. This won't be easy. In total, there's almost 1,200 embryos to sort and identify. So the patients wait again. They hope the audit will finally bring clarity. Instead, it exposes just how unstable CRH's operations really were, and how much trust had already been broken. I'm Melissa Jeltsin. From School of Humans and iHeart Podcasts, this is What Happened in Nashville. Episode 4, The Audit. great anxiously awaiting this letter the date on this is october 2nd 2024 and you know the crh closed in april so this is a long time coming this is kristen wall she and her wife diana are both former patients of the Center for Reproductive Health. When the clinic closed, they were new parents to a baby conceived through IVF. One of the 2,000 children, Dr. Vasquez boasted of bringing into the world. We just had our baby. We were enjoying it, soaking that in, and we had our embryos frozen at CRH. We hadn't even talked about or 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, something's happened to them. And I was terrified. 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 Vasquez apparently struggling to service the tanks. Then news breaks that Ferrer Dyer isn't a licensed doctor. Kristen and her wife are stunned. He was our first contact point at CRH. He introduced us as Dr. Dyer. Everyone referred to him as Dr. Dyer. He had a white coat on, brought us into his office. They had met with Dyer as they navigated fertility treatments at the clinic. Although he didn't perform IVF procedures at CRH, 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. Kristen and Diana had picked the 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 Kristen planned to carry. Their first embryo transfer resulted in a miscarriage. On the second attempt, Dr. Vasquez transferred two embryos to Kristen's uterus, both implanted until one stopped developing. I became pregnant with twins. Wow. Yeah. And as you probably know, an IVF pregnancy with twins is definitely a very high-risk pregnancy. And unfortunately, I lost one of the twins, so I miscarried one of them. I have what's called vanishing twin syndrome and 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 my own emotions around it And then when this CRH thing happened, it just threw me right back to it. I immediately just started questioning everything. And when Kristen and Diana finally get their medical records from the clinic, they become even more alarmed by the state of things. In Diana's file, 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 like, who is this? This is a woman that had an egg retrieval at CRH, 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. Kristen's own records are no better. She says there's no documentation of her second embryo transfer, the one where Vazquez transferred two embryos, and which resulted in the birth of their child. My records had absolutely no indication or record that I had a transfer with two embryos. It just felt really invalidating because it felt like I didn't even go through that process. I just, I was like, you couldn't even take the time to document it or put that in my records. 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 adds to a growing sense of panic. If the paperwork is wrong, what else might be? 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. The receiver releases regular status reports to update patients on what's happening behind the scenes. Kristen, like many patients, carefully reads through each report. And some of the details she learns are shocking. I read the receiver discovered evidence that at least two patients received incorrect embryos for their frozen embryo transfer procedures. And I immediately was like, holy shit, like this is, that is my biggest fear. 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. Kristen and all the other patients must now wait for the official embryo audit by the Tennessee Fertility Institute, the one that requires going through three sets of incomplete records to understand more. 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 it says, please see below for the results. And it says you have 10 of 10 embryos identified in the inventory audit of the CRH doers. The count of your genetic material matches your CRH patient record. This might seem like reassuring news. 10 out of 10 embryos identified. Everything with its own matching record. But it's not. What we should have is eight. 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 10 and we're only supposed to have eight. The couple originally had 11 embryos. They transferred three, which means they should have had eight left. But the letter says they have 10 embryos in the tanks. This is exactly what Kristen had been worried about. I mean, I about shut down. My immediate thought was we have two embryos that aren't ours, or you transferred somebody else's embryos to me. Kristen 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 explain why the mix happened Was it because of CRH's messy record-keeping? Was it a miscommunication? It doesn't make Kristen feel any better. So they were like, sorry, clerical error. And I'm like, well, okay, so you have a clerical error. how am I supposed to trust that the audit, the full audit you did, was accurate. In these receivers' reports, you're just naming all these discrepancies in the records. So I just had zero trust that this was right. Kristen isn't alone. The audit uncovers widespread problems. According to a report filed by the receiver, out of a total of 664 patients, 154 had genetic material in storage that did not match up with their records. That's nearly 25%. Some women, like Kristen, are told they have more embryos than they thought. Others, fewer. One woman who believed she had none discovers she has three. And then there are other issues. 87 patients with genetic material in storage but no mailing address on file. And 12 specimens with missing or indecipherable labels, which means there's no way to verify who they belong 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 used the correct person's genetic material, just not the intended embryo for 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 that's worth noting you pay for, you expect meticulous care. Every label confirmed. Every detail exact. Every record airtight. My wife and I both agreed that if we couldn't be 100% certain that these embryos are ours, we would not feel comfortable using them. I was angry, honestly, and frustrated. The whole audit and how the results are communicated leaves patients like Kristen and Diana feeling abandoned. I felt like we deserved a phone call from somebody. I just felt like we deserved more. 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 in getting pregnant. These people just don't seem to understand or care or they're just trying to cover their butts. I'm Nancy Glass, host of the Burden of Guilt Season 2 podcast. This is a story about a horrendous lie that destroyed two families. Late one night, Bobby Gumpright became the victim of a random crime. He pulls the gun, tells me to lie down on the ground. He identified Jermaine Hudson as the perpetrator. Jermaine was sentenced to 99 years. I'm like, Lord, this can't be real. I thought it was a mistaken identity. The best lie is partial truth. For 22 years, only two people knew the truth. Until a confession changed everything. I was a monster. Listen to Burden of Guilt Season 2 on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is the biggest night in podcasting. The countdown is on to our 2026 iHeart Podcast Awards. Live from South by Southwest, March 16th, we'll honor the very best in podcasting from the past year and celebrate the most innovative, talented creators in the industry. It's truly a who's who of the podcasting world. Creativity, knowledge, and passion will all be on full display. And the winner of the iHeart Podcast Award is... See all the nominees now at iHeart.com slash podcast awards. Audible is a proud sponsor of the Audible Audio Pioneer Award. Explore the best selection of audiobooks, podcasts, and originals all in one easy app. Audible. There's more to imagine when you listen. Sign up for a free trial at audible.com. Hey, everyone, it's Emily Simpson and Shane Simpson from the Legally Brunette podcast. Each week, we're bringing you true crime through a legal lens. Whether you want all the facts on the disappearance of Nancy Guthrie or you still need to wrap your head around the ditty verdict, we're breaking it all down step by step. And we're not just lawyers. We're also husband and wife. It makes for some pretty entertaining episodes. Listen to Legally Brunette on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. This is Ryder Strong with a podcast called The Red Weather. In 1995, my neighbor, Anna Traynor, disappeared from a commune. It was nature and trees and praying and drugs. No, I am not your guru. Back then, I lied to everybody. They have had this case for 30 years. I'm going back to my hometown to uncover the truth. You can now binge all episodes of The Red Weather on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. everyone needs to take care of their mental health even running back bijon robinson when i'm on the field and feeling the pressure i usually just take a deep breath when i'm just breathing and seeing what's in front of me everything just slows down it just makes me feel great before i run the play just like bijon we all need a strong mental game on and off the field make a game plan for your mental health at loveyourmindplaybook.org love your mind brought to you by the huntsman mental Health Foundation, the Arthur M. Blank Family Foundation, and the Ag Council. 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 against time. 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. This is Dr. Alan Penzias, a reproductive endocrinologist and associate professor at Harvard Medical School. Just a biological fact that as women get older, reproductive capacity goes down. The numbers tell the story. If you go through IVF when you're under 35, you have a more than 50% chance of having a baby after just one egg retrieval. Those are great odds. But the older you get, the lower your chances. 40% when you're 35 to 37. 26% between ages 38 and 40. 13% in your early 40s. And once you're over 42, you have just a 4% chance of having a baby after a single egg retrieval. So biology sets the clock. but often money sets the ceiling. 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 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, are expected to have protocols in place if they need to close, whether for retirement, emergencies, or natural disasters. We know that hurricanes sometimes happen. And if there's a hurricane that's threatening to go past where an IVF center, sometimes it's necessary to take precautions to lock things down and to make sure that the tanks are topped off. In addition to treating patients at Boston IVF, Dr. Alan Penzias 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. 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. There are roughly 500 fertility clinics in the U.S. Dr. Penzias notes that when one has to close, which happens from time to time, there's a well-established protocol to follow. So in the case of a program that knows they might be closing, for one reason or another, let's say a doctor who's in solo practice has had a great practice, is going to retire. And they know that in six months they're going to be closing the practice. What do they do? Well, they notify all their patients in advance. They make sure that anybody who has stored materials knows that they 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 storage and notified those patients to the best of their ability. And this isn't unique to fertility treatment. Continuity of care, meaning there's no interruption and 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, urged to find a new provider, and told how to obtain their medical records. 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. It would be very unusual for somebody to all of a sudden have a problem that arose overnight that would require just the door to be padlocked and nobody be available. I can't imagine a circumstance where that would be reasonable. 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 emotional toll of not knowing when or if you'll ever be able to have children. One thing that is interesting is that the American Medical Association only recognized infertility as a disease of the reproductive system in 2017. So that's really quite recent. This is Maria Polyakova, an economist and associate professor of health policy at Stanford School of Medicine. She studies the impacts of infertility on patients. What we were curious about is what happens to people who go through this process in other areas of their life and in the long run. I think we underestimate the psychological aspects of this experience. 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 U.S. doesn't really have a system that tracks who undergoes fertility treatment or what happens afterward. But Sweden does. In a study released in 2024 by the National Bureau of Economic Research, Pauliakova and her colleagues used nationwide health and pharmacy records to follow 1.8 million Swedish women of childbearing age, offering a rare window into how widespread infertility is and how profoundly it shapes people's lives. We found that basically one in eight women have some sort of interaction with, you know, infertility treatment. That's as common as breast cancer in the U.S. We don't have the data for the U.S., but I don't think there is any reason that that wouldn't be applicable to the U.S. 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 women who remain childless after treatment, Polyakova found that they are also likely to experience other harmful effects. They are 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 infertility experience itself results in poor mental health Polyakov theory is that it isn the medical procedures themselves that leave such deep scars but the uncertainty of not knowing what, if anything, will work. 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 people's health. It's this experience of, like, hoping and then hopes not being realized and this uncertainty. 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 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, found a new therapist, kept myself busy with friends so I didn't spiral into negativity. There was no reason 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 had run out. I only had one more embryo. One more chance. At the age of 41, 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 reminder of what I already had. As a thought experiment, I 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. Still, 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 CRH shut down. No matter where I'm at in this journey, I mean, I've been on it for forever. And I'm always ending up somehow back at square one. And it's like at some point you have to start and think like, OK, the universe is literally trying to tell me something, right? 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. 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. 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 will be available, Mary feels hopeless. It feels like I just keep getting older and my embryos keep sitting in a tank. Her biggest fear is ending up in that 25% 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 solve all her problems. Out of the blue, another local couple reaches out. They had heard of our story. They had seen us on the news. They heard about Mary's traumatic experience at the Center for Reproductive Health and offered a gift Mary and her husband their leftover embryos. The family that owned the embryos, they were older. And they didn't want them just to sit in a tank or go to science. 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 cells. Which means there's less of a chance they'll result in a healthy pregnancy. But Mary is desperate. We didn't know if we would have our embryos, like when they were going to be released. And we had this opportunity. 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. So she transfers them both and takes the chance. It feels like the only one she has. Like if 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 hitting rock bottom and picking yourself back up. I'm Nancy Glass, host of the Burden of Guilt Season 2 podcast. This is a story about a horrendous lie that destroyed two families. Late one night, Bobby Gumpright became the victim of a random crime. He pulls the gun. tells me to lie down on the ground. He identified Jermaine Hudson as the perpetrator. Jermaine was sentenced to 99 years. I'm like, Lord, this can't be real. I thought it was a mistaken identity. The best lie is partial truth. For 22 years, only two people knew the truth until a confession changed everything. I was a monster. Listen to Burden of Guilt Season 2 on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is Ryder Strong with a podcast called The Red Weather. In 1995, my neighbor, Anna Traynor, disappeared from a commune. It was nature and trees and praying and drugs. No, I am not your guru. Back then, I lied to everybody. They have had this case for 30 years. I'm going back to my hometown to uncover the truth. You can now binge all episodes of The Red Weather on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is the biggest night in podcasting. The countdown is on to our 2026 iHeart Podcast Awards. Live from South by Southwest, March 16th, we'll honor the very best in podcasting from the past year and celebrate the most innovative, talented creators in the industry. It's truly a who's who of the podcasting world. Creativity, knowledge, and passion will all be on full display. And the winner of the iHeart Podcast Award is... See all the nominees now at iHeart.com slash podcast awards. Audible is a proud sponsor of the Audible Audio Pioneer Award. Explore the best selection of audiobooks, podcasts, and originals all in one easy app. Audible. There's more to imagine when you listen. Sign up for a free trial at audible.com. Hey, everyone, it's Emily Simpson and Shane Simpson from the Legally Brunette podcast. Each week, we're bringing you true crime through a legal lens. Whether you want all the facts on the disappearance of Nancy Guthrie or you still need to wrap your head around the ditty verdict, we're breaking it all down step by step. And we're not just lawyers. We're also husband and wife. It makes for some pretty entertaining episodes. Listen to Legally Brunette on the iHeartRadio app, Apple Podcasts or wherever you get your podcasts. everyone needs to take care of their mental health even running back B. John Robinson when I'm on the field and feeling the pressure usually just take a deep breath when I'm just breathing and seeing what's in front of me everything just slows down it just makes me feel great before I run the play just like B. John we all need a strong mental game on and off the field make a game plan for your mental health at love your mind playbook.org love your mind brought to you by the Huntsman Mental Health Foundation, the Arthur M. Blank Family Foundation, and the Ag Council. In November 2024, 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. 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. Currently 13 weeks because of TFI and Dr. Miller. We transferred November 5th at TFI and it was a success. Fingers crossed it will be the same for you. Just tested positive today. I can't believe it. It's been a crazy year. Sending baby dust to all. Don't give up hope. 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, 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. 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 U.S., would you see similar problems? I asked Dove Fox, a national expert on health law and bioethics. 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. Fox walked me through how IVF is overseen in the U.S. 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. 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 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 receive the highest level of care. In 2021, 66% 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. 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 self-regulation has a lot of limits. We would just never accept this in other areas of medicine. 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. In other areas of healthcare, states make hospitals monitor and report major avoidable errors. So things like a mismatched blood transfusion, surgery on the wrong body part or the wrong patient We call these things never events because they things that 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 U.S., when it comes to things like, you know, fertility freezer failures or donor switches, the buck stops nowhere. 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 when, say, a white couple unexpectedly gives birth to 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. You don't see very many, if at all, where like the kids look kind of similar. They're just not the person that was supposed to be used. Well, all the switches just happen to involve a, 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 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. The audit at CRH didn't reveal the kind of headline-grabbing mix-ups 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 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, cared for, or even what testing had been done. By the end of November, only 17 patients managed to relocate their embryos out of TFI. By late January 2025, that number creeps up to just 39. One patient still looking for a new home for her embryos is Erin Meyer. I'm Erin, and we live in North Carolina. We have a small farm, and we grow flowers. Erin and her husband, Gregor, begin researching alternative pathways to parenthood after they learned they were both genetic carriers of the same rare condition. There was a 25% chance that we would have a child with severe complications from this genetic condition. 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 Dr. Vasquez, which offers patients donated eggs and embryos, often the ones left over after another couple has completed their fertility care. Even though Dr. Vasquez's facilities are located in Tennessee, not North Carolina, Erin and her husband feel like this is a new way forward. I was approaching 40, starting to feel the pressure a little bit more and trying to say, OK, what is the fastest route? And to some degree, the cheapest route, right, because it's still very expensive. And so adoption of an embryo seemed like a good route to go. In August 2022, Erin and Gregor start working with the American Embryo Adoption Agency. They buy three embryos for $18,000. 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. 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 stunned to learn that all of them are genetically abnormal. None are suitable to use. $18,000 down the drain. As a consolation, AEAA offers them an additional genetically tested embryo for free. Erin is eager to do an embryo transfer, so she and her husband and drive the 10 hours to the Center for Reproductive Health for the procedure. The transfer doesn't work. 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 to get out of bed. Eventually, I went and got depression medications to help pull me through this time. Still, Aaron and Gregor don't want to give up. And so when they're ready, they turn once more to Dr. Vasquez's embryo agency to see what's available. So we had gone back to them. Really, I felt the pressure of time at this point. So I was 41, about to turn 42, 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 with them and that just the time really was the pressure that I was feeling the most. In February 2024, the couple decides to purchase more embryos. We went ahead and pulled the trigger. Everything in IVF is a gamble. And so, you know, we took this gamble. 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. It was, this is a one-time thing. 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. The couple paid $11,000 for two embryos. The plan was for Aaron to begin taking medications for the embryo transfer in April 2024. I tried calling the clinic. Nobody was answering. The answering service said, well, I don't know. They're out today. They're going to be back tomorrow. OK, 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 that I'm not getting a response back. At that point, the message bounced on the message portal. That's when she learns the clinic is closed. for good. I mean, my heart sank and panic set in because this was our last chance. This was all the money on the table that we were going to be able 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. 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. Going back to Tennessee is not my, it's not the top of my list. Like, I don't trust the state of Tennessee to handle my health care. 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. My cynical viewpoint was that Dr. Vasquez and the American Embryo Adoption Agency was taking any embryos, the rejects that other programs were not allowing into their system. They were accepting embryos that were not considered the highest grade or the most viable and the ones that were best for their patients. I asked Dr. Vasquez's attorney about these claims, but haven't received a response. Aaron is now involved in the state's consumer protection case against the clinic. You know, we certainly haven't gotten any of the money back. I don't know what we're going to do yet. Erin'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. And Dasquez took our last chance to try and have children. Next time on What Happened in Nashville. Long before the clinic's abrupt closure, cracks were already forming. A patient who sued the Center for Reproductive Health a year before it shut down shares their story. It's been the wildest of experiences of feeling isolated and disregarded and then learning that we're not the only ones. and they have their own horror stories. Plus, newly uncovered FDA reports reveal just how deep the problems ran. 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. What Happened in Nashville is a production of School of Humans and iHeart Podcasts. Written, reported, and hosted by me, Melissa Chilton. Our producer is Edelise Perez. Our senior producer is Amelia Brock, with additional production by Emily Seiner and Carl Cadel. Theme song by Jesse Nye Swanger. Sound design, scoring, and mixing by Jeremy Thal and Jesse Nye Swanger. Fact-checking by Savannah Hughley and Austin Thompson. Our production manager is Daisy Church. Voice acting by Grace Walker, Nikki Speak, and Daisy Church. Executive producers are Jason English, Virginia Prescott, Brandon Barr, and Elsie Crowley. If you're enjoying the show, tell everyone you know, and don't forget to leave a rating in your favorite podcast app. Tune in again next week for What Happened in Nashville. I'm Nancy Glass, host of the Burden of Guilt Season 2 podcast. This is a story about a horrendous lie that destroyed two families. Late one night, Bobby Gumpright became the victim of a random crime. The perpetrator was sentenced to 99 years until a confession changed everything. I was a monster. Listen to Burden of Guilt Season 2 on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is Ryder Strong, and I have a new podcast called The Red Weather. In 1995, my neighbor, Anna Traynor, disappeared from a commune. It was nature and trees and praying and drugs. No, I am not your guru. Back then, I lied to everybody. They have had this case for 30 years. I'm going back to my hometown to uncover the truth. Listen to The Red Weather on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is the biggest night in podcasting. The countdown is on to our 2026 iHeart Podcast Awards. Live from South by Southwest, March 16th, we'll honor the very best in podcasting from the past year and celebrate the most innovative, talented creators in the industry. It's truly a who's who of the podcasting world. Creativity, knowledge, and passion will all be on full display. And the winner of the iHeart Podcast Award is... See all the nominees now at iHeart.com slash podcast awards. Audible is a proud sponsor of the Audible Audio Pioneer Award. Explore the best selection of audiobooks, podcasts, and originals all in one easy app. Audible. There's more to imagine when you listen. Sign up for a free trial at audible.com. When segregation was a law, one mysterious black club owner, Charlie Fitzgerald, had his own rules. Segregation in the day, integration at night. It was like sipping on another world. Was he a businessman? A criminal? A hero? Charlie was an example of power. They had to crush him. Charlie's Place, from Atlas Obscura and Visit Myrtle Beach. Listen to Charlie's Place on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, everyone. It's Emily Simpson and Shane Simpson from the Legally Brunette podcast. Each week, we're bringing you true crime through a legal lens. Whether you want all the facts on the disappearance of Nancy Guthrie, or you still need to wrap your head around the ditty verdict, we're breaking it all down step by step. And we're not just lawyers. We're also husband and wife. It makes for some pretty entertaining episodes. Listen to Legally Brunette on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. This is an iHeart Podcast. Guaranteed human.