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This is an I Heart Podcast. Guaranteed Human. This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or OSA in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snored loudly, or if you spend your days fighting off excessive tiredness, irritability and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lilly, a medicine company. So you're telling me that the AI that's meant to make everyone's job easier to manage just adds more to manage on top of the thousands of apps the IT department already manages? Funny how that works. Any business can add AI. IBM helps you scale and manage AI to change how you do business. Let's create Smile to Business IBM. This is Matt Rogers from Los Culturistas with Matt Rogers and Bowen Yang. This is Bowen Yang from Las Culturistas with Matt Rogers and Bowen Yang. Hey Bowen, it's gift season. Ugh, stressing me out. Why are the people I love so hard to shop for? Probably because they only make boring gift guides that totally uninspired. Except for the guide we made in partnership with Marshalls where premium gifts meet incredible value. It's giving gifts with categories like Best Gifts for the mom whose idea of a sensible walking shoe is a stiletto, or Best Gifts for me that were so thoughtful I really shouldn't have. Check out the guide on marshalls.com and gift the good stuff at Marshalls. What do you do when things get tough? You don't give up. You stand your ground. If you've been diagnosed with metastatic prostate cancer and have tried hormone therapy, ask your doct about Lutetium Leu177 Bifatide Tetrexitan Pluvicto is not chemotherapy. It's a different treatment that targets PSMA positive cells. Pluvicto can be used before chemotherapy for some people. Pluvicto is a prescription treatment used to treat adults with prostate specific membrane antigen positive metastatic castration resistant prostate cancer or PSMA positive MCRPC who have already been treated with hormone therapy and are considered appropriate to delay chemotherapy. Bluvicto involves contact with radioactivity which may increase the risk for cancer and cause fetal harm. Drink plenty of fluids, urinate often, use contraception and talk to your doctor about ways to reduce the risk of exposing others to radiation. During and after treatment, BlueVicto can cause low levels of blood cell counts, kidney problems and infertility. Tell your doctor if you have weakness, pale skin, shortness of breath, bleeding or bruising more easily, an infection, or changes in urination. Side effects include decreased blood cell counts, tiredness, dry mouth, nausea, appetite loss, joint or back pain, and constipation. Ask your doctor about Pluvicto, because every day without cancer progression is a victory. Visit pluvicto.com to learn more. Then the space hamster flew his hot air balloon all the way to the bottom of the ocean. Where did that story come from? Book Dream? Nope. It came from a conversation. Meet Meco Mini plus, the AI companion that co creates personalized story adventures with your child in real time. What color was the hamster's cape? And what. What did he pack for lunch? Unlock your child's imagination. Discover Miko Mini plus and the magic of AI exclusively at Costco. You can't go through IVF and still be 100% the same person you were when you first started out. It's going to change you. I'm sitting with Sydney in her home outside of Nashville. She's holding her baby daughter, who's giving me sweet eyes and dribbling on her bib. I know how lucky we are that we did have best case scenario. And I know that others are still trying to get there, and I. I just really hope for the best. My heart hurts for them. Sydney's daughter's name is Story for the story she represents. Sydney gave birth to her in May 2025, just a little over a year after the center for Reproductive Health shut down. She was born from one of the embryos that Sydney managed to retrieve from the clinic right before it closed and the state took over control of the cryogenic tanks. We had gone back and forth and I was like, well, what if we name her story? She has such a story. We went through so much to get here to like this point. From me having an ectopic pregnancy to going through all the things we did at the fertility clinic. And she was our little embryo that could. I will definitely share all the things that we went through to have her one day and hope she knows like how wanted she was too. She's our best little sweet story. We love her to pieces. And maybe here is where those old fairy tales return. The ones where women sacrifice everything for a child. For Sydney, her fertility journey was a wild and unpredictable experience. She lived through a burst fallopian tube Surgeries, an egg retrieval, an embryo rescue mission, and multiple transfers before she got her happy ending. Honestly, the baby snuggles are unmatched. I love a good baby snuggle with a little nap, but it's all so sweet. And I know that even though sometimes the days are long and I don't get the most sleep, that it's going to pass by so fast and she'll be going to school and everything before I know it, so I'm just trying to soak it all up. I'm Melissa Jeltson from School of Humans and iHeart podcasts. This is what happened in Nashville. Episode 6 beginnings and endings. When Sydney had story it felt like there was finally some good news after the abrupt closure of the center for Reproductive Health. Though even this happy outcome came with a bittersweet edge. She was the only patient, as far as I could tell, who managed to get her embryos out before the clinic shut down, which meant she got a head start on moving and using them. For everyone else who had embryos in storage, they had to wait from April to November, about seven months, and by then, Sydney was already three months pregnant. She told me she felt terrible about that, almost a sense of survivor's guilt that she was able to move forward while others were stuck in limbo. So she was careful about what she shared publicly in the Facebook support group, wanting the focus to remain on the patients with more pressing needs. It made me extremely nervous, like, to share just because I know what that feels like. It's a gut punch, you know, to see other people experience pregnancy while their embryos are still being inventoried. I would never want to hurt their feelings. But she did confide in one person, another former CRH patient, Mary. Having Mary, like, completely changed everything for me because, like, I had somebody to talk to that not only, like, listened, but actually, like, understood. Completely understood. I will say that the people that you do meet while going through IVF are some of the best people. So that's one thing that I'm thankful for, that because of this, because of what Dr. Vasquez has done, I will have lifelong friends like Mary. As you may remember, Mary was the woman who had an appointment the same morning as Sydney, but wasn't told about the clinic's imminent closure. Like so many others, Mary had embryos in storage, trapped behind closed doors and procedural red tape. Her dilemma, which Mary spoke about on the news, caught the attention of another local couple who offered to donate their unused embryos to her. Running out of time and patience, Mary used them and it worked. She got pregnant. And because Mary's son was premature, she actually gave birth a few weeks before Sydney. He's a five and a half months. And he just learned how to roll over from his back to tummy. So now he's just kind of rolling all over the place. So that's really cute. When I talked to Mary in the throes of new parenthood, I was struck by just how different she seemed. During most of our conversations over the past year and a half, she'd been angry, frustrated, and sad. Now she had a lightness about her. She was smiling. He has the best belly laughs. His armpits are really ticklish. And so he does this like big belly laugh when you tickle him. And it just is like, it makes you laugh so hard you cry because it's the cutest thing you've ever, like, oh, I don't know. I'm. I spend every minute I can on the floor with him, just like doing tummy time, talking, playing, and oh, everything about him is just the best. Motherhood has reshaped Mary's life in ways she's still processing. I don't even know how to explain it. It's everything and more. It's probably more. I mean, it's exhausting, but like, in the best way. I just, I love it. I love every aspect of it, all the stages. After the center for Reproductive Health shut down, Mary became a patient at a different fertility clinic, the Nashville Fertility center, which was where she had her embryo transfer. With everything Mary and her husband had been through, establishing care somewhere new required a leap of faith, a willingness to trust again. But the new clinic made it easy. Almost immediately, she told me, the difference in care felt unmistakable. I mean, the Nashville Facility center, it's just, you know, the nurses call you back same day. The doctors care so much. When we went for my first appointment with them, the doctor told me that he had spent two hours on the weekend reviewing my file before my appointment. And he wrote up notes from my experience before even talking to me to feel like he was also coming in prepared instead of just being hit with a thousand pages of medical records. So he really took the time on his days off even to prepare for our appointment. And to me, I will never forget that now with fertility care she feels she can trust. Mary wants to try for another baby soon. She finally has access to the two embryos she and her husband had in storage at crh, the ones created with donor eggs and her husband's sperm. Morty's so ready to do Another transfer. I'm like, you know, we're planning on doing one in February, so we just got cleared actually. Actually, today I had appointments, and we just got cleared, and everything looks really good. So we're gonna move forward in February with another one with our actual embryos. Since Mary successfully got pregnant and gave birth from her first embryo transfer with the Nashville Fertility center, she's hopeful about her chances of doing it again. But she still worries that her two embryos that were trapped at CRH after it shut down might have been compromised while stored there or during the transport process. Will a part of me always feel like if this doesn't work, it's because of how they were taken care of? Absolutely. But it's something I'll have to work through. That anger, that sadness. I'm trying to learn how to process that still, but it's getting there. Beyond the immediate concerns about her embryos, her quick success with the Nashville Fertility center also raises a bigger, more painful question. Mary can't help but wonder, would things have turned out differently if she hadn't started her IVF journey at the center for Reproductive Health? She did two IVF cycles with Dr. Vazquez, ending up with just one embryo, an embryo that didn't implant. After that, she says she was encouraged to move on to donor eggs and told that her own genetics were likely the issue. But what if that wasn't true? She can't stop thinking about whether she might have conceived sooner and with her own eggs if she'd been at a different clinic from the beginning. Even the specialty doctor I'm with now at the Nashville Fertility center, we had a really long meeting a month ago, and she was just like, I really think you could be successful if we did a round of ivf, like using the protocols here. She wished we had the money to do a round because she feels that we could be more be successful with having a baby with both our genes. But another round of IVF is not in the cards for the couple. If the two embryos they already have don't work, they've agreed that they'll be done with fertility treatments. We've put so much of our money, like, we. We can't move into a bigger house because, I mean, we just. We've poured every year's worth of my husband's Christmas bonuses into fertility for six years. If we keep going, we're going to take away from our son. It's going to take away from him. If I'm at appointments all the time or if I'm on you know, hormone treatments and not in, you know, they don't make you very fun. And just the expense of it all takes away from us being able to move forward in our lives. So it's not just about me and my husband anymore. Mary's not the only one left with lingering what ifs. Over the year and a half I spent reporting this case, I heard it again and again from other patients. Would our story have been different at another clinic? The truth is, there's no easy answer. Even with excellent doctors, well trained staff and impeccable care, not everyone succeeds with fertility treatment. There's that nearly 25% who try for years but never end up with a child. Sometimes there's simply no clear explanation. You can't necessarily tell if you're unsuccessful because of bad luck, biology, or if the care you got wasn't very good. Even for women who ultimately did have a child at crh, there are stubborn questions about the quality of care they received. Here's Kristen Wall, who we heard from in episode four. She and her wife had gone to CRH for reciprocal ivf. I immediately just started questioning everything. I was concerned about the care I received and I honestly thought, like, would my outcome have been different had I gone somewhere else? Kristen's first transfer with Dr. Vazquez, when she was 29 years old, ended in a miscarriage. For her second transfer, the clinic recommended she transfer two embryos at once, a practice that has largely fallen out of favor for, for healthy younger patients like Kristin. They were really pressuring us into transferring two embryos. I never, I didn't want to. I was really vulnerable at that time and really upset. In hindsight, I probably shouldn't have jumped into a transfer so quickly afterwards, but I did. And I was like, yes, do it. Like, just do it. Because they were pushing me to. And I was terrified. As you may remember, both embryos implanted and Kristin became pregnant with twins. But soon after, she had a type of miscarriage called vanishing twin syndrome when she lost one of the embryos in utero. This was exactly the type of thing she'd been wanting to avoid and why Kristin had resisted the idea to transfer two in the first place. These back to back losses impacted her deeply. Then add on to all of that, the abrupt closure of the clinic where she'd successfully conceived her child and the confusion in the months that followed. I'd been in therapy this whole last year, like, for that specific reason, because I do feel such conflicted feelings about everything, because on one hand I have a child and that's what we wanted. And she's beautiful and healthy and happy. And on the other hand, I feel a little bit robbed of that experience because I feel like I spent the first year of her life going through this really traumatic event and having to deal with it. Recently, Kristen went to another fertility clinic as she and her wife are getting ready to try to expand their family once more. There she discovered she had a condition called low protein S, which can cause blood clots and early miscarriages. Her new doctor told her that she would proactively be put on a blood thinner after she does her next embryo transfer to help prevent miscarriages. But as far as Kristin can remember, this issue never came up at crh. She doesn't think they tested for it. It's possible she has developed it since. But still the question remains. She had two miscarriages at crh. Could those have been avoided despite the challenges she faced? Kristen is now a mother because of CRH and Dr. Vazquez, and she's grateful. And so I've really been trying to come to the understanding with myself that it's okay to have two feelings at once. It's okay to be happy that that happened, and also really frustrated and sad that the other thing happened as well. And I understand that my story is my story, and it's what led me to my child. And if I'm being perfectly honest, I would go through it all again just to have her. So let me get this straight. Your company has data here, there, and everywhere, but your AI can't use the data because it's here, there, and everywhere? Seems like something's missing. Every business has unique data. IBM helps your AI access your data wherever it lives to change how you do business. Let's create Smile to Business. IBM, This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or OSA in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snore loudly, or if you spend your days fighting off excessive tiredness, irritability, and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lilly, a medicine company. This is Jacob Goldstein from what's yous Problem? When you buy business software from lots of vendors, the costs add up and it gets complicated and confusing. Odoo solves this It's a single company that sells a suite of enterprise apps that handles everything from accounting to inventory to sales. Odoo is all connected on a single platform in a simple and affordable way. You can save money without missing out on the features you need. Check out odoo@o d o o dot com. That's o d o o dot com. Then the space hamster flew his hot air balloon all the way to the bottom of the ocean. Where did that story come from? Book? Dream? Nope. It came from a conversation. Meet Meco Mini plus, the AI companion that co creates personalized story adventures with your child in real time. What color was the hamster's cape and what did he pack for lunch? Unlock your child's imagination. Discover Miko Mini plus and the magic of AI exclusively at Costco. Season two of Unrivaled Basketball is here and the talent is unreal. Paige Beckers, Nafiza Collier, Kelsey Plumb, Brianna Stewart and more are back to redefine the game. Unrivaled basketball season two sponsored by Samsung Galaxy tips off January 1st 5th on TNT True TV and HBO. Max I cannot think of another situation in life where you are in a absolute cycle of hope and despair and hope and despair and hope and despair and hope and despair every single month, time after time. It's. It's so much to bear. I returned to Nashville in September 2025, a year and a half after the clinic closed, to check in on the people I'd been following. I had planned to get together with Sydney, Mary, and both their babies, but Mary had to cancel at the last minute as she and her baby had hand, foot and mouth disease mom problems. But I did get the chance to see other CRH patients like Sarah and penny. They were two of the women who had undergone IUIs at the clinic with Dr. Ferrer Dyer, a man they say they only later learned did not have a medical license. We met at Sarah's house, the same place we'd sat together the year before, back in 2024. That was the same trip when we unsuccessfully tried to talk to Dr. Vazquez at the hearing. Since then, both women had moved to a new clinic and gone through a full round of ivf. Neither yet had a child. Whatever early optimism they once had, the belief that treatment might be straightforward or quick had been discarded. Here's Sarah the last year has been extremely difficult. We took some time to focus on my health, lose weight, and then do ivf. We had a family member, my aunt, generously offer to pay for IVF for us, and so we were able to do it, and first protocol wasn't right, so we had to stop it halfway through, start over with new meds. Second protocol, everything was perfect. I had tons of follicles, and when they got in there to do the egg retrieval, they couldn't get to over half the eggs because of a fibroid that had grown. We got nothing out of it. So we have no embryos. We don't really know what our next steps are going to be. Right now, we're weighing multiple options. Going into another egg retrieval feels very scary. I don't. I don't. I honestly don't think that I can mentally or physically make it through another failed egg retrieval. I asked Sarah how this experience, the clinic's collapse and everything that followed had affected her. I think I was so focused at a certain point on the betrayal and the mistrust and how could somebody do this? And obviously, that's never going to go away. That's always going to be there. But at this point, it's figuring out how to not let that take life away from me. Even when everything goes the way it's supposed to. Sarah told me fertility treatment changes you. This journey is one that people go on and they don't realize what's going to happen. You are never going to be the same person you were before this. Your husband's not going to be married to the same woman that he's married to before you start infertility. I spent the first two years of us doing treatments just like, I've got to get back to myself. I've got to get back to myself, but that's not reality. I'm a different person, and that's okay. And I need to find out who she is, and that's what I've spent the last eight or nine months doing. Sarah said she'd reached a point where she could think about life beyond treatment and what it might look like if IVF didn't work. If we get to the end of this and we don't end up with a baby, then we'll move on and we'll have a happy life, and we'll adopt 100 cats and animals, and we'll have a big farm, and it'll be fabulous. It's not the end of the world. It was, at one point the absolute end of the world for me not to be a mom. But I also have come to realize that just because I don't have a child of my own doesn't mean that I don't get to be a Mom, I still have two wonderful little nephews. There's kids in the neighborhood that every single kid in the neighborhood comes to our front porch. I'm a mom to whoever needs it. When Penny arrived at Sarah's house, still in scrubs from her job at a lab, she told me that she too was finally learning to live with everything that happened at the center for Reproductive Health. I mean, I think at this point it's kind of wild to say, but I think I've kind of moved past it. They never came out and said sorry for anything. But I think in my mind I have to just forgive them and move on. And she had cautiously good news to share. After the clinic closed, she had moved on to another fertility clinic in Nashville, where she had an egg retrieval. Her first embryo transfer ended in a chemical pregnancy, but her second had stuck. So far, by her count, she was five weeks pregnant. Still, she wasn't celebrating yet. She was too worried about the potential of losing the pregnancy. I think I'm. Because I've had two miscarriages, it's almost like I'm not pregnant because you don't want to get your hopes up and then shot down. So it's almost easier in my mind to just count it out. So then if anything good happens, you're on the positive side of that. But until I'm holding a baby, I think I'm going to be skeptic. I think that's the reality of it. I still test every day. I make sure the line's there, which is kind of wild because it doesn't really get darker after a certain point and you kind of just start to lose your test line. But I think I'm going to be like that until the day that I actually give birth. I think that's the reality of it. I'm trying to tell myself not to stress it one way or the other because I can't control it one way or the other. Sadly, Penny was right to guard her heart. Three weeks later, I got a text from her at Penny's eight week appointment. She'd found out the baby had no heartbeat. She'd had another miscarriage at the time. This episode comes out December 2025. The state's case against Dr. Vazquez and the center for Reproductive Health is still active. In the beginning, the focus had been on protecting genetic material and securing patient records. Since then, the case has slowed to a crawl. There's still some hope that patients might eventually receive financial restitution, but so far no one has seen a dime. I keep thinking about what accountability could even look like for people whose fertility journeys were disrupted at such a crucial point. Many patients told me they felt like the lawsuit didn't truly acknowledge the reality of what had been taken from them. The framing as a consumer protection case felt almost absurd to them. A legal category meant for knockoff products and false advertising was being used to explain what had happened to their bodies, their embryos, their mental health, their families. That's the model. It does not afford any recognition for the more profound nature of the loss. Here's legal scholar Dove Fox. Again, it says that you are a consumer, and a business did not represent the truth of a product, whether it be a TV or nachos or whatever else. It doesn't recognize your stake in health care or reproductive hopes and dreams or family planning as anything that is special that accordingly, would merit either greater protections, more care, or more compensation. And yet, a consumer protection lawsuit is often the only legal path available in cases like this, not because the harm is small, but because the law has almost no mechanism for recognizing what fertility patients actually lose when things go wrong. Fox calls this kind of harm reproductive negligence. The law just doesn't recognize the disruption of family planning as a legal cause of action. Our laws don't recognize those kinds of injuries as the sort that are either real or substantial enough for the law to care about, for courts to intervene in, to compensate people who are victims of misconduct. When the law frames these losses as simple consumer disputes, it misses their true weight. And that, says Fox, speaks to a larger unease in how the US Defines and values fertility treatment. We are really, really uncertain in this country with what it is and how we value it and how we treat it. Patients are left in the dark to plan a family at their own risk, to steel themselves against the consequences of medicine and technology when it goes awry. So let me get this straight. Your company has data here, there, and everywhere, but your AI can't use the data because it's here, there, and everywhere? Seems like something's missing. Every business has unique data. IBM helps your AI access your data wherever it lives to change how you do business. Let's create smarter business. IBM, This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea, or osa, in adults with obesity? They may be happening to you without you knowing. If anyone has ever said you snore loudly, or if you spend your days fighting off excessive tiredness, irritability, and concentration issues, it may be due to osa. OSA is a serious condition where your airway partially or completely collapses during sleep, which may cause breathing interruptions and oxygen deprivation. Learn more at don'tsleep on OSA.com this information is provided by Lilly, a medicine company. Jacob this is Jacob Goldstein from what's yous Problem? Business software is expensive, and when you buy software from lots of different companies, it's not only expensive, it gets confusing. Slow to use, hard to integrate. Odoo solves that because all Odoo software is connected on a single affordable platform. Save money without missing out on the features you need. Odoo has no hidden costs and no limit on features or data. Odoo has over 60 apps available for any needs your business might have, all at no additional charge. Everything from websites to sales to inventory to accounting. All linked and talking to each other. Check out Odoo at o d o o.com that's o d o o.com then the space hamster flew his hot air balloon all the way to the bottom of the ocean. Where did that story come from? Book? Dream? Nope. It came from a conversation. Meet Mikomini, the AI companion that co creates personalized story adventures with your child in real time. What color was the hamster's cape and what did he pack for lunch? Unlock your child's imagination. Discover Miko Mini plus and the magic of AI Exclusively at Costco. Season two of Unrivaled Basketball is here and the talent is unreal. Paige Beckers, Nafiza Collier, Kelsey Plumb, Brianna Stewart and more are back to redefine the game. Unrivaled basketball season two, sponsored by Samsung Galaxy Tips off January 5th on TNT, TruTV and HBO. Max. On my last morning in Nashville, I got up early and walked from my hotel room to the site of the former center for Reproductive Health so I could see it for myself. I brought my toddler with me, pushing her in her stroller. The walk took about 30 minutes. As I got closer, the landscape shifted from coffee shops and student housing into a full blown medical district. Suddenly it was all tall buildings, neatly marked entrances, and the kind of parking lots that wrap around hospitals like a moat. I used to work at a children's hospital in Boston and the whole scene felt familiar. Everything about it projected competence and safety. It was the kind of environment where you'd go for an MRI or cancer treatment. I could imagine as a patient of crh, how reassuring it would have felt like you were in good hands. I found the right building and walked in without issue. Jumped in the elevator. I got off on the fourth Floor. And immediately to my left, I saw the door to the now closed center for Reproductive Health. Through the glass I could see a darkened lobby, now empty of furniture. In the window, someone had taped a piece of paper explaining that the clinic was the subject of a state lawsuit and instructing patients elsewhere for more information on the sign outside the clinic, the name of the practice had been removed. It's just blank now. After a year and a half of reporting the story, I still don't have answers to everything. But I do have a theory about what happened at the center for Reproductive Health. It's not overly dramatic or conspiratorial. It's something far more ordinary and in some ways more unsettling. It's undeniable that over the years Dr. Vazquez and his team helped women become mothers. There are many children alive today because of his work. But running a full service fertility clinic is logistically complex and expensive. Dr. Vazquez had a clinical practice, an operating room and a lab. To keep it all going required constant coordination, careful record keeping and layers of internal checks. CRH was essentially a one doc shop. Dr. Vasquez wasn't part of an academic center or a multi physician practice. He didn't have the built in safeguards that come from working alongside other leaders and medical peers, the people who challenge your decisions, flag problems and keep standards tight. I don't think this is a story of intentional wrongdoing. I think it was a slow, grinding collapse. A clinic that fell behind, a physician without adequate support and no one around to intervene before the consequences shut everything down. That doesn't excuse what happened, but it does help explain how a place meant to create life could unravel the way this one did. In the end, I'm left with the belief that what happened in Nashville could happen somewhere else, and probably already has. Even in the course of reporting this story, I've met women who've had similar, though not exactly the same events occur at their clinics. One told me her fertility clinic merged with another and she lost access to her embryos for about a year, with the clinic even telling her at one point they didn't know where they were. A year of her fertile window spent just waiting, hoping to get them back. So if the same kinds of errors and missteps are happening across the IVF industry, often going unreported and undetected, then there's a bigger issue here. One that should worry anyone who's looking to go into fertility treatment. How can we prevent these mistakes and protect the patients who are risking everything? The Question is, how much regulation of those clinics do we want? This is Naomi Khan, legal scholar and author of Test Tube why the Fertility Market Needs Legal Regulation. As someone who clearly sees the need for more oversight, I recognize there's also the chance, particularly in a post Dobbs world where we are concerned about overregulation of the fertility space. On the other hand, there's also the concern that you don't want fertility clinics to be using outdated procedures or medical equipment or outdated practices, and so it's difficult to strike that middle line. Still, she believes there are many improvements that can be made. I would be looking for mandatory reporting of errors, not just to a regulatory agency, but also to the individual patients. I'd also be looking for more insurance coverage of infertility related issues. And I would be looking for making some of the voluntary guidelines mandatory. For example, with respect to donated gambin, there's no requirement that fertility clinics follow up and check on any of the information that is reported to them by the individual donor. Khan also stresses the importance of patient education and transparency around assisted reproduction. Better oversight, just of the informed consent process at fertility clinics would be helpful. We need to make sure that people understand just what the risks are, both in the procedure as well as in ultimately producing a bouncing baby at the end. And so ensuring that deceptive practices or misleading claims are not made about these services seems to be incredibly important. There are some professional guidelines and some state requirements on this, but again, there's no federal, we have no uniformity on this. But there are risks to any regulation. For example, costs for everyone, doctors and patients alike, could increase. And then there is, as Kahn mentions, the concern that greater government involvement could inadvertently imperil the IVF industry. Many IVF advocates here in the US fear that bringing more scrutiny to a practice that involves creating embryos could backfire, leading to new restrictions that hurt both patients and providers. And their worries aren't hypothetical. Just a few months before CRH shut down, the Alabama Supreme Court made headlines by ruling that frozen embryos should be considered children under state law. The case stemmed from a wrongful death lawsuit brought by families whose embryos were destroyed while in storage. The ripple effects were immediate. IVF clinics across Alabama paused services, afraid they could now face criminal or civil liability for routine parts of treatment like discarding non viable embryos or even freezing them. And Tennessee has been navigating that same tension. This bill is something that I have been working on with legal and stakeholders for the last several months. It has been a difficult and challenging journey trying to find information regarding what minimum standards are, what the regulations are, what the federal statute requires as it relates to the practice of art, which is assisted reproductive technologies. That's Ryan Williams, a Republican state lawmaker addressing a subcommittee of the Tennessee House. Nearly a year after CRH shut down, Williams introduced a bill he said would strengthen oversight of fertility clinics, especially in the wake of what happened at the center for Reproductive Health. The members may also know that the attorney general is trying an open case now regarding a fertility clinic that closed abruptly in Nashville. And the reason for that concerns me a little bit. The bill would have created new licensing requirements for IVF doctors and clinics, but it also would have profoundly changed how IVF is typically performed, suggesting bans on genetic testing of embryos and capping how many embryos could be created per patient. The bill ultimately died in committee, and months later, Tennessee lawmakers passed a very different bill, one that explicitly protected access to ivf. But even that victory was uneasy. Some legislators immediately pushed back, arguing the state shouldn't endorse a practice that involves creating and discarding embryos. Within days, legislative leaders were already signaling that IVF would be back on the agenda next session. It was a reminder that the politics surrounding IVF was aren't settled. Not in Tennessee, not in Alabama, maybe not in any state. While I was in Nashville, Sydney posted a question to the Facebook group she had started a year and a half before to connect former CRH patients to each other. It has been so quiet in this group, and I do wonder, you know, how everybody's doing, like, you know, what's the update? Because I had seen where a few had announced that they were pregnant, and then we haven't heard anything. So just kind of like a check in. So I think I'm gonna do that just to see how everybody's doing. The responses flooded in. Some former CRH patients had had babies like her. Others were still trying at new clinics, hopeful that this next round of ivf, this next transfer, would be the one. And then there were women who'd stopped fertility treatments completely, even without success. Women like Erin Meyer, the North Carolina flower farmer who spent her retirement funds on embryos from Dr. Vazquez's agency. We're about a year and a half out from the initial trauma. It has shaped my trust or has shaken my trust, I would say, in healthcare and medical professionals. I don't trust that the industry is not out for the profit. They see desperation and they see dollar signs. I'm still very cynical at this point, and personally, I'm done with IVF I can't stomach any more of it. It's difficult physically, of course, and it's difficult emotionally going through it, but it's even more difficult when you don't trust the healthcare providers and you don't trust that the honesty of the outcomes of what's going to actually what the challenges are, what the outcomes might be. Erin and her husband are now considering adoption instead. Give the day what we hope to have as a child, to raise together and to have a fulfilling life where there's a little human being brought up that cares who we are and what happens to us and to have that experience of shaping a human together. And so adoption is the direction we're headed. Erin is not sure what to do with the embryos they obtained from crh, the ones that her clinic of choice considered too poor quality to be used. Our embryos technically are in con still. We've taken responsibility for these two potential lives, but we don't trust the information on what is contained in these two embryos and what their chances are and what their issues are. It's left to us to figure out how, what happens to them. I don't know what to do with them. And so at this point, because our time is limited, we need to focus on how we are going to start a family now. And with time and healing, it will hopefully become more clear what we want to do with those embryos. Looking back, Erin knows she can't change what happened at crh, but she hopes what she learned can spare someone else the same pain. Anybody coming into ivf. I want this to be a cautionary tale. If I knew what I know now and was starting over at a younger age, I would have gone to the best clinic. If you're going to do this, if you're going to go through ivf, go with a clinic that has a reputation for success. Do your research, ask hard questions, don't take things for granted that you're told and you're like, that doesn't quite make sense. After everything that happened at crh, Erin is left feeling frustrated, not just by what she went through, but by how few legal avenues exist for patients like her. She believes choosing Dr. Vazquez's services changed the entire course of her reproductive life. And it feels like no one will have to answer for that. I don't foresee there being any punishment. She had wanted to bring her own civil lawsuit against Vasquez, to hold him to account for what she believes he took from her her opportunity to birth the baby herself. Ultimately, though, she gave up on that idea, too. It seemed her chances of success were too low for the financial cost she'd have to expend. I spoke with a number of other patients who came to the same conclusion. They feel profoundly impacted by the clinic's closure, but their resources are limited. They're still navigating that tense balance of time and money, hoping to get pregnant before their biological clock runs out for good. When you're talking about women and families that are spending so much energy trying to start a family and navigate all of the components that come with that and navigate the trauma, all the stuff that happened, the reality is nobody has that sort of bandwidth to go after him in that way. I don't know what the end game is. I don't know how. The chapter closes with no resolution in sight. Aaron remains in the uncomfortable uncertainty of not knowing how her journey to parenthood will resolve. She made the same sacrifices familiar to any fertility patient. And yet, three years after she started at crh, she doesn't have her fairy tale ending. Erin has already gambled so much. How many bargains can one person make? It's wasted time, wasted resources, resources, wasted dreams. I mean, it's. It's real. Real. Consequent. What Happened in Nashville is a production of School of Humans and I Heart Podcasts, written, reported and hosted by me, Melissa Chelson. Our producer is Edelise Perez. Our senior producer is Amelia Brock with additional production by Emily Siner and Carl Cadel. Theme song by Jesse Nye Swonger Sound design, scoring and mixing by Jeremy Thal and Jessie Nye Swanger Fact checking by Savannah Hughley and Austin Thompson. Our production manager is 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. This is Sophie Cunningham from Show Me Something. Do you know the symptoms of moderate to severe obstructive sleep apnea or OSA in adults with obesity? They may be happening to you without you knowing. 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