The Audit — Nashville E4

Summary

Podcast Summary: What Happened in Nashville — Episode 4: The Audit

Podcast: What Happened in Nashville
Host: Melissa Jeltsen (sometimes transcribed as Cheltsen/Johnson)
Episode: The Audit — Nashville E4
Date: December 10, 2025

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Overview

This episode, "The Audit," dives into the turmoil following the sudden closure of Nashville’s Center for Reproductive Health (CRH). Host Melissa Jeltsen unpacks how hundreds of patients were left in limbo, their fertility treatments interrupted, and their embryos stranded. Through patient testimony, expert interviews, and reporting on the failed audit, the episode highlights how cracks in the fertility industry—namely poor record-keeping, minimal oversight, and lack of robust regulation—came to a head at CRH, leaving families devastated and questioning the system’s integrity.

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Key Discussion Points & Insights

1. The Fallout: Clinics Shut, Patients Stranded

• Closure & Immediate Aftermath:
  • CRH closes abruptly in late April 2024; state seizes control; a court-appointed receiver takes over.
  • Priority: preserve and monitor 5 cryogenic tanks storing ~1200 embryos, eggs, and sperm.
  • Receivership struggles: CRH operated with three non-matching inventory systems (paper, two electronic) [02:48–04:22].
  • Delay in transferring embryos to a safer facility; families receive vague reassurances but no concrete answers.

“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.” — Melissa Jeltsen (04:05)

2. Chaos of Record-Keeping: The Audit Begins

• TFI Takes Charge:
  • After several months, Tennessee Fertility Institute (TFI) agrees to accept CRH’s stored genetic material [04:22–05:07].
  • TFI quickly discovers records are incomplete, mismatched; a full audit is required before patients regain access.
  • Audit reveals that “nearly 25%” (154 out of 664) of patient records don’t match the material in storage [14:51–15:41].

“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%.” — Melissa Jeltsen (14:51)

3. Patient Stories: Heartbreak & Mistrust

• Kristin & Diana Wall:
  • Had embryos stored at CRH; after closure, discovered significant discrepancies and missing information in medical records [06:59–10:44].
  • Audit further undermines confidence: a letter first states they have 10 embryos, then 8 after a “clerical error” is acknowledged [13:10–14:29].

“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.” — Kristin Wall (13:47)

• Widespread Issues:
  • Patients report:
    • Missing test results
    • Entirely omitted procedures
    • Evidence of incorrect embryos being used (though no pregnancies resulted) [11:58–12:41]
    • 87 patients couldn’t be contacted due to missing addresses; 12 samples utterly unidentifiable [14:51–15:41]

“Each discrepancy adds to a growing sense of panic. If the paperwork is wrong, what else might be?” — Melissa Jeltsen (11:06)

• Loss of Trust:
  • “If we couldn’t be 100% certain these embryos are ours, we would not feel comfortable using them.” — Kristin Wall (16:30)

4. The Cost of Lost Time

• Medical & Emotional Toll:
  • Host and Dr. Alan Penzias, Reproductive Endocrinologist, underscore the unforgiving role of time in fertility [20:40–22:59].
  • IVF success rates plummet with age; every month lost due to clinic disarray or mismanagement matters.

“With fertility, it’s always a race against time.” — Melissa Jeltsen (20:40)

“As women get older, reproductive capacity goes down.” — Dr. Alan Penzias (21:11)

• Financial Ruin:
  • Every delay is not just an emotional setback, but a financial one—each cycle costs tens of thousands, mostly not covered by insurance [21:19–22:59].

5. Systemic Flaws & Regulatory Voids

• Lack of Oversight:
  • US IVF clinics largely self-regulate; reporting to the CDC is limited to success rates [40:18–41:44].
  • Professional oversight is voluntary; no mandatory reporting of “never events” (major errors), unlike in other medical fields.

“IVF today in the United States is far less regulated than virtually any comparable part of medical practice…” — Dov Fox, Health Law & Bioethics Expert (40:00)

• Opaque Error Rates:
  • Most patient-impacting mistakes remain hidden; Fox believes only the most obvious (e.g., racial mismatches) come to light, and the true frequency of errors is impossible to know [43:54–44:25].

“There are just so many question marks. We don’t even know how frequent these errors are.” — Dov Fox (43:54)

6. The Emotional Devastation of Infertility

• Enduring Impact:
  • Interview with Dr. Maria Polyakova, Stanford economist: infertility has long-lasting impacts, far beyond the medical. About 1 in 8 women require fertility treatment, and failure is strongly linked to poor mental health outcomes [26:05–28:30].

“Infertility experience itself results in poorer mental health.” — Dr. Maria Polyakova (28:13)

• Host’s Perspective:
  • Melissa shares her own IVF struggles, underlining the psychological punishment of repeated setbacks and the inescapable presence of hope and uncertainty [29:11–30:32].

7. Families in Limbo & Desperate Choices

• Mary’s Story:
  • Five years trying to conceive, embryos trapped, resources exhausted, time running out. Mary is offered donated embryos from another couple—a risky, desperate shot [33:11–34:33].

“It feels like I just keep getting older and my embryos keep sitting in a tank.” — Mary (32:46)

• Erin & Gregor Meyer:
  • Sought donor embryos through CRH-associated American Embryo Adoption Agency. Spent savings, retirement funds, but after the collapse, found their embryos’ quality and documentation so poor that other clinics won’t take them [46:32–51:37].
  • Erin’s summary: “Vasquez took our last chance to try and have children.” (52:13)

8. Hard Choices & Meager Silver Linings

• As of November 2024, after seven months, patients regain access to their embryos—some succeed, some find missing embryos or lingering mysteries.
• Only a small fraction (39/700+) of patients are able to relocate embryos to a new clinic by January 2025, because many clinics refuse to accept CRH-origin embryos with questionable records [45:26].

9. Industry Implications & Warnings

• Episode closes with questions about whether CRH is a cautionary tale or a canary in the coal mine for an industry operating with little transparency or oversight.

“What happened in Nashville isn’t just the story of one tragedy — it’s a warning about a system where families have everything at stake and far too little protection.” — Melissa Jeltsen (Episode description; echoed at end of episode)

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Notable Quotes & Memorable Moments

• On discovering record errors:

  • “I was scrolling, and all of a sudden I see another woman’s name. And I’m like, who is this?” — Kristin Wall (10:13)
  • “My records had absolutely no indication...that I had a transfer with two embryos. It just felt really invalidating.” — Kristin Wall (10:44)

• Confronting potential mix-ups:

  • “I read the receiver discovered evidence that at least two patients received the incorrect embryos for their frozen embryo transfer procedures. And I immediately was like, holy shit. Like, this is...my biggest fear.” — Kristin Wall (11:58)

• Audit results further erode trust:

  • “They were like, sorry, clerical error. And I’m like, well, okay...How am I supposed to trust that the audit, the full audit you did, was accurate...?” — Kristin Wall (14:29)

• On the pain of infertility:

  • “Infertility is a lot of hitting rock bottom and picking yourself back up.” — Mary (34:18)

• Expert critique:

  • “We would just never accept this in other areas of medicine.” — Dov Fox (41:44)

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Important Timestamps

• [02:48–05:07] — CRH closure, tanks in limbo, record chaos surfaces
• [06:40–14:51] — Kristin and Diana’s story: missing files, audit confusion, emotional fallout
• [14:51–16:30] — Audit reveals 25% mismatch rate, broad system failure
• [20:40–22:59] — The significance of time and escalating costs in fertility treatment
• [26:05–28:30] — Psychological impact of infertility (Dr. Polyakova research)
• [33:11–34:33] — Mary’s desperate decision to use donated embryos
• [40:00–44:25] — Dov Fox on U.S. IVF oversight gaps, voluntary standards, “never events”
• [45:26–45:55] — Clinics reluctant to accept CRH-origin embryos, few relocated
• [52:13] — Erin Meyer: “Vasquez took our last chance to try and have children.”

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Conclusion & Tone

The episode blends empathetic firsthand reporting, expert insight, and patient voices to paint a picture of profound system failure and personal loss within the lucrative but under-regulated fertility industry. The tone is compassionate but exposing, sounding the alarm on an industry where the stakes are existential—and so are the consequences when the system fails.

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For Listeners:

If you feel heartbroken or outraged after hearing these stories, that’s the point. This episode pulls back the curtain on just how vulnerable hopeful families are when system safeguards are weak or simply absent. The episode closes by hinting more revelations are coming, promising to go deeper next week into the warning signs that went ignored.

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If you haven’t listened, this summary gives you the arc, the central voices, and the critical stakes of this haunting chapter in Nashville’s fertility scandal.

Transcript

[Melissa Cheltsen]

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[Kristin Wall]

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[Dr. Alan Penzias]

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[Melissa Cheltsen]

The center for Reproductive Health is closed. The clinic itself is dark. The door is locked. Dr. Vazquez 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 I65.

[Kristin Wall]

To Franklin last week.

[Melissa Cheltsen]

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 1200 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 and had already been broken.

I'm Melissa Johnson from School of Humans and I Heart Podcasts. This is what happened in Nashville. Episode 4 the Audit.

[Erin Meyer]

Great.

[Kristin Wall]

Anxiously waiting this letter. The date ON this is October 2, 2024. And you know the CRH closed in April, so this is a long time coming.

[Melissa Cheltsen]

This is Kristin 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 2000 children Dr. Vazquez boasted of bringing into the world.

[Kristin Wall]

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. They're not viable like they are. Something's happened to them, and I was terrified.

[Melissa Cheltsen]

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.

[Kristin Wall]

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.

[Melissa Cheltsen]

They had met with Dyer countless times 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. Kristin 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 Kristin planned to carry. Their first embryo transfer resulted in a miscarriage. On the second attempt, Dr. Vazquez transferred two embryos to Kristin's uterus. Both implanted until one stopped developing.

[Kristin Wall]

I became pregnant with twins.

[Dr. Alan Penzias]

Wow.

[Kristin Wall]

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.

[Melissa Cheltsen]

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.

[Kristin Wall]

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.

[Melissa Cheltsen]

Kristin's own records are no better. She says there's no documentation of her second embryo transfer, the one where Vasquez transferred two embryos and which resulted in the birth of their child.

[Kristin Wall]

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.

[Melissa Cheltsen]

Other patients are also receiving their medical records and sharing their reactions on the Facebook page Sydney created. It turns out the inconsistencies that Kristin 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?

[Kristin Wall]

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.

[Melissa Cheltsen]

The receiver releases regular status reports to update patients on what's happening behind the scenes. Kristin, like many patients, carefully reads through each report, and some of the details she learns are shocking.

[Kristin Wall]

I read the receiver discovered evidence that at least two patients received the incorrect embryos for their frozen embryo transfer procedures. And I immediately was like, holy shit. Like, this is. That is my. My biggest fear.

[Melissa Cheltsen]

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.

[Kristin Wall]

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.

[Melissa Cheltsen]

This might seem like reassuring news. 10 out of 10 embryos identified everything with its own matching record. But it's not.

[Kristin Wall]

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.

[Melissa Cheltsen]

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 Kristin had been worried about.

[Kristin Wall]

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.

[Melissa Cheltsen]

Kristen and her wife reach out to a lawyer who, who contacts the receiver. And after an additional review, the couple gets another letter retracting the original count. Actually, there are only eight embryos in storage. The receiver doesn't explain why the mix up happened. Was it because of CRH's messy record keeping? Was it a miscommunication? It doesn't make Kristen feel any better.

[Kristin Wall]

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.

[Melissa Cheltsen]

Kristin 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 Kristin, 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 it's worth noting. You pay for, you expect meticulous care. Every label confirmed, every detail exact, every record airtight.

[Kristin Wall]

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.

[Melissa Cheltsen]

The whole audit and how the results are communicated leaves patients like Kristen and Diana feeling abandoned.

[Kristin Wall]

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.

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[Kristin Wall]

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[Melissa Cheltsen]

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.

[Dr. Alan Penzias]

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.

[Melissa Cheltsen]

This is Dr. Alan Penzias, a reproductive endocrinologist and associate professor at Harvard Medical School.

[Dr. Alan Penzias]

Just a biological fact that as women get older, reproductive capacity goes down.

[Melissa Cheltsen]

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.

[Dr. Alan Penzias]

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.

[Melissa Cheltsen]

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.

[Dr. Alan Penzias]

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.

[Melissa Cheltsen]

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.

[Dr. Alan Penzias]

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.

[Melissa Cheltsen]

And this isn't unique to fertility treatment. Continuity of care, meaning there's no interruption in your access to medical treatment, is one of the core obligations of medicine. In fact, Tennessee law requires physicians to notify patients if they're retiring. Anyone seen in the past three years must be contacted, urged to find a new provider, and told how to obtain their medical records.

[Dr. Alan Penzias]

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, 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.

[Melissa Cheltsen]

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.

[Maria Polyakova]

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.

[Melissa Cheltsen]

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.

[Maria Polyakova]

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.

[Melissa Cheltsen]

Much of the impact of infertility remains hidden. People going through it don't always talk about it publicly. And even understanding how common it is isn't simple. The US doesn't really have a system that tracks who undergoes fertility treatment or what happens afterward, but Sweden does. In a study released in 2024 by the National Bureau of Economic Research, Polyakova 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.

[Maria Polyakova]

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 US we.

[Melissa Cheltsen]

Don'T have the data for the US.

[Maria Polyakova]

But I don't think there is any reason that that wouldn't be applicable to.

[Melissa Cheltsen]

The US 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.

[Maria Polyakova]

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 poorer mental health.

[Melissa Cheltsen]

Polyakova's theory is that it isn't the medical procedures themselves that leave such deep scars, but the uncertainty of not knowing what, if anything, will work.

[Maria Polyakova]

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.

[Melissa Cheltsen]

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.

[Kristin Wall]

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. It's like you're at some point you have to start and think, like, okay, the universe is literally trying to tell me something, right?

[Melissa Cheltsen]

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.

[Kristin Wall]

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 him out and we're going to transfer and we're going to be a family.

[Melissa Cheltsen]

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.

[Kristin Wall]

It feels like I just keep getting older and my embryos keep sitting in a tank.

[Melissa Cheltsen]

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.

[Kristin Wall]

They had heard of our story. They had seen us on the news.

[Melissa Cheltsen]

They heard about Mary's traumatic experience at the center for Reproductive Health and offer to gift Mary and her husband their leftover embryos.

[Kristin Wall]

The family that owned the embryos, they were older, and they didn't want them to sit in a tank or go to science.

[Melissa Cheltsen]

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.

[Kristin Wall]

We didn't know if we would have our embryos, like, when they were going to be released. And we had this opportunity, and it was like, do we keep waiting around? I think at that point, I, like, I didn't know how else I was going to hit more rock bottom.

[Melissa Cheltsen]

So she transfers them both and takes the chance. It feels like the only one she has.

[Kristin Wall]

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.

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[Melissa Cheltsen]

This is where mindset comes in.

[Trainer Games Announcer]

Someone will be eliminated.

[Kristin Wall]

Pressure is coming down.

[Melissa Cheltsen]

This is Trainer Games.

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Watch it on prime video starting January 8th.

[Dr. Alan Penzias]

Shh.

[Melissa Cheltsen]

You won't believe what my new friend just told me about dinosaurs.

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[Malcolm Gladwell]

Hello. Hello. I'm Malcolm Gladwell, host of the podcast Smart Talks with IBM. I recently sat down with IBM's chairman and CEO Arvind Krishna, and I asked him, how can companies use AI to its fullest potential to create smarter business? My one advice to them, Pick areas you can scale. Don't pick the shiny little toys on the side. For example, if anybody has more than 10% of what they had for customer service 10 years ago, they're already five years behind. If anybody is not using AI to make their developers who write software 30% more productive today with the goal of being 70% more productive. Yeah, so we are not asking our clients to be the first experiment on it. We say you can leverage what we did. We are happy to bring out all our learnings, including what needs to change in the process, because the biggest change is not technology is getting people to accept that there's a different way to do things. To listen to the full conversation, visit IBM.com smarttalks.

[Melissa Cheltsen]

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.

[Kristin Wall]

13 weeks because of TFI.

[Melissa Cheltsen]

And Dr. Miller, we transferred November 5th at TFI and it was a success. Fingers crossed it will be the same for you.

[Trainer Games Announcer]

Just tested positive today.

[Melissa Cheltsen]

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 Dov Fox, a national expert on health law and bioethics.

[Dov Fox]

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.

[Melissa Cheltsen]

Fox walked me through how IVF is overseen in the US 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.

[Dov Fox]

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.

[Melissa Cheltsen]

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.

[Dov Fox]

In other areas of health care, 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're 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 US when it comes to things like, you know, fertility freezer failures or donor switches, the buck stops nowhere.

[Melissa Cheltsen]

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.

[Dov Fox]

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 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.

[Melissa Cheltsen]

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.

[Erin Meyer]

I'm Erin and we live in North Carolina. We have a small farm and we grow flowers.

[Melissa Cheltsen]

Erin and her husband Gregor, begin researching alternative pathways to parenthood after they learned they were both genetic carriers of the same rare condition.

[Erin Meyer]

There was a 25% chance that we could have a child with severe complications from this genetic condition.

[Melissa Cheltsen]

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 AEA. 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.

[Erin Meyer]

I was approaching 40, starting to feel the pressure a little bit more and trying to say, okay, 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.

[Melissa Cheltsen]

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 Erin 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 drive the 10 hours to the center for Reproductive Health for the procedure. The transfer doesn't work.

[Erin Meyer]

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.

[Melissa Cheltsen]

Still, Aaron and Gregor don't want to give up. And so when they're ready, they turn once more to Dr. Vazquez's Embryo Agency to see what's available.

[Erin Meyer]

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 it just the time really was the pressure that I was feeling the most.

[Melissa Cheltsen]

In February 2024, the couple decides to purchase more embryos.

[Erin Meyer]

We went ahead and pulled the trigger. Everything in IVF is a gamble. And so, you know, we took this.

[Melissa Cheltsen]

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.

[Erin Meyer]

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.

[Melissa Cheltsen]

The couple paid $11,000 for two embryos. The plan was for Erin to begin taking medications for the embryo transfer in April 2024.

[Erin Meyer]

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. Okay. And I put a message through the portal saying, I have tried to reach you guys multiple ways. I don't understand what's happening. I'm a little concerned that I'm not getting a response back. And at that point, the message bounced on the message portal.

[Melissa Cheltsen]

That's when she learns the clinic is closed for good.

[Erin Meyer]

I mean, my heart sank and panic set in because this is, these were our last, this was our last chance like this. 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.

[Melissa Cheltsen]

In November, Erin 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.

[Erin Meyer]

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 healthcare.

[Melissa Cheltsen]

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.

[Erin Meyer]

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 or the ones that were best for their patients.

[Melissa Cheltsen]

I asked Dr. Vazquez's attorney about these claims, but haven't received a response. Erin is now involved in the state's consumer protection case against the clinic.

[Erin Meyer]

You know, we certainly haven't gotten any of the money back. I don't know what we're going to do yet.

[Melissa Cheltsen]

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.

[Erin Meyer]

Vasquez took our last chance to try and have children.

[Melissa Cheltsen]

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.

[Dr. Alan Penzias]

It's been the wildest of experiences of.

[Melissa Cheltsen]

Feeling isolated and disregarded and then learning.

[Dr. Alan Penzias]

That we're not the only ones.

[Melissa Cheltsen]

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 I Heart podcasts, written, reported and hosted by me, Melissa Cheltsen. Our producer is Edelise Perez. Our senior producer is Amelia Brock, with additional production by Emily Siner and Carl Cadle. Theme song by Jesse Nye Swonger. Sound design, scoring and mixing by Jeremy Thal. And Jessie Nye Swonger Fact checking by Savannah Hughley and Austin Thompson. Our production manager is Daisy Church. Voice acting by Grace Walker, Nikki Speake 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.

[Trainer Games Announcer]

10 athletes will face the toughest job interview in fitness that will push past phys and mental breaking points.

You are the fittest of the fit. Only one of you will leave here with an IFIT contract for $250,000.

[Melissa Cheltsen]

This is where mindset comes in.

[Trainer Games Announcer]

Someone will be eliminated.

[Kristin Wall]

Pressure is coming down.

[Melissa Cheltsen]

This is Trainer Games.

[Prime Video Announcer]

Watch it on prime video starting January 8th.

[Dr. Alan Penzias]

Shh.

[Melissa Cheltsen]

You won't believe what my new friend just told me about dinosaurs.

[Meco Mini Plus Advertiser]

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[Trainer Games Announcer]

Come for the Black Friday seasonal savings. Stay for the award winning reporting for a limited time. Access to the Washington Post is just 99 cents. That's unlimited access to all of the posts for only 99 cents every four weeks. That's a great deal for the first year. After that it'll cost $12 every four weeks. You can cancel anytime, but don't wait. This Black Friday seasonal offer won't be here for long. Go to washingtonpost.com iheart and grab this deal before it's gone. That's washingtonpost.com iheart.com the world's best ski.

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And snowboard athletes are chasing medals now. You can follow their every move. Join Insider, the official US Ski and Snowboard fan loyalty program and get premium viewing at World cup ski events, exclusive athlete meetups, discounts from brands you love, and a custom welcome gift mailed direct to your doorstep. This winter. Show your support as they race for the podium. Head to inside.

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[Melissa Cheltsen]

O u n d this is an I heart podcast. Guaranteed human.