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

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.

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)

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)

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.”

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.

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.

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.