On April 12, Mary Schacher sat in the lobby of the Center for Reproductive Health for the last time. Earlier that month, on April 4, the management at the Nashville medical office, which billed itself as a “boutique fertility clinic,” had sent a letter to its employees saying their paychecks would be late. According to the letter, “Unforeseen circumstances have led to a financial deficit,” but it promised staff would be paid promptly once funds were available. Around 4 p.m. the next day, according to Schacher, a nurse called to cancel her appointment later in the month. Schacher had been scheduled to come in to prepare for an embryo transfer — her embryos had been genetically tested and both deemed viable, and she was hoping to become pregnant later that month. The nurse told Schacher to keep taking her medications in the hopes it would be rescheduled the following month.
On April 8, Schacher heard on the news that the office had suddenly closed; no one answered the phones, so she or her husband showed up in person for the rest of the week. When her husband tried visiting the clinic that week, he found an unlocked lobby door and a sticky note with a key taped to the front reception desk, possibly from a former employee who had dropped it off, saying “Thank you for everything & great opportunity!” He told the security of the main building that the doors were unlocked and medical records and genetic material were inside, unprotected.
Peter Ricci and Allena Berry found out the clinic had closed from their lawyer. They had gone to CRH in June 2022 after deciding to pursue surrogacy. Berry had been diagnosed with ovarian cancer before meeting Ricci and underwent a hysterectomy and oophorectomy as part of her treatment. At the clinic, they used donor eggs and Ricci’s sperm to create one viable embryo that they hoped to use with a surrogate. They also adopted embryos through CRH to have more options in case their created embryo didn’t work. In total, they spent over $40,000. The following May, they moved to Illinois and decided to switch fertility clinics to one there and begin the surrogacy process. The new clinic told them they were missing a piece of documentation called a summary of records, which is required by the FDA to prove a clinic performed all necessary tests in the creation of an embryo. Then came another blow: Even if their new clinic had the summary of records, it wouldn’t be able to accept their embryo anyway because it was created with an egg donor who was a carrier for spinal muscular atrophy. The couple had just moved into a new apartment in Chicago, where Ricci was placing books on a bookshelf in their living room, when their lawyer called to say he had received a call from Tennessee’s attorney general asking to speak with him about CRH. “That was quite astonishing,” Ricci said.
Taylor Peraino learned of the clinic’s closing from a voice-mail greeting when she called about starting the surrogacy process for her single frozen embryo. She had first gone to CRH in spring 2023 to begin testing for fertility treatment. Soon after, she was diagnosed with a brain tumor. After a craniotomy in June, she went back to CRH to do a round of IVF, which ultimately produced one viable embryo. During that time, her oncologist recommended radiation as soon as possible, which she completed after the IVF cycle was complete. There was a 50 percent chance that after radiation she would be completely infertile. The cycle she did with CRH was basically her only shot. After she called the clinic, she was shocked to hear a message saying it was closed. She then checked the website, which confirmed it was put into a receivership.
For nearly a decade after it opened in 1995, the Center for Reproductive Health was one of at least three centers in the area that offered IVF, and by 2021, it was still only one of nine in the entire state, according to the Centers for Disease Control and Prevention. In the weeks immediately following the clinic’s closure, the lab was left basically unattended, with the clinic’s director, Jaime Vasquez, to monitor it and field patients’ questions or requests for records — which patients say he generally ignored.
On April 26, the attorney general of Tennessee, Jonathan Skrmetti, filed a lawsuit against Vasquez and CRH, as well as the labs and embryo adoption program Vasquez ran. Since the closure of the clinic, the AG’s office said that Vasquez failed to provide patients with the services they had already paid for; that the clinic endangered frozen eggs, sperm, and embryos; and that it was not able to provide continuity in care for patients, including not providing medical records. The AG’s office said that under the Tennessee Consumer Protection Act, Vasquez is liable for these “deceptive and unfair acts.” (Through statements from Vasquez’s lawyer, he denies that he was responsible for the doors being unlocked and the allegations that the genetic material inside was left unprotected and unmonitored. He claims the clinic’s team was able to address many requests for medical records until the receivership began.)
On Schacher’s last visit to the shuttered office, other patients had also gathered in the hallway outside the lobby. Per court records, a public health inspector was at the clinic that day and recorded that there was not adequate staff, the temperature of the cryogenic tanks storing genetic materials hadn’t been recorded since April 6, and the lab itself was in general disarray. The backup cryogenic tank was not equipped with an alarm system meant to alert workers if the temperature reached an unsafe level, according to the lawsuit. The inspector watched as Vasquez opened a storage tank containing embryos and sperm without wearing the appropriate protective gear, which she reported created a risk of infection in the specimens. Also noted: broken glass and an “unidentified sticky substance.”
Schacher was determined to get her medical records, which she needed to continue fertility treatment anywhere else and prove ownership of her embryos. She finally cornered the attorney and cried, begging for her records until she went to the back to search for them. Other patients weren’t so lucky. In Reddit threads, on the clinic’s social-media pages, and in the Support for Families of CRH Facebook group, hundreds of patients scrounged social media asking for help and information. Ricci and Berry have restarted the process from scratch with a new egg donor at a different clinic. Peraino’s embryo was moved to a different clinic, but she isn’t confident that it’s viable anymore. Court documents estimated there were 650 patients of CRH when it closed, with over 1,300 embryos stored in its facility.
The IVF process is grueling. Weeks and months of testing and sometimes painful medication with hefty side effects is just the beginning. While undergoing treatment, patients need to wait for frequent test results before they can move on to the next step. Every phone call or message from a provider can mean going forward — or not. An average of 70 percent of mature eggs retrieved will go on to successfully fertilize, becoming embryos, per the Cleveland Clinic. Of those embryos, an average of 50 percent successfully become blastocysts, the most suitable stage for an embryo to be transferred into the uterus for the chance it will develop into a pregnancy or frozen for possible later use. Over the next several days after insemination, lab workers monitor the embryos to see which will form blastocysts — an excruciating wait for the patient.
Schacher started IVF with CRH in 2023. In April, after weeks of bloodwork, medication, and monitoring appointments, Vasquez inserted a needle into her ovaries to manually remove each egg that had developed. When it was over, she learned he retrieved ten viable eggs. After insemination, four embryos became blastocysts, but after genetic testing, Schacher learned that only one was viable.
At the end of June, Schacher underwent her embryo transfer. “Our one & only Schacher baby was implanted today at 1pm, and we feel so hopeful!” she posted on Facebook. During the procedure, she wore a hospital gown, and her socks had the words “Stick baby stick” on the bottom of one, and “Lucky transfer socks” on the other.
The transfer resulted in a chemical pregnancy; a very early pregnancy loss is rare for a genetically tested viable embryo. Soon after, she asked to meet with Vasquez to discuss why this happened to her. “They were like, ‘That just happens,’” she said. Schacher said Vasquez talked fast and had a tendency to go on tangents. “He would just kind of go in circles about why something didn’t work,” she said. “I didn’t really know how much more to dig.”
Schacher took some time to let her body heal, and then she prepared to undergo another egg retrieval. Her insurance would only cover so many cycles of fertility treatment, so “it was my last round of IVF,” she said. This time, a provider named Farere Dyer helped form her treatment plan and, after a few weeks, Vasquez performed the second retrieval. One egg, and it wasn’t viable.
Schacher had a call with Vasquez and the embryologist and asked what happened and where to go from there. He recommended using the clinic’s donor program. After perusing egg-donor profiles, she and her husband decided to purchase a package of eight eggs for $10,000 — they paid for it using her husband’s Christmas bonus. The clinic also gave them two eggs for free because they were the last ones available from the donor they selected. So with ten eggs, they began the process of creating embryos. A lab worker fertilized the eggs in January of this year. According to Schacher, “That’s when shit got way worse at that clinic.”
An embryologist called Schacher within three days of fertilization and told her that seven eggs were successfully fertilized, becoming embryos. Schacher said that the embryologist told her someone would call on day five with an update. No one did.
Schacher messaged the clinic through its patient portal: “I was wondering if you knew anything? I’m terribly anxious and hoping maybe someone has an update?”
“No, I do not; we did not get an update today,” was the response from a patient coordinator.
“It’s day 7! Any news by chance?”
“Nothing, you would know before me.”
On day ten, Schacher wrote another message asking for an update. “I just want to know if we have any embryos or did we just throw $10K out the window :(. I’m so anxious,” she wrote.
Before her last egg retrieval with CRH, Schacher had discussed canceling it so she wouldn’t waste insurance coverage of the cycle if the results looked like they might be disappointing. “They were like, ‘No, you have already come this far,’” she said.
Finally, a lab worker responded, explaining the lab was severely understaffed. But she had news: Two embryos became blastocysts.
Schacher wrote back, asking for an explanation: “Did something happen with the lab shortage and that’s why we went from 10-2? Or how did 7 eggs fertilize and then drop to 2? What are our options if the report comes back with 0 … I know you are a lab tech. And shorthanded. I’m just scared. Can anyone help us?”
The American Embryo Adoption Agency, which Vasquez founded and owns, promised prospective parents a chance “to experience the love they have always desired through adopting an embryo child — ultimately bringing hope and happiness into this world.” The program claimed it would take care of all the legal aspects and screening for donors to provide a “secure, responsible, and honorable” option for families.
According to the CDC, the clinic’s percentage of total cycles that used donor eggs or embryos was much higher than the national average. In 2021, data shows 12.3 percent of cycles at CRH for patients younger than 35 used donor materials compared with 2.3 percent nationally. For 35- to 37-year-olds, 26.5 percent of cycles used donor materials at CRH compared with 3 percent nationally, and for patients over 40, 79.2 percent of cycles used donor materials compared with 21.8 percent nationally.
Some patients I spoke with felt pushed toward donor materials because the clinic brought it up as an option earlier than they expected it would be introduced. “They’re like, you can do embryo adoption and it’s $10,000. So they almost try to get you to do that first,” said patient Penny Coe. “And you fall for it because you’re like, well, maybe my eggs aren’t good. So then you start questioning, do I need to do the $25,000 procedure with my own eggs or do I need to take the shortcut and do the $10,000 procedure?” Another patient said the clinic pitched a curated and customized approach to her care, but she only received disorganized and unclear responses once her treatment began. “Looking back on it, they were phenomenal salespeople,” she said. (Vasquez said he never pressured any patient to use donor material or is aware of another CRH employee doing so, according to his lawyer.)
Another patient bought three sets of embryos through the program. In 2022, she bought a package of three embryos for $18,000, a cheaper price tag than others she researched. (Depending on the services provided and the program used for embryo matching, it could cost more than $10,000 for just a single embryo.) The embryos were highly graded but had not been tested for viability, so she chose to do that before using them for an embryo transfer. None, it turns out, were viable.
The office seemed to “feel badly for us,” she said, and gave her one additional embryo from a different donor profile for free. That one was viable but didn’t result in a pregnancy. So, in February 2024, using money from her retirement account, she got a package of two more embryos for $11,020. But when she went to transfer the embryos to a clinic closer to her home in another state, the clinic wouldn’t accept the embryos. The embryo records were missing paperwork that it needed to accept them at its facilities. So she stuck with CRH. She was on the phone with the pharmacy shipping her fertility medication when she learned the clinic closed.
In an August 12 statement provided to the court, Vasquez has accused a handful of former employees of financial mismanagement. He said they did not submit bills for payments by insurance companies, gave unauthorized raises to certain employees, and used the work credit card for unauthorized trips, contributing to CRH’s lack of funds and ultimate closure.
Resignation letters from some employees in the months before the clinic’s closure tell a different story. Jayme Bess, the embryo adoption agency’s director under Vasquez, resigned in February, claiming staff turnover, lack of support, and lack of key lab personnel as reasons for her decision. After the clinic’s closure, News Channel 5 in Nashville discovered that Dyer wasn’t a licensed doctor. Patients I spoke with said he introduced himself as Dr. Dyer, and the clinic’s social media referred to him as such. (Vasquez’s lawyer said his lab coat said “fellow” and it’s common for patients “to assume someone who is wearing a white lab coat is a physician. For example, many patients think they are seeing a physician when the treating providers are, in fact, mid-level providers such as nurse practitioners, who happen to be wearing a white lab coat.”) We attempted to reach Dyer for comment, but his listed phone number seems to have been disconnected. At least two other resignation letters from Bess’s co-workers also claimed a toxic work environment and risky legal and ethical practices as reasons for leaving. Patients I spoke with corroborated the staff turnover, saying the staff they communicated with changed frequently.
In a statement to the court filed on April 26, a junior embryologist who started at the clinic in March 2024 said her training had been inadequate. “It seemed like the staff didn’t know how to direct me for this position due to it being outside of their scope of practice. I started looking at training manuals from the World Health Organization because I didn’t know what the best practices were,” she said. According to her statement, there was a list of people to call if the alarm on the tanks went off due to low liquid nitrogen — but that the staff wasn’t sure who was on the list because of all the turnover. On the last day she was at the clinic, April 10, she said when she got there, the only staff member there was Vasquez. He told her that he “didn’t understand why this was all happening, and that he is not broke and has money to pay staff.”
Both proponents of IVF and conservatives hoping to restrict the procedure have long argued that the industry is under-regulated, explains Mary Ziegler, a law professor and author of Roe: The History of a National Obsession. Salustiano Ribeiro helped establish a clinical licensure program for clinical reproductive biologists in California, in part to help standardize training and competency in the field. Depending on the state, licenses can be required for diagnostic testing of tissues. Licensure requirements can vary by state to work in a tissue-bank facility — where the thawing, fertilizing, and monitoring of embryos for IVF occur. There are guidance and accreditation programs offered by certain organizations, but the government largely hasn’t caught up with the industry, Ribeiro said. “If there is an issue with a clinic where this person did something, and if they’re not licensed, they can just move to another clinic,” Ribeiro said. “You’re not able to eliminate some of the bad apples that may be doing bad things.”
The legal landscape for donated eggs, sperm, and embryos can be difficult to wade through. Regulations governing gamete and embryo donation largely don’t exist, said Molly McCafferty, a director of the Donor Sibling Registry. There are several areas, such as family limits on embryos created by the same donated material and access to updated and accurate medical history, without clear legal paths to follow.
The people left to deal with navigating the fallout from a case like CRH’s are largely donor-conceived people and IVF patients. “It feels like I’m fighting a battle that no one understands,” Schacher said. “It’s bullshit. Like, no other word for it, it’s just kind of bullshit.”
As one employee put it in their resignation letter: “I truly hope that you see what is happening to your practice and make the necessary changes in the way you treat people, to support your employees and provide ethical and morally appropriate care of your patients.”
After the closure, patients made complaints to the Tennessee Health Facilities Commission that they couldn’t contact the clinic for access to their records or embryos. Although it took months, the genetic materials from CRH have been moved to a new clinic, the Tennessee Fertility Institute. As of early November, TFI said it had completed an inventory audit, but patients remain in limbo, unsure if what is stored is viable — or even theirs.
In the meantime, the state attorney general’s office is still investigating its consumer affairs case. Some patients are shoring up representation to file their own lawsuits. In June, Vasquez filed a counterclaim denying the attorney general’s allegations and asserting his own claims of defamation, negligence, and tortious interference of contract against the attorney general’s office.
Meanwhile, patients and families are dealing with the consequences of losing time and money they can’t get back. In 2020, Berry’s father was diagnosed with dementia. “I really want my dad to know our kid and have some memory of that. That’s not going to happen anymore,” she said. She and Ricci have since created four new embryos and had one embryo transfer with a surrogate that did not result in a pregnancy. They hope to try again.
Patients are also worried about maintaining access to IVF as the legal environment changes. Jonathan Skrmetti, Tennessee’s attorney general, issued a statement in 2022 saying the disposal of embryos that haven’t yet been transferred to a woman’s body does not qualify as an abortion under the state’s strict ban. However, the opinion also said that such an embryo may fit the definition of an unborn child. A bill to clarify that the abortion ban does not include disposal of embryos as a part of fertility treatments was blocked earlier this year. “It’s possible that this investigation and this particular incident won’t have anything to do with that,” Ziegler said. “But I think it’s still reasonable to fear that any investigation or any discussion of IVF in a state like Tennessee will intersect with fetal personhood and the pretty open desire of abortion opponents to prevent or restrict or shut down IVF altogether.”
Access remains top of mind for many patients I spoke with, who want to maintain access to IVF but also find some kind of legal remedy for the situation they are in. The American Society for Reproductive Medicine has recently released a congressional scorecard assessing members of Congress and their position on legislation that could affect IVF and reproductive care. In Tennessee, both senators have voted in ways that are anti-IVF, according to the ASRM.
In the months that followed CRH’s closing, Schacher’s biggest fear was that access to IVF would get cut off before she could have her embryos implanted. She wondered if she needed donor eggs at all, or if the clinic had been using its donor program as a way to get money from families. “I hope someone reads our story and feels the desperation and desire I have to become a mom,” she wrote in a grant application for funds to use toward IVF. “I have been fighting for five years and I don’t plan to stop.”
Someone did hear her story. A few months ago, after learning of Schacher’s struggles with CRH, a family reached out to her and her husband and asked if they would be interested in adopting their last two mosaic embryos.
In the meantime, she takes care of her pets and goes to work and, in between all of that, checks for court dates and updates on her embryos still at TFI. “You just have to keep living in the hopes that one day you’re going to get that phone call that you can finally move on and that you can move forward,” Schacher told me in August. That same month, she transferred the adopted embryos. Within two weeks, she learned one of them resulted in pregnancy. She’s due next May.