Episode Transcript
[00:00:00] The fertility space doesn't sit still. It never has.
[00:00:04] New laws get passed, old ones get challenged, costs go up, more families get left out. And somewhere in the middle of all of it, real people are trying to navigate a system that still has a long way to go. This is the season seven finale. I want to talk about all of it. The good that's actually happening, the stories that have shaken this industry over the past year and a half, the politics that are very much part of the conversation, whether we want them to be or not, and where I see things going from here. Let's get into it. Welcome to the Fertility Cafe where we explore the beautiful complexity of modern family building.
[00:00:40] I'm your host Eloise Drain and this is a space for honest conversations about surrogacy, egg donation and the journey to parenthood. With expert insights and real stories, we're here to guide you through the medical, legal and emotional aspects of third party therap family building.
[00:00:59] We believe that love has no limits and neither should parenthood.
[00:01:09] Welcome back to Fertility Cafe. I'm your host, eloise drain. Season 7 we covered a lot. We heard from doctors, patients, professionals, a woman who chose not to have children, the first IVF baby born in this country, a sperm donor, a donor conceived, adult surrogates, egg donors, and people who have been through long road of infertility and kept going. Today I want to do a few things. Look back at the season, talk honestly about what's been happening in this industry, including the stories that have shaken people's trust and the structural problems that keep producing them.
[00:01:47] Get into the politics because we can't not and then tell you what's coming next. We opened the season with Virginia Hart and I think that was exactly the right place to start. Insurance and protection for surrogates and egg donors is one of the most misunderstood pieces of this entire process. In her episode filled in gaps I know a lot of people didn't even know they had. Then Elise Daniel Barnes, an embryologist, came on and told the truth about what actually happens inside the IVF lab. What the conditions of a lab tell you about the care you're going to receive, what questions patients should be asking and almost never do. That episode matters because that information really makes it out of the clinical setting into a real conversation. We had Arvis Smith back. Some of you know her story from season five. She came back to share the next chapter. Finally becoming a mom after everything she went through. That episode reminded me why personal stories belong on the show. It is not just information, it is knowing that Someone else survived the hardest part. Geena Davis walked us through how genetics actually impacts fertility, donor selection and embryo testing. Lisa Hendrickson Jack came on and told the truth about birth control, ovulation and what your hormones are actually doing. Those two episodes together are some of the most practical, useful content we have put on this show. Dr. Renita White had a very honest conversation about what your OB GYN isn't telling you. That one hidden nerve for a lot of people because so many in this community have experienced being dismissed, being under informed, having to fight to be taken seriously in medical settings. It needed to be said. Dr. Chanel Adams broke down the surrogate's full medical process from screening to transfer, which I think every woman considering surrogacy should hear before she signs anything. The real process, what the timeline looks like, what the medications do to your body, what you are actually committing to. Pamela Marshall came on and talked about what surrogacy actually feels like from the inside.
[00:03:59] That conversation was candid in a way that I think you can only get when someone is truly willing to be honest about the full experience, not just the beautiful parts.
[00:04:10] Dr. Hohen talked acupuncture and fertility, which I know is a topic a lot of people have questions about, specifically how it supports hormones cycles and IVF success. And Richard Westerby joined us to talk through what navigating fertility care in the US actually looks like for international parents, which is a perspective that doesn't get enough airtime on this show. Griffin Jones asked whether fertility care is actually getting better or just getting bigger. That question has stayed with me because the answer is bigger. Both, and they are not the same thing.
[00:04:46] Shaquita Lockley talked about being childless by choice. That conversation belongs here just as much as any other and I'm glad we had it. Elizabeth Carr, the first IVF baby in the United States, reflected on what it has been like to grow up as a symbol of something while also just being a person. The access, the stigma, the future. That was a powerful hour.
[00:05:09] Darnay Pitts came on and talked about carrying babies for other families not once but twice. What it looks like to go back and do it again, what you carry with you from the first time into the second. That conversation is one I think about a lot. And then there was the episode with Dr. Daniel Shapiro and Josh, if you haven't listened to that one yet, stop what you're doing and go back. A sperm donor from the 1980s who is also a fertility specialist, a sitting senator and the donor conceived adult who came looking for him the conversation about what that discovery meant for both of them and what it means for how this industry handles donor conception and something this show will build on for a long time.
[00:05:54] Jennifer Silva walked intended parents through surrogacy from start to baby, the real process, and Christina Elsia took us through the egg donation screening process from application to retrieval in a way that demystifies something a lot of are curious about but don't fully understand going in. And Dr. Crawford closed out the season talking about rethinking fertility through egg, embryo and sperm health. That conversation reframes something a lot of people come in with assumptions about. And I think it's a strong note to end on clinically 19 episodes, 19 conversations. I'm proud of every one of them.
[00:06:34] I want to give credit where it's due because things have moved. Not far enough, not fast enough, but they've moved. IVF is now being talked about at the federal level as a medical necessity. That is new. There have been steps to reduce the cost of fertility medications through a government purchasing platform and some guidance around how employers can structure fertility benefits for the people those things reach. It matters.
[00:07:03] My issue with it is that voluntary programs and narrow drug discounts help people who already have some resources. They don't reach the person who's uninsured or self employed or working for a smaller employer who opted out or living in a state that hasn't acted. And right now, those same federal conversations also include policies that restrict IVF access.
[00:07:29] Progress on one side and obstruction on the other at the same time is not a coherent approach to helping people have families. It's a political calculation and the people in the middle of it are patients. The states have been doing the work that the federal government hasn't. California now requires large group health plans to cover infertility treatment, including ivf. And they expanded the definition of infertility to include people who can't conceive for non medical reasons, which means same sex couples are covered without having to prove a medical diagnosis. That's a real equity step. Georgia, Tennessee and Colorado passed laws affirming the right to pursue fertility care.
[00:08:13] Michigan legalized compensated surrogacy. These things matter. Every state that moves puts pressure on the ones that haven't. But I want to be real about the limits. California's mandate covers large group plants. If you work for a small employer, if you're self employed, if you're on Medicaid, if you live somewhere that hasn't done anything yet, you are largely on your own. One IVF cycle can run between 15 and $20,000 before medications.
[00:08:44] A surrogacy journey in this country is anywhere from $150,000 to over $200,000. We need a federal insurance mandate. That's what would actually move the needle for most people. Everything else helps at the margins. The science is getting better, too, and I don't want to skip over that. AI assisted embryo selection, better genetic screening before transfer, improvements in how eggs and embryos are preserved when those tools are being used well and patients actually understand what they're being offered and why outcomes improve.
[00:09:20] The problem is that too often these technologies get presented as upgrades without patients really understanding what they do. And don't tell you that conversation needs to get better.
[00:09:33] And then Costco got into fertility care. In March 2026, they announced a partnership with the telehealth platform and the major fertility clinic network. Members now have access to IVF, IUI, and egg freezing at reduced prices and up to 80% off fertility medications through the Costco pharmacy. When a company with over 80 million members makes fertility care part of what it offers, that shifts something. It normalizes it in a way that matters. My caveat is always vet carefully understand what's included and what isn't, and make sure your specific medical needs are being met. But as a signal that access is moving into different spaces, that's real. This industry has a trust problem. And it didn't happen randomly. It happened because of what occurs when there is a lot of money, very little oversight, and people who are emotionally and financially at their most vulnerable walking through the door. We've seen agencies shut down abruptly, leaving intended parents with no money and surrogates mid pregnancy with no support and no answers.
[00:10:42] People who put in tens and thousands of dollars, some people over $100,000 gone. Funds that were supposed to be held safely weren't. When people asked questions about how their money was being managed, they were talked out of their concerns. That is not a mistake. That's manipulation.
[00:11:01] And it keeps happening because surrogacy agencies in the United States do not require a license to open.
[00:11:08] There is no federal standard, no required training, no required background, no required financial structure. Anyone can decide tomorrow that they are running a surrogacy agency. And some people are doing exactly that with very little understanding of what this work actually requires and a lot of focus on the bottom line. Now, I want to be clear about something before I go further. There are agencies doing this the right way.
[00:11:35] There are people in this industry who have dedicated their careers to doing this ethically and well. I don't want that to get lost. But when the bar to enter this industry is this low, it creates space for the wrong people to do a lot of damage to people who have no protection against it. Then there's something that happened in 2025 in California that everybody is talking about because it shows a different kind of failure entirely.
[00:12:01] A couple was running what appeared to be a surrogacy agency. Women across the country were matched with them and told they were carrying for a couple who couldn't have another child a sympathetic, believable story. What those women were not told is that multiple surrogates were simultaneously carrying pregnancies for the same couple. The agency and the intended parents were the same people. The women thought they were helping a family. They were being used to build something that had nothing to do with their well being or, or the well being of the children being born.
[00:12:32] 21 children were ultimately removed from that home. Some of the surrogates are still fighting in court for the children they carried. One woman found out the baby she delivered was in foster care. Another was still pregnant when everything came out. These women were trying to do something meaningful. That's what makes it so hard to sit with. And then there's the billionaire situation, which is on its own. Conversation about what happens when surrogacy becomes a tool for something that has nothing to do with family.
[00:13:02] There are wealthy men, some from countries where surrogacy is banned, using the American surrogacy system to father enormous numbers of children. One case that became very public involved a man reported to have over 100 children born through surrogacy in the United States. Children being raised by nannies. A father who appeared in court by video from overseas and said he hadn't met them yet because work had been busy. Men requesting 200 children through agencies, some agencies refusing, some not. The women carrying those pregnancies, aren't told the full picture. The children being born into those situations aren't being considered in any meaningful way by the people who created them. And the systems that are supposed to screen intended parents before a match is made are not catching this or in some cases, aren't looking for it. On the egg donation side, the ethical gaps are real and they don't get talked about honestly enough.
[00:13:58] Egg donors are still not uniformly protected. The information and counseling a donor receives before she donates varies enormously depending on the agency or clinic she works with. There are donors who go through this process without truly understanding what the physical commitments involve, what the medications do to the body, what the short term and long term risks are long term. Outcome data for egg donors is still limited. The industry has relied on compensation as the primary conversation and compensation matters, but it is not a substitute for real informed consent and real ongoing support. The anonymity piece is something this show has talked about before and will keep talking about for a long time. Anonymity was the default. It was sold to donors, to recipient parents, and to the children as protection.
[00:14:51] What we now know from donor conceived people themselves is that it was not protection. It was a closed door on something they had every right to know. Home DNA tests has opened that door, whether the industry was ready for it or not. And families are dealing with the fallout of choices that were made decades ago without any input from the people most affected by them. There's also a transparency problem with fertility clinics that doesn't get enough attention. Success rates are reported in ways that don't always give patients a clear picture. Clinics can select for better prognosis patients, which makes their numbers look better. Marketing language gets used where medical honesty should be.
[00:15:31] People walk in with questions and walk out with optimism, which is not the same thing. Optimism without accurate information does not serve patients. It sets them up for decisions made on an incomplete foundation. And then there are the embryo mix ups. This has happened more than once over the past couple of years, and it has to be part of the conversation. A woman in Georgia went through ivf, became pregnant, gave birth to a baby who was not genetically related to her. The clinic had transferred the wrong embryo. She bonded with that baby, she raised him for five months and then she had to hand him over to his biological parents. She said it was the hardest day of her life. A couple in Florida is fighting in court right now after the same thing happened to them in late 2025. They gave birth to a baby who was not theirs, and they still don't know what happened to their own embryo or whether someone else is raising their biological child.
[00:16:31] These cases aren't not just tragic, they expose something structural. There is no federal requirement for IVF clinics to report embryo mix ups. None. No agency tracks them. No authority investigates them unless the family files a lawsuit. The existing guidelines around embryo labeling and transfer protocols are recommendations. They're not enforced. So when a mistake happens, the family finds out, either in the delivery room or through a DNA test. And then they're on their own to navigate the legal fallout of something the client clinic caused. This connects to something I've talked about on the show before, and we'll keep talking about the history of fertility fraud Doctors who use their own sperm to inseminate patients without consent. This went on for decades. We know about it now because the children who were conceived are adults with access to home DNA tests. And what they're finding is changing their lives and their understanding of their own identities.
[00:17:32] More than 50 doctors in the United States have been connected to this kind of fraud. Cases are still emerging, and in most states, for most of those years, it wasn't even a crime. Several states have now criminalized it. There's a federal bill that would do the same nationally, but it hasn't passed yet. The thread running through all of it is that the people who get hurt are the most vulnerable. People involved. Intended parents who trusted someone with everything they had. Surrogates who were pregnant and alone when an agency disappeared. Patients deceived in the most intimate way possible.
[00:18:07] Donor conceived. People placing together who they are from a DNA kit because no one thought they had the right to know. That is not acceptable. And talking about it is not an attack on the industry. It's how the industry gets better. I also want to say something about surrogate screening, because this doesn't get discussed honestly enough.
[00:18:27] Not every woman who applies to become a surrogate should be a surrogate. That's not a judgment. That's a reality. Carrying a pregnancy for someone is a specific physical, emotional, and psychological commitment, and it is not right for every person at every point in their life. A real screening process exists to figure that out, and when it's working, it protects everyone. The surrogate, the intended parents, and the child.
[00:18:56] When agencies are moving fast and focused on revenue and matching numbers, that process becomes a formality.
[00:19:04] Boxes get checked, conversations don't happen. Women get approved who aren't ready, and the costs of that land on the real people. The agencies that cut corners on screening aren't doing anyone a favor. They're creating situations that fall apart in ways that are very hard to recover from. I also want to name cost as what it is, a barrier that functions as a filter. The families who can afford surrogacy journey at 150 to over $200,000 are a specific group. The families who can't are a much larger group, and they are disproportionately people of color, people in lower income brackets, LGBTQ couples, and single people. When we talk about access to family building, we have to be honest about who access is actually reaching. Because if the cost stays this high and the coverage stays this incomplete, we're not talking about access. We're talking about privilege. And look, this industry needs to do better. I'm not saying that to be critical for the sake of it. I'm saying it because I'm in this space and I care about it, and I'm watching it fall short of what it's supposed to be. The organizations that set standards need to do better. Guidelines mean nothing if there's no accountability when they're ignored. You can write ethic policies all day long. If a clinic or an agency can violate them and keep operating without consequence, those policies are just paper.
[00:20:32] Use the authority you have or stop pretending you have it. Professionals need to do better. All of them. The reproductive endocrinologists, the embryologists, the mental health professionals, the coordinators, the attorneys, the agencies, all of us. Patient care has gone out the window in too many places. The person sitting across from you spent years getting to that appointment. They may have spent everything they have. They are not a chart or a cycle to manage. They are a person in one of the hardest moments of their life. And the care they receive should reflect that. Too much of this has become about the bottom line. Volume over quality. Move the patient through the protocol, build a cycle. Next. And I want to say clearly, this is not just a fertility problem. This is what medicine in this country has become. Across the board, patients in every specialty are being seen for less time, given less information, and sent home without enough support. The fertility space is not an exception to that. It's part of it. But that doesn't make it okay here. The people who come through these doors aren't here for a routine checkup. They're here because they want a family, and they can't get there without help that comes with the responsibility no billing code captures. If you've been in this work long enough to forget that, it's worth asking yourself what you're actually doing here. And let me talk about the politics, because you cannot have this conversation honestly right now without going there. There are people in positions of political influence who are very publicly concerned about declining birth rates. The birth rate is dropping. The population is aging. We need more babies. That is the message. And in the same breath, some of those same people are supporting policies that make it harder to have babies, policies that treat IVF embryos as having legal rights, which puts them in direct conflict with how IVF actually works. IVF creates multiple embryos. Not all of them get transferred. Not all of them result in a pregnancy. In states where that personhood argument has gained legal ground, clinics have had to stop doing IVF entirely. People mid cycle had been left with nowhere to Go. Real families trying to do a very real thing, stuck in the middle of an ideological argument that never considered them. You cannot say you want more people to have children and then support policies that take away the most effective medical path to having them. These two things don't go together, and people in this community are living inside that contradiction every day. There's also a push to elevate something called restorative reproductive medicine in federal policy.
[00:23:20] The idea is that before someone can pursue ivf, they should first try lifestyle changes, hormone monitoring, ovulation tracking, and I want to be clear about what that actually means in practice. It delays care for people who need it now. It does nothing for male factor infertility, which lifestyle interventions cannot fix. And it sends a message that IVF is extreme or a last resort when it is just medicine. When policy adds hoops between a patient and the care they need, that is a barrier.
[00:23:52] Dress it up in wellness language all you want, it is still a barrier.
[00:23:56] We're also watching staffing cuts at the federal agencies that oversee public health data and reproductive medicine. Less capacity to track outcomes, catch problems, and protect patients. That infrastructure is there for a reason. When it gets gutted, patients feel it. Policymakers do not.
[00:24:16] Florida is another example of what I mean when I say watch what people are actually doing. Florida is trying to pass a bill through both House and Senate that bans gestational surrogacy contracts if any party is involved in a citizen or resident of what the state designates as a foreign country of concern. That list includes China, Russia, Iran, North Korea, Cuba, Venezuela, and Syria. That stated reason was a reaction to the California case involving the dozens of children born through surrogacy to a Chinese couple under investigation for abuse. I understand the impulse that situation was disturbing. But the lawmakers who added this provision to a foreign interference bill did so without testimony from surrogacy attorneys, without input from the reproductive medicine community, and without a full understanding of the downstream effects. Critics are already pointing out that it could create unintended consequences for surrogacy and adoption involving any person from those countries, including people who are legally living in the United States. When you attach reproductive policy to national security legislation and rush it through without expert input, you get bad law, and it's the families caught in the middle who pay for it. And then there's the Vatican. Pope Francis has called for a universal global ban on surrogacy, calling the practice a grave violation of the dignity of both the surrogates and the child. The Vatican has taken this position to The United Nations. They frame surrogacy as closer to trafficking than to family building. And they've called on the international community to prohibit it entirely. I want to be direct about where I stand on this. I have been a surrogate. I know what the experience was for me. I know the women in this space. The characterization of surrogates as exploited women with no agency, no voice, and no genuine choice is not the reality of what ethical, supported, legally protected surrogacy looks like. The concerns about exploitation and surrogacy are real and they deserve serious attention in places where women are not protected, where contracts don't exist, where there is no independent legal representation and no medical oversight.
[00:26:37] But the answer to those failures is not a blanket ban. It is regulation, transparency, and real protections for the women who choose to do this. Surrogates are not victims of surrogacy. The women who get hurt are victims of bad actors and unregulated systems. Those are very different problems that require very different solutions. I'm not going to tell you who to vote for. What I will say is watch what people are actually doing, not just what they're saying. Because right now, the gap between the rhetoric around family building and the actual policy decisions affecting people in the space is significant.
[00:27:18] And the people paying the price for the gap are the ones who are already in the hardest part of this journey. Vet.
[00:27:25] And I mean that in every direction, not just one. If you are pursuing surrogacy, whether you're the surrogate or the intended parent, you need to vet your agency thoroughly. Ask who holds the escrow, how it's structured. Ask for proof of insurance. Ask what happens to your funds if the agency closes. Ask how long the people running it have been doing this work and what their background actually is. A good website and active social media are not credentials.
[00:27:54] If someone makes you feel like asking these questions is a problem, that is your answer right there. Surrogates, you have every right to know who you're carrying for, know their situation.
[00:28:06] Understand what the relationship and support structure looks like during the pregnancy and after. If that information is being kept vague, ask again.
[00:28:17] And then ask again. You are not being difficult. You are being responsible about a decision that involves your body, your family and months of your life.
[00:28:27] On the egg donation side, recipient parents need to vet donors beyond the profile. The profile is a starting point, actually. Understand the donor's medical history, her motivations, what she's been told about the process and what she genuinely understands about it. The more informed everyone is going in, the better the outcome tends to be for everyone involved. And egg donors. You have every right to vet the recipient parents in the clinic or agency you are working with. What are the terms? What are you agreeing to? What happens if there are complications? What support exists during the process and after? These are not difficult questions. They are basic questions. And anyone who dismisses them or makes you feel like they're inappropriate is not running an ethical operation. Take the screening process seriously. If you are a woman who wants to be a surrogate and you go through a screening process and are cleared, that means something. It means the right questions were asked and the answers pointed in the right direction. If you're not cleared, that is not a judgment on you as a person. It means this specific thing at this specific time is not the right fit. That outcome is the screening process doing exactly what it's supposed to do. That outcome is the screening process doing exactly what it's supposed to do. And any agency that skips it is not protecting you. Social media is not a substitute for professional guidance. There is so much information circulating about fertility, surrogacy, egg donation, ivf, and a lot of it is incomplete or flat out wrong. For decisions that involve your health, your money and your legal rights, you go to a reproductive attorney and your medical team, not a Facebook group. If you've been hurt by what's happened in this industry, it was not your fault. You trusted people who were supposed to be trustworthy.
[00:30:18] Document everything you have, get a reproductive attorney involved immediately and know that what happened to you matters and it deserves to be addressed.
[00:30:28] Stay informed about what's happening legislatively in your state. The landscape is moving, and what applies today may look different in six months. Your state representatives hear from constituents. If access and coverage matter to you, say so. I have spent most of this episode talking about what's broken, and I meant every word of it. But I want to end somewhere different. Because if I don't, I'm not giving you the full picture either. The stories that make the news are the ones where something went wrong. The agency that collapsed, the embryo that got mixed up, the fraud, the scandal. The stories spread because they're alarming and they should alarm us. But they are not the whole story of this industry. Not even close.
[00:31:09] Every single day, surrogates and intended parents are matching with each other and building relationships that change both of their lives. Embryo transfers are happening and working babies are being born and going home to families who waited years for them. Egg donors are helping people become parents who had run out of other options. IVF cycles are succeeding Women are carrying pregnancies for other families and coming out on the other side saying it was one of the most meaningful they've ever done. Intended parents are sending photos and letters for years afterwards.
[00:31:46] Some of these relationships last a lifetime.
[00:31:50] You don't hear about those stories because there's no headline in them.
[00:31:54] Nobody reports on the surrogate who delivered a healthy baby girl in March and went home to her own family feeling whole. Nobody reports on the gay couple who tried for four years and finally got the call. Nobody reports on the egg donor who found out five years later that the family she helped now has two kids and still thinks about her every birthday. Those stories are happening constantly in every state across every kind of family. Nobody reports on the egg donor who found out five years later that the family she helped now has two kids and still thinks about her every birthday. Those stories are happening constantly in every state across every kind of family structure. They just don't make noise. I think about the guests we've had on the show over seven seasons. Surrogates who said they'd do it again without question. Intended parents who described the moment they held their child for the first time in ways I can still hear. People who came through infertility and who came out on the other side of it with families and with the perspective on life that they wouldn't trade donor conceived adults who have made peace with their story and found meaning in it. That is also what this community is. The problems are real and they need to be addressed. The industry needs more oversight, more transparency and more accountability. But the reason those things matter is because what's at the center of this, when it works the way it should, is genuinely extraordinary. People are bringing children into the world who wouldn't exist otherwise. Women are doing something for someone else that cannot be repaid.
[00:33:31] Families are being created in ways that didn't exist a generation ago. That is worth protecting, that is worth fixing the broken parts for. So, yes, pay attention to what's going wrong. Ask the hard questions. Vet your agency, protect yourself. But don't lose sight of why people are in this space to begin with. The stories that don't make the news are the majority, and most of them are beautiful.
[00:33:57] Season eight is coming later in 2026, and before that, we're launching a surrogate series. First person stories directly from women who have carried pregnancies for other families. The full experience in their own words. If you're thinking about surrogacy from any angle, it's going to be worth your time. Thank you. For season seven. This community is something real and I don't take that lightly. Stay with us. Thanks so much for listening to Fertility Cafe. If you've enjoyed this episode, be sure to subscribe so you never miss an interview. Leave us a review and connect with us on socials. We're ertilitycafe. You can also watch the full video version of today's conversation over on our YouTube channel. Until next time, remember, love has no limits. Neither should parenthood.
