Inside Ivf Mix-ups That Left Women Carrying Embryos That Weren’t Theirs

From the moment she found out she was pregnant, Krystena Murray was excited to capture every step of the journey.

"I have always known I wanted to be a mom," Murray told ABC News. "There was an assignment for school when I was younger, and we were supposed to pick a career. My mom said 'What do you want to be?' And I said, 'A mom.' And she says 'No, like, what do you want to do with your life?' And I looked at her and said, 'A mom.' "

The Savannah, Georgia resident chose in vitro fertilization (IVF), a fertility treatment where mature eggs are collected from ovaries and fertilized by sperm in a lab. IVF is a game changer for many families, and recent data show that in the US about 250,000 patients per year receive IVF cycles.

"I was a single woman, and I spent years trying to find the perfect person," Murray said. "And the older I got, the more I realized I was more interested in being a mother before I got any older than I was in pursuing a person."

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The 38-year-old photographer was an oncology nurse for nearly a decade before switching careers. To afford IVF, she worked two and a half jobs, nearly depleting her life savings.

Her first IVF embryo transfer was unsuccessful, but her second one worked.

Murray imagined what the baby she was carrying would look like, saying she chose a sperm donor with features similar to hers: dirty blonde hair, blue eyes and fair skin.

Her baby arrived in December 2023. In the delivery room, that feeling of euphoria shattered moments after the baby boy was born.

"They actually held him up for me to see before they took him off to be cleaned and weighed and footprints and all of the things," Murray said. "My first thought was "He's absolutely beautiful. He's gorgeous.' And my second thought was, what happened?"

According to Murray, the baby was African American. It was immediately evident that something didn't go as planned.

"My first thought was, 'Was it the embryo or was it the sperm?'" Murray said. "My next thought was, 'If he is not mine and he's someone else's embryo, can he be taken?'"

Shortly after, she took a DNA test, which confirmed that the baby was not biologically hers.

More than a month and a half later, Murray says the clinic Coastal Fertility Specialists informed her that they had identified the baby's biological parents, who were living in another state.

"I was still hoping that, you know, there would be some way that I could keep custody of him," Murray said.

However, Murray said that the baby's biological parents sued her for custody, and that was when she made what she called an impossible decision. After raising him for the first five months of his life, she gave up the only son she had ever known.

"That was the worst day of my life," Murray said. "It wasn't just that I was bonded to him. He was bonded to me."

Murray sued Coastal Fertility Specialists, seeking a judgment of more than $75,000, along with punitive damages, recovered attorney fees, treble damages and all other costs.

Coastal Fertility Specialists said in a statement to ABC News that their practice "deeply regrets the distress caused by an extremely rare human error" and extends their "sincerest apologies." They emphasized that "this incident does not reflect the high standards we have upheld for 15 years, and no other patients were affected."

They also informed ABC News that they implemented additional human witnessing in their lab. They said they also introduced a state-of-the-art digital witnessing system that electronically verifies patient samples in real time using advanced scanning technology.

Murray's story may be shocking, but it is not the first of its kind. Daphna and Alexander Cardinale experienced a similar situation. Five years ago, the Los Angeles couple was excited to make their daughter, Olivia, a big sister but struggled to conceive. Eventually, they turned to IVF and were able to get pregnant.

Daphna and Alexander Cardinale filed a lawsuit against their fertility clinic and ultimately reached a private settlement.

Daphna gave birth to a baby girl. Even though the infant didn't resemble her older sister at first, the couple didn't think much of it. However, Alexander couldn't shake the doubt from his mind, especially when others pointed out that their baby appeared to be Asian. The Cardinales are caucasian.

The couple requested a DNA test.

"That image will be burned into my brain forever," Alexander said. "That reading that it's 99.9% accurate that you're not the father. And then she asked me to read the results for the mother, and then it was 99.9%. It's earth-shattering!"

The clinic informed them that their embryo had been switched with the embryo of another couple. That couple had given birth to Alexander and Daphna's biological daughter, named Zoe. Even more shocking, the two families lived just miles apart.

They agreed to meet when both baby girls were just over three months old. The two families got together almost every day for the next few weeks. Eventually, they made an agonizing decision: they would switch their four-month-old babies.

"It was surreal," Daphne said. "I gave her a bath the first night she was here. And then after I gave her a bath I was like "Oh, you smell like home." And so I was like, okay. I think that was the moment when I spelled it that I was like "Oh, you are my baby."

The Cardinales filed a lawsuit against their fertility clinic and ultimately reached a private settlement.

Attorney Adam Wolf represented both Murray and the Cardinales. He told ABC News that his firm has also represented more than a thousand others in lawsuits against fertility clinics.

"Whether it is dropping eggs or embryos on the ground, or mixing the wrong sperm with the egg or switching embryos from couple A to couple B," Wolf said. "Those are things that are life-altering."

Mishaps may be rare, but families who experience them face unimaginable consequences.

Wolf says that at the crux of the issue is a need for more regulation to prevent and track mistakes, and better enforcement in the event of an error.

“This is now a maturing industry that greatly needs regulation,” Wolf said. “People like Krystena needed it a year ago, and the next Krystena will need it before this happens.”

The American Society for Reproductive Medicine (ASRM) says that IVF is “one of the most heavily regulated procedures in all American medicine.”

They also say that medical providers have an ethical duty to disclose clinically significant errors.

ASRM’s affiliate group The Society for Assisted Reproductive Technology (SART) accredits and oversees IVF clinics. ASRM says on their website that “to be a SART member, clinics must meet a rigorous set of standards, including credentialing of clinic staff, accreditation of their laboratory, and adherence to the routinely updated Practice and Ethics guidelines set by ASRM.” Those recommendations include protocols for embryo transfers and genetic testing.

Boston IVF employee gives insight into safe practices.

However, Dov Fox, who studies the intersection of fertility care and health law, says that these are “just recommendations” and that “they’re not enforced in any meaningful way.” Dov Fox is the Herzog Research Professor of Law at the University of San Diego where he directs the Center for Health Law Policy and Bioethics. He is also the author of an academic book “Birth Rights and Wrongs: How Medicine and Technology are Remaking Reproduction and the Law” and investigative podcast “Donor 9623” on this topic.

Regarding the state of regulation, Fox says that “assisted reproduction in the United States is not the wild west, but there are no enforceable measures to reliably keep things from going wrong or from making them right if and when they do.”

“Federal policy is limited to FDA requirements that donors be tested for communicable diseases like AIDS, and a 1992 law that asks clinics to report pregnancy rates to the CDC.”He explains that CDC data “doesn't include either why successes didn't happen, what the failure resulted from… Was it pre existing infertility complications for example, or a mix up, switch loss or destruction that might have related to negligent misconduct?”

There is also no federally mandated requirement for clinics to report mistakes if they occur, nor is there a centralized database that tracks errors.

However, according to Fox, regulation could pose the risk of increasing prices and therefore potentially reducing access and stifling innovation.

For Krystena Murray and the Cardinale family, they say there are measures that can be implemented that would prevent mistakes from occurring, and they are insisting on change.

Alexander and Daphna Cardinale have launched a nonprofit ‘Hope Without Harm.’ “And so now our purpose has become just educating everybody else about it and saying that this is probably not going to happen to you, and here are the steps you can take to be safer about it,” Alexander Cardinale said. “There was a mistake made, and then because a mistake was made, we can say, oh, well, how do we prevent it next time?”

"I wanted to tell my story," Murray said. "I wanted people to realize that this isn't just something that might happen or that could happen, this is something that does happen. And for them to hear how hard it is when it does happen."