Woman’s horror story reflects loosely regulated nature of US fertility industry

By Rob Kuznia, Allison Gordon, Nelli Black and Kyung Lah | CNN 

Victoria Hill never quite understood how she could be so different from her father – in looks and in temperament. The 39-year-old licensed clinical social worker from suburban Connecticut used to joke that perhaps she was the mailman’s child.

Her joke eventually became no laughing matter. Worried about a health issue, and puzzled because neither of her parents had suffered any of the symptoms, Hill purchased a DNA testing kit from 23andMe a few years ago and sent her DNA to the genomics company.

What should have been a routine quest to learn more about herself turned into a shocking revelation that she had many more siblings than just the brother she grew up with – the count now stands at 22. Some of them reached out to her and dropped more bombshells: Hill’s biological father was not the man she grew up with but a fertility doctor who had been helping her mother conceive using donated sperm. That doctor, Burton Caldwell, a sibling told her, had used his own sperm to inseminate her mother, allegedly without her consent.

But the most devastating revelation came this summer, when Hill found out that one of her newly discovered siblings had been her high school boyfriend – one she says she easily could have married.

“I was traumatized by this,” Hill told CNN in an exclusive interview. “Now I’m looking at pictures of people thinking, well, if he could be my sibling, anybody could be my sibling.”

Hill’s story appears to represent one of the most extreme cases to date of fertility fraud in which fertility doctors have misled their female patients and their families by secretly using their own sperm instead of that of a donor. It also illustrates how the huge groups of siblings made possible in part by a lack of regulation can lead to a worst-case scenario coming to pass: accidental incest.

In this sense, say advocates of new laws criminalizing fertility fraud, Hill’s story is historic.

“This was the first time where we’ve had a confirmed case of someone actually dating, someone being intimate with someone who was their half-sibling,” said Jody Madeira, a law professor at Indiana University and an expert on fertility fraud.

A CNN investigation into fertility fraud nationwide found that most states, including Connecticut, have no laws against it. Victims of this form of deception face long odds in getting any kind of recourse, and doctors who are accused of it have an enormous advantage in court, meaning they rarely face consequences and, in some cases, have continued practicing, according to documents and interviews with fertility experts, lawmakers and several people fathered by sperm donors.

CNN also found that Hill’s romantic relationship with her half-brother wasn’t the only case in which she or other people in her newly discovered sibling group interacted with someone in their community who turned out to be a sibling.

At a time when do-it-yourself DNA kits are turning donor-conceived children into online sleuths about their own origins – and when this subset of the American population has reached an estimated one million people – Hill’s situation is a sign of the times. She is part of a larger groundswell of donor-conceived people who in recent years have sought to expose practices in the fertility industry they say have caused them distress: huge sibling pods, unethical doctors, unreachable biological fathers, a lack of information about their biological family’s medical history.

The movement has been the main driver in getting about a dozen new state laws passed over the past four years. Still, the legal landscape is patchy, and the US fertility industry is often referred to by critics as the “Wild West” for its dearth of regulation relative to other western countries.

“Nail salons are more regulated than the fertility industry,” said Eve Wiley, who traced her origins to fertility fraud and is a prominent advocate for new laws.

Accountability in short supply

More than 30 doctors around the country have been caught or accused of covertly using their own sperm to impregnate their patients, CNN has confirmed; advocates say they know of at least 80.

Accountability for the deception has been in short supply. The near-absence of laws criminalizing the practice of fertility fraud until recently means no doctors have yet been criminally charged for the behavior. In 2019, Indiana became the second state, more than 20 years after California, to pass a statute making fertility fraud a felony.

Even in civil cases that have been settled out of court, the affected families have typically signed non-disclosure agreements, effectively shielding the doctors from public scrutiny.

Meanwhile, some doctors who have been found out were allowed to keep their medical licenses.

In Kentucky, retired fertility doctor Marvin Yussman admitted using his own sperm to inseminate about half a dozen patients who at the time were unaware that he was the donor. One of them filed a complaint to the state’s board of medical licensure when her daughter – who was born in 1976 – learned Yussman was the likely father after submitting her DNA to Ancestry.com.

“I feel betrayed that Dr. Yussman knowingly deceived me and my husband about the origin of the sperm he injected into my body,” the woman wrote in a letter to the board in 2019. “Although I realize Dr. Yussman did not break any laws as such, I certainly feel his actions were unconscionable and depraved.”

In his response to the medical board, Yussman said that during that era, fresh sperm was prioritized over frozen sperm, meaning donors had to arrive on a schedule.

“On very rare occasions when the donor did not show and no frozen specimen was available, I used my own sperm if I otherwise would have been an appropriate donor: appropriate blood type, race, physical characteristics,” Yussman wrote.

He added some of his biological children have “expressed gratitude for their existence” to him and even sent him photos of their own children. Yussman, who noted in his defense that he didn’t remember the woman who made the complaint, said his policy decades ago was to inform patients that physicians could be among the possible donors, though neither he nor the complainant could provide records that clarified the protocol.

The board declined to discipline him, citing insufficient evidence, according to case documents. Reached on the phone by CNN, Yussman declined to comment.

The story that really put fertility fraud on the national radar was that of Dr. Donald Cline, who fathered at least 90 children in Indiana. Cline’s case spurred lawmakers to pass legislation that outlawed fertility fraud but wasn’t retroactive, meaning he was never prosecuted for it. But he was convicted of obstruction of justice after lying to investigators in the state attorney general’s office who briefly looked into the case. Following that conviction in 2018, Cline surrendered his license. Cline’s lawyer did not respond to an email seeking comment.

Netflix followed up with a documentary about Cline in 2022 that inspired two members of Congress – Reps. Stephanie Bice, an Oklahoma Republican, and Mikie Sherrill, a New Jersey Democrat – to coauthor the first federal bill outlawing fertility fraud. If passed, the Protecting Families from Fertility Fraud Act would establish a new federal sexual-assault crime for knowingly misrepresenting the nature or source of DNA used in assisted reproductive procedures and other fertility treatments. The bill has found dozens of backers – 28 Republicans and 20 Democrats – amid a renewed effort to push it on Capitol Hill.

A group of advocates including Hill plans to go to DC to champion the bill on Wednesday.

To be sure, passage wouldn’t mean that any of the dozens of doctors who have already been accused of fertility fraud would go to prison, as the crime would have occurred before the law existed. But the measure would provide more pathways for civil litigation in such cases.

The push to better regulate the fertility industry isn’t without critics. It inspires unease – if not outright opposition – from some who fear any industry crackdown could have the unintended effect of making the formation of families less accessible to the LGBTQ community, which comprises an outsized share of the donor-recipient clientele.

“I think we should pause before creating additional criminal liability for people practicing reproductive medicine,” said Katherine L. Kraschel, assistant professor of law and health sciences at Northeastern University. “It gives me great pause … to say we want the government to try to step in and regulate what amounts to a reproductive choice.”

Some experts also point out that the advent of take-at-home DNA tests by companies such as 23andMe and Ancestry has pretty much stamped out fertility fraud in the modern era.

“To my knowledge, the majority of fertility fraud cases took place before 2000,” said Julia T. Woodward, a licensed clinical psychologist and associate professor in psychiatry and OBGYN in the Duke University Health System, in an email to CNN. “I think it is highly unlikely any person would engage in such practices today (it would be too easy to be exposed). So this part of the landscape has improved significantly.”

But activists in the donor-conceived community still want laws, in part to provide pathways for civil litigation, and also to send a message to any medical professional who might feel emboldened by the lack of accountability.

“Let’s say arguably that it doesn’t happen anymore,” said Laura High, a donor-conceived person and comedian who, with more than 600,000 followers on TikTok, has carved out something of a niche as a fertility-industry watchdog on social media. “Pass the f**king legislation just in case.

“Why not just out of the optics – just out of a, ‘Hey we’re going to stand by the victims.’ Let’s just do this. We know it’s never going to happen anymore, but let’s just make this illegal.”

‘You are my sister’

The lack of a law in Connecticut appears to have been a stumbling block for a pair of siblings seeking recourse for what they allege is a case of fertility fraud.

The half-siblings – a sister and brother – sued OBGYN Narendra Tohan of New Britain in 2021, saying he deceived their mothers when using his own sperm in the fertility treatments.

He has derailed the suit with a novel defense, arguing successfully that it amounts to a “wrongful life” case, which typically pertains to people born with severe life-limiting conditions and isn’t recognized in Connecticut. Tohan, who is still practicing, did not return an email or call to his office seeking comment. The siblings are appealing the ruling.

Madeira, the expert in fertility fraud from Indiana University, called the “wrongful life” decision absurd.

“In fertility fraud, no parent is saying that – no parent is saying I would have gotten an abortion,” she said. “Every parent is saying, ‘I love my child. I just wish that my wishes would have been respected and my doctor wouldn’t have used his sperm.’”

And then there is Dr. Burton Caldwell, who declined CNN’s request for an interview. One of his apparent biological children decided to sue him last year, even though she knows it will be an uphill battle without a fertility fraud law on the books. Janine Pierson and her mother, Doreen Pierson, accuse Caldwell – who stopped practicing in the early 2000s – of impregnating Doreen with his own sperm after having falsely told her that the donor would be a Yale medical student.

Janine Pierson, a social worker, thought she was an only child until she took a 23andMe test in the summer of 2022 and was floored to learn she had 19 siblings. (That number has since grown to 22.)

“It was like my entire life just came to this screeching halt,” she told CNN.

When she learned through one of her siblings that Caldwell was the likely father, Pierson said she immediately phoned her mom, who was stunned.

“We both just cried for a few minutes because it just felt like such a violation,” Pierson said.

Pierson said she decided to pursue the lawsuit even though she knows the lack of a fertility-fraud law in Connecticut could pose a challenge.

“It shouldn’t just be, you know, the Wild West where these doctors can just do whatever it is that they want,” she said.

Hill is watching her newly discovered half-sister’s case closely.

For her, the first surprise was learning the dad she grew up with wasn’t her biological father.  Although her mom had told her when Hill was younger that she’d sought help conceiving at a fertility clinic, she also said – falsely – that the doctor had used her dad’s sperm.

When Hill learned that the biological father appeared to be Caldwell a few years ago, she contacted lawyers to inquire about filing a suit, but was told she doesn’t have much of a case, so she didn’t pursue it. Now, she said, her statute of limitations is about to expire.

Last year, Hill was hit with another shattering revelation.

In May, she and her three closest friends were celebrating their 20-year high school reunion over dinner.

She was sharing the tale with them of how she learned about her biological father. Everyone was captivated, except one person – her former boyfriend. He looked like he was turning something over in his head. Then he noted that his parents, too, had sought help conceiving from a fertility clinic.

A couple months later, in July, as Hill was leaving for a summer vacation with her husband and two young children, the ex-boyfriend texted her a screenshot showing their 23andMe connection.

“You are my sister,” he said.

Fertility industry regulations in US lax relative to other countries

Hill’s high school boyfriend isn’t the only person she knew in the community who turned out to be a sibling.

“I have slept with my half-sibling,” Hill said. “I went to elementary school with another.”

What’s more, Hill said, back in the early 2000s, she lived across the street from a deli in Norwalk she often went to that was owned by twins who she later learned are her siblings.

Pierson, too, discovered recently that she’d crossed paths with a sibling long ago. She said she has a group photo from when she was a kid at summer camp that shows her on a stage and a boy in the audience. In 2022, she learned that he is her older half-brother.

“Within 20 feet of one another, and we have no idea,” she said.

In general, the bigger the sibling pool, the greater the risk of accidental incest – regardless of whether fertility fraud came into play.

“I don’t date people my age. I can’t do it,” said Jamie LeRose, a 23-year-old singer from New Jersey who has at least 150 siblings from a regular sperm donor, not a doctor. “I look at people my age and I’m automatically unattracted to them because I just, I go, that could be my sibling.”

With this in mind, activists also often advocate for laws that cap the number of siblings per donor – and that do away with donor anonymity. (Neither of these restrictions are included in the proposed federal bill.)

Other countries have instituted such regulations. Norway for instance limits the number of children to eight; Germany, to 15. Germany and the UK have banished anonymity at sperm banks.

The United States government has no such requirements – and the professional association that represents the fertility industry wants to keep it that way.

“What we have not done very much in this country is pass regulations about who gets to have children,” said Sean Tipton, the chief advocacy and policy officer for the American Society for Reproductive Medicine. “If you’re going to say you should only be able to have 50 children, that’s fine. But that should apply to everybody. It shouldn’t apply just to sperm donors.”

Regarding the concern among donor-conceived people about accidental incest, Tipton added, “if you want to be sure that before you have children with somebody, you can run DNA tests to make sure you’re not related.”

The ASRM, which often clashes with donor-conceived activists, has not taken a stance on the federal bill, Tipton told CNN.

The organization does offer nonbinding guidelines that address concerns about incest, recommending for instance no more than 25 births per donor in a population of 800,000.

Although most of the donor-conceived people who spoke with CNN for this story said they wanted to see legislative change, they also described an emotional aspect of the topic that no new law or regulation could begin to quell: a yearning to better understand one’s origins and identity. For Pierson, it was this desire, coupled with a mix of anger and curiosity, that compelled her to pay Caldwell an unannounced visit one day in 2022 – weeks after she’d learned he was most likely her biological father.

Confronting Caldwell