'I was trying to survive': Yale Fertility Center patients say signs of neglect were there all along

Her babies had been delivered too early to survive, and Lauren Rosenberg barely had herself.

In November 2019, Rosenberg was transferred from Greenwich Hospital to Yale New Haven Hospital with a severe pregnancy complication.

“My liver was failing. It was really dire,” Rosenberg said.

While grieving the loss of her twins, she felt hopeless. One of the doctors who saved her life specialized in fertility treatment. Rosenberg, who was 40 years old at the time, told the doctor: “I need a plan. This cannot be the end of the story. I just want to be a mom.”

She was told there was a 40% to 60% chance she might develop a life-threatening complication called HELLP syndrome during pregnancy, but she could do IVF and find a gestational carrier. She was referred to the Yale Fertility Center.

In January 2020, she started her first round of IVF injections.

Patients thought the Yale name meant they'd be receiving quality care

After her near-death experience, Rosenberg prioritized going to a top-notch clinic.

“I felt with the name Yale that they were going to take great care of me,” Rosenberg said. “I never once questioned that they wouldn't know what was going in my body or that they wouldn't care about how I was feeling.”

But during her first retrieval, she was horrified.

“When you get an egg retrieval, you’re in stirrups. You’re in a vulnerable position,” Rosenberg said. “They have you strapped down too, (so) you can only move so much.”

Immediately, she felt excruciating pain. Her body jerked, and she was told to stop moving.

“My body was convulsing on the table, and I just remember the look of irritation on the doctor’s face,” Rosenberg said. “He put his hands up and he said, ‘She has to stop moving, or I can't do this procedure.’”

At that moment, she told herself to “get it together” and that it was her fault the doctor was so irritated. The nurse told her to take a deep breath and try again.

“It happened again, and I said, ‘I’m feeling everything.'"

Finally, she was given more medicine, but it didn’t help.

“I asked the nurse: 'That really, really, really hurt. Is that normal?’” Rosenberg said. “And she said something like, ‘It’s not like you were getting a manicure.’”

Without the nurse or doctor expressing any urgency or concern regarding her experience, Rosenberg convinced herself that her level of pain was normal.

“Maybe this is just how painful this is. Maybe this is what I have to endure to be a mom,” she remembers thinking. “And at that point, honestly, I was willing to do anything to be a mom.”

One thing that shocked her about her experience was how different it was from everybody else's based on those she had spoken to ahead of time. Rosenberg had always considered herself “tough,” and after the procedure, she felt ashamed she couldn’t withstand the pain.

“I was almost embarrassed to tell people how painful (it was),” Rosenberg said.

'It was 45 minutes of living hell and just absolute torture'

For Angela Cortese, the neglect began even before the first retrieval.

In 2017, Cortese and her partner decided to assess what kind of reproductive intervention she would need to have children. At her first fertility consultation, doctors discovered she had only one fallopian tube and a “unicorn uterus,” which meant her right ovary was not in the expected anatomic position.

In December 2019, she went forth with her first egg retrieval at Yale Fertility Center. That plan was for Cortese to undergo IVF and for her partner to carry the baby.

Leading up to the procedure, Cortese had a string of uncomfortable check-ins during which doctors and nurses struggled to find her right ovary.

"They’re telling you, ‘You can stop whenever you want.’ But you really can’t, because you only have so much time in that appointment. You want to see how the follicles are developing,” Cortese said.

But on the day of the retrieval, everything seemed to be operating as normal ? until the procedure: “It was 45 minutes of living hell and just absolute torture,” Cortese said.

With each needle insertion, the nurses ? who were all women ? tried to keep Cortese calm as she convulsed on the table.

“But it's the male doctor who's at the end of the table saying, ‘Well, do you think you could like hold on a little bit longer?’” Cortese said.

She remembers being told she had maxed out on medication, but the doctor told her he could retrieve three more follicles and she had to push through if she “wanted the best odds.”

Cortese was awake for the entirety of the procedure but was never asked if she needed to take a break. She felt like an inconvenience and pushed through the pain.

“I was trying to survive,” Cortese said. “I was trying to figure out how to convince my body to just handle the pain because if I couldn’t do it, then I was jeopardizing my entire family’s future. It was balancing the excruciating pain with that feeling of ‘This is your fault.’”

After the procedure ended, the pain lingered. Her mind raced with worries that her pain had interfered with the success of the retrievals. The doctor came into the room and prescribed her pain medication but did not check in with her again.

Cortese’s first retrieval resulted in her wife getting pregnant, but that pregnancy ended in a miscarriage. So they made the difficult decision to have a second retrieval.

While preparing for the second retrieval, she was finally able to address the harrowing experience from the first procedure.

“One of the nurses finally commented like, ‘Yeah, it wasn’t a normal amount of pain that you were in,’” Cortese said. "But they found ways to just justify what I was feeling."

'I was literally crying. There were tears coming out.'

Rosenberg's first egg retrieval created the embryo that resulted in her two twin boys. But it was the only viable embryo from her procedure. Fear sunk in as she reviewed data on the success of transfers, which suggested there was a high risk of the embryos not taking. So, she decided to have a second retrieval, despite lingering concerns about how painful it had been.

For her second retrieval in June 2020, she was sedated and alone in the clinic. COVID-19 protocols had shifted the environment ? the facility felt isolating, and her partner wasn’t allowed to accompany her inside. Her anxiety around the procedure had increased, but she did not experience pain during it. Instead, an intense, sharp pain followed it. Unlike her first retrieval, she was unable to walk afterward and was brought out to her car in a wheelchair.

Similarly, she was incoherent and slipped in and out of consciousness during her third retrieval in August 2020.

After these procedures, she tried to share her pain with doctors, but she felt no one wanted to engage.

“I think the desperation I had for a family allowed me to endure it,” Rosenberg said. “As I was lying there and that needle was going in and out, I was literally crying. There were tears coming out. To have that be just dismissed I think speaks volumes.”

Cortese’s second retrieval also took place in June 2020 and was just as traumatic as her first. Without her wife in the clinic, Cortese’s anxiety was greater than ever before.

“There was no acknowledgment that I had been through something traumatic,” Cortese said. “It was basically 'Suck it up, Buttercup, or else we’re not gonna get this done.'”

Though she had been sedated this time, she woke up mid-procedure to members of her medical team saying she was in distress and had maxed out on pain medication. Once they noticed she was awake, they terminated the procedure before retrieving eggs from both ovaries.

No one checked in on her after the procedure. Instead, she was given pretzels and ginger ale and told she could leave the clinic after she ate.

Her wife pulled up to the front door as Cortese was wheeled out to the car, and while being transferred from a wheelchair to the car, a nurse informed her there were further complications during the procedure.

“She told me (they) went through my bladder, so I might have some bleeding,” Cortese said. “She was not anybody who was in the procedure room with me. She wouldn't even be able to answer (questions) because it was beyond what she knew.”

Again, Cortese felt like a burden who had taken up too much of the doctor’s time.

This retrieval was successful, but she decided to immediately go ahead with a third retrieval for financial reasons ? she didn’t have the money to wait until later in case this pregnancy resulted in another miscarriage.

At this point, she was angry with the poor quality of care she received at the clinic. She told the team they could go forth with an abdominal procedure to avoid continuous difficulties with finding her right ovary. “I was like: I don't want to have to keep experiencing this. Clearly, my body can't handle it. Like, get them out,” Cortese said.

As she was brought into the room to start the procedure, she experienced an intense panic attack.

“I really hadn't processed and truly understood the scope of the damage that the first two retrievals had inflicted,” Cortese said.

Her second retrieval resulted in the birth of her son.

The truth delivered by mail

The letter came in the mail in December 2020. Each woman got an identical copy. Yale had “learned of an event that may have involved (their) care.”

The center disclosed that they had discovered that on multiple occasions, a Yale Fertility Center nurse had been replacing fentanyl with saline in "some medication vials," which “may have” resulted in some patients receiving saline instead of the intended narcotic during their procedures.

“While there’s no reason to believe that this event has had any negative effect on your health or the outcome of the care that you received,” the letter stated, “we believe that you should be informed.”

All of a sudden, everything made sense. The convulsions. Sweats. Tears.

Not only was their pain real, but it could have been avoided if the medical staff had been willing to do one thing: believe the women in stirrups crying out in pain.

Studies show doctors are less likely to believe women in pain

Behavioral and attitudinal traits that are considered “female,” such as vulnerability, dramatics and emotionality, can cause providers to believe that women have a lower pain tolerance and exaggerate the severity of their conditions. Providers are more likely to recommend psychological services in response to complaints of pain to a woman than a man, yet are more likely to offer analgesic drugs to men.

In a 2019 study, 1 in 5 women reported that they felt their symptoms were overlooked or disregarded by a health care provider, and 17% believed they had been treated differently because of their gender ? compared with only 6% of men.

During the retrievals, all Cortese wanted was someone to acknowledge her pain and help her make it better. Now, any trust she had in doctors is gone. Even after leaving Yale and having a validating experience at a different fertility center, she is still on edge.

“You never think that the doctors are just letting this go by unnoticed or they're not addressing it,” she said. “I certainly didn't think that a nurse was going to be stealing fentanyl and putting me in this position to feel this much pain.”

Rosenberg, who came to Yale after a near-death experience, was relieved that she “wasn’t crazy,” but at the same time, felt horrified and violated.

“The minute I opened the letter, I knew they were talking about me,” she said. “It felt like a knife in the back.”

There was a number you could call with questions, but Rosenberg was too angry to speak with anyone. Instead, her husband rang the line, and no one answered; the clinic had sent the letters out just before winter break. A week later, they finally received a call back. Her husband asked for a record of which vials of fentanyl Rosenberg received. To their dismay, the representative told her husband that they "don’t keep track of those."

“In that moment, I just remember feeling so incensed that they just didn’t have protocols in place to protect their patients,” Rosenberg said.

Rosenberg’s trust in medical professionals has also changed dramatically since her experience, even affecting her in medical settings outside of reproductive or maternal care.

She manages her care more closely now, even cross-referencing her prescriptions with photos of the medication online to ensure that the pharmacy is giving her what she needs.

“I was put in a position to beg for medication, to beg to not be in excruciating pain,” Rosenberg said. “I go into every situation wondering if I’m going to be heard.”

And though she feels grateful for her twin boys, it angers her that she can't separate them from this experience. "It feels really sad to know that I could have made them without all that pain," she said.

Yale Fertility Center under lawsuit for drug diversion and medical negligence

It was later disclosed that Donna Monitcone, a former nurse responsible for managing controlled substances at the Yale Fertility Center, had been stealing at least 75% of all fentanyl housed at the clinic and replacing vials with saline solution over at least five months. In November 2020, she brought in about 175 vials of stolen fentanyl and dispensed them in waste containers at the REI clinic.

Monitcone, who struggled with opioid addiction, pleaded guilty to a federal charge of tampering with a consumer product and surrendered her nursing license in October 2021. She had been using the fentanyl on herself – self-injecting it both in the clinic and at home. Yale paid the Justice Department a $308,250 settlement in October 2022 to resolve allegations that it violated the Controlled Substances Act.

"Yale deeply regrets the distress suffered by some of its patients when a former nurse at the Yale Fertility Center diverted pain medication intended for patient procedures," Yale University said in a statement. "After Yale discovered the nurse’s misconduct, she was removed from the Center; the university alerted law enforcement agencies and notified patients who might have been affected. The Center also reviewed its procedures and made significant changes to further oversight of pain control and controlled substances."

Along with Rosenberg and Cortese, dozens of patients who experienced severe pain during fertility procedures are suing Yale on the accusations of drug diversion and medical negligence.

“This is a case of staggering neglect and betrayal by Yale University,” Josh Koskoff, an attorney, said in a news release last year.

The women say this could have easily been avoided. There were signs all along ? but no one listened.

This article originally appeared on USA TODAY: Yale Fertility Center patients say signs of neglect were there all along