Early one morning in the fall of 1991, a fresh sperm sample arrived in a sealed plastic cup at the University of California, Irvine's Center for Reproductive Health.

Clinic staffers were puzzled.

The sperm was from the husband of a former patient, Mrs. A., but she wasn't scheduled for surgery and didn't have any eggs waiting to be fertilized.

"Just keep it fresh," Dr. Ricardo Asch, the clinic's director, told a medical assistant.

That afternoon, Mrs. M came in, her ovaries swollen with eggs after painful hormone injections. Asch extracted the eggs and told lab biologist Teri Ord to set three aside for Mrs. A.

It seemed like routine surgery. But two days later, a troubled Ord walked into the operating room and posed a shocking question.

Had the woman consented to donate her eggs to another patient?

"That's when it really clicked," said medical assistant Della Morrison, who watched Ord break into tears when told the woman had not consented. "From then on, we just started figuring things out and putting it together."

In extensive interviews with The Orange County Register, Morrison, Ord and four other former employees have provided the first look inside the clinic, which closed June 2 amid allegations of egg and embryo theft, insurance fraud and other financial improprieties. They sketch a detailed portrait of life in the clinic, where an unfolding scandal has left scores of former patients wondering who and where their genetic children are.

The former employees had firsthand knowledge of the clinic's day-to-day operations. There's the lab biologist who set aside women's eggs for other infertile patients. The operating-room nurse who found handwritten reports tracking the egg swaps. The front-office admissions worker who says Asch begged her to pull patients' charts and keep the names secret when UCI officials paid a surprise visit to the clinic.

Asch, a renowned fertility specialist, and his partners, Drs. Jose P. Balmaceda and Sergio C. Stone, have denied wrongdoing and have refused requests for interviews about the allegations -- which are the subject of seven federal, state and university investigations.

Through his lawyer Friday, Asch said he had never mistreated patients or misused their eggs or embryos.

"Dr. Asch denies being involved in any nonconsensual transfers of any kind," attorney Ken E. Steelman said.

Many women desperate to have children say the physicians worked magic. Clinic employees contend, instead, that the doctors profited from a practice that abused patients and staff alike. According to the employees:

• Biologist Ord was ordered to inseminate "donor" eggs in at least 50 cases since 1986. Yet clinic workers at UCI could recall few instances in which an infertile patient consented to donate eggs.
• Women paid up to $10,000 for fertility treatments. Yet, without their knowledge, some surgical procedures were performed by foreign fertility trainees not licensed to practice medicine in the United States.
• Asch routinely kept anesthetized patients waiting up to 45 minutes in the operating room while he chatted with his horse trainer or talked tennis with a friend in Florida.

No one knows with certainty how many human eggs or embryos might have been given away without consent. University of California officials say the improper transfers involved at least 40 women. Former clinic employees say it could be twice that many -- or more.

How could it happen?

Norbert "Gil" Giltner, a former operating-room nurse, says the answer may lie in the confidence Asch instilled in prospective patients.

The message, Giltner said, was clear: Asch could get them the babies they couldn't get anywhere else.

On a typical morning, as many as 60 women, many with husbands in tow, filled a neat but sparsely appointed waiting room designed for 35. It was first-come, first-served, and some waited more than eight hours to see the doctor.

"It was chaotic, hectic, stressful," said Yvonne Alexander, who processed patient admissions. "It was just really crazy."

Many of the patients were from Orange County and elsewhere in Southern California. Others came from such far-flung locales as Japan, Africa, South America and the Middle East.

Some of the well-heeled patients showered the doctors, especially Asch, with presents. His cluttered office was filled with paintings, sculptures, leather goods, handmade rugs, neckties, candies and liquors. One couple even flew Asch and three of his employees to Venezuela for a week to celebrate their child's baptism.

To his patients, Morrison said, the native Argentine was "the great Dr. Asch."

In 1984, he and Balmaceda, then in their 30s, had developed a successful fertilization process known as gamete intrafallopian-tube transfer, or GIFT. It involved surgically removing a woman's eggs, then returning several of them to her fallopian tubes, along with drops of her husband's sperm.

Asch's fame as a fertility miracle worker spread. By 1990, he and his partners were operating two clinics in Orange County, one at Saddleback Memorial Hospital Medical Center in Laguna Hills, the other at UCI Medical Center, in a new building outfitted especially for the doctors.

But while the patients were impressed, most of the core support staff of eight were increasingly put off by their physician bosses and the way they treated patients.

Despite promised appointments, employees said, consultations and operations would be pushed back or postponed at Asch's whim. If he didn't feel like working on a weekend when he had scheduled surgery, nurse Giltner said, patients would be kept on their egg-producing medications until Monday, or turned over to another doctor.

But the greatest aggravation, and the source of most delays, the employees said, was Asch's passion for racehorses. At one time, he owned at least five thoroughbreds, which he raced at the track in Del Mar.

Though the clinic staff jokingly derided the horses as the "Alpo Express" because they lost so often, Asch had big dreams.

"He told us once that he was already famous for GIFT. Now he wanted to be famous for winning the Kentucky Derby," Giltner said.

When Asch's horse trainer, Robert Hess Jr., called the clinic, he would be put through immediately, even if patients were on the operating table, according to Sharon Gray, then the clinic's patient coordinator.

Their bodies anesthetized, their legs in stainless-steel stirrups, the women often waited a half hour or more for Asch to finish his call -- much to the chagrin of Giltner and others who bided their time in the operating room.

"Gil would come out and go, `Where is he?' " Morrison recalled. "And I'd go, `He took a phone call from Bob Hess.' And Gil would kick the wall."

Attorney Steelman called those allegations totally false.

"The only matter that ever disturbed the attention of the doctor were other medical emergencies that might have taken precedence," Steelman said. "There was never any time when patients were kept waiting because of any indifference or preoccupation with any nonmedical matters."

If there were problems with the management of the clinic, he said, it was because of UCI's lack of management.

"There was no power or authority by Dr. Asch to hire or fire any employees whatsoever," Steelman said.

Covering for Asch's absences, coping with scores of hormonally charged patients and trying to make order from the endless patient inquiries about fertility procedures and shifting surgical schedules created a special bond among the staff.

They shared war stories. And they commiserated over being subjected to the explosive temper of Stone, who former employees say belittled them and called them "imbeciles," flinging charts or pounding his fists on tables at the slightest provocation.

"They existed in an environment of fear, terror and incredible anxiety," said attorney Melanie Blum, who represents Giltner, Morrison, Gray and Alexander.

Staffers had their reasons for enduring the turmoil. Their salaries ranged from $24,000 to $80,000 and they had formed close relationships with many patients. Alexander, an aspiring singer, was meeting patients with ties to the record industry. Gray was receiving discounted fertility treatments from the doctors.

"It wasn't so much job security -- it was pregnancy security," Gray said. "I needed them to get pregnant."

Giltner, fed up, left the clinic for a year. But when a new office manager came on board, he returned to help straighten things out, he said.

When Asch was absent or distracted, Giltner and others say, foreign trainees, who worked under Asch in the clinic's fellowship program, became de facto physicians at the clinic. They performed patient ultrasound procedures, Pap smears and pelvic examinations, and assisted with surgeries.

Balmaceda, who ran the Saddleback clinic, was upset when he came to UCI one day and found foreign trainees treating patients, Morrison said.

"He said, `What in the heck is a fellow doing clinic for? I told you that fellows are not allowed to do clinic. I don't want fellows doing clinic. Get Dr. Asch,' " she recalled.

"I said, `He's in his office. You go tell him. ... I've been trying for hours to get him out here. I got 60 people in the waiting room.' "

UCI put an end to fellows practicing at the clinic after a patient sued, alleging that an unlicensed trainee had represented himself as a doctor and performed an unnecessary cervical dilation without consent.

Steelman said clinic fellows never participated in surgical procedures, although they were allowed to observe operations until the university ordered it stopped.

"They did not perform any operations or procedures without patients' permission," Steelman said.

Besides fame, the clinic brought Asch and his partners fortune -- $4.6 million from 1992 to August 1994. Auditors say the doctors took in an additional $1 million they didn't report to the university.

Despite the high cost of the fertility treatments, there was no guarantee of success. But desperate patients saw Asch as their savior.

"I pronounce you pregnant," he would tell them after performing in-vitro procedures, according to Toula Batshoun, Asch's former office manager.

At this news, "the patient would start crying because she was so happy," she said. "When (the procedure) worked, he would never let you forget it." When it didn't work, "he'd say, `Well, I didn't mean it.' "

The clinic staff learned fast that patients wanted to know everything about their eggs. Even before the anesthesia wore off, they'd ask in groggy voices about the quantity and quality of their eggs.

Afterward, they'd call repeatedly to find out whether the eggs were forming embryos, or why they weren't.

Batshoun, who did the clinic's billing for years and saw the lab sheets, said she noticed early on that some patients who started out with many eggs ended up with a paltry number of embryos.

Staffers also became suspicious when women showed up for egg or embryo implants even though they hadn't had their eggs harvested, didn't have frozen embryos and didn't have donor eggs lined up.

"When you run the back office you know who has what -- what they're doing and where they're going," said Gray, the patient coordinator. "It doesn't take too many brains."

Nearly all patients wanted any unused eggs inseminated and frozen for their future use, Morrison said. Staffers understood this was the accepted practice unless the patient -- by checking a specific box on the consent form -- requested that her unused eggs be donated or destroyed.

Gray and Morrison, who were in direct contact with the patients, said infertile women rarely wanted to donate unused eggs.

Yet Ord, the clinic's biologist, said Asch on many occasions told her in the laboratory that a patient wanted to donate.

Although Asch has since contended that any improper use of eggs or embryos would be the fault of the staff, the clinic workers say that is not plausible.

"In every way, you name it, Dr. Asch was in charge," Morrison said. "What Dr. Asch said, went. What Dr. Asch wanted, was done. Dr. Asch ran the show, period."

After Morrison and Gray learned from Ord about Mrs. M's eggs, Giltner made his own discovery.

In the recycling bin next to the office's photocopy machine, he found handwritten reports summarizing Mrs. M's operation, and embryo- and egg-tracking sheets. They showed that the Orange County woman's eggs were given to Mrs. A of Los Angeles County, who later gave birth to a boy.

With no way to formally check the donation, Giltner became a detective, stealing glances at the laboratory logs and surreptitiously pulling patient charts to check donor consent forms.

No one dared ask Asch if the woman had given oral consent to donate. (She told the Register in May that she did not.) Asking such a question, the employees said, would be tantamount to accusing him.

"I was too afraid of him," Morrison said. "I knew I'd lose my job. I didn't have proof. Who am I to accuse the great Ricardo Asch of doing something like this? Who's going to believe me?"

Still, the employees began comparing notes on patients. And it wasn't long, months perhaps, before a similar questionable egg transfer occurred. And then another, and another, and another.

"I just remember the first one, and then it was just like ... just like habit with him," Morrison said.

Over time, employees said, it became clear that Asch's selections were not random: The women he took the eggs from were attractive and usually had a lot of eggs harvested. Those who received them were rich or influential couples, sometimes Asch's friends, who needed donor eggs.

"It was always someone who had money," Morrison said. "In fact, it got to the point where we were so jaded and so disgusted, there would be a patient coming in, and I could tell you by the way she looked" if she'd become one of the patients Asch would try extra hard to help.

Ord began to question every previous union of sperm and eggs donated by infertile patients.

"You kind of started thinking, 'Well, did any of them donate?' "

How many egg "donations" did she know about?

"I could say there was more than 50," Ord said. "I remember there was quite a bit."

Clinic employees, their suspicions aroused, began taking precautions to try to minimize the damage, Gray said.

She, Morrison and Giltner paid special attention to consent forms, making sure they were filled out completely. Some patients' husbands were advised to contribute "backup" sperm so they would have enough to inseminate all eggs -- reducing the risk that unused eggs would be given to someone else.

For three years, the suspected unauthorized egg swaps were the clinic employees' secret. But that's not what they had intended.

The potential risks of unauthorized egg transfers were not lost on Giltner, who had helped open the clinic.

"What happens in 20 years when Patient X's child and her half-child meet somewhere in college in New York and decide to get married?" he wondered. "This is half-brother and half-sister. You're talking a genetic bomb."

Giltner said he first tried to alert university officials in late 1991 or early 1992. Internal auditors were looking into the clinic's handling of cash and other financial operations.

Using diagrams to illustrate the egg sheets he had found at the copy machine, Giltner sketched the alleged transfers for an auditor -- who had trouble grasping the information.

"I ended up spending about 2 hours in a conference room explaining what happened," Giltner said. "When we were all done, he just said, `I don't know what to do with this, but I'll include it in my report.' "

The egg information was not included in the final report, however, and nothing came of the meeting.

Batshoun, the former office manager, also told the auditor about egg-theft allegations. But she was under investigation at the time -- accused of and later fired for filing false forms to avoid health-insurance deductibles. Though she denied any wrongdoing, auditors concluded her allegations were not credible.

Giltner later told two other medical-center officials about his suspicions, again with no results. One left for a new job out of state; the other retired.

"I kept telling the same story, time and time again, but nobody'd listen to me," Giltner said.

It wasn't until 1994, after Giltner told his story to Debra Krahel, the medical center's ambulatory-care director, that anything happened.

They met secretly one afternoon in an unused wing of Building 29, across the street from the medical center. The room was windowless, dusty, crammed with old file boxes. Seated side by side at a folding table, they pored over the egg sheets.

What Giltner told her made her "nauseous," Krahel said. "This was not a liver or a cornea we were talking about. This was robbing someone of their biological offspring."

The clandestine meeting led to other meetings, between Giltner and another auditor who was investigating the clinic's alleged use of illegal fertility drugs.

When the auditor asked for documentation to go with the egg sheets, Giltner located the records in a cabinet in Asch's office, but didn't make copies, Giltner said.

"Two days later they're gone -- gone, gone, gone, gone," Giltner said. "Who took them, I don't know."

Based largely on a formal "whistle-blower" complaint filed by Krahel's attorney in September, UCI officials appointed a clinical panel to investigate allegations of egg theft and other medical issues.

In December 1994, medical-center officials showed up to examine patient charts. Asch pulled admissions employee Alexander into his office and handed her a handwritten list of patient charts he wanted pulled and brought to him. She immediately recognized the names as those the clinic staff members believed were involved in egg diversions.

"I was kind of shaking," Alexander recalled. "Once I looked at the list, the first three names I saw on the list, I was like, 'Oh, boy.' "

Asch, she said, was frantic, pleading with her not to show the UCI officials the list of names. " 'Don't show it to anybody. ... Don't tell anybody, don't tell anybody, please Yvonne, please Yvonne,' " she remembers him saying.

Alexander found one chart; fearful, she refused to pull the others.

Asch's lawyer said the doctor often asked employees to pull charts, but never for the purpose of concealing them.

"There was no effort to prevent UCI from inspecting them," Steelman said.

As the investigations mounted over several weeks, Asch started waiting around to debrief employees after they had talked to auditors and other investigators.

"Sometimes he'd call me at home. And I would never tell him. I just lied to him," Morrison said. "And he'd say, did he ask you this? Yeah. Did he ask you that? No. Did you tell them anything?"

The scandal exploded in May when The Orange County Register, citing medical records and interviews, reported that two women's eggs had been harvested and, without their consent, transferred as embryos to two other women who later had children.

UC officials now suspect at least 40 women were unwitting donors or recipients of eggs or embryos taken at clinics at Garden Grove, UCI and UC San Diego.

With the clinic closed, the doctors have gone their separate ways. Asch has opened an office in Santa Ana, Balmaceda remains at Saddleback and Stone has set up in Fountain Valley.

Their futures hinge on whatever actions, if any, are taken by the medical board, federal officials and others looking into the case.

As for the former employees, some have been contacted by the university, the doctors or the doctors' lawyers. All have been hounded by the media.

Batshoun, who was fired before the clinic's problems became public, wants UCI to correct the record to show that she reported the problem in 1991.

Alexander went on stress leave in February, and hopes to make a go of it as a singer.

Ord returned to Texas with her husband and two new babies. She is angry because Asch says she and lab co-workers are chiefly responsible for any egg errors.

Morrison, who had a son eight months ago after treatments at the clinic, is still on leave from the university.

Gray, who left on maternity leave in 1993, also thanks to clinic doctors, is raising her two sons in Riverside County. She is saddened that the issue has become so public and caused so much pain to former patients.

Giltner, who left the clinic before it closed, said the fertility scandal has changed his life.

When he walks into a room at UCI Medical Center, co-workers often fall silent. Or they rib him about his role, demanding to know, "Where is your whistle?"

Giltner laughs it off. Most of it, anyway. "I watch the rear-view mirrors for people following me."

The tragedy, he said, is that many of the alleged egg thefts could have been averted if UCI officials had pursued his initial suspicions.

"They had the chance, but they didn't move fast enough. They could have had it all. Could have had it all, boxed up neat and tidy," he said.

"But nobody would listen. ... Now the records are gone, the computers are gone. The trail is cold."

Register staff writer Carol McGraw contributed to this report.