A Manhattan cop spies a young, naked woman wandering in a daze, repeating, "they took my baby." He's just radioing HQ when a man we'll call Perry rushes up to shoot the cop and the woman dead. Back in D.C., Liz and Tom check out an ultrasound of the baby boy that will be their son - the adoption has suddenly become very real. Liz announces she wants to take time off work to be with the baby, even if it means risking her job. Red also has adoption on his mind - in the form of the Cyprus Adoption Agency. It's designer adoptions for the wealthy using truly evil methods - they abduct children, then adopt them out. Red has a photo of their next adoptee, a baby boy who's slated to go to David and Wendy Roland.
The Rolands meet with the Cyprus Agency's lawyer, Ted Caldwell, while Liz and Ressler listen from a nearby surveillance van. When the Rolands start asking questions about the baby's origins, Caldwell steps outside to call his boss, and Liz and Ressler step in. Rather than face their questions, Caldwell steps into the path of an uptown bus. The FBI moves on to the Cyprus Agency, now a crime scene, to talk to Owen Mallory, the agency's director. Claiming his operation is clean, Mallory directs the FBI to his overseas partners, and puts himself at their service. Meanwhile, Red has Meera tied up and interrogated by a Mr. Brimley, who claims she's telling the truth. It's complicated, but Meera knows she was set up, so she proposes Red let her go so she can find the real mole.
Liz returns to the FBI with files on 27 adoptions, none of which can be authenticated. After Cooper orders DNA panels all the kids, Liz tries to ask for time off. That's when Meera shows up, looking like hell and blaming her tardiness on a bad night with her daughter. Cooper is unsympathetic. Working on his unit means no family issues, which prompts Liz to swallow her request. But she does tell Red of her intention to make this her last case for a while. When she explains that none of the Cyprus kids were reported missing, Red advises her to run the DNA again - but this time, look to relatives, not an exact match. Oh, and if Liz has any doubts about Tom, she shouldn't go through with her own adoption. Liz promises she has not a single shred of doubt.
After running the DNA again, Liz and Ressler discover that five missing women are the mothers of 12 of the 27 Cyprus babies. All were in college when they disappeared, and all the babies were conceived after their abductions. Aram locates a file on Georgetown student Charlotte Patterson, who appears to be the Cyprus Agency's next target. Liz and Ressler reach the campus just as Perry is driving off in a van containing an unconscious Charlotte. While all this is going on, Meera steals Cooper's ID and copies confidential files off his computer.
Perry drives straight to a meeting with Mallory, who promptly shoots him, then proceeds to Galatea Fertility Clinic to tell Dr. Gideon Hadley it's time to shut down "the pipeline." And did they "lose" another one the other day? Hadley tells him Perry "took care of it," just as a dog walker finds Kate Ellison's body in Maryland. The ME offers some odd findings: Kate has severe muscular atrophy and was likely kept in an induced coma for years. Worse yet, she gave birth three times while comatose. Aram calls Liz with news about Mallory: he attended Harvard but enrolled under the name Charles Lassiter, Jr., son of Charles and Jill - who don't seem to have any children.
Liz and Ressler visit the Lassiters. Forty years ago, they adopted a seven-year-old foster child named Michael Shaw, who suffered from some severe emotional disorders. When he started threatening to hurt himself and his adoptive parents, they returned him to foster care, but they still blame themselves for the whole terrible situation. That night, Meera gives Red her purloined document, which includes the name of the real mole. Satisfied, Red tells Meera their business is done.
The next day, Liz meets Red outside an upscale suburban home, hoping for help tracking Hydroxipam, used to sedate the Cyprus Agency's victims. There's a 24-hour party going on inside, courtesy of Red's narcotics dealer pal, Russell, who knows all about Hydroxipam. Nobody wants it. Only three pharmacies within 1200 miles stock it, and only one fertility doctor, Dr. Gideon Hadley, has written a script in the last year. Liz and Ressler make a beeline for the Galatea Clinic, where Mallory and Hadley are meeting. Mallory sends out the receptionist, Nestor, to convince them to leave, but when Liz and Ressler decide to look around, Nestor pulls a gun and Hadley makes a run for it. Chasing Hadley, Liz stumbles into a terrifying clean room, filled with 22 comatose women in all stages of pregnancy.
Liz's jaw drops, so she's not ready when Mallory jumps from behind a hospital bed to tackle her. Luckily, Ressler rounds the corner and shoots Mallory in the arm. After the dust settles, Liz tells Mallory they have enough evidence to put him away, and she knows his story with the Lassiters. Mallory explains the Lassiters never really wanted a child; they wanted the perfect accessory for their perfect lives, and that's what he sells. But it's not about the money for him; his legacy is complete, and there's nothing Liz can do to change it. That's when Liz realizes - Mallory fathered all the Cyprus Agency's children.
Tom finds Liz at home crying. She tells him they're not ready. She doesn't know what's wrong, but something's not right, and she can't have a baby right now. Liz stays home sobbing while Tom meets Jolene. Meanwhile, Red blasts a Gordon Lightfoot song in Diane Fowler's living room, an invitation to a confrontation. Fowler claims she acted in the interest of his protection, and "they" came into the Post Office to make a point. Saying, "you talk too much," Red shoots her. He has an agreement with Fitch, not her. She offers to tell him the truth about what happened to his family - which Red wants to know more than anything. But if Diane knows the truth, then someone else does too. Blam, blam, blam. Three shots, Diane Fowler is dead. It's not long before Mr. Kaplan arrives to clean up.
On the eve of Liz's adoption, Red puts her on the trail of an adoption agency gone evil. Campbell Scott guest stars.