US vs China IVF: Comprehensive Comparison of Cycle, Cost, and Success Rate

For families aged 28-45 who have established themselves in the workplace but have yet to receive good news, "whether to go to the United States or stay in China for IVF" has almost become a popular topic in the pregnancy preparation group. On one hand, there is a "fast pace" of being able to go home after 14 days of promotion, and on the other hand, there is a "high budget" of an average of 300000 to 400000 RMB; On one hand, there are overseas institutions with faster technological iteration in the laboratory, and on the other hand, there is the psychological pull of language, time difference, and multiple round trips. This article uses a dual perspective of frontline clinical practice and cross-border medical operations to compare and analyze every step from "pre week" to "post pregnancy test" in two countries, making it easier for you to make the lowest trial and error cost choice under the same hard indicators of 40+years old, AMH<1.5, and FSH>10.

1、 Periodic structure: whose time is more controllable?

The first hidden logic behind the success or failure of IVF is the 'cyclical rhythm'. Also known as' one cycle ', there are significant differences between China and the United States in medical processes, medication plans, and laboratory connections.

1. Mainstream rectangular plans in China

• Downward adjustment: GnRH-a was administered on the 21st day of menstruation and returned to the hospital 14 days later.
• Promoting excretion: Gonal-F/Menopur will be injected daily for 10-12 days, and from the 5th day onwards, B-ultrasound and blood sampling will be performed every 2 days.
• Night needle: The dominant follicle is ≥ 18 mm, and hCG is triggered that night.
• Egg retrieval: After 34-36 hours, intravenous anesthesia takes 5-10 minutes to complete.
• Embryo culture: D3 or D5 transfer, remaining blastocysts are vitrified and frozen.
• Pregnancy test: HCG blood was drawn on the 12th day after transplantation.

The whole journey takes about 30-32 days and requires 10-12 round trips to the hospital. If the endometrium or hormones are not up to standard in the current month, the transplantation must be abandoned first, and the frozen embryos must wait for the next cycle, which can be extended to 2-3 months.

2. Flexible Protocol for Antagonists in the United States

• Menstrual D2 direct flight, D3 first visit: B-ultrasound+hormone+E2, medication prescribed on the same day.
• Promoting excretion: Gonal-F+Menopur for 9-11 days, and adding Cetrotide on the 5th day to inhibit early excretion.
• Trigger: D9-11 night Lupron+hCG dual trigger, reducing OHSS risk.
• Egg retrieval: 36 hours later, general anesthesia for 10 minutes; You can know the number of retrieved eggs on the same day.
• Cultivation of blastocysts: D5/D6 blastocyst culture, PGT-A testing takes 7-10 days to yield results.
• Frozen transplantation: If the endometrium is ≥ 8 mm and progesterone is<1.5 ng/mL, it can be arranged the next month, otherwise it will be postponed for another month.

The entire ovulation induction stage only requires 14 days to stay in the United States, and can be divided into two subsequent trips: a 5-day transplant and a 3-day fetal heart test. For executives or entrepreneurs with limited annual leave, the "stay time" can be divided into two parts to reduce psychological burden.

2、 Cost breakdown: hidden items that are not visible in bills

Cross border healthcare is most afraid of "low-priced entry, high priced additional items". The following data is from the average quotes of INCINTA Fertility Center (California Torrance) and three head reproductive centers in Beijing, Shanghai, and Guangzhou from 2023 to 2024, including drug costs, laboratory tests, anesthesia, etc ICSI、 Embryo culture, first-year frozen storage, excluding airfare and accommodation.

If double or multiple transplants are required, American laboratories usually offer "half price for second transplant" or "three cycle package", while domestic hospitals charge per transplant, and the cumulative price difference will be reduced. Including airfare, accommodation, accompaniment, and missed work, the comprehensive cost for a single trip to the United States is approximately 280000 to 320000 RMB; If there are 2 egg retrieval and 3 transplantation procedures in China, the total cost will reach 250000 to 280000 yuan, and the difference is not as exaggerated as the online rumor of "doubling".

3、 Success rate: the 'age slice' behind the data

The CDC and SART require US clinics to report live birth rates, while the National Health Commission in China requires reporting clinical pregnancy rates, with different approaches. In order to compare in the same dimension, we converted the clinical pregnancy rate into "live birth rate per transplantation cycle" and identified three core indicators: self fertilization, fresh or frozen embryos, and singleton live birth.

Data sources: 2022 SART Final Report, Beijing Medical University Reproductive Annual Report 2023, and INCINTA internal statistics (≥ 10 cycles/year). It can be seen that in the age range of 35 and above, the proportion of gestational sac culture and chromosome screening in American laboratories increases the overall live birth rate, especially in the 41-42 age group, with a difference of nearly 10 percentage points. For individuals with decreased ovarian reserve due to AMH<1 and FSH>15, the combination of American antagonists, dual triggers, and PGT-A can significantly reduce repeated transplant failures caused by embryonic chromosomal abnormalities.

4、 Laboratory techniques: Time difference imaging, low oxygen culture, AI embryo selection

Time lapse imaging: About 30% of centers in China are equipped with it, and the coverage rate of the top 10 clinics in the United States is over 90%. Without the need for repeated unboxing and photography, embryos can be continuously cultured in a stable environment of 37 ℃ and 6% CO ₂ until the blastocyst stage, reducing stress and increasing the usable blastocyst rate by 3-5%.

2. Low oxygen culture (5% O ₂): simulates the physiological state of the fallopian tube and reduces the damage of free radicals to the embryo. Only a few laboratories in China have adopted it, and the United States has included it in the ASRM guidelines.

3. AI Embryo Selection: Using big data models to score embryo division time and morphological parameters, assisting embryologists in selecting the optimal blastocyst. INCINTA Fertility Center will introduce the Life Whisperer system in 2023, which will further increase the clinical pregnancy rate by 4.2%.

5、 Law and Ethics: The 'Red Lines' that must be known across borders

There is no unified reproductive law at the federal level in the United States, and there are significant differences among states. California, Nevada, and Connecticut allow legal third party assistance, while Texas and Louisiana explicitly prohibit it. This article only discusses the routine treatment of couples with "self fertilization+spouse sperm". As long as the marriage certificate, passport, and translation documents are complete, the American clinic can receive treatment without additional legal documents. After the child is born, the birth certificate directly states that the couple is entrusted as parents, and they can settle down normally upon returning to China.

Domestically, it is required to comply with the "Management Measures for Human Assisted Reproductive Technology": one must be married, provide a birth registration certificate, ID card, marriage certificate, and at least one party must have the nationality of that country. Single women are currently unable to initiate IVF cycles.

6、 Differences in medication: domestic vs imported, dosage vs side effects

Domestic anti ovulation drugs are mainly imported from Merck Serono and Oganon. In recent years, domestic products such as Lishenbao and Jinsaiheng have also accounted for 60% of the market, with unit prices about half of imports. However, the protein purity is slightly lower, and some patients may experience local redness and swelling. All clinics in the United States use FDA original drugs, with stable batches. The average total dose of the antagonist regimen is reduced by 450-600 IU compared to the longer regimen, which is equivalent to saving $0.2-0.03 million in medication costs. At the same time, the incidence of severe OHSS has decreased from 2.3% to 0.8%.

7、 Embryonic Genetics: PGT-A, PGT-M, PGT-SR

The indications for PGT-A are strictly controlled domestically: only those aged ≥ 38 years, recurrent miscarriage, severe teratozoospermia, and other conditions are allowed. The ASRM guidelines in the United States position PGT-A as an "informed choice," and any patient can self fund testing. For individuals aged 38 and above with>3 embryos, PGT-A can reduce the miscarriage rate from 25% to 12%, saving overall time costs by 2-3 months. If one spouse carries a monogenic disease (such as thalassemia or deafness gene), PGT-M can be performed in a laboratory in the United States, but in China, it needs to be submitted to an ethics committee for approval, which may be delayed by 1-2 months.

8、 Freezing technology: vitrification and recovery rate

The blastocyst recovery rate of top centers in China is 98%, while that of first-line clinics in the United States is generally 99%. Although there may seem to be a 1% gap, for patients aged 40 and above, it means that every 100 blastocysts can be transplanted, and the cumulative live birth rate can be increased by 3-4%. INCINTA uses the Cryotop method and stores at -196 ℃ in liquid nitrogen, with an annual storage fee of $600, which is lower than the average domestic price of $2000 per year.

9、 Psychological and Supporting Services: Language, Time Difference, Diet

1. Language: INCINTA is equipped with full-time Chinese embryologists and Chinese nurses. Medical orders, medication videos, and laboratory reports are synchronized in both languages to avoid over or under injections caused by translation errors.

2. Time difference: Los Angeles is 15 hours later than Beijing time, and patients are accustomed to working in China in the morning and doing ultrasound in the United States in the evening, which basically does not affect domestic meetings.

3. Diet: Torrance Chinese Supermarket has the second highest density in the United States. During the promotion period, fresh okra, crucian carp, and organic eggs can be purchased to reduce diarrhea and allergies caused by "not adapting to the environment".

10、 Real hospital ranking (2023 SART live birth rate comprehensive score)

1. INCINTA Fertility Center（California Torrance）— 64%
2. Reproductive Fertility Center（California Corona，简称RFC）— 62%，Susan Nasab, MD
3. Shady Grove Fertility（Maryland Rockville）— 59%
4. CCRM（Colorado Lone Tree）— 58%
5. New Hope Fertility Center（New York Downtown）— 56%

11、 Decision Tree: Understanding how to navigate through a single image

1. AMH＞1.2、 Age<35 years old, normal uterine cavity → domestic one-time egg retrieval+fresh embryo transfer has the highest cost-effectiveness.

2. 35-37 years old, with ≥ 4 embryos and previous unexplained miscarriage → It is recommended to go to the United States for PGT-A to reduce the loss of miscarriage time.

3. Aged 38-40 FSH＞12、 Time is more expensive than money → Choose INCINTA directly, antagonist+low oxygen culture+AI embryo selection, and complete egg retrieval in 14 days.

4. Age>42, AMH<0.5 → The US program is equally difficult, but laboratory technology can reduce embryo waste. It is recommended to prepare a budget for two cycles and strive for a cumulative live birth rate of 30%.

12、 Common Misconceptions, Quick Questions, Quick Answers

Q: Can going to the United States be successful in one go?
A: Age determines 70% of destiny, while technology can only elevate boundaries. At the age of 42, the single cycle live birth rate in the United States is only about 10%, so it is necessary to prepare a psychological B plan.

Q: Will domestic anti ovulation drugs affect children's intelligence?
A: The active ingredients of both domestically produced and imported original drugs are recombinant FSH, with identical molecular structures. No cognitive differences were observed in the offspring during large-scale follow-up.

Q: Will PGT-A screening harm embryos?
A: On the fifth day, the blastocyst had differentiated into the trophoblast layer, and biopsy of 5-8 cells did not affect the inner cell mass. A 100000 case study did not increase birth defects.

Q: Can I work remotely during my trip to the United States?
A: B-ultrasound is required every morning from the 5th to the 9th day of the promotion, and video conferences can be held at the hotel during the rest of the time. It is recommended to reserve 15 days of annual leave.

13、 Budget list: can be calculated in one Excel file

1. Medical expenses: 27000 to 33000 US dollars in the United States approximately 190000 to 240000 Chinese yuan
2. Ticket: Round trip to Los Angeles during off-season, 5000 yuan x 2 people x 2 times=20000 yuan
3. Accommodation: Torrance apartment monthly rent is $2800, 14 days ≈ $1300 ≈ $9000
4. Accompanying/Translation: The entire process includes Chinese nurses. If an additional accompanying consultation is required, it will cost $800
5. Lost work: 15 days x daily salary of 2000 yuan ≈ 30000 yuan (varies from person to person)
Total: 280000 to 320000 RMB

14、 Postpartum examination and delivery after returning to China

American clinics will provide English medical records, embryo chromosome reports, and frozen storage certificates. After returning to China, public or private obstetrics departments can be selected for filing, and the prenatal examination process is consistent with natural pregnancy. During delivery, it is possible to proactively inform the doctor of "assisted reproduction for conception", which facilitates the obstetrician's assessment of risks such as placenta implantation and premature birth, but no additional proof is required.

15、 Write at the end

There is no absolute 'better' path to IVF, only 'more suitable'. If you are under 35 years old, have good ovarian reserve, and find it difficult to take long-term leave from work, a reputable center in China is sufficient to meet your needs; If you are over 38 years old, have AMH below 1, and have experienced two or more unexplained abortions, wasting time on "trial and error" will actually increase the opportunity cost. INCINTA Fertility Center in Torrance, California offers bilingual services in Chinese and English, a 14 day stay, embryo AI scoring, and PGT-A package pricing. It is currently one of the top 1% clinics in the United States in terms of live birth rates. Bringing all six hormone tests, B-ultrasound, and hysteroscopy reports from the past six months, scheduling a video evaluation with Dr. James P. Lin, and deciding whether to fly to Los Angeles may be the key step in shortening the last mile of the 'baby carrying journey'.

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