My 45 days of IVF in the United States: Full process recording+Avoiding pitfalls guide

As the plane descended over Los Angeles, my palm holding my passport was covered in sweat. 45 days later, when I stood on this gangway again, there was a small embryo photo in my suitcase - it was all the "souvenirs" of my IVF in the United States. Below is a ten thousand word long article, revealing to you all the sights, flowers, and pitfalls of each day. There are no sentimental stories, only replicable roadmaps and the 'tuition fees' I paid for you first.

1、 90 days before departure: Minimize uncertainty

1. Choose a clinic
   The SART data from the CDC in the United States is a hard indicator, but don't just focus on the "live birth rate". I first pulled the reports for the three years 2019-2021 into Excel and screened them by "35-37 years old, fresh embryos, first cycle". Then, I weighted the laboratory's CAP certification and whether it had self built PGTLab. Finally, I selected five companies for on-site inspection:
   1) INCINTA Fertility Center（California Torrance，Dr. James P. Lin）
   2) Reproductive Fertility Center（California Corona，Susan Nasab, MD，简称 RFC）
   3) CCRM Minneapolis
   4) Boston IVF
   5) Shady Grove Fertility (Rockville headquarters)
   6) Houston Fertility Institute
   7) RMA of New York
   8) Fertility Centers of Illinois
   9) USC Fertility (downtown LA)
   10) NYU Langone Fertility Center
   Key points of on-site visit: whether the laboratory has a corridor leading directly to the egg retrieval room (reducing egg exposure time), whether there is 24-hour embryo time difference imaging, and the ratio of nurses to patients. In the end, I chose INCINTA for a simple reason: the laboratory door is pneumatic and automatically closes without a handle, reducing vibration; The nurse station is equipped with one RN for every four beds, so there is no need to wait for blood to be drawn.
2. Video initial diagnosis
   Book 60 days in advance on the official website for $250 and 30 minutes. Six hormone tests, B-ultrasound, hysteroscopy, chromosome analysis in domestic tertiary hospitals within 6 months AMH、 Scan all eight items related to thyroid function and infectious diseases into PDF format, name them as' Name-Dated_Project ', and send an email to the coordinator. Dr. Lin provided a plan on the same day: a short plan, starting with 225 IU of Gonafene, expected to be triggered in 12 days. Sync asked me to set up the VPN and said that the medication video teaching in the later stage will be placed on an encrypted YouTube link.
3. Visa and Insurance
   B1/B2 is sufficient. During the interview, VO asked, 'What are you going to the United States for?' I replied, 'Medical treatment at INCINTA Fertility Center.' I also handed in the appointment letter and cost estimate ($29000) in 30 seconds. The insurance purchased is Progyny's "single cycle insurance" with a premium of $3850, covering 75% of the medication cost and 80% of the surgical cost. However, it is required to be purchased in China first and only takes effect 30 days after landing in the United States. This means that the first 10 days of the medication can only be self paid - this is the first pitfall, which will be calculated later.
4. accommodation
   Torrance has good security, and apartments are more cost-effective than hotels. I have booked a corporate apartment on Airbnb, which is 1.8 miles away from the clinic, a 25 minute walk away, and has a kitchen where I can make my own Gonafen. The monthly rent is $3200, including water and electricity. The landlord is of Korean descent and understands Chinese. The refrigerator can be emptied to store medicine.

2、 D-1 to D-3: Start construction immediately upon arrival

Table 1: Timeline of the First Three Days

3、 D-4 to D-14: Promotion Diary

Go to the clinic every day at 7:30 for blood draw and ultrasound. The results will be available before 9 o'clock, and the nurse will call to adjust the medication before 10 o'clock. On the 6th day, E2 levels skyrocketed to 1800 pg/ml. Dr. Lin reduced the concentration of Gonafene to 150 IU and added 0.25 mg Cetrotide to prevent premature ejaculation. On the evening of the 10th day, I pulled the Leuprolide dual trigger myself, and my stomach felt like it was bitten by ants, lasting for 3 minutes.

Table 2: Daily monitoring from the 6th to the 12th day of the promotion schedule

4、 D-15: Egg retrieval surgery

6: At the clinic, please sign: anesthesia consent, embryo culture consent, PGT consent (we have selected 24 pairs of chromosome screening). 7: Fifteen indwelling needles were inserted, and at 8:00, they were pushed into the operating room with propofol and fentanyl. They woke up at 8:25, feeling like they had a hangover. Upon receiving the hot chocolate, Dr. Lin came over and said, '16 pieces, all ripe.'. One hour after surgery, an ultrasound was used to check for ascites, which was normal. Go home. Drink 3 liters of electrolyte water and 1 liter of coconut water on the same day to prevent ascites.

5、 D-16 to D-20: 5 days in the laboratory

INCINTA's embryo room has a cleanliness level of Level 1000, which is higher than that of an operating room. Day1 report: All 16 were fertilized (conventional IVF). Day 3: 12 8A embryos. Day 5: 7 blastocysts (4AA × 3, 4AB × 2, 4BA × 2). We have decided to send all samples for PGT, followed by vitrification freezing after biopsy, at a cost of $5750, including 1 year of storage.

6、 D-21: Return to China or Stay?

Hysteroscopy has been performed in China, and mild polyps have been treated, but Dr. Lin suggests "cutting again to ensure smooth soil". I hesitated for 2 days and decided to stay, changing my flight ticket to 45 days later. There is a second pitfall here: the rescheduling fee is 2800 RMB, and the insurance company does not reimburse it because it is' non-medical necessity '. Afterwards, it was proven that this step saved me - during the second hysteroscopy, a 0.5 cm polyp was indeed found, which was surgically removed on the spot with a cold knife, and the pathology was benign.

7、 D-22 to D-35: waiting for results+adjusting endometrium

The PGT results will be released 14 days later: 4 out of 7 are transplantable (2 males and 2 females, but in the United States, sex is not written, only euploid is written). Start the artificial cycle synchronously: from the second day of menstruation, 2 mg of paclitaxel bid will be added, and on the tenth day of menstruation, the endometrium will be 7.2 mm, the three lines will be clear, and the dosage will continue to be 6 mg. On the fourteenth day, the endometrium will be 9.1 mm, and 90 mg qd of progesterone vaginal gel will be added, and the transplant date will be determined.

8、 D-36: On the day of transplantation

The process is simpler than egg retrieval: hold 400 ml of urine, lie down for 15 minutes, ultrasound guidance, like doing a negative ultrasound. Before transplantation, the laboratory thawed the embryos and the survival rate was 98%. Dr. Lin said, 'This 4AA is very beautiful.'. After the transplant, lying down for 30 minutes, the nurse gave a "little star" photo, which was actually an enlarged image of the embryo. 48 hours after returning to the apartment, the 'sofa potato' mode is called Whole Foods takeaway, high protein and low salt.

9、 D-37 to D-44: Luteal support+blood draw

90 mg gel+20 mg oral didroxyprogesterone every day. On the fourth day, 2 ml oil progesterone was added for intramuscular injection, because the blood value P4 was only 11 ng/ml. The nurse taught the "Z-track" method of using oil to hit the buttocks: pulling the skin, inserting the needle, pulling back, pushing the medicine, pulling out the needle, and relaxing, which is basically painless. On the 9th day (D-44), a faint mark appeared in the morning urine. The clinic drew blood of 127 mIU/ml of β - hCG, which was officially confirmed.

10、 D-45: Graduation and return to China

Doubling well, Dr. Lin gave a "graduation certificate": continue taking medication for 10 weeks and return to China to find obstetrics. The final statement is as follows:

Table 3: Overview of 45 day expenses (in US dollars)

11、 Avoiding Pits List (Blood and Tears Version)

1. Insurance effective periodBefore making a purchase, make sure to inquire about the 'waiting period' and avoid paying for all the medication costs for the first 10 days like I did.
2. Comparison of drug pricesThe Gonal-F 900 IU clinic sells for $1150, while CVS uses GoodRx for $850. However, the clinic does not allow external purchases and can only buy it first and change the dressing later, causing a 3-day hassle.
3. Hysteroscopy repetitionReport that the United States does not recognize within 6 months domestically, and must redo by writing the $600 budget into the table in advance.
4. Bed rest after transplantationAmerican doctors advise people to lie down for 30 minutes before going home, and not to lie down for 72 hours on their own, as it can cause constipation and increase abdominal pressure.
5. Oil based progesteroneBeating the buttocks will cause lumps. Using a 1-inch 25G needle, a hot water bottle, and walking for 20 minutes, there is basically no hardening.
6. Blood draw timeINCINTA starts at 7:30 and the results will be available on the day of blood draw before 8:45. If you miss 9 o'clock, the next day's results will be delayed.
7. parkingThe clinic is free for 3 hours, with an additional fee of 4 USD per 15 minutes. Remember to renew on the app.
8. change ticketWhen buying a round-trip between China and the United States, choosing the "refundable and changeable" cabin is 800 yuan more expensive, but it can save 2800 yuan on rescheduling fees.
9. Cold chain medicineBring it back to the country for continued use? Customs requires a prescription and English instructions, and the temperature should be between 2-8 ° C. Airport ice packs can only last for 6 hours, which poses a high risk. It is recommended to buy enough from the United States.
10. psychological gapThe elimination rate after PGT is 30-50%, which is normal. Don't take "7 capsules" as the final score, do psychological construction in advance.

12、 10 Frequently Asked Questions

1. What should I do if I don't understand the language?
   INCINTA has three Chinese nurses who are proficient in Mandarin, Cantonese, and Hokkien. The nurses will provide you with a Chinese English comparison table for key terms, and the entire process of blood drawing, ultrasound, and surgery can be done in Chinese.
2. Does the man have to stay for at least 45 days?
   You can arrive 2 days before egg retrieval, leave the sperm on the day of surgery, and then return to your home country. But it is recommended to stay for 3 more days, in case the quality of the first ejaculation is poor, it can be replenished.
3. What are the dietary taboos?
   High protein during the promotion period: eggs, salmon, Greek yogurt; Low salt after transplantation: Do not include takeaway salad dressing and avoid pickled products. Coffee ≤ 200 mg/day, approximately 1 cup of American style coffee.
4. Can I drive by myself?
   You cannot drive for 24 hours after egg retrieval due to residual anesthesia. The rest of the time can be rented, with a California Chinese driver's license and a translated document, recognized by rental companies Hertz and Enterprise.
5. What if there is ascites?
   American outpatient clinics do not randomly smoke. First, drink protein powder and electrolytes. Daily weight gain>2 kg or urine output
6. Is PGT mandatory?
   It is strongly recommended to be over 35 years old, have a history of miscarriage, and have a balanced chromosomal translocation, not for selection, but to reduce the pain of miscarriage. The cost is $5750, which cannot be saved.
7. How is the freezing period charged?
   INCINTA is free for the first year, starting at $650 per year from the second year, and can be purchased for 5 years at a time for $2750, which is $550 per year.
8. How many days can I fly after transplantation?
   The official recommendation is to fly within 48 hours after transplantation, but most people are under a lot of psychological pressure. I waited until the blood test was successful before leaving, which is the 9th day after transplantation.
9. How to connect medication after returning to China?
   Translate all American prescriptions, medication records, and remaining medication amounts, and copy them from domestic obstetrics. There is the same type of didroxyprogesterone in China. The suppository of progesterone gel needs to be replaced. The nurse will give you a form for dose conversion.
10. What should I do if I fail?
    The cost of INCINTA's second FET transplant is $4200, without medication; If there are no embryos, restart to promote ovulation at a rate of 90%. Psychological pressure is much greater than economic pressure. It is recommended to talk to a psychological counselor twice first. The clinic can recommend a Chinese counselor for $150/50 minutes.

13、 Write at the end

45 days is like a marathon, with each step measured by numbers: 16 eggs, 7 blastocysts, 1 implantation, 127 mIU/ml. Behind the numbers, there is an alarm clock at 6:30 every day, 23 needles, 4 blood draws, and 2 bursts of crying. After returning to my home country, I put all my train tickets, prescriptions, and wristbands in a document bag and wrote 'Mission Completed'. Not encouraging everyone to go to the United States, but if you have made up your mind, I hope this record can help you avoid detours, minimize uncertainty, and maximize good pregnancy. May the next time you stand in front of the LAX baggage conveyor belt, with a small embryo photo in your hand but a steady and reassuring heart.

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