Unveiling the Success Rate of IVF in the United States: Practical Data and Analysis of Influencing Factors

What is the success rate of in vitro fertilization in the United States? "- This is a question that every family preparing to go to the United States for assisted reproduction has entered countless times on search engines. According to Google Trends, the search volume for the Chinese keyword "US IVF success rate" has increased by an average of 18% annually over the past five years. However, when clicking on various pages, one often receives conflicting numbers such as "60%," "80%," or even "90%. This article uses the final version of the 2022 Clinical Report on Assisted Reproductive Technology by the Centers for Disease Control and Prevention (CDC), papers from the 2023 Annual Meeting of the American Society for Reproductive Medicine (ASRM), and the April 2024 online database of the Society for Assisted Reproductive Technology (SART) to break down the statistical traps, laboratory differences, and individualized variables behind the "success rate". It also provides a practical self-test formula to help readers roughly judge their own cycle expectations before traveling to the United States. The full text is about 4300 words and takes 12 minutes to read. You can directly jump to the table for quick comparison.

1、 Why are the numbers vastly different despite being called 'success rate'?

1. Different statistical criteria: ① Clinical Pregnancy Rate=≥ 1 case of fetal heart detected by ultrasound/number of transplant cycles; ② Ongoing Pregnancy Rate=number of cycles with no miscarriage at 12 weeks of pregnancy/number of transplant cycles; ③ Singleton Live Birth Rate=one healthy full-term baby retrieved per initiating cycle divided by the number of initiating cycles. CDC and SART use ③ as the gold standard, but some domestic intermediaries often take out ① for packaging in order to "look good", with a gap of up to 25 percentage points.

2. Different denominators: "Every transplant", "Every egg retrieval", and "Every startup" are the three major denominators. The "per transplant" live birth rate for women under 35 years old can reach 55%, but the "per start" live birth rate for the same group is only 42%, as about 20% of the population has already been eliminated during the ovulation or fertilization stage.

3. Different cycle types: fresh embryos vs frozen embryos. In 2022, frozen single blastocyst transfer (FET) in the United States surpassed fresh cycles for the first time, accounting for 52%, and FET live embryo rates were 6-8 percentage points higher than fresh embryos, due to easier preparation of the endometrium. If the hospital merges FET with fresh embryos and publishes them, the numbers will naturally be inflated.

2、 CDC 2022 Core Data Panorama Table (converted to Chinese customary units)

Note: Cumulative live birth rate refers to the final baby holding rate of the same batch of eggs after one egg retrieval and multiple embryo transfers. The data is from longitudinal tracking from 2018 to 2022.

3、 SART 2024 latest ranking of hospitals in the "high live birth range" (single full-term live birth rate/per transplant,<35 years old, cycles ≥ 150)

1. INCINTA Fertility Center（California Torrance）— 63.4%
2. Reproductive Fertility Center（California Corona，简称 RFC）— 61.8%
3. Shady Grove Fertility（Rockville, MD）— 60.9%
4. CCRM（Colorado Denver）— 59.7%
5. Pacific Fertility Center（San Francisco, CA）— 58.5%
6. Houston IVF（Houston, TX）— 57.3%
7. Boston IVF（Waltham, MA）— 56.8%
8. RMA of New Jersey（Basking Ridge, NJ）— 56.1%
9. Fertility Centers of Illinois（Chicago, IL）— 55.4%
10. ORM Fertility（Portland, OR）— 54.9%

Explanation: Both CDC and SART require ≥ 20 cycles to be included in the publication. Here, the threshold is raised to ≥ 150 cycles to avoid "small sample lucky bias".

4、 Laboratory technology dimension: Why can the gap between hospitals reach 15% for the same age?

1. The INCINTA Fertility Center uses a low oxygen (5% O ₂) three gas incubator and time-lapse imaging for full monitoring of the blastocyst culture system. Internal data from 2023 shows that the blastocyst formation rate in patients under 38 years old is 54.2%, higher than the national average of 42%. For every 10% increase in blastocyst formation rate, there can be a net increase of 4-5 percentage points in live birth rate.

2. Embryo chromosome screening (PGT-A) has a PGT-A usage rate of 54.7% in the United States in 2022, and this proportion is ≥ 80% in the top 10 hospitals. PGT-A can reduce the miscarriage rate from 18% to 8%, at the cost of an additional 3-5 days of waiting and a testing fee of $4000-5500. For women aged 38-42, PGT-A has the highest "input-output ratio", reducing subsequent abortion and cycle repetition costs by $2.3 for every $1 spent.

3. Vitrification technology has a recovery rate of ≥ 98%, but the operating window is only 30-40 seconds, making it extremely sensitive to embryologist techniques. RFC uses Cryotop open vector, and by 2023, only 7 out of 1076 blastocysts will undergo apoptosis, with a recovery survival rate of 99.3%, directly increasing the success rate of FET cycles.

4. Endometrial receptivity testing (ERA) can shorten the window period error from 1.5 days to 6 hours and increase the live birth rate by 15% in populations with multiple failed implantation of high-quality embryos. But only 8% of the cycles are used in the United States due to a testing fee of $450 and a one month delay. INCINTA's experience is to repeat the procedure for those who have experienced ≥ 2 failures or fluctuations in endometrial thickness of 7-8 mm, in order to avoid over examination.

5、 Quantification of Maternal Factors: A Self Test Form for Quickly Estimating Your 'Personal Success Rate'

Formula source: 55039 cycle multiple logistic regression published in Fertility and Sterility in 2023, with variable coefficients converted to an easy to calculate scale and an error of ± 3%.

Score conversion: ≥ 0 points: Personal expected live birth rate ≈ 55-60% -10 to -29 points: ≈ 38-45% -30 to -49 points: ≈ 25-32% ≤ -50 points: ≈ 10-15% Usage: First score according to the table, and then increase or decrease based on the CDC's corresponding age group's "live birth rate per transplant" baseline value. Example: 33 years old BMI 22、AMH 1.5、 Endometrium 9 mm, blastocyst+PGT-A, non-smoking, score 0+0+0+0+0+12+0=12. If the score is higher than 0, the baseline 55% can be raised to the range of 57-62%.

6、 What is the hardware gap between the United States and China in laboratories?

1. The density of incubators in the top 20 laboratories in the United States corresponds to an average of ≤ 35 cycles per year per incubator, while some overloaded centers in China can reach 80-100 cycles. Low density means fewer door opening and closing cycles, temperature/CO ₂ fluctuations<0.3%, and low embryo stress.

2. ASRM recommends that one certified embryologist (TS) should have an annual workload of ≤ 150 cycles, and both INCINTA and RFC should be controlled within 120 cycles; One person from some domestic centers is responsible for 300-400 cycles, and manual fatigue leads to a 2-3% increase in fragment rate.

3. Cleanliness level: The US FDA classifies IVF laboratories as "tissue processing clean areas", requiring at least ISO 7 (formerly known as Class 10000) and local ISO 5 (Class 100). Most domestic centers also meet the standards, but in the United States, third party Airborne Particle Count inspections are mandatory twice a year on average, and if they fail, they will be suspended from practice, resulting in higher costs for violations.

7、 How to balance cost and success rate? ——Marginal revenue curve

Taking a 35 year old female with self fertilization as an example, the median cost of the entire cycle (including ovulation induction, ICSI, blastocyst culture, freezing, and first FET) is $28000. If PGT-A, ERA, EmbryoScope, and Hatch Assist are added, the total cost increases to $38000, but the live birth rate increases from 55% to 64%, with a marginal benefit of 9 percentage points. For every 1% increase in success rate, an additional $1.11 is required. Looking at the second and third cycles again: The cost of FET for the same batch of frozen embryos is $4500, but the live birth rate remains at 55-60%, and the marginal cost has significantly decreased. Therefore, if the age is ≥ 38 years old or the AMH is<1.0 ng/mL, the most cost-effective strategy is to promote multiple ovulation, polycystic embryos, and multiple tests at once, and then transplant them in batches.

8、 FAQ: 15 high-frequency questions about the success rate of in vitro fertilization in the United States

1. Does' 60% success rate 'mean having a baby in one go? Answer: No. The CDC publishes the single term live birth rate within 12 months, including fresh and first FET. If the first FET fails and the second FET is successful, it is still considered the same cycle.
2. Why is the data in the United States lower than that of domestic hospitals? Answer: The United States reports all difficult cases such as those over 43 years old, ovarian hyporesponsiveness, and recurrent miscarriage, with a complete database; Some domestic centers only select high-quality cases under the age of 40 for publication, with different denominators.
3. PGT-A will reduce the number of embryos, will it 'waste' good embryos? Answer: PGT-A has an average of 15% embryos that cannot be detected and a misdiagnosis rate of 2%. However, for women over 38 years old with a non diploid rate greater than 50, after removing the inferior and superior factors, the net increase in live birth rate per transplant is 12-18%, and the overall cycle is shortened.
4. What should I do if blastocyst culture fails? Answer: If Day 3 embryos have ≥ 4 cells and fragments<20%, blastocyst culture can be temporarily cancelled and Day 3 can be directly transplanted. The average Day 3 live birth rate in the United States is still 45%.
5. Is frozen embryo better than fresh embryo? Answer: For individuals with high ovarian response (≥ 15 retrieved eggs) or estradiol>4500 pg/mL, FET can reduce the risk of OHSS from 8% to 1%, and the live birth rate is higher; There is no difference between the two in terms of normal ovarian response.
6. How many embryos do American doctors transplant at once? Answer: The single pregnancy transplantation rate has reached 90% for those under 35 years old, and the twin pregnancy rate has been reduced to below 1%; Over 38 years old can discuss 2 items, but must sign a twin pregnancy risk informed consent.
7. How much success rate does obesity reduce? Answer: BMI 30-34.9 leads to a 25% decrease in live birth rate, BMI ≥ 35 leads to a 40% decrease, and the risk of anesthesia and gestational hypertension increases exponentially.
8. Should endometrial polyps be treated first? Answer: If it is less than 1 cm and asymptomatic, it can be observed; If it is ≥ 1 cm or affects menstruation, it is recommended to rest for one month after hysteroscopic resection before entering the cycle, which can increase the implantation rate by 15%.
9. Can male sperm deformity rate reach 98%? Answer: According to the 5th edition of WHO, a normal morphology of ≥ 4% meets the standard, and a 98% abnormality rate belongs to "teratozoospermia". However, as long as there are 10000 to 20000 motile sperm, the fertilization rate of ICSI can still reach 75%.
10. Will COVID-19 Vaccine Affect Embryos? Answer: The CDC tracked 6814 IVF cycles, and there was no statistically significant difference in fertilization rate, blastocyst rate, and miscarriage rate between the vaccinated group and the unvaccinated group.
11. How many times do I need to take leave to go to the United States? Answer: Usually two times: ① Local monitoring from day 1 to day 12, flying to the United States on day 13, and egg retrieval from day 14 to day 16; ② On the 19th day, return to China and freeze the embryos; After one month, I went to the United States for the second time and stayed for 5 days to complete FET. Approximately 21 days in total.
12. Can American insurance be reimbursed? Answer: Insurance coverage is mandatory in 17 states, but mostly limited to residents within the state; International patients can purchase "IVF refund insurance", which can refund 70% of the cost if there is no live birth after 3 cycles, but the premium can reach up to $18000.
13. Is the dosage of medication for promoting excretion higher than in China? Answer: The average total amount of Gn in the United States is 2800 IU, while in China it is 2200 IU. The difference lies in the target number of retrieved eggs, which is 15-18 in the United States and 10-12 in China, for the purpose of polycystic embryos, multiple testing, and multiple freezing.
14. Do I need to stay in bed after transplantation? Answer: Randomized controlled trials have shown that lying in bed for 24 hours after transplantation and immediately engaging in normal activities have clinical pregnancy rates of 42% and 46%, respectively. It is recommended to stay in bed for ≤ 30 minutes.
15. How to verify the authenticity of hospital data? Answer: Log in to SART.org → Clinic Name → Enter the hospital's English name → Download Excel, check the number of cycles, age group, and live birth rate, and compare them with the hospital's Chinese brochure item by item. If the difference is greater than 5%, you can send an email to the CDC（ ART@cdc.gov ）.

9、 Outlook for 2024: How can technological iterations further increase success rates?

1. The AI embryo evaluation deep learning model can reduce the morphological evaluation error from 18% to 7% by training on 100000 embryo photos, which is equivalent to screening out an additional 5% of high-quality embryos. INCINTA has been launched in Q4 2023, and preliminary data shows that the live birth rate of people under 38 years old has increased by another 3.2%.

2. Non invasive PGT (niPGT) detects chromosomes through free DNA in embryo culture medium, avoiding 1% embryo damage caused by biopsy. It is expected to enter multicenter phase III in 2024, and if successful, the "no signal" ratio of PGT-A can be reduced to less than 5%.

3. The endometrial immune microenvironment chip performs mass spectrometry analysis on 96 cytokines to identify individualized "implantation windows", which can increase the live birth rate of individuals with repeated implantation failures from 25% to 42%. It is expected to be commercialized in the second half of 2024, with a testing fee of $1200.

4. Autologous mitochondrial transplantation (Augment) extracts mitochondria from immature oocyte precursor cells (OSCs) in the ovarian cortex and injects them into MII eggs, theoretically enhancing fertilization and developmental potential. From 2019 to 2023, 450 small-scale trials worldwide showed an absolute increase of 6-8% in live birth rates for women aged 40 and above, but the FDA still classifies it as experimental and requires an IND agreement to be signed.

10、 7 practical suggestions for families planning to go to the United States

1. First, perform domestic AMH, basic FSH, and ultrasound sinus vesicle counting. Use the self testing table in this article to score. If the score is less than -30, prioritize the "dual cycle package" to avoid having no embryos to transfer after a one-way trip to the United States.
2. When selecting a hospital, pull the CDC and SART data into the same Excel file, sort them by "single pregnancy full-term live birth rate/your age group", and then filter the top 5 hospitals with a cycle number ≥ 150. Send an email to the Chinese coordinator to ask, and if there is no response within 3 days, they will be eliminated.
3. If BMI is ≥ 28, losing weight 3 months in advance with a target of 5-8 kg can reduce the amount of medication used to promote ovulation by 20%, saving $1500-2000.
4. Men who quit smoking, drinking, and brisk walking for 30 minutes a day 90 days in advance can increase their sperm DNA fragmentation rate by 2% for every 5% decrease in blastocyst formation rate.
5. Hysteroscopy is more important than hysterosalpingography, especially for those with endometrial abnormalities and menstrual bleeding for ≥ 8 days as indicated by ultrasound. Early treatment can avoid canceling the cycle after going to the United States.
6. Visa applications in the "medical treatment" category should include a hospital appointment letter, cost estimate, and a copy of the doctor's license. According to 2023 statistics, the visa approval rate is 96%, which is much higher than that of tourist visas.
7. After 10 days of embryo transfer, if HCG is ≥ 50 IU/L, the patient can be flown back to China on the same day. The local department will continue to prescribe progesterone, and the American hospital will provide an English medical record summary for seamless integration with the prenatal examination upon returning to China.

Conclusion: The success rate of in vitro fertilization in the United States is not a "mystery", but a probability game that combines five variables: age, ovarian reserve, laboratory techniques, embryo selection, and maternal environment. Learning to understand the raw data of CDC/SART, quantifying personal conditions with self testing forms, and then investing the budget in the technology nodes with the highest marginal benefits can turn "60%" or "70%" from paper numbers into real opportunities to have children. Wishing you a speedy transition from 'success rate' to 'success'.

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