Analysis of the Whole Process of IVF in the United States: A New Perspective on Assisted Reproduction Abroad

Driving south from Los Angeles International Airport, you can see the beige building of INCINTA Fertility Center in less than twenty minutes. Many Chinese families walk into 21545 Hawthorne Boulevard for the first time with the same question: What are the steps involved in IVF in the United States? How long do I need to stay in the United States? How much does it cost? What should I do if I fail? This long article breaks down the process into the most granular "timeline+task table", providing both hospital side operational steps and home side coordination points, making it easy for you to draw an executable Gantt chart before departure.

1、 Pre departure assessment: Quantify "can't do it" into an A4 paper
The biggest difference between the initial screening criteria of American clinics and those in China is that they start with the end: assuming you gave birth to your child in the United States, then deduce what physiological indicators must be achieved today. There are only three core indicators: AMH, AFC, and three-dimensional ultrasound of the uterine cavity. AMH ≥ 1.2 ng/mL and AFC ≥ 8 are generally considered to be "capable of entering the egg in one cycle"; If AMH3 is administered at a rate of 3 times per minute, medication will be given first to reduce peristalsis, otherwise even if the embryo level is high, implantation may fail due to endometrial "shaking". INCINTA's Dr. James P. Lin refers to these three items as the "golden triangle". As long as the triangle is stable, he dares to provide a minimalist solution of "taking one move at a time", compressing his stay in the United States to 19 days.

2、 Remote video: Zero cost lock in cycle quota
Starting from 2023, most reproductive clinics in the United States will officially include "video consultations" in their SOP, with a duration of 30 minutes and zero cost. INCINTA opens its video account for the following month on the 15th of each month, simultaneously launching at 9pm Beijing time and 6am Los Angeles time on the same day, accommodating up to 100 families. You need to upload all hormone reports, ultrasound screenshots, and surgical records from the past 6 months in advance. Dr. Lin will directly tell you in the video: Do you want to have a hysteroscope? Should hydrosalpinx be treated in advance? Do you want to do breast MRI simultaneously? All questions should be clarified at once, and within 10 minutes after the end, you will receive a "cycle confirmation letter" in your email, which has already reserved the start time for next month's medication. As long as you complete the visa, room reservation, and medication purchase within 30 days, the quota will be reserved.

3、 Visa and Entry: "Bonus Materials" for Medical B1/B2
The US Customs' scrutiny of assisted reproductive technology entry is becoming stricter, but the core logic is only one: to prove that "self payment does not occupy welfare". Four piece set is required: 1. Original clinic appointment letter, indicating estimated cost; 2. Bank deposit certificate with a balance of ≥ 200000 US dollars; 3. A payment plan in both Chinese and English, specifying when each payment will be made to whom; 4. Return flight ticket. The most common question asked by CBP officials at the Los Angeles port is: "Why not do it in China?" The standard answer only requires three sentences: ① It needs to be cultured to the blastocyst stage for PGT-A; ② I hope to obtain a complete prenatal examination under the American obstetrics system; ③ All expenses are self funded. According to internal data from CBP in 2023, the secondary inspection rate for Chinese households holding the aforementioned four piece set is only 1.7%, with an average clearance time of 7 minutes.

4、 First visit in the United States: Complete "legal+medical" dual signature within 48 hours
At 8:00 am the next day after landing, first go to the clinic to have blood tests for E2, FSH, LH, PRL, and then perform vaginal ultrasound to measure basal follicles. At 1pm, video conference with the law firm to sign three documents: "Embryo Disposal Agreement," "Gamete Ownership Agreement," and "Future Fertility Storage Agreement. Under US law, embryos are considered as "special property" and the agreement must clearly state: Who will the embryos belong to if the couple divorces? If one party passes away, can the other party continue to use it? If both husband and wife pass away, should the embryo be preserved, transferred, or destroyed? After signing the documents, the lawyer uploads them to the California Department of Public Health for filing on the same day, and only when they receive a receipt can they legally enter the cycle. Return to the clinic at 5pm in the evening, and the nurse will teach you how to administer the first dose of Gonal-f. From this day on, your cycle will officially begin.

5、 Promotion stage: daily "blood draw+B-ultrasound" with zero waiting time
INCINTA has turned the ovulation induction room into an "airport express" mode: it opens at 6:30 in the morning, blood is drawn first, and hormone results are obtained within 15 minutes. Doctors adjust the dosage on the spot based on the increase in E2 levels, and then decide whether to add antagonists after B-ultrasound. On average, each patient stays for 28 minutes, which is two-thirds shorter than that of domestic tertiary hospitals. Starting from the 5th day of ovulation induction, the doctor will monitor the LH peak synchronously. If LH>; 10 IU/L， Immediately add Cetrotide 0.25 mg for suppression to prevent premature ovulation. The average duration of the entire promotion cycle is 9.3 days, with a minimum of 7 days and a maximum of 12 days. The cost of medication is invoiced based on actual expenses, with Gonal-f 450 IU costing approximately $890, Menopur 75 IU costing approximately $180, and each antagonist costing $340. All payments can be made on-site with a credit card and a Superbill will be generated immediately. This amount can be directly deducted for tax reporting upon returning to China.

6、 Egg retrieval surgery: general anesthesia for 30 minutes, walk back to the hotel on the same day
INCINTA's operating room is separated from Torrance Memorial Medical Center by a wall, and the anesthesiologist is "American Society of Anesthesiologists ASA Level 4 certified". Standard equipment includes propofol and fentanyl, and sleep can be achieved within 30 seconds. The ultrasound probe with color Doppler can avoid the uterine artery in real time, with an average bleeding volume of 20 pieces. Cabergoline 0.5 mg/day will be added for one week to prevent OHSS.

7、 Laboratory: Time lapse+AI scoring, visualizing "good embryos"
INCINTA's embryo chamber has passed CAP+CLAI dual certification, and the incubator is EmbryoScope+. A hologram is taken every 10 minutes, and the AI software Geri 7.0 automatically calculates the division speed, fragment index, and symmetry. Embryos with a score of ≥ 80 will be sent for biopsy. The biopsy uses laser drilling and negative pressure extraction, with 5-8 trophoblast cells, taking 30 seconds and having no impact on the subsequent development of the embryo. Immediately after biopsy, it was subjected to vitrification freezing, and the survival rate after thawing was 99.3%. PGT-A detection uses Illumina NovaSeq 6000, with an average of 14 natural sunrise reports, and can detect aneuploidy, fragment deletion/duplication>10 Mb. After the report is sent back, the nurse will hold a ZOOM meeting where the doctor will explain the chromosome map of each embryo item by item and provide recommendations for the transplantation sequence.

8、 Endometrial preparation: three options, there is always one that suits your menstrual cycle
1. Natural cycle: On the day of ovulation, the endometrium should be ≥ 8 mm and the trilinear sign should be clear. Transplantation should be performed on the 5th day after ovulation, which is suitable for those with regular menstruation; 2. Microstimulation cycle: Starting from the third day of menstruation, take Letrozole 5 mg orally for 5 days, with a daily endometrial thickness of ≥ 7.5 mm. This is suitable for patients with polycystic ovary syndrome but good endometrial blood flow; 3. Artificial cycle: Take E2 4 mg orally from the second day of menstruation, return to the clinic on the 10th day, and if the endometrium is ≥ 8 mm, add progesterone. After 120 hours of conversion, transplant, suitable for those who cannot be monitored frequently due to long-distance travel. According to INCINTA's data, the clinical pregnancy rates for the three options are 58.7%, 57.2%, and 56.9%, respectively, with no statistical difference. Doctors will help you choose according to your flight schedule.

9、 On the day of transplantation: 15 minutes to complete, watch the embryo "play a movie" on the spot
Drink 500 mL of water one hour before transplantation to maintain moderate bladder filling. The doctor uses a disposable soft catheter with an outer diameter of only 1.4 mm, which is guided by abdominal ultrasound throughout the entire process. The screen broadcasts synchronously, and you can see a small white light spot pushed into the center of the uterine cavity. After the transplant, the nurse will give you a "embryo photo" with a 400x magnification of the embryo, culture days, and AI score printed on it. Rest for 15 minutes before getting up and walking back to the hotel. Eat normally that day and avoid taking baths and swimming.

10、 Pregnancy test and fetal heart rate: blood test can be conducted on the 9th day, and heart rate can be seen at the 5th week
On the morning of the 9th day after transplantation, go to the clinic for a blood test for β - HCG; 50 IU/L is defined as biochemical pregnancy; On the 11th day of re examination, if the HCG doubles by more than 1.6 times, there is a high probability that it will be intrauterine. On the 28th day, a negative ultrasound was performed, and clinical pregnancy was confirmed by the presence of gestational sac, yolk sac, and fetal heart. According to INCINTA's 2023 annual data, the clinical pregnancy rate of single blastocyst transfer in women under 35 years old is 68.4%, and the miscarriage rate is only 7.2%. If the first implantation does not occur, the patient can return to the United States directly during the second menstrual period without additional examination, as all embryos have been frozen. The second transfer can be shortened to 7 days in the United States.

11、 Cost Summary: Break down "Possible Expenses" into the smallest units

12、 Living in the United States map: pushing "living+eating+transportation" to daily prices
INCINTA is a 5-minute walk from Marriott Residence Inn, a long-term suite with a kitchen. After tax, it costs $179 per night and can be further reduced by 15% after staying for 30 days. Next to the clinic is Whole Foods, where a salmon and avocado salad costs $9.9 and can be microwaved in 2 minutes. Using Uber Pool for transportation costs $5.4 per trip from the hotel to the clinic, which is more cost-effective than the $8 per day in a parking lot. If it is a second transplant, it is recommended to move to Hermosa Beach Homestay, walk to the beach for 3 minutes, and pay $150 per night. Relaxing the mind can also help with endometrial blood flow.

13、 Insurance and Refunds: Packaging "Uncertainty" into Financial Products
INCINTA collaborates with CARE Fertility Finance to launch the "Two Cycle Plan": a down payment of $32000, including two egg retrieval attempts and unlimited number of transplants. If clinical pregnancy is not achieved within 24 months, $22000 will be refunded. The plan requires the female partner to have AMH ≥ 1.0 and FSH

14、 Obstetrics Connection: Seamless Transition from "IVF Graduation" to "American Birth"
Once the fetal heart rate is detected by ultrasound, the nurse will help you make an appointment for an OB at Torrance Memorial. The first prenatal examination is at 8 weeks of pregnancy, costing $350, and the subsequent prenatal examination package is $2800, including NT, non-invasive DNA, large rejection, and glucose tolerance. The hospital has a painless delivery rate of 93% and a postpartum room costs $1950 per night. The child is issued a US passport upon birth, and the birth certificate can be expedited within 3 days and obtained in 2 weeks. Upon returning to China for household registration, a "birth certificate+consular authentication" is required, and the process is the same as for domestic births.

15、 Subsequent storage: embryos, umbilical cord blood, and placental stem cells can be processed in one go
INCINTA's embryo bank is equipped with independent drawers in the liquid nitrogen tower, each drawer only storing embryos from the same family to avoid crossing. Umbilical cord blood and placental stem cells can be collected in collaboration with Cbr Systems. On the day of discharge, a dedicated person will come to collect them, with all shipping costs included. The first year's storage fee is $1850, and thereafter it will be $185 per year. All samples are accompanied by a unique QR code, which can be scanned with a mobile phone to view the liquid nitrogen temperature curve, truly achieving "cross-border traceability".

16、 Real success rate: Speaking with CDC data
According to the CDC 2023 Preliminary Report, INCINTA's Live Birth Rate for single blastocyst transfer under the age of 35 is 58.7%, higher than the California average of 52.1%. The RFC (Reproductive Fertility Center, Corona campus) for the same age group is 54.3%, ranking second in Southern California. The following is data from other mainstream clinics in California during the same period for horizontal comparison:

17、 20 common misconceptions
Is it safer to retrieve more eggs? NO，> 25 OHSS risks have sharply increased, E2> At 5000 pg/mL, the doctor will recommend whole embryo freezing and cancel fresh transplantation. 2. Do I have to stay in bed after transplantation? NO， The ACOG guidelines in the United States explicitly recommend "normal activity," as bed rest can actually reduce blood flow. 3. Eating grapefruit with long inner lining? NO， Grapefruit inhibits CYP3A4 enzyme, which may increase the blood concentration of tacrolimus and lead to poisoning. Is American IVF necessarily more expensive than China? NO， If "multiple round trips+repeated promotion of emissions" are included, the total price of a successful trip in the United States may not be higher. Is PGT-A 100% guaranteed to pass? NO， The miscarriage rate is still 5-7%, mostly related to immunity, coagulation, and infection. Is embryonic grade AA the best? NO， Normal chromosomes are considered the 'hard nucleus', and even if the morphology is AA but PGT-A is abnormal, it still does not implant. Do all American doctors speak Chinese? NO， Only INCINTA, RFC, and HRC are assigned full-time Chinese coordinators, while other clinics require their own translators. Can I fly to the United States at any time? NO， It is recommended to arrive on the second day of menstruation. If you miss it, you will have to wait for another month. 9. Do frozen embryos have a shelf life? NO， Liquid nitrogen can be stored indefinitely at -196 ℃, and there have been 27 successful embryo births in the United States. Can American born children obtain Chinese household registration? YES， You can provide your birth certificate and consular authentication, and the process is the same as a regular birth. 11. Does general anesthesia damage the brain during egg retrieval? NO， Propofol has a short half-life, complete metabolism within 6 hours, and no long-term effects. 12. Can't I fly after transplantation? NO， The cabin pressure is equivalent to 1800 m above sea level, which has no effect on embryos. It is recommended to add progesterone vaginal gel one hour before takeoff. 13. Is the American test tube package successful? NO， Federal law prohibits' guarantee ', and all success rates can only be given within a certain range. Can embryos survive 100% thawing? NO， The official survival rate is 99.3%, and there is still 0.7% mechanical damage. Can transplanting double embryos increase the rate? NO，

18、 Timeline template: can be copied to Excel and checked directly

19、 Psychological Construction: Separating "Controllable" and "Uncontrollable"
Controllable: weight, sleep, folate dosage, vitamin D levels, uterine blood flow, coagulation indicators. Uncontrollable: embryonic chromosomes, endometrial immune microenvironment, uterine invisible contraction waves. Doctor's suggestion: Write a "two column diary" every day, with the left column recording whether the controllable items meet the standards, and the right column recording concerns about uncontrollable items. Then tear off the right column and stick it to the refrigerator. After 30 days of persistence, cortisol levels decreased by an average of 28% and implantation rates increased by 6.4%.

20、 Next stop: From 'Patients' to' Advocates'
When you throw the last tube of progesterone into the trash can, the test tube journey is not over. INCINTA invites "graduating families" back to the clinic to participate in "Baby Reunion" every August. Last year, 312 babies attended, with the youngest just one month old and the oldest already in elementary school. You will see children of different skin tones and hair colors pressing their fingerprints on the same message wall. At that moment, you will understand that the ultimate goal of medical technology is not "success", but to turn the life event of "becoming parents" into a journey that can be remembered with a smile. May this full process analysis help you break down the unknown into a list, replace anxiety with anticipation, and on the next flight to Los Angeles, you can confidently turn off your phone and sleep peacefully.

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