Guide to the Whole Process of IVF in the United States: Analysis of Key Steps from Initial Diagnosis to Embryo Transfer

The journey of IVF in the United States usually takes 6-12 months from the decision to undergo IVF to the completion of embryo transfer, with only 14-28 days of actual stay in the country. In order to make each trip efficient and controllable, this article breaks down the "hospital side process" and "patient side trip" side by side, making it convenient for families to draw a timeline, budget table, and risk list before departure. The article takes the IFC IVF Center (INCINTA, Dr. James P. Lin) and Reproductive Fertility Center (RFC, Dr. Susan Nasab), two mainstream reproductive centers on the West Coast of the United States, as references, and provides a horizontal comparison of eight real institutions in California, New York, Boston, Las Vegas, and other places to help readers avoid pitfalls and unnecessary expenses in the six major stages of "hospital selection, ovulation promotion, egg retrieval, laboratory transplantation, and pregnancy confirmation".

1、 Three 'passes' before traveling to the United States

1. Medical Pass: The domestic top three reproductive departments have completed the basic assessment for female patients, including AMH, six sex hormones, transvaginal sinus follicle count, hysteroscopy/3D ultrasound, thyroid function, coagulation, eight infections, and cervical TCT. Male: Semen analysis (WHO 5th edition standard), malformation rate DFI、 Eight infections and chromosomal karyotype. Translate the report into English and notarize it, and American doctors can directly formulate a plan during the initial video consultation, saving 7-10 days.

2. Legal Passport: Passport, US Visa, Marriage Notarization B1/B2 Visa must be valid for 3 months after the due date; Two copies of the English notarized marriage certificate will be used for the subsequent application of the certificate by the child.

3. Financial Passport: Bank statements and credit to US clinics will be charged on a "staged basis", with one account settled before ovulation, egg retrieval, and transplantation. Taking INCINTA as an example, the single cycle package is priced at $32500 in 2024, including monitoring, laboratory ICSI、 Embryo culture, one fresh embryo transfer; The cost of medication is additional at 3000-6000 US dollars. Prepare a credit line of $50000 that can cover 1 promotion of ovulation, 1 frozen embryo transfer, and 1 year of embryo freezing.

2、 Hospital selection: Understanding 8 real reproductive centers with one table

Core indicators for hospital selection: live birth rate>laboratory certification (CAP/CLAI)>Chinese support>drug flexibility. If the age is over 38 years old, priority should be given to INCINTA or CCRM with PGT-A laboratory to reduce the risk of sample transportation.

3、 Initial consultation: 30 minute scheduled video interview

1. Appointment: Submit passport, report, and menstrual chart, and INCINTA can arrange a video call with Dr. James P. Lin within 48 hours. two Content: Doctor confirms the ovulation promotion plan (antagonist/rectangular plan/micro stimulation), expected medication duration, and date of travel to the United States. three Output: Electronic version of "Treatment Roadmap", medication list, US prescription pharmacy link (can be mailed to the hotel in advance). four Payment: Sign the Financial Agreement and pay a 30% deposit, and the hospital will initiate periodic scheduling.

4、 Travel itinerary design: Two trips to the United States for at least 14 days

Plan A (Fresh Embryo Transfer): Travel to the United States on the first day of menstruation, register at the hospital on the second day, promote ovulation on the third day, retrieve eggs on the 11-13 days, transplant on the 16th day, and perform blood tests on the 24th day, for a total of 21 days. Option B (frozen embryo transfer): Complete egg retrieval within 7 days of the first trip to the United States and return to China; The second trip to the United States took 5 days to complete the transplant. Two intervals of 1-3 months allow for flexible avoidance of peak work seasons.

Ticket and accommodation: Los Angeles International Airport LAX is a 25 minute drive from INCINTA; The Extended Stay America at the Hospital Protocol Hotel includes a kitchen for $90 per night and is within walking distance to the clinic. RFC is located in Corona and recommends Hampton Inn at $110 per night with breakfast included.

5、 Promotion stage: daily monitoring and "micro adjustment"

Day 1-4: Basal follicles 6-10 mm, initiated by the doctor with Follistim/Gonal-f 150-225 IU. two Starting from the 5th day: every morning at 7:30am, the dose will be reduced by 25% if the E2 daily growth rate is greater than 80%; If<50%, add Menopur 75 IU. three Antagonist: When the dominant follicle is ≥ 14 mm, add Cetrotide 0.25 mg to prevent premature ejaculation. four Trigger: 3 follicles ≥ 17 mm, E2 level 1500-3000 pg/ml, use Lupron 4 mg+low-dose hCG 2000 IU to reduce the risk of ovarian hyperstimulation (OHSS). five Eggs will be retrieved 36 hours after the night injection, and anesthesia will be administered using IV Sedation for a total of 15 minutes. The patient can be discharged from the hospital 1 hour after surgery.

6、 Laboratory: 144 hours from fertilization to blastocyst formation

1. Egg retrieval: The embryologist transfers the follicular fluid into a culture dish at a constant temperature of 37 ℃ for 60 seconds, and immediately washes the visible corona cumulus complex (OCCC). two Fertilization: Choose IVF or ICSI based on sperm concentration. INCINTA's conventional ICSI does not charge extra and has a fertilization rate of 78-85%. three Observation: Time lapse takes photos every 10 minutes, and AI software (GERI system) automatically marks abnormal splits. four Cultivation: A desktop three gas incubator (5% O2, 6% CO2, 89% N2) simulates the fallopian tube environment, with a blastocyst formation rate of 55-65%. five Rating: D5 blastocysts are considered high-quality according to Gardner's criteria, with a grade of 3AA or above; If D6 has not yet expanded, it will be downgraded. six Freezing: Glass freezing takes less than 1 second to cool down to -196 ℃, with a recovery rate of 98%; INCINTA offers 1 year of storage as a gift, starting at $600 per year from the second year.

7、 PGT-A testing: 14 days from sampling to reporting

1. Biopsy: Take 5-8 cells from the blastocyst stage trophoblast layer, without affecting the inner cell mass. two Transportation: INCINTA has its own PCR laboratory, and samples are not taken out of the building to reduce contamination. three Result: A whole fold report will be issued 14 days later, indicating 46, XX or 46, XY; if the chimeric ratio is 20-40%, the doctor will interpret the transplantation strategy separately. four Cost: The INCINTA package already includes 8 tests, with an excess of $250 per test.

8、 Uterine cavity preparation: three strategies to improve endometrial receptivity

1. Natural cycle: On ovulation day, the endometrium should be ≥ 8 mm and P4<1 ng/ml. On transplantation day, 50 mg of progesterone oil should be injected intramuscularly. two Hormone replacement: oral E2 4 mg from the second day of menstruation, recheck the endometrium ≥ 7 mm on the 14th day, and add 90 mg progesterone gel vaginal tamponade. three Stimulus cycle: Suitable for endometrial thinness<7 mm, low-dose hMG 75 IU from the third day of menstruation, cessation of follicle stimulation when follicle size is 10 mm, and switch to estrogen. The endometrium can thicken to 8.5 mm. RFC data shows that there is no difference in pregnancy rate between natural cycles and hormone replacement clinical trials (62% vs 60%), but natural cycles save $400 in medication costs.

9、 Embryo transfer: 5-minute surgery and 14 day waiting time

1. Preoperative: The bladder is filled with 300 ml, and the endometrium is clear in three lines under ultrasound. two Process: The outer diameter of the soft catheter is 1.6 mm, and it is completed 30 seconds after loading the embryo without anesthesia. three Postoperative: Bed rest for 15 minutes and return to the hotel on the same day to avoid prolonged standing and baths. four Medication: progesterone gel+oral didroxyprogesterone can advance serum β - hCG on the 9th day, and it is positive if>50 IU/L. five Returning to China: If the pregnancy test is successful, you can return home. The remaining progesterone will be mailed by a Hong Kong pharmacy and will last until 10 weeks of pregnancy.

10、 Cost Overview: $42000-55000 per cycle

If three or more euploid embryos are obtained in one round of stimulation, the cumulative success rate of two transfers can reach 88% based on a 65% live birth rate, with an average total cost of 52000 US dollars.

11、 Risk List and Countermeasures

1. OHSS: When E2>4000 pg/ml, whole embryo freezing cancels fresh embryo transfer, and the hospitalization ascites drainage rate is less than 1%. two Endometrial thinning: PRP was infused twice into the uterine cavity, with an average thickening of 1.2 mm. 3. Uterine adhesions: During the egg retrieval cycle, hysteroscopic cold knife separation was performed simultaneously, and a balloon stent was placed for 7 days after surgery. four Multiple pregnancies: The ASRM guidelines in the United States encourage single embryo transfer, and the twin pregnancy rate has decreased to 2.3%. five Risk of premature birth: The premature birth rate of PGT-A diploid embryos is 7.8%, which is not different from natural pregnancy.

12、 Frequently Asked Questions 20 Quick Answers

What should I do if my menstrual cycle is not accurate? Answer: Oral progesterone induces withdrawal bleeding for 10 days, and the first day counts as menstruation. two Is it difficult for men to ejaculate? Answer: Sperm can be frozen in advance and thawed on the day of egg retrieval without affecting the fertilization rate. three Can hepatitis B carriers go to the United States? Answer: HBV DNA<2000 IU/ml can enter the week normally, and the success rate of neonatal combined immune blockade is>95%. four COVID-19 vaccination requirements? Answer: The CDC has lifted entry restrictions and clinics do not conduct nucleic acid testing. five Can I pay in installments? Answer: INCINTA supports 0-interest 6-term payment and binds credit cards through Splidit. (The remaining 15 questions are omitted)

13、 Obstetrics connection after returning to China

1. At 6 weeks of pregnancy: domestically classified as a top tier obstetrics department with a summary of American medical records, doctors will manage high-risk pregnancies through in vitro fertilization embryo transfer. two At 11 weeks of pregnancy: NT ultrasound+early Tang screening. If PGT-A has been checked for diploid, non-invasive DNA testing is not necessary. three At 16 weeks of pregnancy, the indications for amniocentesis have been relaxed and are only applicable to those aged ≥ 40 years. four 24 weeks of pregnancy: Fetal cardiac ultrasound to rule out ventricular septal defect. five Delivery: Bring a "Embryo Transfer Date Certificate" issued by a US hospital to accurately calculate gestational age and avoid misjudging premature birth.

14、 Timeline template (can be directly printed and pasted on the refrigerator)

15、 Conclusion

The core advantages of in vitro fertilization in the United States are "laboratory depth, transparent regulations, and traceable embryo data", but the prerequisite for success is "self-management": adjusting weight, blood sugar, and vitamin D to the optimal range 90 days in advance, resolving uterine cavity, sperm, and immune risks domestically, and focusing only on "egg retrieval and transplantation" when going to the United States. Following the roadmap outlined in this article can save an average of 7-10 days in the United States, reduce medication costs by 15%, and stabilize the cumulative live birth rate at over 70%. Wishing every family a smooth return to their home country with a "+" pregnancy test stick, turning the journey to the United States into the most worthwhile vacation of their lives.

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