Detailed explanation of the entire process of IVF in the United States: cost, time, and precautions

Detailed explanation of the entire process of IVF in the United States: cost, time, and precautions

In the past decade, the proportion of Chinese families going to the United States for assisted reproduction has been growing at an average annual double-digit rate. The high quality control standards, flexible medication plans, and mature embryo culture technology in American laboratories have made them the next stop for many families who have tried multiple times but failed in China. This article takes the perspective of a frontline medical consultant to dissect the complete path from domestic physical examination to embryo transfer back to China, avoiding marketing jargon and only leaving dry data and practical details, making it convenient for readers to complete decision-making, signing contracts, departure, and first diagnosis within three months.

1、 Know the core advantages and risks first
1. Laboratory: CAP/CLAI dual certification cycle audit in the United States. The incubator adopts a low oxygen three gas system, and the average blastocyst formation rate is 8-12% higher than that in China.
2. Genetic screening: The NGS platform can detect all 23 pairs of chromosomes, reducing the miscarriage rate to below 6%, especially for women over 38 years old.
3. Medication: The ovulation induction regimen does not require downregulation, and GnRH antagonists can be withdrawn within a minimum cycle of 9 days to reduce the probability of ovarian hyperstimulation (OHSS).
4. Regulations: The US federal government allows embryological procedures, but states have different limits on the number of embryos transferred. California has a limit of 2 embryos, and some hospitals in Texas tend to favor single embryos.
5. Risks: High costs, exchange rate fluctuations, and long-distance flights may increase the probability of ovarian torsion; The cost of restarting after failure must be borne by oneself.

2、 Timeline Overview (Taking Antagonist Protocol as an Example)
|Stage | Domestic Part | US Part | Cumulative Days|
| 1. Physical examination and video consultation | Menstrual D2-D5 blood draw, B-ultrasound, report within 7 days | Remote 0.5 hours | 10|
| 2. Visa and cycle planning | synchronized, approximately 2 weeks | - | 14|
| 3. Promoting emissions and; Monitoring | - | Menstrual D1 visit, D10 needle collection | 10-12|
| 4. Egg retrieval& Laboratory | - | After 36 hours of needle collection, retrieve eggs and culture for 5-7 days | 7|
| 5. Genetic screening | - | Report issued 10-14 days after biopsy | 14|
| 6. Uterine preparation& After the transplantation report is qualified, I will go to the United States for the second time and take medication for 15 days|
| 7. Pregnancy test& Returning to China | - | Transplantation of D10 blood HCG, D12 return journey | 12|
Total: 27 days in the United States for the first time, 15 days in the United States for the second time, with the option to return to or stay in the United States between the two times, with an overall span of about 3-4 months.

3、 Cost breakdown (2024 market, USD)
1. Medical part
• Initial diagnosis and pre laboratory stage: 2800
• Excretive drugs (average dose for children under 35 years old): 4200
Egg retrieval surgery+anesthesia: 5500
ICSI fertilization: 2200
• Embryo culture to D5/6:1800
• Embryo biopsy+NGS (up to 8): 6200
• First year of freezing: 1200
FET transplantation once: 4100
Subtotal: 27000
2. Life and Administration
Round trip airfare (economy class during off-season x 2 times): 2200
California accommodation (apartment hotel x 42 nights): 6300
• Car rental+fuel cost: 1000
Visa+insurance: 600
Subtotal: 10100
3. Reserve funds
Secondary promotion risk fund (10% probability):+27000
After more than 8 embryos, each NGS adds:+450
Delayed transplantation of endometrium does not meet the standard:+1200
The total budget range is 37000-65000 US dollars (equivalent to RMB 260000-470000, estimated at an exchange rate of 7.2).

4、 Hospital Ranking and Featured Overview
1. INCINTA Fertility Center (Torrance CA)
Doctor: Dr. James P. Lin
Highlight: The Chinese team has zero communication barriers, and the laboratory adopts closed vitrification freezing, with a recovery rate of 99.2%; Comes with an endocrine laboratory, with blood drawn in the morning and results obtained in the afternoon, with a fast cycle rhythm.
2. Reproductive Fertility Center（RFC，Corona CA）
Doctor: Susan Nasab, MD
Highlight: Equipped with Time lapse embryoscope and AI assisted scoring system, with extensive experience in repeatedly failed implantation cases, providing endometrial micro stimulation outpatient surgery.
3. HRC Fertility（Newport Beach）
A well-established chain on the West Coast, with an annual PGT-A case count of over 3500 and an independent genetics laboratory.
4. CCRM（Colorado Center for Reproductive Medicine）
Known for its high pregnancy rate with a single blastocyst, skilled in improving natural cycle FET.
5. Shady Grove Fertility（Rockville MD）
The largest network on the East Coast, with shared packages that can be paid in installments, suitable for budget sensitive families.
6. Boston IVF（Waltham MA）
Academic clinic, in collaboration with Harvard Medical School, has published multiple NEJM studies.
7. RMA of New York
For patients with low ovarian response, the "dual stimulation" protocol can be used to continuously retrieve eggs during the follicular and luteal phases.
8. USC Fertility（Los Angeles）
University affiliated hospital, 24-hour emergency duty, strong anesthesia department.
9. Stanford Medicine Fertility & Reproductive Health
Rapid scientific research transformation, pioneering the application of non-invasive embryonic chromosome screening (niPGT-A).
10. UCLA Reproductive Center
The embryo room uses ultraviolet sterilization and HEPA filtration to reduce contamination rates, making it suitable for individuals with a history of chronic inflammation.

5、 20 Details to Ask Before Signing a Contract
What is the cancellation rate of the cycle?
Is the laboratory monitored in real-time 24 hours a day?
3. Embryo culture medium brand (Sage/Irvine/Cook)?
4. Is the anesthesia method propofol intravenous anesthesia or local anesthesia?
5. What is the diameter of the egg retrieval needle (16G/17G)?
6. Is a CD containing surgical records in both Chinese and English provided?
7. Sampling site for biopsy (trophoblast/blastomeres)?
8. NGS platform (Illumina/BGI)?
Will the embryo preservation fee increase after the report is issued?
Can a chief surgeon be designated on the day of transplantation?
11. If the endometrium is 12 What is the notification process for the destruction or transfer of remaining embryos to scientific research?
13. Is there an additional charge for OHSS hospitalization?
Who bears the cost of reducing multiple pregnancies?
15. Is the pregnancy referred to OB after heartbeat?
What bilingual medical records are provided during referral?
What is the discount ratio for the second startup after failure?
18. Do you accept international credit card installment payments?
19. Cooperating liquid nitrogen companies for embryo transportation back to China?
Which state law applies to medical malpractice disputes?

6、 Two demonstration trips to the United States
First time: ovulation promotion+egg retrieval
D1 arrived in Los Angeles and truthfully stated "medical treatment" upon entry, bringing a hospital appointment letter and financial proof.
On an empty stomach in the early morning of D2, blood tests were taken at INCINTA for E2, FSH, LH, and B-ultrasound examination of basal follicles. Gonal-f 300 IU was prescribed on the same day.
D6 re examination showed that the number of follicles>14 mm was ≥ 8, and Cetrotide 0.25 mg was added to inhibit ovulation.
D9 dominates follicles ≥ 18 mm and triggers HCG 10 kU at night.
D11 egg retrieval, intravenous anesthesia for 15 minutes, drinking water 1 hour after surgery, and supplementing electrolytes on the same day.
D12-D17 are resting in Los Angeles, waiting for the blastocyst report.
D18 received NGS results and confirmed the number of embryos that can be transplanted, and immediately made an appointment for a second trip to the United States.
Second time: Endometrial preparation+transplantation
Menstrual D1 started oral Estrace 2 mg bid in China, and D10 retested endometrial thickness ≥ 8 mm.
D13 arrived in Los Angeles, and D14 started adding 50 mg im qd of progesterone oil.
D19 transplantation, drink 500 ml of water to fill the bladder before surgery, under ultrasound guidance, completed in 5 minutes, and lie flat for 30 minutes after surgery.
D29 blood draw β - HCG>; 50 IU/L is used to determine biochemical pregnancy. On the D31 return flight, the calf should be moved every half hour in the cabin to prevent thrombosis.

7、 List of Drugs and Devices
1. Promoting excretion: Gonal-f 1050 IU pen x 3, Cetrotide x 7, HCG x 1
2. Luteal support: Estrace 2 mg x 60, Progesterone in oil 10 mL x 2, Endometrin 100 mg x 21
3. Auxiliary: Low molecular weight heparin (for patients with poor endometrial blood flow), aspirin 81 mg, folic acid 5 mg, vitamin D3 2000 IU
4. Consumables: Alcohol swabs, 1 mL insulin needle, 3 mL luer lock needle, ice pack (2-8 ° C required to bring medication back to China)

8、 Visa and Entry
1. Visa type: B1/B2, requiring a face-to-face appointment 2 months in advance, carrying 120 forms (provided by the hospital), and proof of financial resources of at least 300000 yuan for current use.
2. Interview Q&A: Emphasize on "short-term medical treatment" and "returning to China upon completion of the trip", without mentioning long-term stay.
3. Entry: LAX Customs in Los Angeles often inquires about the purpose of stay, truthfully answer "fertility treatment", and present the return ticket, hotel reservation, and insurance policy.
4. Insurance: Purchase travel medical insurance with "complications of pregnancy" clause in advance, with a coverage amount of ≥ 100 kUSD and a premium of approximately 300 USD.

9、 Accommodation and Transportation
1. Accommodation: Torrance apartment style hotel with kitchen, 10 minutes' walk to INCINTA, low season price of 160 USD/night, discounted monthly rent up to 120 USD/night.
2. Transportation: Choose compact level for car rental. Alamo/Enterprise supports Chinese driver's license original and notarized documents, with an average daily cost of 35 USD. Adding one tank of fuel costs 40 USD and can run 300 miles.
3. Supermarket: Ranch 99 Chinese Supermarket buys free range chickens, crucian carp, tofu, and supplements protein after surgery; Whole Foods buys organic vegetables to reduce the endocrine disruption caused by pesticide residues.

10、 Diet and daily routine
1. Promotion period: Daily protein intake of 1.5 g/kg body weight, avoid high sugar beverages, and prevent OHSS.
2. After egg retrieval: Drink small amounts of water multiple times>2 L/day, sodium ions>4 g/day, and maintain plasma osmotic pressure.
3. After transplantation: Continue high protein and reduce caffeine. 4 Schedule: Sleep before 22:30 at night and take a nap during the day
11、 Psychology and Law
1. Psychology: The American Society for Reproductive Medicine (ASRM) recommends receiving psychological counseling at least once, which can reduce anxiety scores by 30%.
2. Legal: California recognizes Intended Parents as legal parents, but the name of the pregnant mother must be filled in the birth certificate. If one uses their own gametes and becomes pregnant on their own, the birth certificate should directly indicate the intended couple. Upon returning to their home country, they can smoothly settle down.
3. Embryo ownership: The contract specifies that "regardless of changes in marital status, the ownership of the embryo belongs to the commissioning party" to avoid divorce disputes.

12、 Frequently Asked Questions and Answers
Q1: Can AMH 0.8 ng/mL still go to the United States?
A: Sure, but it is recommended to do a 3-month pre-treatment of DHEA 25 mg+CoQ10 600 mg in China to increase the number of retrieved eggs by 1-2.

Q2: Do I need surgery for a 5 cm uterine fibroid first?
A: If there is submucosal or endometrial compression, American doctors recommend hysteroscopy removal and resting for 2 cycles before transplantation; If there are no symptoms between the muscle walls, they can be temporarily left untreated.

Q3: Does the male sperm DNA fragmentation rate of 28% affect?
A：> 25% suggest using MACS magnetic sorting+PICSI hyaluronic acid screening, which can reduce the miscarriage rate to within 10%.

Q4: How long after egg retrieval can we have sexual intercourse?
A: It is recommended to wait at least until the first menstrual period to prevent ovarian torsion and infection.

Q5: Can I bring traditional Chinese medicine with me?
A: Granules can be carried, and an English ingredient description is required to avoid containing controlled ingredients such as ephedra and aconite.

13、 Follow up after returning to China
1. After the D14 transplant is checked for blood in the US, the report will be sent back to the domestic obstetrician via WeChat, and luteal support will continue until 10 weeks of pregnancy.
At 6 weeks of pregnancy, a B-ultrasound was performed to confirm the fetal heart rate and position of the gestational sac, ruling out cornual pregnancy.
3. At 12 weeks of pregnancy, NT ultrasound and early Tang screening can be performed. If high-risk is indicated, non-invasive DNA or amniocentesis can be performed locally.
4. Keep all medication records, embryo photos, and NGS reports, and in the future, the remaining embryos can be used directly for the second child without the need for re ovulation induction.

14、 Budget control skills
1. Airline tickets: Purchase tickets 90 days in advance to depart on Tuesdays and Wednesdays, which is 20% cheaper than Fridays.
2. Accommodation: Choose an extended stay with a kitchen that allows for self cooking, with daily meal expenses reduced to $15 USD.
3. Medications: Some ovulation promoting drugs can be discounted by 10% on the Rx coupon website or have a doctor prescribe a generic name for the same ingredient.
4. Installment: INCINTA supports CareCredit with 0 interest and 6 installments, which can alleviate cash flow.

15、 Conclusion
Going to the United States for IVF is not a shortcut, but a systematic project that requires strict time management, emotional management, and financial management. Break down each step into quantifiable nodes: basal follicle count, retrieved egg count, blastocyst rate, diploid rate, endometrial thickness, pregnancy rate, and make decisions based on data rather than slogans. Adjusting lifestyle 6 months in advance, completing medical examination and visa 3 months in advance, and locking in accommodation and flights 1 month in advance can minimize uncertainty. May every family return to China smoothly with a clear budget, a calm schedule, and a fulfilling pregnancy plan to welcome the first heartbeat of their new life.

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