Analysis of the entire process of in vitro fertilization in the United States: Preparation, costs, and key considerations for going to the United States

Completing an in vitro fertilization (IVF) cycle in the United States typically requires 6-8 weeks of medical treatment, but may affect overall planning for over six months. If Chinese families want to be efficient, compliant, and avoid pitfalls, they must thoroughly understand the four things of "preparation before going to the United States - clinical process - cost structure - follow-up" at once. The following text is based on the real operational rhythm of frontline reproductive centers, combined with the latest visa, exchange rate, drug price, insurance, and transportation information in 2024. It is broken down into 7 schedules, 9 expense lists, and 12 key precautions, which can be directly printed out as a checklist.

1、 90 days before going to the United States: parallel processing of visa, medical examination, and remote consultation

1. Visa: Medical B1/B2 is the safest option. In 2024, the average waiting time for appointments in Shanghai, Beijing, and Guangzhou is 18 days. It is recommended to schedule appointments for both husband and wife simultaneously. During the interview, bring a letter of appointment from the reproductive center, financial proof, and itinerary. When the visa officer asks about the purpose of going to the United States, simply answer "receiving reproductive treatment" without additional explanation. If you have a 10-year round-trip visa, it is also recommended to check "Medical" when updating EVUS to avoid being locked up in a small black house upon entry.

2. Physical examination: The female party will undergo AMH, basal FSH, E2, LH, PRL, and TSH on the 2nd to 3rd day of menstruation, while the male party will undergo semen analysis, abnormality rate, and DNA fragmentation rate, and report within 7 days. American doctors are accustomed to using international standard units, so remember to have the laboratory convert them to ng/mL, IU/L, × 10 ⁶/mL, etc., to save the need for secondary checks. Chromosome karyotype and eight infectious diseases (HBV, HCV, HIV, syphilis, etc.) are valid for 12 months and can be done in advance.

3. Remote video: INCINTA (Dr. James P. Lin) and RFC (Dr. Susan Nasab) both provide 30 minute free videos, and reports need to be uploaded 5 working days in advance. The doctor will provide an initial medication plan based on AMH and estimate the number of retrieved eggs. At this point, it is necessary to decide whether to synchronize PGT-A, as it involves subsequent package prices.

4. Proof of Funds: American clinics do not collect Chinese yuan on behalf of clients. It is necessary to convert the Chinese yuan to a limit of 50000 US dollars per person and then transfer it to the designated US dollar account of the clinic. It is recommended to complete the appointment 45 days in advance, leaving 7-10 days for international wire transfers to be in transit. The clinic will only send the official appointment letter after the payment is received.

2、 30 days before going to the United States: medication initiation, accommodation booking, itinerary adjustment

1. Medication promotion: American pharmacies operate independently, and clinics only prescribe medication. There are three common procurement routes: ① Express delivery to China (takes 7-10 days, cold chain 2-8 ℃); ② Buy now at local CVS/Walgreens after flying directly to the United States; ③ Group buying through Chinese pharmacies. Taking the 300 IU/day antagonist regimen as an example, Gonal-F 900 IU pens with 3 tubes, Fyremadel 250 μ g 7 tubes, and Tetratide 0.25 mg 7 tubes will have a group purchase price of $3200 in Los Angeles in May 2024, which is 18% cheaper than clinic pharmacies.

2. Accommodation: General anesthesia is required for both egg retrieval and transplantation surgeries. It is recommended to stay at a clinic within a 20 minute drive. 2-bedroom apartments in the vicinity of INCINTA, Torrance district, with a monthly rent of $3800 to $4200, equipped with a separate washing machine and a fire function; The cost of living in the vicinity of RFC in Corona District ranges from 3000 to 3400 US dollars. If choosing a study room in Erwan or Akadia school districts, the monthly rent will increase to $5500, but Chinese food and purchasing services are convenient.

3. Airline ticket: It is recommended to see a doctor on the 9th to 10th day of the menstrual cycle. It is suggested to fly to the United States on the 1st day of the menstrual cycle, with a flight time difference of 12 hours. China Eastern Airlines, Air China, and China Southern Airlines offer direct flights to and from Los Angeles for 6500 yuan during the off-season and 9500 yuan during the peak season; If departing from Shenzhen or Xiamen and transiting through Hong Kong, you can save an additional 800 yuan.

3、 The clinical process of IVF in the United States (taking antagonist regimen as an example)

4、 Overview of IVF Costs on the West Coast of the United States in 2024 (priced in US dollars, including 9.5% consumption tax)

5、 Hidden costs and "avoiding pitfalls" tips

1. Anesthesiologist: California law requires that egg retrieval must be performed by a licensed anesthesiologist. Some clinic quotes do not include anesthesia and require an additional payment of $650-900. Before signing the contract, ask if "all inclusive" includes anesthesia.

2. Embryology laboratory level: CAP/CLAI dual certification is the bottom line, it is best to check the SART annual report again. Taking 2022 data as an example, the live birth rate of INCINTA under 35 years old per cycle is 54.7%, RFC 52.1%， All are higher than the national average of 47.9%.

3. Second transplant discount: If the first transplant does not result in clinical pregnancy, INCINTA's second transplant fee will be halved, and RFC will provide a free FET once, but limited to use within 12 months.

4. Exchange rate fluctuations: In 2024, the Chinese yuan fell below 7.28 against the US dollar. If the total amount is 30000 US dollars, delaying payment by one month may result in an additional 6000 yuan. It is recommended to lock in exchange rate tools.

5. Insurance: IVF insurance in the United States is mostly purchased by employer groups. Individual short-term insurance does not cover IVF, but can be purchased with complication insurance (ovarian cyst torsion, OHSS hospitalization), with a premium of $380 and a coverage of $25000. It is valid for 7 days after egg retrieval.

6、 Horizontal comparison of 8 mainstream reproductive centers in the United States (2023 SART data)

7、 30 day actual budget for airfare, accommodation, and transportation (RMB)

8、 12 key precautions

1. The passport must be valid for at least 6 months. If the passport is about to expire, please replace it with a new one before making an appointment for the visa to avoid the hassle of binding the visa page with the old passport for replacement.

2. The US Customs is extremely strict about carrying drugs, and drugs that require clearance must be accompanied by a prescription, English translation, and the original packaging of the drug. Those that have been opened will be confiscated.

3. Within 24 hours after egg retrieval, it is not allowed to drive alone. Renting a car requires purchasing 24-hour Roadside Assistance to prevent fainting after surgery.

4. Avoid lifting heavy objects weighing more than 5 kg for 48 hours after transplantation. Book a business class or aisle seat for the return journey to facilitate calf movement every 30 minutes and reduce venous thrombosis.

5. After a successful pregnancy test, stay in the United States for another 7 days and return to China after doubling normally; If doubling is not satisfactory, timely medication can be added to avoid air abortion.

6. Domestic prenatal examination filing only requires a "US IVF clinical summary+translation", which is recognized by community hospitals in various regions and does not require re examination of hormones.

7. Citizenship by birth in the United States is not related to IVF. Whether a child is born in the United States depends on the place of birth and is not related to the source of the embryo, so no additional documents are required.

Currently, only three companies in the United States have the qualification for liquid nitrogen dry transportation of embryos back to China, with a cost of $3800 and a cycle of 45 days. It is necessary to apply for an "Embryo Import License" from the receiving hospital in advance.

9. According to US law, a maximum of 1-2 embryos can be transferred at a time, and the live birth rate for single births under the age of 35 is higher. Do not force multiple embryos.

10. If AMH<1.0, a "double promotion" plan can be considered, which involves two egg retrieval attempts in the same cycle. INCINTA charges an additional $4200 to obtain 30% more blastocysts.

11. Pharmacies in the United States can use Visa/Master, but they do not accept UnionPay. They need to apply for a full currency credit card in advance, otherwise they can only use cash.

12. All expenses can be deducted as medical expenses when filing a 1040NR with the IRS, with a maximum tax refund of 10%. Remember to keep the original Clinic Invoice.

9、 Timeline and luggage list (can be directly screenshot and saved)

Day-90: Visa → Medical Examination → Video Consultation → Currency Exchange
Day 30: Book a plane ticket → Book an apartment → Buy medicine → Rent a car
Day-1: For domestic flights, carry your passport, prescription, medication, and English report with you
Day 1: Entry to the United States → Check in → Time difference
Day 2: First visit to the clinic → Start promoting bowel movements
Day 12: Egg retrieval → Return to the apartment to rest
Day 17: Fertilization report → Deciding to raise the sac
Day 24: blastocyst report → decide whether to test or not
Day 30: Returning to China or Staying for Transplantation
Luggage: passport, prescription, medication, thermos, electric blanket, U-pillow, slippers, sanitary napkins, pads, protein powder, multivitamins, electronic thermometer, ovulation test paper, pregnancy test stick, Chinese English medical records, charger, adapter, credit card, cash of $2000.

10、 Write at the end

IVF in the United States is not a one-time transaction, but a complex project spanning seven disciplines: obstetrics and gynecology, embryology, genetics, anesthesia, laboratory, law, and finance. The biggest advantage of Chinese families is "fast decision-making and strong execution", while the biggest weakness is "information gap". Print out the 7 tables and 12 precautions above, and mark each completed item with a checkmark, which can basically compress accidents to within 5%. The remaining 95% is entrusted to science and time.

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