Guide to the Whole Process of IVF in the United States: A Practical Guide from Evaluation to Returning to China

Guide to the Whole Process of IVF in the United States: A Practical Guide from Evaluation to Returning to China

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Why go to the United States for IVF?

2. Medical evaluation and data preparation before going to the United States

3. Visa, insurance, budget, and itinerary planning

4. Disassembly of the entire process of in vitro fertilization in the United States

5. Highlights of Embryo Culture and Laboratory Technology

6. Luteal support and pregnancy testing after transplantation

7. Early pregnancy prenatal check ups and record keeping

8. Choice of giving birth in the United States or returning to China for delivery

9. Process for handling newborn documents and returning to China

10. Cost Overview and Savings Tips

11. Frequently Asked Questions and Answers

Why go to the United States for IVF?

Assisted reproductive technology in the United States started early, with the first IVF baby born in 1981. The clinical pathway is mature, laboratory quality control is strict, and medication plans are personalized. For families with multiple domestic failures, endometriosis, adenomyosis, recurrent biochemistry, advanced age, carrying monogenic diseases, chromosome balance translocation, Roche translocation, severe oligoasthenozoospermia, decreased ovarian reserve, immunological infertility, endometrial thinning, intrauterine adhesions after surgery, tubal hydrosalpinx and occlusion, uterine malformation correction surgery, a history of high risk of ovarian hyperstimulation syndrome (OHSS), or poor tolerance to ovulation induction regimens, the US Reproductive Center can provide more drug combinations and laboratory strategies. In addition, the embryo laboratory is equipped with a real-time micro operating system, laser assisted hatching, blastocyst culture up to Day 7, embryoscope delayed imaging, mitochondrial potential scoring, artificial intelligence embryo morphology dynamics analysis and other hardware, which can improve the utilization rate of embryos under the same number of egg retrieval. The US FDA implements GTP (Good Tissue Practice) annual inspection for reproductive laboratories, which includes mandatory indicators such as air cleanliness, incubator gas concentration, membrane replacement frequency, and batch traceability of culture oil to reduce embryo fragmentation rate. At the legal level, California, Nevada, Texas, Illinois, Washington, Maryland, Vermont, Rhode Island, Connecticut, New Jersey, New York, Massachusetts, and other states are friendly to assisted reproduction. Both prospective parents can confirm their parental rights through court documents in advance, reducing barriers to returning home and settling down.

2. Medical evaluation and data preparation before going to the United States

It is recommended to complete the "complete set of test tube preparation" in China, translate the report into English and notarize it, in order to save time and cost for testing in the United States. Female: FSH, LH, E2, PRL, T, AMH on the 2nd to 4th day of menstruation; At any time, antral follicle count (AFC); Three dimensional ultrasound exclusion of intrauterine adhesions, polyps, and submucosal fibroids on the 7th to 10th day of menstruation; Thyroid function (TSH, FT4, TPOAb), fasting blood glucose, glycosylated hemoglobin, coagulation function (D-dimer, antiphospholipid antibody spectrum), TORCH screening, vitamin D, homocysteine, blood routine, urine routine, liver and kidney function, hepatitis B, hepatitis C, AIDS, syphilis, ECG, chest film. Male: semen analysis (WHO version 5), sperm morphology Diff Quik staining, sperm DNA fragment rate (SCSA or TUNEL), blood routine, liver and kidney function, hepatitis B, hepatitis C, AIDS, syphilis, blood type, chromosome karyotype. If there have been records of hysteroscopy, laparoscopy, hysterosalpingography, endometrial pathology, immunotherapy, and ovulation induction plans, please organize them together. All imaging data is burned into DICOM format CDs for easy access by American doctors in PACS systems. Bring two bilingual summaries of the patient's condition, stamped with the hospital seal, and can also be used as auxiliary materials during visa interviews.

3. Visa, insurance, budget, and itinerary planning

The first choice for medical treatment in the United States is B1/B2 visa. When making an appointment for an interview, fill in DS-160 and truthfully check "Seeking Medical Treatment". Preparation materials: appointment form, passport, photo, property ownership certificate, proof of employment income, bank statement with a balance of at least 100000 RMB in the past 6 months, medical itinerary to the United States, hospital appointment letter, and expense estimate. Visa officers often ask: Why not do it in China? Answer: Individualized plan, laboratory technology, legal environment. Budget reference: Approximately 32000-38000 US dollars per cycle for ovulation promotion, egg retrieval, blastocyst culture, and PGT-A testing; The transplant cycle is between $8000 and $12000; The cost of medication ranges from 5000 to 9000 US dollars; If hysteroscopy, fallopian tube embolism, immunoglobulin, heparin, ERA, EMMA, ALICE testing are required, an additional $0.2 to $0.4 million will be charged for each item. Cost of living: Monthly rent for Los Angeles/Irvine apartments is $2500-3500, car rental is $600-800, and dining is $1000-1500. Insurance: IVF clinics in the United States do not require insurance, but short-term travel medical insurance (cover acute illness), as well as flight delay insurance and luggage insurance can be purchased. Travel plan: The female partner is expected to arrive in the United States within 30-35 days (1-2 days of menstruation, 10-12 days for ovulation induction, 5 days for blastocyst formation after egg retrieval, 10 days for blood testing after transplantation, and 3-5 days after confirming pregnancy and no bleeding before returning home). The man only needs to stay for 3-5 days to complete the sperm collection, and can freeze the sperm in advance to reduce leave.

4. Disassembly of the entire process of in vitro fertilization in the United States

Step 1 Remote Video Initial Diagnosis: After submitting all reports, the American doctor provides a preliminary plan (rectangular plan, antagonist plan, PPOS, micro stimulation, natural cycle). Step 2 Domestic Pre conditioning: Oral Coenzyme Q10 600 mg/day, DHEA 25-50 mg/day (with caution for males), Vitamin D3 2000 IU/day, Folic acid 0.8 mg/day, Deep Sea Fish Oil 2 g/day. Male partners take L-carnitine 2 g/day, Zinc 30 mg/day, Vitamin E 200 IU/day, and quit smoking and drinking for 3 months. Step 3: Go to the United States for the week: On the 1st and 2nd day of menstruation, go to the clinic for blood draw and ultrasound, E2＜50 pg/mL、 Undominant follicles can begin to stimulate ovulation. Common antagonist regimen: Gonal-F or Follistim 150-300 IU/day, with Cetrotide 0.25 mg/day added on the 5th day. Trigger is triggered when two dominant follicles are ≥ 18 mm and E2 is 200-300 pg/mL per mature follicle. Trigger the use of Lupron 0.8 ml+low-dose hCG 1000-2000 IU to reduce the risk of OHSS. Step 4 Egg retrieval: Intravenous anesthesia for 15 minutes, ultrasound-guided 17G needle puncture through the vaginal vault, and can be discharged 30 minutes after surgery. Synchronous sperm retrieval: The male partner abstains from sexual activity for 3-5 days and masturbates to retrieve sperm. If it is difficult, electronic sperm retrieval (TEA) or micro TESE can be performed. Step 5 Fertilization: Conventional IVF or ICSI, with a fertilization rate of 75-85%. Step 6: Embryo culture: On Day 3, transfer 8 cells of embryos into a continuous culture box (low oxygen 5% O2, three atmospheres), and on Days 5-7, blastocysts are formed. Step 7 Embryo detection: If PGT-A is performed, take 5-10 trophoblast cells, perform whole genome amplification+NGS within 24 hours, and the results will be available within 3-5 days. Non diploid cells can be screened. Step 8 Freezing: Vitrification freezing, embryo survival rate ≥ 95%. Step 9 Transplantation cycle: natural cycle (endometrium ≥ 8 mm on ovulation day), artificial cycle (estrogen 6 mg/day starting, progesterone conversion 5 days after transplantation), ovulation induction cycle (letrozole+low-dose gonadotropin). Step 10: Transplantation: Ultrasound guided soft catheter, completed in 5 minutes, bed rest for 30 minutes after surgery to be discharged from the hospital. Step 11 Pregnancy test: On the 9th day after transplantation, serum β - hCG ≥ 50 IU/L is considered positive, and within 48 hours, it doubles to ≥ 66%. Step 12 Ultrasound: The gestational sac and yolk sac are visible at 6 weeks of pregnancy, and the fetal heart is visible at 7 weeks of pregnancy.

5. Highlights of Embryo Culture and Laboratory Technology

The IFC IVF Center (INCINTA) in the United States uses EmbryoScope+time-of-flight imaging to take photos every 10 minutes. The AI algorithm automatically labels abnormal division patterns (such as 3 cells directly to 5 cells) and prioritizes selecting blastocysts with high ploidy rates and stable development curves. The RFC Reproductive Center is equipped with Saturn 5 Active laser system, which can thin the transparent band within 5 microseconds and improve the implantation rate of patients with thin endometrium (<7 mm). Both centers use Global Total LP culture medium, which contains hyaluronic acid, non essential amino acids, and antibiotic substitutes to reduce embryonic toxicity. The incubator is equipped with 24-hour pH and temperature probes, and an alarm will be triggered if the deviation is greater than 0.1. Mouse embryo quality control (MEA) is conducted once a week in the laboratory, and human embryo manipulation can only continue if the blastocyst formation rate is greater than 80%.

6. Luteal support and pregnancy testing after transplantation

The mainstream program in the United States: 1 piece of Crinone 8% gel per day+Prometrium 200 mg oral bid, or Endometrin 100 mg vaginal tid, maintaining serum P>20 ng/mL. If there is a history of miscarriage or immune abnormalities, low molecular weight heparin 40 mg/day, prednisone 5 mg/day, and cyclosporine 100 mg bid (monitoring blood drug concentration 100-150 ng/mL) can be added. On the 9th day after transplantation, blood was drawn, and β - hCG ≥ 50 IU/L was considered a biochemical pregnancy. On the 14th day, ≥ 500 IU/L indicated a high probability of live birth in the uterus. If the doubling of hCG is not satisfactory, hCG 2000 IU can be added by intramuscular injection every other day, or G-CSF 150 μ g can be injected subcutaneously to promote invasion of the trophoblast layer.

7. Early pregnancy prenatal check ups and record keeping

After confirming the fetal heart rate, one can choose to return to their home country or stay in the United States. If returning to China and traveling by plane at 8-9 weeks of pregnancy, a doctor must issue a "Fit to Fly" certificate, choose an aisle seat, exercise for 5 minutes per hour, and wear 20-30 mmHg gradient elastic socks. After returning to China, immediately go to the obstetrics department to establish a record, bring the US B-ultrasound report and blood value report, and domestic doctors will conduct NT, early Tang screening, and non-invasive DNA testing. If you want to undergo prenatal check ups in the United States, we recommend UCLA Health, Cedars Sinai, Hoag Hospital, Newport Beach Orange Coast Maternity and Child Health, all of which provide Chinese customer service. The rhythm of prenatal check ups in the United States: NIPT at 10-12 weeks of pregnancy, major rejection at 18-20 weeks of pregnancy, glucose tolerance at 24 weeks of pregnancy, and ultrasound monitoring of growth and umbilical cord blood flow every 2 weeks at 28-36 weeks of pregnancy.

8. Choice of giving birth in the United States or returning to China for delivery

If you plan to stay in a confinement center in the United States 45 days before the due date, choose Irvine, Chino Hill, Roland Hill, Arcadia, Diamond Bar, and provide a production inspection car, confinement nanny, and certification agent. The cost of vaginal delivery is 12000 to 15000 US dollars, cesarean section is 18000 to 22000 US dollars, anesthesia is 1500 US dollars, and pediatrics is 500 US dollars. If returning to China for childbirth, take a plane before 32 weeks of pregnancy to avoid airline refusal. Before returning to the United States, undergo newborn hearing screening, congenital heart disease screening, and metabolic disease heel blood (48 hours) screening in pediatrics. If you receive an English report, you can avoid repeated needle injections upon returning to the country.

9. Process for handling newborn documents and returning to China

Fill out the birth certificate information form at Vital Records within 48 hours of birth, which can be collected within 3 days. Birth paper urgently costs $40 per copy, it is recommended to have 3 copies. The Social Security Number (SSN) will be automatically mailed for 2 weeks. Passport: To make an appointment at the Federal Building, please bring your birth certificate, parents' passport, DS-11 form, 2 x 2 inch photo, expedited $75, 5 working days. Travel Permit: To arrive at the Consulate General in Los Angeles, a birth certificate, parents' passport, residence permit, marriage certificate, and 2 photos are required, with an urgent 2-day processing time. Level 3 certification: Secretary of State certification+Consulate certification, used for returning to China to settle down. Boarding back to China: Buy a baby ticket (10% of the adult full price), and make a reservation for carrying the basket. Entering China: Holding a travel permit through the Chinese citizen channel can result in household registration.

10. Cost Overview and Savings Tips

11. Frequently Asked Questions and Answers

Q1: Is IVF successful in the United States in one attempt?
A: The live birth rate of single blastocyst transfer is 60-65% for those under 35 years old, 45-50% for those aged 38-40, 30-35% for those aged 40-42, and 15-20% for those aged 42 and above. The success is related to multiple factors such as age, ovarian reserve, endometrium, immunity, and embryo quality, and cannot be guaranteed in advance.

Q2: Is general anesthesia for egg retrieval harmful to the body?
A: In the United States, propofol and fentanyl are used for intravenous anesthesia. The dosage is small, the metabolism is fast, and the patient wakes up 30 minutes after surgery without affecting memory. The ovarian puncture hole is 1-2 mm and heals within 3 days.

Q3: Can two embryos be transplanted?
A: According to the ASRM guidelines of the United States, single blastocysts can be discussed at the age of 35 – 37, and double blastocysts can be considered at the age of 38. However, twin pregnancy needs to be informed that the risk of preterm delivery, eclampsia, and diabetes in pregnancy increases 2-3 times.

Q4: Will PGT-A damage embryos?
A: Take 5-10 cells from the trophoblast layer, which does not affect the development of the inner cell mass. The vitrification cryopreservation recovery rate is 95%, and the birth defect rate is consistent with natural pregnancy.

Q5: Can I get an invoice to return to Reimbus after undergoing IVF in the United States?
A: American clinics provide invoices and receipts, listing diagnosis and treatment items, drugs, laboratory codes, and can submit commercial insurance (including global medical insurance) or personal income tax major illness deductions in China, but medical insurance does not cover them.

Can I travel during my trip to the United States?
A: From the first to the seventh day of promotion, one can drive within a 1-hour range, such as Santa Monica and Disney; After the 8th day, the follicles will become large and there will be bloating. It is recommended to rest quietly; 48 hours after transplantation, avoid long-distance bumps and take a walk in the community.

Q7: Do American doctors speak Chinese?
A: INCINTA IVF Center has a full-time Chinese coordinator, and RFC Reproductive Center provides WeChat video translation. Reports and medication instructions are available in Chinese.

Q8: Can I bring traditional Chinese medicine for conditioning?
A> You can bring granules of Rehmannia glutinosa, Paeonia lactiflora, Angelica sinensis, and Ligusticum chuanxiong, with an English ingredient description and customs declaration required; Avoid containing ingredients such as musk, aconite, and aristolochic acid to prevent being detained.

Q9: How many years does embryo freezing last?
A: There is no age limit in the United States, with an annual storage fee of $600-800. Remote credit card payments can be made, and the plan is to notify the clinic 2 months before pregnancy to unfreeze.

Q10: Do I need a paternity test to settle down in my home country?
A: Holding a travel permit, birth certificate, and Level 3 certification is sufficient. If the birth certificate only states the mother, a paternity test must be supplemented; Suggest writing both parents on the birth certificate to reduce procedures.

Conclusion: Going to the United States for IVF is a high-end medical path that requires both funding, time, and emotional management. Starting physical examinations, visas, and financial planning six months in advance, selecting experienced clinics and coordinating teams can minimize uncertainties. Wishing every family a safe return home with a healthy baby.

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