In vitro fertilization in the United States: a complete analysis of the process, costs, and precautions

Assisted reproductive technology (ART) in the United States started early, has high laboratory standards, and a relatively clear legal framework. In the past decade, it has attracted more and more Chinese families to seek medical treatment overseas. This article takes "process cost precautions" as the main line, breaking down the most common questions about going to the United States for IVF into actionable information, making it easier for you to establish an "action roadmap" before actually leaving. The full text is about 13000 words, with a reading time of 25 minutes. It is recommended to save it and view it in chapters.

1、 Who is suitable for undergoing IVF in the United States

1. Multiple domestic transplants have failed to implant, and we want to rely on high-end laboratories in the United States to further investigate the reasons;
2. Elderly (≥ 35 years old) with decreased ovarian reserve, hoping to obtain more personalized ovulation promotion plans;
3. If one spouse carries a monogenic disease, pre implantation genetic testing (PGT-M) is required;
4. Complex uterine problems such as thin endometrium, intrauterine adhesions, and adenomyosis require synchronous surgery and IVF;
5. Other medical reasons that prevent self conception, but comply with local regulations in the United States, can be addressed through compliant third party services.

2、 The overall process of IVF in the United States (taking self pickup and self conception as an example)

1. Domestic preliminary inspection (1 month)
Female: AMH, six levels of sex hormones, vaginal ultrasound, hysteroscopy (if necessary), thyroid function, coagulation, and eight levels of infection;
Male: Semen analysis+malformation rate+DNA fragmentation rate, eight infections, chromosome karyotype.
The report will be translated and submitted to American doctors for preliminary evaluation to confirm the itinerary for travel to the United States.

2. Remote video consultation (once, 30-45 minutes)
The doctor provides a plan for promoting ovulation, medication schedule, and estimated duration of stay in the United States based on the examination results;
Nurse explains medication injection videos, drugs can be shipped directly from American pharmacies to home, practice in advance.

3. Visa and Entry (Suggest applying for B1/B2)
Interview materials: appointment letter, doctor invitation letter, cost estimate, itinerary, work and asset proof;
Customs Q&A: Truthfully state the purpose of medical treatment in the United States, carry medication prescriptions and English medical records with you.

4. Going to the United States to promote emissions; Monitoring (10-12 days)
D2 cycle, basic negative ultrasound+blood draw;
Recheck on the 5th, 7th, and 9th days to adjust the dosage of antagonists or agonists;
When the dominant follicle is ≥ 18 mm, the night needle (HCG or Lupron) is triggered.

5. Egg retrieval and fertilization (D0)
Intravenous anesthesia lasts 15-20 minutes, and patients can be discharged 1 hour after surgery;
On the same day, the man retained his sperm and the laboratory used ICSI or conventional IVF;
After 24 hours, check the number of fertilizations, preliminarily grade on the 3rd day, and form blastocysts on the 5th to 6th day.

6. Embryo testing& Freezing (D5-D7)
If PGT-A/PGT-M is performed, take 5-10 trophoblast cells and send the samples to a third party genetic testing company;
Embryos are vitrified and frozen, stored in liquid nitrogen tanks at -196 ℃, and theoretically can be preserved indefinitely.

7. Returning to China for endometrial treatment (1-2 months)
Starting from the second menstrual period after egg retrieval, oral estradiol was administered. On the 10th day, the endometrial thickness was ≥ 8 mm and blood E2 was ≥ 200 pg/mL;
Synchronize with American doctors to confirm the transplant window and book a flight to the United States.

8. Thawing transplantation (D0)
The survival rate of thawed embryos is over 95%, and 5-minute ultrasound-guided transplantation is required without anesthesia;
After surgery, lie down for 30 minutes and return to the hotel on the same day. On the 10th day, a blood test for pregnancy will be taken.

9. Early pregnancy monitoring
β - hCG>100 mIU/mL is considered a biochemical pregnancy, with a doubling of>66% within 48 hours;
At 6-7 weeks of pregnancy, fetal heart rate can be observed on a transvaginal ultrasound. Once the intrauterine live birth is confirmed, the patient can be transferred to obstetrics.

3、 Timeline Quick Check Table

4、 Cost breakdown (2024 market, unit: USD)

1. Doctor's cycle fee
New patient registration 500-800;
Promoting emission monitoring 2 500-3500;
Egg retrieval surgery 4000-6000;
Embryo culture 3000-4500;
ICSI 1 500–2 000；
Embryo freezing 1200 (first year including storage).

2. Laboratory Additional
PGT-A (per embryo) 300-450;
PGT-M (monogenic disease) 1 800 – 2 500/family locus;
Secondary thawing and transplantation of 3500-4500.

3. Medications
Gonal-F/Menopur/Metrotide 3000-5500;
Endometrial preparation (Estrace, Prograf, Crinone) 500-800.

4. Third party clinical services
Anesthesia 600-800;
Embryology specialized treatment (assisted hatching, magnetic screening of sperm, etc.) 500-1200.

5. Life and Travel
Round trip airfare between China and the United States: 1200-2000;
California Express Hotel 120-180 per night;
Car rental+fuel cost 60-80/day;
Daily meals are 40-60 per person per day.

6. Summary (one egg retrieval+one transfer, including 8 PGT-A embryos)
Basic medical care 28000-32000;
Drug 4000;
Life 6000;
The total amount is approximately 38000-42000 US dollars, equivalent to 270000-300000 Chinese yuan.

If a second thawing transplant is needed, only an additional $4000- $5000 is needed for medical and living expenses, which is still lower than the cost of re egg retrieval.

5、 Real Hospital Ranking and Characteristics

The CDC reports that the live birth rates of the following institutions in 2023 are higher than the national average (>55% for those under 37 years old), and they have a Chinese coordination team for reference:

1. INCINTA Fertility Center - Torrance, CA; Attending physician: Dr. James P. Lin; Advantages: High proportion of Chinese nurses, same day PGT examination, 24-hour delay photography in the embryo room.
2. Reproductive Fertility Center（RFC）—— Corona, CA； Attending physician: Susan Nasab, MD; Advantages: Endometrial immune research project, synchronous treatment of chronic endometritis.
3. Shady Grove Fertility（SGF）—— Rockville, MD； The largest chain on the East Coast, shared laboratory, with a live birth rate of 58% under the age of 37.
4. CCRM（Colorado Center for Reproductive Medicine）—— Lone Tree, CO； Known for its high difficulty cases, it has its own genetic testing laboratory.
5. HRC Fertility—— Newport Beach, CA； Established in the heart of Southern California, the Chinese market is mature and ranks among the top five in terms of cycle volume in the United States.
6. RMA of New York—— New York, NY； Strong academic atmosphere, collaborating with multiple NEJM papers.
7. Pacific Fertility Center—— San Francisco, CA； Pioneering embryo vitrification freezing technology, the laboratory has obtained dual certification from CAP+CLAI.
8. Boston IVF—— Waltham, MA； The oldest history in the New England region, the PCOS emission promotion program has been adopted by many countries.
9. ORM Fertility—— Portland, OR； Strong genetic disease team with 15 years of PGT-M experience.
10. Fertility Centers of Illinois—— Chicago, IL； The largest network in Midwest has a live birth rate of 56% within the age of 37.

6、 How to Choose a Clinic: Five Hard Indicators

1. CDC/SART live birth rate: First, look at the single birth live birth rate in the age groups of under 35 years old and 38-40 years old. If it is higher than 50%, it is in the first tier;
2. Laboratory certification: It is required to have triple qualifications of CAP, CLIA, and FDA, and the certificate number can be checked;
3. Chinese service: Are there full-time Chinese nurses, domestic coordinators, and 24-hour response on WeChat;
4. Cycle size: If the annual egg retrieval cycle exceeds 1500 cases, the experience curve will be smoother;
5. Cost transparency: Can the official website download the price list, whether it is packaged in one go, and whether there are any hidden additions.

7、 Visa and Entry Details

1. Material authenticity>asset amount, bank statements for 6 months, balance of 200000 RMB is sufficient;
2. The doctor's invitation letter must indicate "Estimated treatment duration 4-6 weeks", which matches the itinerary;
3. Customs often ask: What are you doing in the United States? How long will you stay? Who pays the fees? Answer: Medical treatment, paid by myself, 4 weeks;
4. Medications must be accompanied by a prescription and English instructions, and injection needles should be kept in checked baggage and may be confiscated;
5. It is recommended to reschedule the return flight ticket to avoid being stuck on a dead date due to failed transplantation.

8、 Insurance and Refund Plan

In the United States, IVF is rarely successful, but multiple clinics offer "Multi Cycle Packages":
Pay 2.5 times the single cycle fee, unlimited egg retrieval and transplantation within three years. If a single live birth is not achieved, 70-100% will be refunded;
Restrictions: Female FSH ≤ 12, AMH ≥ 1.2, BMI ≤ 32, and cannot use third party services;
Suitable for families with decent ovarian function and planning 2-3 children, saving an average of 15% in costs.

9、 Legal and ethical red lines

1. There is no federal level unified IVF law in the United States, and there are significant differences among states: California, Nevada, Illinois, Maine, and others allow legal third party assisted reproduction, while Texas and Louisiana prohibit it;
2. The legal parental rights of both spouses can be confirmed through the "court judgment" or "parental rights confirmation" procedures, and the name of the commissioning party can be directly written on the birth certificate;
3. Embryo disposal: In the event of divorce or the death of one party, the ownership of the remaining embryos must be signed in advance in the form of a Disposal Agreement, otherwise it will lead to lengthy litigation;
4. PGT can only be used for medical purposes, and embryo screening for non-medical reasons violates ASRM ethical guidelines, and clinics will refuse it.

10、 Common Risks and Responses

1. Ovarian hyperstimulation (OHSS)
The combination of antagonist regimen and low-dose initiation (150 IU) can reduce the incidence rate to below 1%;
If E2>4000 pg/mL or follicles>25, switch to Lupron trigger and cancel fresh transplantation.

2. Thin inner membrane
The commonly used "triple therapy" in the United States: long-acting GnRH-a downregulation+sildenafil vaginal suppository+PRP intrauterine infusion, with a rate of ≥ 8 mm increased to 85%;
If the standard is still not met, the natural cycle or frozen embryo waiting can be changed to avoid wasting embryos through forced transplantation.

3. Chromosomal abnormalities in miscarriage
PGT-A can screen out 40-60% of aneuploidy in 35 year old women, reducing the miscarriage rate from 25% to 8%;
However, PGT cannot detect monozygotic diploids, microdeletions/duplications, and requires non-invasive prenatal DNA testing.

4. Multiple pregnancies
The ASRM guidelines in the United States strongly recommend single blastocyst transfer. Although twin pregnancy has a high live birth rate, premature birth, eclampsia, and ICU costs increase exponentially;
If two have already been transplanted and three or more fetuses are found at 8-10 weeks of pregnancy, a reduction surgery is required, which imposes enormous ethical pressure.

11、 Life Strategy: Tips for Saving Money on Food, Housing, and Transportation

1. Accommodation: Torrance and Corona are both located in Greater Los Angeles. Airbnb bookings for the entire month can be discounted by 30%, and cooking with a kitchen can save $40 per day;
2. Transportation: Uber costs $30-40 one-way, renting a compact car for a monthly fee of $700, and fuel costs $4 per gallon;
3. Supermarket: Whole Foods organic vegetables are expensive, you can go to 99 Ranch (Dahua) or H Mart, Chinese label, hot pot base is $3;
4. Communication: T-Mobile Traveler Card costs $50 per month, with unlimited data and hotspot sharing;
5. Time difference: Los Angeles is 15 hours later than Beijing, and blood tests are mostly done between 7-9 am. It is recommended to adjust your schedule one week in advance.

12、 Drug storage and cross-border shipping

1. The medication for promoting ejaculation requires 2-8 ℃, and can be stored in a medical refrigerator with ice cream, with a battery life of 36 hours;
2. US Customs allows individuals to enter the country using doses, but requires an original prescription;
3. If you choose "Medication to Home" and use FedEx Cold Chain, the shipping cost is $180-220 and it will arrive in 3 days;
4. For the last mile of the domestic cold chain, buyers need to bring their own ice packs and immediately store them in a 4 ℃ refrigerator upon receipt to avoid repeated freezing and thawing.

13、 Psychological Construction: How to Get Through the Waiting Period

1. The embryo result ≠ final live birth, with a PGT pass rate of 55-65%. Allow yourself to be sad, but do not blame yourself;
2. Join a regular patient education group and do not easily believe in "secret formulas" and "health products". American doctors prohibit the use of unknown traditional Chinese medicine during the cycle;
3. A "whiteboard" is common 10 days after transplantation, and blood hCG is the gold standard. Early urine testing will only increase anxiety;
4. If unsuccessful, request the doctor to provide a "cycle review report", including embryo images, hormone curves, and endometrial thickness, to facilitate the next optimization process.

14、 FAQ Quick Questions, Quick Answers

Is it still necessary to go to the United States at the age of 43?
A: AMH ≥ 0.8 and AFC ≥ 5 can be attempted, but 3 egg retrieval cycles need to be prepared, with a cumulative live birth rate of 35-40%.

Q2: Should I undergo surgery for a 3 cm uterine fibroid first?
A: If the submucosal or endometrial cavity is compressed, American doctors recommend hysteroscopic resection and transplantation 2 months after surgery; If there are no symptoms between the muscle walls, they can be temporarily left untreated.

Does HPV positivity affect test tubes?
A: As long as TCT is normal, HPV is not a contraindication for transplantation; If CIN2+requires conization first, it will be performed 6 months after surgery.

Q4: Sir, with a severe abnormal sperm rate of 99%, can only ICSI be used?
A: Yes, and it is recommended to add IMSI (selecting morphologically normal sperm under high magnification), which can increase the fertilization rate by 15%.

Q5: Can two embryos be transferred at once?
A: The clinic will respect the patient's wishes, but will inform twin pregnancies of pregnancy risks and require both parties to sign a 'Multiple Pregnancy Informed Consent'.

15、 Returning to China for Obstetrics and Gynecology Connection

After receiving the fetal heart rate report at 8 weeks of pregnancy, you can return to your home country. You can choose to travel by the aisle and wear elastic socks to prevent venous thrombosis;
2. Domestic obstetrics documentation: passport, notarized translation certificate, blood hCG and ultrasound report, some hospitals require signatures from American doctors;
3. Non invasive DNA Plus at 12 weeks of pregnancy can detect 100 types of microdeletion syndromes, filling the blind spot of PGT;
4. The prenatal examination card should indicate "IVF-ET" and high-risk identification, and priority can be given to making appointments for three-dimensional large screening.

16、 Summary and Action Checklist

Going to the United States for IVF is not a shortcut, but a precise project that spans time zones, languages, and legal systems. Breaking down the process into 30 executable tasks and checking each completion can minimize anxiety. Remember the three core principles: choose a reputable clinic, allocate sufficient budget redundancy, and respect medical laws. Wishing you a baby soon and a smooth journey.

This article link:https://bken.loadskill.com/usivf/398.html