Guide to IVF in the United States: Full Process, Cost Budget, and Key Points to Note

For many families, going to the United States for IVF is both a medical decision and a life plan. California, located on the west coast of the United States, boasts globally leading embryo laboratories, a relaxed legal framework, and a mature Chinese service chain, making it the preferred destination for high net worth families in China. This article takes "Starting from China to Carrying a Baby Back to China" as the main thread, breaking down the entire process, cost range, and hidden risks to help you quickly establish a rational framework in the face of information overload.

1、 Visa and Entry: The Bottom Logic of Medical B-class Visa

The "medical visa" of the US Consulate is not a separate category and still falls under B1/B2. The key lies in the interview materials: 1. The "Treatment Plan" signed by the US reproductive center, which should indicate the estimated duration of stay, approximate number of cycles, and total cost; 2. Infertility diagnosis certificate from a top tier hospital in China, with English translation and official seal; 3. Asset documents: 6-month bank statements, property and securities statements, with a balance of ≥ RMB 1.5 million, can significantly reduce immigration tendency doubts; 4. Insurance: Medical insurance including overseas complications and neonatal care, with a coverage amount of ≥ 50000 US dollars. The face-to-face interview follows the "three sentence principle" - what to do, who pays, and how long to stay, avoiding repetition. After the epidemic, Los Angeles Customs is sensitive to pregnant women entering the country and recommends booking direct flights, carrying doctor appointment letters, return tickets, hotel orders, and using the "Medical Treatment" channel to truthfully declare medical purposes and shorten inquiry time.

2、 Hospital selection: Laboratory parameters are more important than brochures

The SART (Society for Assisted Reproductive Technology) data officially released by California is updated annually, focusing on three key indicators: 1. Live birth rate of fresh embryos under 35 years old; 2. Embryo formation rate; 3. PGT-A sampling pass rate. The top ten institutions that Chinese people often visit in 2023 have the following data:

Hospital selection formula: live birth rate>60%+blastocyst rate>50%+Chinese coordination department=shortlist. Subsequently, check the doctor's schedule: Dr. James P. Lin (INCINTA) will conduct face-to-face consultations with new patients every Wednesday and Friday, and appointments must be made 6 weeks in advance; Dr. Susan Nasab (RFC) comes to China for free consultations every month, and can complete six ultrasound and hormone tests in advance in China, saving time spent in the United States.

3、 Medical process: domestic initiation → 14 days in the United States → return to China to protect the fetus

1. Domestic preparation (menstrual cycle D2): blood tests for AMH, FSH, LH, E2, PRL, TSH, vaginal ultrasound counting of antral follicles; Male semen analysis+malformation rate+DNA fragments. Send the report to American doctors for pre evaluation to confirm whether it is necessary to take Coenzyme Q10, DHEA, or adjust thyroid function in advance. 2. Video consultation: 30 minutes, determine the ovulation promotion plan (antagonist/rectangular plan/micro stimulation), and simultaneously prescribe medication. American pharmacies can ship directly to China, with the customs declaration stating "Personal Medication" and accompanying prescription. 3. Menstrual Day 1: Book a two bedroom apartment with a kitchen 30 days in advance, with a monthly rent of $2600-3200 and a distance of ≤ 15 miles from the hospital. 4. Day 1-3 in the United States: Go to the hospital for filing, fingerprint recording, baseline ultrasound, and initiate ovulation promotion. The medication mainly includes Gonal-F, Menopur, and Cetrotide, which are injected at 9am every day. The nurse's on-site service fee is $45 per time. Day 8: First monitoring, E2>1000 pg/ml and follicles ≥ 14 mm were treated with Cetrotide to prevent ovulation. 6. Day 12: Night needle (HCG 5000 IU or Lupron dual trigger), egg retrieval after 36 hours. On the day of egg retrieval: intravenous anesthesia for 15 minutes, discharge 1 hour after surgery, accompanied by an adult. On the same day, the male party retained the sperm and used a sterile sperm collection room to deliver it to the laboratory within 30 minutes. 8. Day 1-5: Embryo culture, Time lapse system takes photos every 10 minutes, Day 3 informs the division speed, and Day 5/6 produces blastocyst grade. 9. PGT-A testing: After sampling and freezing, the results will be available within 7-10 days, which can screen out common chromosomal abnormalities. 10. Hysteroscopy/ERA: If the endometrium is less than 7 mm or there are multiple failures, it is recommended to perform ERA to determine the implantation window and report it within 3 weeks. 11. Return to China for conditioning: According to the ERA results, use estradiol, progesterone, heparin, and immune modulators for 2-4 weeks, and wait for the endometrium to be ≥ 8 mm before going to the United States for transplantation. 12. Transplant day: Pain free for 5 minutes, bed rest for 30 minutes after surgery, followed by light activity for 48 hours. On the 10th day, if the blood HCG level is ≥ 50 IU/L, the initial screening is positive. On the 12th day, if it doubles to ≥ 120 IU/L, pregnancy is confirmed. On the 28th day, a negative ultrasound shows fetal heart rate. 14. Obstetrics handover: Graduation at 10 weeks of pregnancy, taken over by OB in the United States, can be done by returning to China or staying in the United States for prenatal check ups.

4、 Cost Model: Calculated on a dual track basis of "single cycle" and "multi cycle"

The US reproductive center's external quotations are all "packages", but hidden items often lead to bill overruns. The following data is based on the hospital's official website and real receipts from Chinese patients in March 2024, in US dollars, with an exchange rate of 7.2.

Funding path: The hospital accepts Visa/Master credit cards, which can be used to settle in RMB with a handling fee of 2.8%; Large wire transfers can enjoy a 1% discount, but must be received 7 working days in advance. Suggest paying in three installments: 30% for filing, 40% on the day of egg retrieval, and 30% for transplantation to reduce the risk of exchange rate fluctuations.

5、 Timeline: The 'Shortest Path' from Face to Face Interview to Baby Hugging

January February: Domestic inspection → Video consultation → Visa → Room reservation; March: On the first day of my menstrual cycle, I went to the United States and stayed there for 14 days to complete egg retrieval; April May: Domestic regulation of endometrium, synchronized PGT-A results; June: Second trip to the United States for 5 days to complete transplantation, pregnancy test on the 10th day; July August: Early pregnancy B-ultrasound, return to China for registration after graduation; March of the following year: Full term delivery. The entire journey requires two trips to the United States, with a cumulative stay of 24-28 days and a total span of 12 months. If the uterine condition is poor and requires third party assisted pregnancy, the process will be extended for another 4-6 months.

6、 Law and documents: newborn passport, travel permit, household registration

The 14th Amendment to the US Constitution grants "birthright citizenship", meaning that babies hold a US passport at birth. To return to China, you need to apply for: 1. Birth Certificate with an urgent 3-day processing fee of $26 per copy. It is recommended to apply for 5 copies at once; 2. The Social Security Number (SSN) will be automatically sent and arrive within 4 weeks; 3. US passport, urgent appointment for 2 weeks, cost $185; 4. Chinese travel permit, issued by the Consulate General in Los Angeles, requires the presence of one parent and a commitment to "not holding foreign nationality". The fee is $25 and it will take 3 working days to collect; 5. Level 3 certification (Secretary of State+Consulate) is used for domestic household registration, with a period of 10 days. After returning to China, you can go to the local police station of your mother's registered residence to apply for a household registration with the Chinese translation of your birth paper, your travel permit, Level III certification, and your parents' household registration book. The process is the same as that of an ordinary newborn, without affecting your American nationality. Attention: If both parents hold permanent residency in a foreign country, an additional "Cancellation of Household Registration for Overseas Residents" declaration must be made, otherwise they will not be able to settle down.

7、 Risks and controversies: ovarian hyperstimulation, uterine infection, premature birth costs

1. OHSS (ovarian hyperstimulation syndrome): Egg retrieval ≥ 20 eggs and E2 ≥ 4000 pg/ml are considered high-risk. In the United States, the routine use of "Lupron+low-dose HCG" dual trigger can reduce moderate to severe OHSS to less than 1%, but still requires daily consumption of 1.5 L of electrolyte water and a high protein diet. If weight gain>2 kg, immediately return to the hospital. 2. Uterine cavity infection: Vaginal bleeding for ≥ 7 days and body temperature ≥ 38 ℃ after egg retrieval require blood culture and vaginal secretion culture. The cost of antibiotics in outpatient clinics in the United States is $450-800, which is not covered by domestic medical insurance. 3. Premature birth: The NICU fee in the United States ranges from $2500 to $4000 per day, with an average hospitalization of 45 days for premature infants under 28 weeks and a bill of up to $110000. Purchasing 'newborn care insurance' can cover 80%, but it must be purchased before conception, with a premium of $1800-2200. 4. Multiple pregnancies: The ASRM guidelines in the United States encourage single embryo transfer. If two embryos are insist on being transferred and twin pregnancy is detected during prenatal diagnosis, the doctor will recommend reducing the number of pregnancies, with costs ranging from $3500 to $5000, and ethical risks to be borne by the individual.

8、 Insurance and Taxation: How to Legally Deduct and Refund Taxes

IRS Announcement 502 specifies that "in vitro fertilization expenses" can be deducted as medical expenses, provided that AGI (adjusted total income) exceeds 7.5%. For example, if a couple has an annual income of $200000 and medical expenses of $50000, they can deduct $15000 by multiplying the amount by 7.5%. The excess of $35000 can be included in the itemized deduction, with a federal tax rate of 22% and a tax refund of $7700. Process: Save hospital receipts, pharmacy invoices, round-trip air tickets, and hotel receipts, and have them reported by CPA before April 15th of the following year. At the Chinese tax level, if a baby is born in the United States and subsequently obtains a US passport, but the parents are still Chinese tax residents, the baby's US income does not need to be included in Chinese personal income tax before the age of 18. However, if the gifted assets exceed RMB 500000 per year, foreign exchange declaration is required.

9、 Psychology and Ethics: Second Decisions After Failure

SART big data shows that the single cycle live birth rate for those under 35 years old is 65%, which means there is still a 35% probability of requiring a second transplant. American hospitals provide "psychological support groups" with weekly online meetings led by licensed psychological counselors, and the cost is covered by insurance. If no transplantable embryos are obtained for three consecutive cycles, it is recommended to pause for 6 months and perform whole exome sequencing (WES) to search for rare genes, or consider switching to different ovulation induction protocols (such as Growth Hormone+CoQ10). Avoid hastily changing hospitals when feeling down. American doctors share the SART database, and frequent job hopping can lead to fragmented medical records.

10、 Obstetrics management after returning to China: how to seamlessly integrate with OB

At 10 weeks of pregnancy during graduation, the American Reproductive Center will issue an "Objective Transfer Summary," which includes the last menstrual period, embryo transfer date, due date, medication list, and early ultrasound images. After returning to China, the first choice is the "International Department of Grade III Obstetrics", which can be directly filed with an English abstract without the need for repeated examinations. Medication connection: didroxyprogesterone → progesterone oral/vaginal gel, dose unchanged; Low molecular weight heparin → evaluated by domestic rheumatology and immunology departments to determine whether to continue; Thyroxine maintains TSH<2.5 mIU/L. The process of NT at 12 weeks of pregnancy, non-invasive DNA at 16 weeks, large rejection at 20 weeks, four-dimensional at 24 weeks, and glucose tolerance at 28 weeks is the same as that of ordinary pregnant women. If NIPT Plus has been done in the United States and the domestic OB approval report has been obtained, the early Tang screening can be skipped. Note: American obstetrics usually use "pound" and "inch", which should be converted into "gram" and "centimeter" to avoid dose error.

11、 Common Misconceptions Q& A

Q1: Can American IVF be done in one go? A: SART data has given a probability of approximately 65% for those under 35 years old, decreasing to 35% for those over 38 years old, and there is no absolute rule in medicine. Q2: Will general anesthesia for egg retrieval affect intelligence? A: Propofol has a short half-life and is fully metabolized within 24 hours, with no evidence of long-term neurotoxicity. Q3: Do I have to stay in bed after transplantation? A: A randomized controlled trial (RCT) study in the United States showed that there was no difference in implantation rate between the walking group and the bed rest group immediately after transplantation, but long-term bed rest increased the risk of thrombosis. Q4: Can drinking soybean milk and eating durian improve the intima? A: The content of phytoestrogens is much lower than that of drugs, and psychological comfort is greater than reality. Excessive calorie intake leads to blood sugar fluctuations, which is not conducive to implantation. Q5: Can babies born in the United States attend public elementary schools in China? A: Yes, you can enjoy compulsory education with your travel card+residence, but you need to return to your registered residence to register for the college entrance examination. The policy is different from that of "overseas Chinese students".

12、 Action Checklist (Printed Version)

1. Menstrual D2 blood test for AMH, six hormones TSH、VD3； 2. Male semen routine+abnormality rate+DNA fragments; 3. Schedule a video consultation with an American doctor to determine a protocol for promoting ovulation; 4. Apply for B1/B2 visas and prepare a deposit certificate of 1.5 million yuan; 5. Book an apartment with a kitchen located less than 15 miles from the hospital; 6. Purchase medical insurance that includes complications and neonatal care; 7. Starting 30 days before egg retrieval, take oral Q10 600 mg/day and DHEA 25 mg x 3/day; 8. Take a nucleic acid test and flu vaccine one week before going to the United States to prevent entry quarantine; After egg retrieval, drink 1.5 L of electrolyte water daily and return to the hospital if the weight gain exceeds 2 kg; On the 10th day after transplantation, HCG was measured in the blood, and on the 28th day, fetal heart rate was observed; 11. At 10 weeks of pregnancy, graduate and return to China to file a summary; 12. Obtain 5 birth certificates, including passport, travel document, and Level 3 authentication simultaneously; 13. Bring all the translated documents back to China and settle down at the police station; 14. In April of the following year, the American CPA will file taxes and deduct medical expenses; 15. Keep all receipts for 5 years for future reference.

Going to the United States for IVF is not a shortcut, but a marathon that requires financial, legal, and emotional preparation. Breaking down each step into quantifiable tasks and managing time and budget with tables can give you the initiative in the information gap. May this 4000 word long article become your "map to avoid pitfalls", wishing you a spring when you hear your baby's first cry on the other side of the Pacific.

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