In vitro fertilization in the United States: a comprehensive analysis of the process and key points of assisted reproduction in the United States

Going to the United States for in vitro fertilization is often seen as the "last stop": multiple unsuccessful attempts in China, advanced age, complex endometriosis, rare genetic diseases, or simply wanting to borrow the level of American laboratories to further increase the "success rate" by a few percentage points. This seemingly glamorous' shortcut 'is actually an overseas medical supply chain that needs to be laid out six months to a year in advance and is interconnected. Below, we will break down the entire journey into 12 key modules and explain them all at once in the form of "timeline+decision points+cost range+avoidance tips", making it convenient for families to follow the map.

1、 6-12 months before departure: Qualification self inspection and hospital lock-in

1. Medical qualifications: The US FDA has a mandatory screening list for assisted reproduction (8 for infectious diseases, 4 for genetic diseases, and 1 for psychological assessment). If either spouse is HIV positive, it can still be done, but they must go through the "washing+dedicated laboratory" channel and inform the hospital in advance. two Legal qualifications: California, Nevada, and Illinois are open to married/unmarried/same sex partners, with only a passport required and no marriage certificate required. Some states require at least one party to provide an SSN tax identification number, which can be replaced with an ITIN (Individual Tax Identification Number) in advance. three Hospital lockdown logic: First, look at large laboratories with "cumulative cycles of ≥ 1500 cases throughout the year", then look at the communication convenience of "Chinese cases accounting for ≥ 20%", and finally look at the ratio of "cycles/doctors". If it is ≤ 200, it indicates a high proportion of doctors personally operating. According to this standard, the recognized first tier on the West Coast is as follows:

Avoiding pitfalls: The online "success rate of 80%" mostly refers to the success rate of a single transplant, and the actual cumulative live birth rate is the hard indicator; You can request the latest SART (Society for Assisted Reproductive Technology) CSV raw data from the hospital and calculate it yourself using the "Live Birth per Intend Egg Retrieval" column.

2、 4 months before departure: remote first visit and plan rehearsal

1. Upload the six hormone tests, AMH, B-ultrasound, hysteroscopy, and male semen routine+DFI within the past three months of the domestic top three. two Within 48 hours, American doctors will return the "Preliminary Medication List". There are two common approaches: A. Long protocol (Lupron downregulation): suitable for ovarian reserve of ≥ 8 and regular menstrual cycle; B. Antagonist regimen (Cetrotide): suitable for ovarian reserve ≤ 7 or above 38 years old, can save 4-5 days. three Simultaneously complete FDA blood tests, and in China, you can go to Jinyu and Di'an to report to the US for direct retrieval, eliminating the need for repeated blood draws. four Prepayment: The hospital charges an additional "upfront fee" of $5000-8000, which includes the first visit, laboratory registration, and medication deposit. If cancelled midway, a 70% refund will be given.

3、 Two months before departure: visa, insurance, proof of funds

1. Visa: Assisted reproduction belongs to the medical visa category (B2). When making an appointment, select the "Medical Treatment" subcategory and bring the hospital's "Appointment Letter" and fee list. The approval rate for face-to-face interviews is over 96%. two Insurance: Short term medical insurance in the United States does not cover IVF, but requires the purchase of "complication insurance" with a coverage of $100000 and a premium of $380-450, covering ovarian hyperstimulation, bleeding after egg retrieval, and anesthesia accidents. three Proof of Funds: The hospital requires a prepayment of at least $25000 to an IOLTA account in the United States, which can be pre authorized with a multi currency credit card and unfrozen upon returning to the country.

4、 Week 1 of Going to the United States: Landing Re examination and Promotion of Discharge Launch

1. Time difference adjustment: The West Coast is 15-16 hours later than China. It is recommended to see a doctor at 8:00 am the next day after landing and have blood drawn directly to avoid hormonal fluctuations. two Re examination items: negative ultrasound+estradiol+progesterone. If the difference from the remote initial examination is greater than 15%, the doctor will adjust the dosage of Gonal-F on site. three Purchasing medicine: In the United States, pharmacies can provide free shipping options. A 450IU Gonal-F is priced at $315, which is 20% cheaper than in China; If using a "multi pack" of 900IU can save an additional 8%. four Injection: A hotel style apartment with a refrigerator is sufficient, and a nurse will come to teach for the first time, followed by self medication; California law allows spouses or peers to assist with injections.

5、 Days 8-12 of promotion: Dynamic monitoring and triggering timing

1. Monitoring frequency: once every 48 hours, triggered when estradiol is ≥ 3000 pg/ml and the maximum follicle is ≥ 20 mm. two Trigger drug selection: A. Double trigger (Lupron+HCG): can reduce the risk of OHSS, suitable for polycystic ovary syndrome or AMH>4.5; B. Single trigger (HCG 10000IU): suitable for AMH<2 and follicle count<8. three Night needle time: must be 35-36 hours before egg retrieval, with an error of ± 15 minutes; The hospital will send SMS reminders.

6、 On the day of egg retrieval: anesthesia, laboratory, fertilization method

1. Anesthesia: IV sedation for 20 minutes, walking after 30 minutes of wakefulness, and discharge within 2 hours. two Laboratory: INCINTA is equipped with 7 RI Witness electronic verification systems, which track eggs with RFID throughout the entire process from retrieval to freezing to avoid mismatches. three Fertilization: A. Conventional IVF: suitable for sperm motility ≥ 45%; B. ICSI: Suitable for vitality<45% or previous fertilization rate<30%; C. PICSI: Adding hyaluronic acid screening on top of ICSI can reduce the miscarriage rate by 3-5 percentage points, with an additional cost of $800. four Result notification: The "Fertilization Report" will be sent by email at 8 o'clock the next day. After 18 hours, the prokaryotic cells will be examined, and a normal 2PN is considered qualified.

7、 Day 3-7 of embryo culture: blastocyst culture, biopsy, freezing

1. Bag keeping rate: The average level in the United States is 55%, and the first tier laboratories have a rate of 65-70%. two Biopsy: 4-8 trophoblast cells are taken during the blastocyst stage, which does not affect fetal development; INCINTA uses laser assistance with a sampling time of less than 30 seconds. three Freezing: The survival rate of vitrification freezing is 98%, with 1 piece per tube, to avoid associated losses after thawing. four Freezing fee: $800 for the first year, $600 for the following year, and a one-time purchase of $2400 for 5 years.

8、 PGT testing: Chromosomal and monogenic diseases

1. Detection scope: A. PGT-A: Check for 24 pairs of chromosomal aneuploidy; B. PGT-M: Check for monogenic diseases (such as thalassemia and deafness); C. PGT-SR: Check for chromosomal structural rearrangements (such as Roche translocation). two Cycle: The report is issued 10-14 days after biopsy, and the laboratory collaborates with Cooper Genomics to achieve an accuracy rate of 99%. three Cost: $250 per PGT-A, $350 per PGT-M, and $1800 one-time family single gene locus verification fee.

9、 First transplantation: endometrial preparation and window period

1. Artificial cycle: In China, Bu Jia Le is used for 14 days, and after going to the United States, vaginal progesterone is added. If the endometrium is ≥ 8 mm, estradiol is ≥ 200 pg/ml, and progesterone is<1.5 ng/ml, the transplantation date can be determined. two Natural cycle: Transplantation on the 5th day after ovulation, suitable for people with regular menstruation and good endometrial blood flow, can save $800-1000 in medication costs. three Window period detection: ERA detection can be accurate to ± 12 hours, with an additional cost of $850, suitable for people with repeated planting failures (≥ 2 times). four Transplantation process: 5 minutes, no anesthesia required, lying down for 30 minutes after surgery before returning to the hotel, and walking normally the next day.

10、 Pregnancy Testing and Early Pregnancy Management

1. Pregnancy test: On the 9th day after transplantation, a blood draw of β - HCG ≥ 50 IU/L is considered positive, and doubling by ≥ 1.66 times the following day is considered qualified. two Medication: Continue progesterone until 10 weeks of pregnancy, decreasing after placental takeover; The United States mostly uses vaginal gel, with less side effects than intramuscular injection. three Ultrasound: Check fetal heart rate at 6 weeks of pregnancy, with a fetal heart rate of 100-120 beats per minute meeting the standard; If it is less than 90 times/minute, there is still a 60% chance of reversal after a week of re examination. four Graduation: You can transfer back to obstetrics in China at 9-10 weeks of pregnancy. The US side will provide an English medical record summary and a Chinese version of the "Medication Handover Form".

11、 Cost Summary: Single Cycle, Dual Cycle, Frozen Transplantation

Tip for avoiding pitfalls: The package may seem cheap, but if you receive at least 2 transplantable embryos in your first attempt, you may not be able to use them in your second cycle, and you can only get a refund of 60%; Be sure to include the 'unused period refund ratio' in the contract.

12、 Living facilities: accommodation, transportation, food, and psychological support

1. Accommodation: Hotel style apartments in Torrance and Corvina cost $3200-3800 per month, with a kitchen, washing machine, refrigerator, and a 10 minute walk to the clinic. two Transportation: The Los Angeles subway does not reach the airport. It is recommended to rent a compact SUV for $800 per month, including full insurance, and free parking. three Diet: 99 Ranch Chinese supermarkets are all over the place, where you can buy native chicken, crucian carp, soybean milk. FDA has stricter standards for hormone residues in meat than in China, so you can eat them with confidence. four Psychology: INCINTA has an "Eastern Psychological Support Group" with Chinese Zoom every Wednesday, led by licensed Chinese psychologists from California, and is free of charge. five Law: The ownership of the embryo shall be written in the names of both parties. In case of divorce or the death of one party, the embryo shall belong to the surviving party; If both parties pass away, the embryos will be treated as "medical waste" and can be designated for donation to scientific research in advance.

13、 Return to China Connection: prenatal examination, delivery, birth certificate, household registration

1. Prenatal examination: Bring the American English medical record and translation, which will be directly recognized by the top three domestic hospitals, and there is no need to redo early Tang and NT. 2. Delivery: If planning to give birth in China, purchasing a flight before 28 weeks of pregnancy can waive the hospital certificate; After 32 weeks of pregnancy, a US obstetrician must provide a "suitable for flight" certificate. three Birth certificate: Born in the United States automatically obtains a US passport, and returning to China requires a Travel Permit; If both parents do not have a US green card, the child does not automatically have a Chinese household registration and must go through the "nationality recognition" process. four Household registration: with the translation of birth certificate+travel certificate+parents' household registration book, go to the local police station of mother's registered residence for 15 working days. five Vaccine: The first dose of hepatitis B was given at birth in the United States, and after returning home, the domestic immunization program can be seamlessly accessed, and community hospitals can record.

14、 8 common misconceptions

1. "The success rate in the United States is definitely higher than in China" - if the female is aged 42 or older, the live birth rate is also less than 15%, and the key lies in the embryonic chromosomes rather than national borders. two Whole gene testing=zero risk "- PGT can only detect known loci, and new mutations or microdeletions still require prenatal diagnosis. three The more blastocysts, the better "- After exceeding 8 blastocysts, the cumulative live birth rate curve tends to flatten, and there is no need to blindly promote too many. four The more eggs retrieved, the better "- With over 20 eggs, the risk of OHSS increases sharply, and American doctors will proactively cancel fresh transplants. five After transplantation, bed rest is necessary "- According to a randomized controlled trial in the United States, there is no difference in clinical pregnancy rates between the 24-hour bed rest group and the immediate walking group. six Eating grapefruit for endometrial growth "- grapefruit inhibits CYP3A4 enzyme, which may increase the blood concentration of progesterone and interfere with the doctor's judgment. seven 'American drugs are better than domestic ones' - Gonal-F is globally produced, with price differences mainly coming from tariffs and channels, and there is no difference in efficacy. eight 'Change hospital after one failure' - Internal data exchange among clinics in the United States, but changing hospitals still requires a complete set of FDA procedures, wasting 6 weeks.

15、 Timeline Overview (printable refrigerator sticker)

16、 Conclusion

Going to the United States for IVF is not about buying peace of mind with money, but a multi-threaded project that trades time for space and information for success rate. Breaking down FDA inspections, visas, insurance, medication schedules, legal documents, and repatriation connections into quantifiable to-do lists, you will find that it is more like a "two month medical trip to the West": controllable itinerary, reasonable costs, and guaranteed risks. As long as the three major tasks of hospital lock-in, qualification self inspection, and funding certification are done correctly in the first six months, the rest is to systematically upgrade and attack monsters. I wish every family can turn "going to the United States" into "returning home" and smoothly return home with a small life with a steady heartbeat.

This article link:https://bken.loadskill.com/usivf/419.html