In vitro fertilization in the United States: an interpretation of the entire process from evaluation to pregnancy

In China, the demand for assisted reproduction is increasing year by year, but the domestic waiting period, age limit, differences in embryo culture technology, and insufficient personalized programs have led more and more families to turn their attention to the other side of the Pacific. California on the west coast of the United States, through its relaxed legal environment, laboratory quality control standards, clinical medication experience, and Chinese service chain, has become the first stop for IVF in the United States. This article takes "from assessment to pregnancy" as the main thread, dismantling a complete path that can be implemented, reviewed, and calculated in terms of time and cost, helping readers turn the unknown into a schedule before departure.

1、 Pre departure assessment: Translate body data into language that American doctors can understand

1. Female core indicators: AMH (anti Mullerian hormone) ≥ 1.1 ng/mL indicates adequate ovarian reserve,<0.5 ng/mL requires ovarian function support to begin 3 months in advance; FSH (2-3 days of menstruation)<10 IU/L is preferred; If the count of antral follicles (AFC) is ≥ 7 on both sides, it is expected that 8-12 eggs will be retrieved in one attempt. Endometrium: thickness ≥ 8mm on ovulation day or mid luteal phase, clear trilinear sign, and blood flow classification of grade A can significantly reduce the failure rate of later transplantation.

2. Male core indicators: Semen routine should be completed within the past 6 months. According to the WHO Fifth Edition standards, forward motile sperm should be ≥ 32%, total motility should be ≥ 40%, and normal morphology should be ≥ 4%; If it is lower than this, additional DNA fragmentation index (DFI) and HDS testing are required. If DFI>25%, it is recommended to perform antioxidant therapy simultaneously.

3. Infectious diseases and genetics: hepatitis B, hepatitis C, syphilis HIV、HTLV、 Gonorrhea, Chlamydia, Cytomegalovirus IgM, Rubella IgG, Toxoplasma IgM, all of which are mandatory requirements by the US FDA, have a validity period of 1 year for reporting; If one spouse has chromosomal translocation, inversion, or monogenic disease, an embryo PGT-M pre-test should be conducted in advance, with an additional 15 days of cycle.

4. Uterine cavity environment: Three dimensional ultrasound or hysteroscopy can exclude submucosal fibroids, polyps, intrauterine adhesions, and uterine septum; If any abnormalities are found, it is recommended to complete the surgery in China and then travel to the United States 2 months after the surgery, which can save about $6000-8000 in surgical costs in the United States.

5. Lifestyle pre intervention: BMI>28 kg/m ² requires a weight loss of 5-10%; Fasting blood glucose>5.6 mmol/L or HbA1c>5.7%, take metformin sustained-release tablets orally 3 months in advance; Thyroid function TSH>2.5 mIU/L, supplement 50 μ g of levothyroxine sodium daily, press TSH to<2.0 mIU/L before entering the week.

2、 Hospital and doctor selection: Breaking down "success rate" into verifiable variables

The CDC in the United States publishes an annual report on assisted reproductive technology, with a data lag of 2 years, but it is still the only official benchmark. Screening logic: First, look at the live birth rate of fresh embryo transfers under 35 years old, then look at the number of self frozen embryo cycles between 38-40 years old, and finally look at the proportion of Chinese cases and the Chinese follow-up system. 2023 West Coast comprehensive ranking (ranked by CDC 2021 live birth rate, only the top 8 are listed):

Hospital selection formula: high live birth rate+high number of Chinese cases+laboratory less than 30 minutes' drive from residence+providing remote video initial diagnosis. Satisfy all four criteria to enter the next round of price comparison.

3、 Visa and itinerary: B1/B2 or medical visa?

1. Visa type: In vitro fertilization belongs to the category of "medical treatment". It is recommended to directly make an appointment for a B2 medical visa, and bring a doctor's appointment letter, cost estimate, itinerary, and bank deposit (≥ 300000 RMB current account) during the interview. If one spouse is a freelancer or holds a white passport, they can attach a copy of their real estate certificate or company business license to reduce immigration bias.

2. Travel template (single cycle):

The entire process takes 34 days and can be divided into two trips to the United States: the first egg retrieval takes 13 days, and the second transplantation takes 7 days, saving 20 days, but increasing the cost of one flight.

4、 Cost breakdown: Break down the "USD bill" into RMB psychological accounts

1. Medical Core Package (INCINTA 2024 Price):

2. 生活成本：Torrance区域四星级公寓月租4500美元，含厨房可做饭；租车中型SUV 800美元/月；日常超市采购人均30美元/天。34天总计约2.2万美元，折合人民币15.8万。

3. 不可预见项：若取卵后腹水，需穿刺引流，单次1200美元；若内膜厚度不达标，加用PRP宫腔灌注，每次800美元；若第一次移植未妊娠，第二次移植仅需4200美元，但需再赴美7天。

4. 保险与退款计划：美国试管无政府医保，但INCINTA提供“多周期折扣套餐”：3个移植周期打包价24,000美元，比单周期节省约6000美元；若3次移植仍未活产，退还15,000美元，相当于风险对冲。

五、促排方案：如何把“获卵数”与“卵巢过度刺激”平衡

1. 标准长方案：前一周期黄体中期开始降调，14天后复查FSH＜5 IU/L、E2＜30 pg/mL，启动促排。优点：卵泡同步性好，获卵数多；缺点：用药时间长、降调期间可能低雌激素症状。适合年龄＜35岁、AMH＞2.0 ng/mL。

2. 拮抗剂方案：月经第2天直接促排，卵泡≥14 mm时加GnRH拮抗剂，防止早发LH峰。优点：周期短、OHSS风险低；缺点：需精确每日监测。适合多囊卵巢、AMH＞4.0 ng/mL或既往OHSS史。

3. 微刺激方案：氯米芬+低剂量Gonal-f 75–150 IU，获卵数4–6枚，质量优先。适合AMH＜1.0 ng/mL、FSH＞12 IU/L，或乳腺癌术后不宜高雌激素者。INCINTA的Dr. Lin对此经验最丰富，可连续累积3个周期，再一起送检PGT-A，节省检测费。

4. 双重刺激（Duo-Stim）：同一周期内，取卵后第2天立即开始第二轮促排，利用FSH窗口期再获1–3枚卵子。适合时间紧迫的卵巢低储备患者，可增加约30%可用囊胚。

六、实验室技术：从“受精卵”到“可移植囊胚”的7天闯关

1. ICSI：单精子注射已普及，INCINTA额外采用“Hyaluronan精子选择”技术，优先绑定成熟度高的精子，可降低DNA碎片率约15%。

2. 囊胚培养：使用连续型培养液（G-1/G-2），搭配低氧环境（5% O₂），囊胚形成率由50%提升至65%。

3. 激光辅助孵化（LAH）：针对38岁以上或胚胎透明带厚度＞18 μm，用1480 nm激光在透明带打10 μm小孔，帮助胚胎孵出，着床率提升约8%。

4. Time-lapse胚胎镜：每10分钟拍照一次，AI算法评分，筛选出“最早分裂”“碎片＜5%”的胚胎，减少人为开关培养箱次数，提高囊胚利用率。

5. PGT-A：NGS法检测23对染色体，INCINTA实验室内 turnaround 时间5–7天，可检测低至20%的嵌合体，嵌合比例＜40%的囊胚仍视为可移植。

七、内膜准备：如何把“土壤”调到最佳pH值

1. 自然周期：排卵日LH surge后第5天移植，适合月经规律、内膜可自行达标者，药物成本最低。

2. 人工周期：雌激素2–6 mg/日，14天后复查内膜≥8 mm，加黄体酮转化，灵活安排移植日，适合多囊或国内远程监测者。

3. 刺激周期：克罗米芬+低剂量HMG，让自身产生雌激素，内膜血流更好，适合内膜薄（＜7 mm）者。

4. 附加武器：

• 宫腔镜轻刮（Scratch）：移植前周期第21天，轻微搔刮内膜，诱导修复反应，提高着床率10%。
• PRP（富血小板血浆）：抽取自体静脉血20 mL，离心后取4 mL血浆注入宫腔，VEGF浓度提升3倍，适合反复移植失败（RIF）。
• ERA（内膜接受窗）：取内膜送NGS检测，判断个人着床窗是否偏移，可避免30%的“时差”失败。

八、移植当天：一次5分钟，却决定14天心情

1. 术前：憋尿300 mL，让超声能清晰显示子宫纵轴；口服芬必得600 mg，放松宫颈。

2. 术中：胚胎装载在Cook导管，外径仅1.4 mm，Dr. Lin在超声引导下将导管尖端置于距宫底5–10 mm处，停留30秒，推出胚胎，整个过程无麻醉、无痛。

3. 术后：卧床30分钟，护士讲解用药表：

4. 生活提示：术后48小时避免久站、盆浴、游泳；可正常乘飞机，舱压12 psi对胚胎无影响，建议靠过道位，每小时起身活动预防血栓。

九、验孕与早期妊娠：跨越半个地球的“阳性”之后

1. 血值解读：移植后第9天（Day9）可抽血，β-hCG≥50 IU/L为临床妊娠；＜20 IU/L基本排除；20–50 IU/L需48小时复查，增幅≥66%为达标。

2. 翻倍规律：单胎48小时增幅1.6–2.2倍；若＞2.8倍需警惕twin pregnancy，＜1.5倍提示胚胎发育迟缓或异位。

3. 一超：移植后28天（孕6周+3天），阴超见孕囊位于宫腔、直径10–18 mm、卵黄囊清晰；若孕囊＞25 mm仍无卵黄囊，考虑空囊。

4. 二超：移植后42天（孕8周+3天），胎芽15 mm、胎心搏动120–160次/分，可减黄体支持。

5. 回国衔接：孕10周前，INCINTA会把用药表、超声报告、英文病历摘要交给患者，国内产科建档只需带“翻译件+护照页”，无需重新检查；若黄体酮凝胶国内缺货，可改用雪诺同每日2支等效。

十、风险与对策：把“万一”写进计划表

1. OHSS（卵巢过度刺激）：取卵后腹胀、体重增加＞2 kg、少尿，需每日饮蛋白粉1.5 g/kg、低分子右旋糖酐500 mL静脉扩容，严重时腹腔穿刺；INCINTA常规采用“全胚冷冻+择期移植”策略，可将发生率控制在0.8%。

2. 多胎妊娠：美国ASRM指南鼓励单囊胚移植，INCINTA＜38岁患者单胚率92%，twin pregnancy率仅1.6%；若意外分裂成twin pregnancy，需在孕11周做NT+无创DNA，评估早产风险。

3. 宫颈机能不全：既往大月份流产史者，孕14–16周做阴超测宫颈长度＜25 mm，可择期行环扎术，术后限制活动。

4. 早产费用：美国NICU收费标准：孕32–34周出生，住院30天约12万美元；建议孕24周后购买“短期旅行医疗险”，保额30万美元，保费1800美元，可覆盖新生儿住院。

十一、时间轴总览：一张甘特图读懂全部节点

从体检到NT通过，总计约4个月；若分两次赴美，可在取卵后回国工作，第二次移植再请假，降低职场影响。

十二、常见问题速答

Q1：赴美试管可以陪产吗？
A：美国海关允许B2签证陪产，但入境时需说明“陪同配偶医疗”，携带医生预约信，可获6个月停留期。

Q2：胚胎不用完怎么办？
A：美国实验室提供长期冷冻，年费600美元；若未来无生育计划，可选择医学销毁或继续保存。

Q3：可以转回国内移植吗？
A：技术上可行，但涉及跨境运输液氮罐，FDA与民航危险品条例限制，运费约3000美元，且国内医院需提前备案，手续复杂，多数患者选择在美国完成移植。

Q4：美国出生宝宝如何落户？
A：出生后48小时内，医院出具出生纸、社会安全号；父母持护照到县 recorder 办公署做认证，再赴中国领事馆办旅行证，即可回国落户，流程约2周。

conclusion

赴美试管婴儿并非一条“捷径”，而是一场用数据、时间与预算堆出来的精准工程。把身体调理前置、把医院选择量化、把费用拆成模块、把风险写进备份方案，你会发现横跨太平洋的14小时航班，只是生命长河里的一段可预见旅程。当B超屏幕上第一次闪现胎心，你会感谢那个提前3个月就开始吃叶酸、每天跑步2公里、把胰岛素降到5.6的自己——因为所有计划，最终都写在了小家伙强有力的心跳里。

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