Guide to Preparing for Pregnancy with IVF in the United States: Process, Cost, and Frequently Asked Questions

Transforming "going to the United States for IVF" from a slogan to a boarding pass takes an average of 8-12 months. In this timeline, there are not only medical nodes, but also six parallel tracks: legal, financial, visa, accommodation, insurance, and emotional. Below, the entire process is broken down into 60 executable actions, combined with the latest 2024 quotation, common Q&A, and avoidance checklist, so that families who are going abroad for the first time can also be as calm as old patients.

1、 Before departure: Write 'why' as' quantifiable goal 'first
1. Clarify medical indications: salpingectomy? Has the teaching failed multiple times? PGT-A demand? Scan domestic medical records into PDF format according to the timeline, and attach reference values to the English chemistry report. 2. Establish a budget ceiling: The official quotes from clinics in the United States are only "bare prices", and what really drains the wallet are medication, round-trip airfare, accommodation, insurance, emergency hysteroscopy, and two promotions and three transfers. It is recommended to use a cash flow model based on a single cycle of $45000 to $55000 and a dual cycle of $80000 to $90000, with an additional 15% contingency fund reserved. 3. State and hospital selection: California is the most friendly to international patients, with high laboratory density, multiple flights, and comprehensive Chinese living facilities; New York, Boston, and Seattle also have top laboratories, but accommodation is 30% more expensive. 4. Visa strategy: Medical B1/B2 is the most secure, and honest visa applicants need to bring a hospital appointment letter, expense list, doctor introduction letter, and deposit certificate; When answering 'purpose of stay' upon entry, simply stating 'productive treatment' is more time-saving than using vague words.

2、 How to choose a hospital: first break down the "success rate" into three levels
CDC official website 2022 fresh cycle<35 year old singleton live birth rate: INCINTA Fertility Center 58.7 %、Reproductive Fertility Center 56.4 %、HRC 55.1 %、SCRC 54.8 %、CCRM 53.9 %、RMA-NY 52.6 %、Shady Grove 50.2 %、Boston IVF 49.7 %、Cleveland Clinic 48.3 %、Mayo 47.8 %。 The number depends on the sample size: INCINTA had 742 egg retrieval cycles for those under 35 years old that year, which belongs to the "big data+high live birth" double high; Although some clinics have 60%, the sample size is less than 100 cases, resulting in significant statistical errors. The second level depends on the laboratory hardware: whether it has 24-hour real-time embryo monitoring (time-lapse), whether it has an independent PGD platform, and whether it has its own genetics laboratory. The third level is to look at the international team: whether there is a Chinese coordinator, whether RMB international remittance is accepted, and whether a Superbill for insurance is issued. Overall, INCINTA in Torrance, Los Angeles County and RFC in Colona, Riverside County have consistently ranked among the top two in international patient reputation. The following costs and procedures will also be based on these two companies.

3、 Timeline: 54 days from the first day of menstruation to a blood test for pregnancy
On Day 1, menstruation started in China. On Day 2, oral contraceptive pills (OCP) were adjusted to regulate the cycle. On Day 18, the patient flew to Los Angeles for entry. On Day 19, the patient had their first consultation (blood draw+B-ultrasound+endometrial baseline). On Day 20, informed consent was signed, financial settlement was completed, and the medication was administered by the pharmacy; From Day 21 to Day 25, return to China or stay in the United States for self injection. On Day 26, fly to LA for two days. On Day 27, return to the hospital for monitoring. On Day 31, receive a night shot. On Day 33, retrieve the egg. On Day 34, provide a fertilization report. On Day 39, obtain blastocyst culture results. On Day 40, perform a biopsy (if PGT is performed). On Day 45, freeze the embryo. On Day 46, start menstruation. On Day 47, begin endometrial preparation (estradiol+sildenafil). On Day 54, transplant. On Day 68, draw blood for β - hCG. If the endometrium or hormones do not meet the standards, the brake can be applied at any time to change the "fresh embryo" to "frozen embryo", extending the time to 75-90 days, but the medical quality is actually higher.

4、 Cost Overview: Understanding 2024 Naked and Hidden Prices with One Table

The 'hidden price' is most easily overlooked: 1 Second promotion discount: If INCINTA returns to the hospital within 6 months, the laboratory fee will be directly reduced by 15%. 2. Accommodation: The monthly rent for apartments in Torrance City is $2800, including a kitchen and washing machine, saving 40% compared to hotels. 3. Flights: Round trip between Guangzhou and Los Angeles costs 7200 yuan during the off-season and 12000 yuan during the peak season. Purchasing tickets 45 days in advance is an average discount of 1800 yuan. 4. Insurance: Overseas Medical Accident Insurance for 14 days at $260, which can cover emergency ovarian torsion after egg retrieval. 5. Exchange rate: The fluctuation range of the US dollar to the Chinese yuan in 2024 is 7.0-7.3. It is recommended to open a multi currency credit card and use real-time exchange rates, which saves 1.2% compared to cash exchange at the counter.

5、 Legal document: Three sheets of paper determine the ownership of embryos
1. Consent Form: It specifies the ownership of gametes, laboratory processing methods, unforeseen risks, and must be signed by both spouses. 2. Partner Consent: If one party travels to the United States first and the other party signs later, it needs to be notarized. 3. Embryo Disposition Directive: Embryo ownership in three scenarios: divorce, death of one party, and debt. Options: continue storage, scientific research, and destruction. The hospital will only enter the training stage after signing. International patients also need to sign HIPAA authorization, allowing hospitals to send reports to domestic attending doctors.

6、 Medication article: Disassemble 450 needles into 7 actions
The average duration of the ovulation promotion stage is 9-12 days, with 1-3 injections per day and a total of 300-450 injections. The INCINTA nurse will send you a "refrigerator map" to tell you how to partition the apartment: refrigerate at 2-8 ℃ and store in Gonal-F and Menopur; Store sildenafil tablets and progesterone oil in the room temperature drawer. When returning to China to renew the vaccination, the customs need to bring a hospital prescription, English instructions, ice pack+insulation bag, declare the biological products in advance in the "Customs Passenger Fingertip Service" mini program, and stamp them through the red channel for tax-free release. Common side effects: Abdominal distension 72%, injection site induration 38%, emotional fluctuations 25%, urinary output<400 ml/24 h, shortness of breath immediately return to the hospital, OHSS excluded.

7、 Laboratory: 6 Key Decision Points for Embryologists
1. Fertilization method: conventional IVF or ICSI? INCINTA standard: If the forward moving sperm count is less than 30% or the rate of two routine fertilizations is less than 30%, ICSI will be automatically upgraded without additional charge. 2. Culture medium: Using Sage 1-step, which has the highest global market share, there is no need to change the medium midway, reducing stress. 3. Embryo scoring: According to Gardner's criteria, a blastocyst size of 3BB or higher is considered worthy of biopsy. 4. Biopsy timing: Before 10am on Day 5, take 5-8 cells from the trophoblast layer without affecting the inner cell mass. 5. Vitrification freezing: Reduce from 37 ℃ to -196 ℃ within 15 minutes, with a recovery rate of 98.2%. 6. Storage tank: The liquid nitrogen tank is independently numbered and can store up to 300 embryos per tank to reduce the risk of cross contamination.

8、 PGT-A or not: a formula for calculating economic accounts
At the age of 33 AMH 3.5 ng/ml、 Taking 15 eggs as an example, the blastocyst rate is 60% → 9 can be biopsied, the chromosome ploidy rate is 55% → 5 are expected to be normal. If directly transplanted, the live birth rate is 40% each time, and an average of 2.5 times are required; First, perform PGT-A with a 65% live yield each time, averaging 1.5 times. Save $4200 on one transplant cost, subtract PGT-A cost of 9 × 450=$4050, resulting in a net savings of $150. More importantly, reduce the time cost of "transplant fetal stop uterine clearance" from 4 months to 0. Therefore, if the age is less than 38 years old and there are ≥ 5 biopsies available, the cost-effectiveness of PGT-A is positive; When the diploid rate is less than 30% at the age of 40, a comprehensive consideration of the number of embryos and budget is required.

9、 Endometrial preparation: three options to determine who gets pregnant faster
Natural cycle: Endometrium ≥ 8 mm on ovulation day, clear third line sign, P>1.0 ng/ml can be transplanted, with minimal medication but requiring 4-5 readmissions, suitable for local patients in the United States. Alternative cycle: Starting from 6 mg/day of estradiol, returning to the hospital on the 10th day, adding progesterone after achieving endometrial standards, controllable schedule, preferred for international patients. Ovulation cycle: Letrozole+low-dose Gonal-F, balancing endometrium and ovulation, suitable for polycystic ovary syndrome, but requiring 3 readmissions. According to INCINTA's 2023 statistics, the clinical pregnancy rates for the three options were 63%, 65%, and 64%, respectively, with no statistically significant difference. Therefore, international patients prefer to use alternative cycles and compress their stay in the United States to 7 days.

10、 On the day of transplantation: Transform the 5-minute ceremony into a 14 day waiting period
Drink 500 ml of water 1 hour before transplantation to maintain moderate bladder filling and facilitate abdominal ultrasound guidance. The operating room temperature was 22 ℃, and embryologists loaded Embryo into the Cook catheter, which was pushed by Dr. James P. Lin within 30 seconds. After rinsing the remaining culture medium, it was confirmed under a microscope that there were no embryo residues. After surgery, lying flat for 10 minutes can get out of bed without hospitalization. After returning to the apartment, do not take a bath, swim, or lift heavy objects weighing more than 5 kg for 48 hours, and other daily activities are not restricted. Progesterone is recommended to use vaginal gel, 90 mg per day, to avoid induration after intramuscular injection of oil, which may affect long-distance flight. On the 9th day, urine test strips can be used for initial screening at home. On the 12th day, blood will be drawn upon return to the hospital. A β - hCG level greater than 50 IU/L is considered positive, and doubling to>66% the following day is considered safe.

11、 24 hours after failure: How to stop losing emotions
After a biochemical pregnancy or empty sac, the hospital will send a "failure analysis report" via email within 24 hours, including embryo microscopy images, chromosome reports, and endometrial immune CD56/16 test results. The coordinator will schedule Zoom appointments synchronously, and Dr. Lin will personally review and provide the next step plan: to replace the cycle? Adding immune regulation? Or direct secondary promotion? At this time, there is no need for follow-up registration fee. In terms of emotional management, INCINTA has partnered with Talkspace to offer 3 free online psychological counseling sessions, with the option of a Chinese tutor. Research has shown that patients who receive professional psychological intervention have an 18% increase in live birth rate in the next cycle.

12、 30 Frequently Asked Questions
Can I enter the country with only 8 months left on my passport? Sure, but it is recommended to wait for more than 6 months. 2. Can hepatitis B Little Sanyang do it? HBV DNA<2000 IU/ml is sufficient, and a dedicated incubator will be added to the embryo chamber. Does promoting ovulation lead to premature ovarian failure? No, each time we recruit follicles that were supposed to be blocked in the current period. Is general anesthesia foolish for egg retrieval? The metabolism of intravenous propofol was completed within 15 minutes without any long-term memory impairment. Do I have to stay in bed after transplantation? No, walking daily after 24 hours actually increases endometrial blood flow. Can I get vaccinated against HPV? The last injection should be administered one month before egg retrieval. 7. Sir, is 20% sperm motility sufficient at the age of 50? Enough, ICSI only needs to find one live sperm. Can a cold be transplanted? If the body temperature is below 37.5 ℃ and there is no suppurative tonsillitis, it can continue. Can I take traditional Chinese medicine to protect my pregnancy? Avoid using medicinal herbs that promote blood circulation and remove blood stasis within 10 days after transplantation. How long can I return to my home country? After transplantation, it can fly within 48 hours and drink 100 ml of water per hour in the cabin to prevent blood clots. 11. Where should blood be drawn after returning to China? The reproductive center of a tertiary hospital informed doctors that on the 12th day of transplantation, they can directly open a ticket to check for β - hCG, E2, and P. How to renew the remaining embryos? INCINTA supports automatic international credit card deductions of $600 per year. Can children born in the United States obtain citizenship? Only those born within the territory of the United States are eligible for landed citizenship, and those who undergo in vitro embryo transfer to give birth in their home country are not eligible. 14. Can I pay in installments? Sure, INCINTA collaborates with Sunbit, with a down payment of 30% and a balance of 24 installments, with an annualized rate of 6.9%. Can single women do it? Sure, California law does not require a marriage certificate. 16. Can a doctor be designated? Sure, Dr. Lin needs to make an appointment 2 months in advance. Can the medication for promoting ovulation be brought back to China? Sure, with a prescription and hospital certificate, you can apply for customs clearance. Will changing flight tickets miss the window period? The replacement cycle can be flexibly postponed by 3-5 days. 19. Can I accompany my mother during childbirth? Sure, the B2 visa can be signed in person together. Can I buy insurance in the United States? International patients generally purchase self paid packages, while domestic insurance in the United States depends on the terms. Is there a risk associated with transporting embryos back to China? Dry transportation of liquid nitrogen is safe for 14 days, but customs policies are tightening and not recommended. 22. Can I swim? Avoid within 14 days after transplantation. 23. Can I do nail art? Yes, choose formaldehyde free water-based nail polish. 24. Can I have coffee? <200 mg of caffeine per day ≈ 1 cup of American style. 25. How many days before ejaculation, sir? 3-5 days before egg retrieval. 26. Can we share a room? Prohibited 2 days before transplantation to prevent uterine contractions. 27. Can I dye my hair? Avoid transplanting in the current month. 28. Can botulinum toxin be administered? Discontinue use three months before transplantation. 29. Can I keep a cat? Sure, a negative Toxoplasma antibody is sufficient. 30. Can I exercise? Avoid curling or squatting for 7 days after egg retrieval, and take a walk for 14 days after transplantation.

13、 Avoiding pitfalls list: 10 lessons learned from old patients who bought it with 2 million yuan
1. Don't easily believe in "low-priced packages". Some clinics charge extra for PGT-A, anesthesia, and cryotherapy, but the total price is actually higher. 2. Do not pay the full amount in one lump sum, pay in stages and leave at least 20% until the transplant date. 3. Do not choose a newly opened laboratory, as a live birth rate with a CDC data sample size of less than 50 cases is not reliable. 4. Do not receive the first dose in China before going to the United States, as the time difference and temperature may lead to adjustment failure. 5. Do not bring traditional Chinese medicine injections into the country, as they will be confiscated directly by Los Angeles Customs. 6. Do not book non refundable apartments, as there may be an extension of 7-10 days due to OHSS in the later stage of promotion. 7. Do not rent a car and drive it yourself, as residual anesthesia and abdominal pain after egg retrieval can double the accident rate. 8. Do not seek unlicensed translators, as errors in medical terminology can lead to misunderstandings of dosage. 9. Don't cook sea cucumbers and ass hide glue in Airbnb. The smell will cause neighbors to call the police, and they will be fined 500 dollars. 10. Do not buy a return flight ticket on the day of transplantation. Once the pregnancy test is successful, the doctor may recommend waiting for an additional week for observation.

14、 Returning to China for prenatal check ups: How to seamlessly transfer American medical records
INCINTA will issue an Early Pregnancy Report on the 12th day after transplantation, which includes 15 indicators including β - hCG, E2, P, thyroid function, coagulation, and immunity, stamped with the hospital seal. It is recommended to choose a direct flight for returning to China. When passing through security, presenting a pregnancy certificate can apply for exemption from X-rays. Within 24 hours after landing, go to the obstetrics department of a local tertiary hospital for registration, bring both Chinese and English medical records and medication lists, and the doctor will directly recognize the American laboratory data without the need for repeated blood draws. When filing, inform that the last menstrual period will be calculated based on "transplant day-17 days", with an expected delivery date error of ± 3 days. NT、 Non invasive DNA and large screening can be performed normally, and the PGT-A results in the United States do not affect the domestic screening process.

15、 Psychology and Marriage: Upgrading "Two People" into "Two Teams"
Going abroad for IVF is a high-pressure project, and research shows that 43% of couples experience escalating arguments during the treatment period. It is recommended to hold three "family meetings" before departure to write down the worst-case scenario (no embryos, failed transplantation, miscarriage) in writing, including financial bottom line, whether to promote secondary education, and whether to accept adoption. During the treatment period, a fixed 15 minute "emotional clock in" will be conducted every day, only expressing feelings without accountability. When the female enters the operating room, it is best for the male to complete a semen renewal at the same time, allowing for a "shared experience" to counteract feelings of loneliness. After returning to China, regardless of success or failure, arrange a 5-day "recovery trip" to wash away the "stress scenes" of the hospital and hotel, and rebuild the daily order of the two people's world.

16、 Conclusion: Fold 4000 words into a boarding pass
There is no magic in American IVF, it just makes every detail extremely transparent: 24-hour cameras in the laboratory, one-on-one real name signatures from embryologists, Excel based cost lists, and Zoom based failure reviews. When you break down processes, budgets, and risks into checkboxes, anxiety is replaced by actionable items. May this 2024 guide help you turn "wanting to go" into "on the road" and "on the road" into "carrying your child home".

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