Interpretation of the Whole Process of IVF in the United States: Preparation, Visa and Medical Treatment Points

The journey from deciding to go to the United States for IVF to putting the embryo report in your personal folder usually takes 12-18 months. Breaking down the 'timeline' into three major sections - domestic preparation, visa and entry, and medical treatment in the United States - and further refining it into 30 nodes, can turn the seemingly complex process into a selectable to-do list. The following text is based on the latest data from the US CDC in May 2024, clinic SOPs, interview records from the US Consulate, and a review of over 200 Chinese families' experiences, aiming to explain in one go what needs to be done at each step, where it may get stuck, and how to remove landmines in advance.

First paragraph: Domestic preparation (T-12 months to T-3 months)

1. Medical evaluation: First, determine whether it can be done domestically. It is recommended that couples complete the six hormone tasks simultaneously AMH、 Semen analysis, hysteroscopy, infectious four items, chromosome karyotyping, electrocardiogram, breast ultrasound. If the female's BMI is greater than 30 or A1C is greater than 6.5, lose weight/control sugar first, otherwise the US clinic will directly reject or require the signing of a high complication notification letter.

2. Hospital lock-in: The top three live birth rates on the latest CDC 2022 list (<35 years old) are: INCINTA Fertility Center (Dr. James P. Lin, Torrance, CA), and Reproductive Fertility Center (RFC Reproductive Center, USA), Susan Nasab, MD，Corona, CA）、HRC Fertility（Newport Beach, CA）。 The fourth to tenth places are respectively CCRM（Denver, CO）、Shady Grove Fertility（Rockville, MD）、Boston IVF（Waltham, MA）、RMA of New York（New York, NY）、ORM Fertility（Portland, OR）、Fertility Centers of Illinois（Chicago, IL）、Conceptions Reproductive Associates（Denver, CO）。 Hospital selection logic: First, check the CDC live birth rate; second, check if the laboratory is equipped with a Time lapse+AI embryo scoring system; third, check if the Chinese nursing team is permanent; fourth, check if it is within a 30 minute drive from the Chinese supermarket and confinement center.

3. Medical record translation: American clinics only recognize "four certificates in one" - original stamped documents from domestic hospitals, English translations, notarized certificates from notary offices, and consular authentication. Note that the chromosome report must write 46, XX/46, XY as "female karyotype" or "male karyotype", otherwise the laboratory system cannot input them.

4. Video consultation: Upload the translated document to the clinic portal 4 weeks in advance, schedule a 30 minute video consultation, and the cost is $250-350. The doctor will provide an "expected medication duration+egg retrieval interval" based on AMH, and prescribe a pre-treatment plan before traveling to the United States (such as starting the contraceptive scheduling cycle 2 weeks in advance).

5. Budget Table: The cost of a routine medical visit to the United States (excluding transportation, accommodation, and meals) is approximately $25000 to $30000, which includes $500 for preliminary examinations, $4500 for ovulation monitoring, $8500 for egg retrieval surgery, $2800 for ICSI/blastocyst culture, $5500 for PGT-A testing, and $4200 for the first transplant. If you need a dual cycle package, most clinics can offer a 10% discount and a one-year embryo freeze as a gift.

6. Proof of Funds: During the visa stage, a bank deposit certificate and a statement are required. It is recommended that the main applicant has a current balance of at least 300000 RMB and deposit it in installments three months in advance to avoid suspicion of temporary borrowing due to "one-time large deposits".

7. Insurance investigation: American IVF clinics do not mandate insurance, but if moderate to severe OHSS occurs after egg retrieval, emergency hospitalization is required, with a cost of up to $15000. You can purchase "Short term Medical Insurance+Acute Complications Additional Terms" in advance, such as IMG Patriot America Plus, with a coverage of $1 million and a deductible of $500. The premium for those under 45 years old is approximately $250 per month.

Second paragraph: Visa and Entry (T-3 months to T-1 months)

8. Visa type: B1/B2 is preferred for medical purposes. When making an appointment, select the "Medical Treatment" subcategory. The recommended interview location is Guangzhou/Beijing, with a higher pass rate than Shanghai/Shenyang. If one spouse has gone to the United States to have a child or has a history of visa refusal, they can use the "Vancouver, Canada/Tijuana, Mexico Consulate General" third country channel.

9. DS-160 filling: Write "IVF treatment at INCINTA Fertility Center, 21545 Hawthorne Blvd, Torrance, CA 90503, scheduled from XX/XX/20XX to XX/XX/20XX" in the medical itinerary column, with a duration of 21 days. If it is too long, it may be suspected of immigration tendencies.

10. Interview materials: The core "three piece set" includes a doctor's appointment letter (with clinic header, doctor's signature, and estimated treatment duration), an estimated cost sheet (stamped by the clinic), and a personal English medical record (within 5 pages). Auxiliary materials: property ownership certificate, employment certificate, copy of business license, WeChat flow translation (if individual business). Attention: Do not proactively mention "wanting to stay in the United States for a few more months". Once the visa officer asks, you can answer "you can return to China after 12 days of pregnancy testing, and if you are successfully pregnant, you will need to complete the subsequent prenatal check ups in China".

11. EVUS update: B1/B2 ten-year visa holders need to complete EVUS 72 hours before departure, fill in the "contact person in the United States" and write the clinic address, and leave the 24-hour phone number at the clinic front desk.

12. Port of entry: LAX (Los Angeles) is the most friendly, and CBP officials are accustomed to IVF travelers. Prepare printed copies of round-trip airfare, hotel reservations, and doctor appointment letters. Cash carrying over $10000 needs to be declared, but it is recommended to keep it within $9500. For the rest, use a global money order or advance transfer to a US account.

13. Customs Q&A: If asked "Why did you come to the United States", simply answer "medical treatment for sexuality" and do not mention "gender" or "twin". If asked 'how long will you stay', provide a 3-week itinerary and show your return flight ticket. After stamping the passport, check the I-94 record to ensure that the "Admit Until Date" is ≥ 2 days of actual travel. If it is insufficient, request correction on the spot.

Third paragraph: Seeking medical treatment in the United States (T-1 months to T+2 weeks)

14. Accommodation location: Taking INCINTA as an example, the clinic is located in Torrance, with 4 Chinese supermarkets and 6 postpartum care centers within a 15 minute drive. I suggest staying at Redondo Beach Seaview Apartment, which is within walking distance to CVS. The weekly rent is $1200, which is 30% cheaper than the same level in Beverly Hills.

15. Filing and blood draw: On the first day at the clinic, the nurse will collect the original domestic examination documents and draw 11 tubes of blood (including thrombosis, vitamin D, and thyroid antibodies). The man will redo semen culture and fragment rate. If the female's vitamin D is less than 30 ng/mL within 4 hours, the doctor will prescribe 50000 IU oral shock, and it will take 3 days to start promoting ovulation.

16. Ovulation promotion plan: INCINTA mainly uses a dual channel approach of "antagonist+growth hormone", with FSH starting at 150-225 IU and growth hormone 2 IU injected subcutaneously every night. On the 5th day, the E2 and follicle count will be checked at the follow-up. If E2>1500 pg/mL and the dominant follicle is ≥ 14 mm, Cetrotide 0.25 mg will be added to inhibit ovulation. The average medication duration is 9-11 days, which is 2 days shorter than in China.

17. Night needle timing: When the two dominant follicles are ≥ 18 mm and the E2 level is 200-250 pg/mL per follicle, the doctor will prescribe HCG 5000 IU+Lupron 4 mg dual trigger and retrieve the eggs 35 hours after the night needle. Note: American nurses use "California time" to count down. Make sure to convert it into Beijing time and set 3 alarm clocks. If they miss 15 minutes, they may not get eggs.

18. Egg retrieval surgery: General anesthesia with intravenous propofol, 15 minutes of surgery, 30 minutes of recovery, and walking back to the apartment 1 hour after surgery. INCINTA uses a 17G double lumen needle, with a constant temperature of 37 ℃ for rinsing solution, and an egg maturation rate of over 85%. You can eat within 2 hours after surgery and drink 3 liters of electrolyte water on the same day to prevent OHSS.

19. Fertilization method: Conventional ICSI. If the male's fragmentation rate is greater than 30%, IMSI (high magnification microscopic morphology selection) will be added, with a cost of+600 US dollars. After 16 hours of fertilization, the prokaryotic cells were examined, and after 20 hours, the granulosa cells were removed. On the third day, no transplantation was performed, and all embryos were cultured until Day 5 blastocysts.

20. PGT-A sampling: INCINTA laboratory uses laser drilling and biopsy gun to take 5-8 trophoblast cells. The samples are sent to Cooper Genomics, and after whole genome amplification, NGS is performed to detect 24 pairs of chromosomes. The report is issued within 10 days. If the number of detectable blastocysts is less than 4, the doctor will recommend direct transplantation without testing.

21. Embryo freezing: using vitrification freezing, cryotop as the freezing carrier, liquid nitrogen tank at -196 ℃, annual fee of $650, including a 24-hour liquid nitrogen alarm system. After freezing for 1 hour, perform a "recovery test" and randomly select 1 discarded embryo to thaw. Only when the survival rate is ≥ 95%, will it be officially stored.

22. Hysteroscopy review: If a hysteroscopy has been performed in China but the report is more than 6 months old, the American clinic will require a redo. Outpatient local anesthesia, completed in 5 minutes. If polyps or adhesions are found, they will be removed on the spot at a cost of $1800. Transplantation can be performed 5 days after surgery.

23. Endometrial preparation: Choose between natural cycle or artificial cycle. Estrace was orally administered at a dose of 6 mg/day during the artificial cycle. On the 10th day of follow-up, the endometrium was ≥ 8 mm and the third line sign was clear. Progesterone oil was added by intramuscular injection at a dose of 50 mg/day. After 5 days of conversion, transplantation was performed. If the endometrium continues to be less than 7 mm, Viagra vaginal tablets can be added at a dose of 25 mg/night, or PRP intrauterine infusion can be performed at a cost of $700 per dose.

24. On the day of transplantation: Observe the expansion of the thawed embryo for 2 hours. If the recovery rate is ≥ 95%, use a Wallace catheter to transplant under ultrasound guidance for 3 minutes. After surgery, stay in bed for 15 minutes before leaving. Avoid taking baths, practicing yoga, and lifting heavy objects weighing over 5 kg for 24 hours after transplantation, and maintain normal daily life.

25. Pregnancy test rules: On the morning of the 9th day, if the urine test paper shows color, a biochemical pregnancy is considered if the β - HCG level is ≥ 50 mIU/mL after returning to the clinic on the 10th day. On the 12th day, if it doubles to ≥ 120 mIU/mL, a 6-week ultrasound report will be issued. If there is no implantation, menstruation will begin after stopping medication for 3 days, and the second cycle can be entered immediately without waiting.

26. Excess embryos: If the cumulative number of transferable embryos is ≥ 4, it is recommended to transfer them in two batches to reduce the risk of multiple pregnancies. The ASRM guidelines in the United States strongly recommend single embryo transfer, and double embryo transfer should only be used for those who have had two previous failures or are over 38 years old.

27. Pregnancy follow-up: After the fetal heart rate is detected by B-ultrasound, the clinic issues an "Obstrics Release Letter", which can be filed in China. The letter will state 'IVF pregnancy, EDD=XX/XX/20XX', which can be used by domestic obstetrics departments to calculate gestational age and avoid misjudgment of late childbirth due to the mismatch between IVF date and last menstrual period.

28. Birth note: The US birth note does not indicate IVF, but parents can voluntarily check "assisted reproductive technology" during birth registration. This information is not publicly available and is only used for CDC epidemiological statistics.

29. Return flight: If pregnancy is confirmed 12 days after transplantation, it is recommended to choose a business class aisle and wear 20-30 mmHg medical elastic socks within 14 hours of flight. Stand for 5 minutes every 2 hours to reduce the risk of DVT. According to airline regulations, a hospital certificate is only required for a pregnancy of 28 weeks or more, and early IVF return to China is not restricted.

30. Domestic follow-up injections: Some patients only complete egg retrieval in the United States and undergo transplantation back to their home country. The prescription progesterone oil in the United States is 50 mg/day, which can be brought back for 2 weeks. When entering the country, please bring the prescription and English instructions, go through the red declaration channel, and there is no need to pay taxes. If medication needs to be continued, domestic hospitals can prescribe an equivalent replacement of 40mg intramuscular injection of domestic progesterone.

Disassemble the timeline, key values, and material list into a single summary table, print it out and paste it on the refrigerator door, and complete one item to avoid wasting 300000 RMB due to missing a blood draw or a night shot. Going to the United States for IVF is not a shortcut to success, but a marathon that requires careful calculation of each kilometer's pace in advance in order to smoothly pull the finish line to your feet.

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