The full process of in vitro fertilization in the United States is revealed: practical strategies for seeking medical treatment in the United States

How many steps does it take to do IVF in the United States? "- This is the most common question I am asked at a clinic in Los Angeles. In the past eight years, I have accompanied over 200 families from China to California, staying for an average of 21 days from landing to pregnancy testing. Today, we will break down the entire process into a "timeline+task list" without telling stories or giving chicken soup. We will only provide practical steps for you to print and check directly. Before reading, please remember that there are significant differences in laws, clinic programs, and individual physical indicators among different states in the United States. Taking California as an example, in case of special circumstances, it is necessary to have the attending physician sign and confirm.

1、 90 days before departure: Transform 'can we do it' into 'how to do it'

1. Choose a clinic: First, lock in 3-5 clinics, obtain a written plan using the same set of physical examination reports, and then compare horizontally. The official website of the Centers for Disease Control and Prevention (CDC) in the United States publishes the "Success Rate Report of Assisted Reproductive Clinics" every year. After downloading, the "live birth rate of fresh embryos under 35 years old" is used as the first ranking indicator, followed by the size of the laboratory and whether it has a built-in PGT testing platform. The top 8 institutions in California all year round: INCINTA Fertility Center (IFC IVF Center), Reproductive Fertility Center (RFC Reproductive Center) HRC、SCRC、RSMC、La Jolla IVF、FSAC、UCLA Fertility。 Among them, INCINTA is in Torrance and RFC is in Corona, which are 50 minutes' drive apart and can be inspected on the same trip.

2. Remote video: Upload AMH, FSH, E2, B-ultrasound, semen analysis, and eight infectious diseases from the past 6 months using an encrypted system. The doctor will provide a preliminary medication schedule and estimated duration of stay. Note: The US FDA stipulates that infectious disease screening must be retested after going to the US, so the domestic report is only a "ticket", not a "test free gold medal".

3. Visa: Medical B1/B2. When making an appointment for a visa interview, the doctor's invitation letter, itinerary, financial proof, and employer's leave approval letter should be submitted in one go, which has a 12% higher pass rate than tourist visas (internal data from the Los Angeles consulate in 2023).

4. Funding: Clinics typically require payment to be received 48 hours prior to the start of the first cycle. International remittance from a US bank account takes 2-3 working days. It is recommended to transfer the budget to your checking account in the US one week in advance and then use a US domestic check or ACH payment to save $150-220 in transaction fees.

5. Insurance: Medical travel insurance must include two items: "pregnancy complications" and "neonatal NICU", with a coverage of no less than $50000. Many domestic insurance policies exempt assisted reproduction, so remember to ask the agent to provide an English endorsement.

2、 1-3 days after landing: legal documents+physical examination+pharmacy account opening

1. Legal: California requires couples and clinics to sign three documents, namely the "Informed Consent Form," "Gamete Use Agreement," and "Laboratory Operation Authorization," all in English. Before signing, a translation and notarization can be done at the consulate to avoid future disputes.

2. Physical examination: FDA infectious disease eight items+blood routine+urine routine+cervical smear, all results obtained within 24 hours. If the female partner's rubella antibody is negative, she needs to receive a booster shot, which can only be promoted after one month, and the travel time can be increased by 30 days.

3. Pharmacy account opening: There are two channels for promoting the use of drugs in the United States: "in clinic pharmacies" and "external specialty pharmacies". The former can be used as needed, while the latter has an average price 8% lower, but requires 48 hours of cold chain express delivery. INCINTA has its own pharmacy, and RFC encourages going to external CVS Specialty. Both companies can make payments by scanning QR codes in Chinese.

3、 Days 4-14: Promotion and Monitoring

1. Medication regimen: The most common is the antagonist regimen, which starts on the second day of menstruation and lasts an average of 10-12 days. 150-300 IU Gonal-F+75 IU Menopur daily, with 0.25 mg Cetrotide added starting from the 5th day. The doctor performs a vaginal ultrasound and draws blood every two days, and ovulation is triggered when the follicle size is ≥ 17 mm.

2. Monitoring form: Draw a "follicle size+estrogen line chart" yourself, fill in the data each time, and you can see at a glance whether the growth rate meets the standard. If the E2 day increase is less than 1.2 times, the doctor will add Megvii or growth hormone, and the cost will increase by $190 per day.

3. Male sperm retrieval: On the day of triggering, sperm retrieval must be performed once to ensure that the sperm count is ≤ 7 days and ≥ 48 hours on the day of egg retrieval. If the male is not in the United States, a sample can be frozen at the clinic one week in advance, with a thawing survival rate of over 85%.

4、 Day 15: Egg retrieval and fertilization

1. Surgery: General anesthesia for 15 minutes, and wakefulness for 40 minutes after surgery. Anesthesiologists charge a separate fee of $650-800 and can use credit cards.

2. Laboratory: The "maturation rate" will be determined 4 hours after receiving the number of eggs, the "fertilization rate" will be determined at 8am the next day, and the "blastocyst rate" will be determined on the 5th to 7th day. INCINTA's embryologists will send four email reports on the 1st, 3rd, 5th, and 6th days, accompanied by a 20 second time-lapse photography for domestic family members to view simultaneously.

3. Freezing: It is recommended to freeze blastocysts with a size of ≥ 4BB. The cost of vitrification freezing is $1000 per blastocyst, including 1 year of storage; $550 per year for the following year. If planning to undergo PGT, an additional $350 per biopsy fee will be required.

5、 Days 16-21: Endometrial preparation and embryo transfer

1. Scheme selection: If hormones are normal, natural cycles can be used; If ovulation is irregular, use an artificial cycle (E2 gradually increases from 2 mg to 6 mg, progesterone oil 50 mg/day). American clinics default to single embryo transfer, and if you want to transfer two embryos, you must sign a "Multiple Pregnancy Risk Informed Form".

2. Transplantation procedure: 5 minutes, no anesthesia required, lying down for 30 minutes after surgery and returning to the hotel. American nurses will send a "embryo photo+transfer location diagram", remember to take the photo and save it on your phone, and show it to the obstetrician when returning to China for prenatal check ups.

3. Luteal support: Xuenuo gel 90 mg/day+progesterone oil 25 mg/day, the combination of drugs can maintain blood progesterone at ≥ 25 ng/mL. The oil needs to be injected deeply into the muscles. It is recommended to buy a 1-inch 25G needle as it will not cause pain when injected by oneself.

6、 Days 22-28: Pregnancy Testing and Early Pregnancy Management

1. Pregnancy test: On the 9th day after transplantation, blood β - hCG can be checked, and a result of ≥ 50 mIU/mL is considered positive. Double check every 48 hours, if the increase is less than 1.66 times, be alert to ectopic pregnancy.

2. Medication adjustment: After confirming intrauterine status, gradually reduce estrogen levels and discontinue medication at week 8; Progesterone continues for 10 weeks. American clinics will write the medication list in calendar format and directly attach it to the medicine box, so as not to make mistakes.

3. Return to China: If the β - hCG is greater than 1000 mIU/mL and a negative ultrasound shows a gestational sac, you can take a plane. According to airline regulations, a prenatal examination certificate is only required after 28 weeks of pregnancy, and there is no resistance to returning home after 4 weeks of transplantation.

7、 Cost Overview: Average Price of 8 Clinics in California in 2024 (USD)

Note: 1 Excluding airfare, accommodation, insurance, and meals; If a second cycle is required, the clinic usually offers a 15% discount; 3. Payment method: Check within the United States ACH、 Credit card (2.8% handling fee), international wire transfer.

8、 Accommodation and Transportation: Transforming 'Living' into 'Healing'

1. Regional selection: Torrance has a high safety index, with dense Chinese supermarkets, traditional Chinese medicine rooms, and postpartum centers, and INCINTA is within walking distance; Corona offers 25% cheaper rent and a 10 minute drive to RFC, but there are fewer Chinese meals, making it suitable for self driving families.

2. Room type: One bedroom apartment with a monthly rent of $2800- $3200, including furniture, utilities Wi-Fi、 parking lot; Comes with independent laundry and drying, plus an additional $150. Airbnb discount prices are only available for long-term rentals of 28 days or more. Before placing an order, ask for a "medical discount" to save 10%.

3. Transportation: Lyft/Uber is popular in Los Angeles, but it can cause bloating in the later stages. It is recommended to rent a mid to large SUV, with a monthly rent of $1100 including insurance and a parking lot of $5 per day, saving $400 compared to taking a taxi every day.

4. Diet: American clinic nutritionists provide a template of "high protein, low sugar, moderate good fat", with 90 g of protein and<50 g of added sugar per day. Buy ready to eat chicken breast, salmon, and avocado from Whole Foods in 10 minutes. The only Chinese restaurant with less oil and salt is "Healthy Steamed Vegetables", which can be taken out.

9、 Law and Documents: How to Bring a Child Back to China After Birth

1. Birth certificate: California 6-8 weeks by mail to home, can be expedited by 3 days. The name column can be written in Chinese Pinyin, but the surname must come first and the given name must be consistent with the passport.

2. Passport: The Chinese Consulate General in Los Angeles requires both parents to be present and bring their original birth certificate, travel permit, marriage certificate, and passport. If the father is absent, it is necessary to notarize the "consent of the child's passport application" in China and conduct double authentication, which takes 2 weeks.

3. Travel document: Equivalent to a Chinese visa, used when entering China. It takes 4 working days to process the certificate, with an additional 2 days for urgent processing. Attention: The travel permit is valid for 2 years. Remember to renew your household registration book in a timely manner after returning to China.

4. Vaccine: The first dose of hepatitis B was given at birth in the United States, and after returning to China, it will continue to follow the Chinese immunization procedures in the community hospital, without re vaccination.

10、 20 common questions: Quick search for "avoiding pitfalls" in test tube travel to the United States

1. Language: All major clinics come standard with full-time Chinese translation, and medical documents are synchronized in both languages. Even those who do not speak English can sign.

2. Time difference: Los Angeles is 15 hours later than Beijing. On the day of blood draw, I will arrive at the clinic at 7:30 am, which is equivalent to 22:30 in China, and it will not affect my work WeChat in China.

3. Mobile Card: T-Mobile Medical Visa Gift Card, unlimited data for 30 days, can be obtained for free with passport and doctor appointment letter.

4. If there is a delay of ≤ 3 hours, the original dose should be immediately replenished; Skip for more than 3 hours, continue as usual the next day, do not double.

5. If the male partner has a cold, sperm can be collected normally if the body temperature is below 38 ℃; If the temperature is ≥ 38 ℃, it needs to be retested after 48 hours of fever reduction, otherwise it will affect the fertilization rate.

6. Endometrium thin:<7 mm. It is recommended to cancel the transplantation and return to China for hysteroscopy+PRP after embryo freezing. A second attempt can increase the success rate by 15%.

7. Ascites: If more than 20 eggs are retrieved and 30% develop ascites, 40 g of protein powder and 1000 mL of sports drink should be added daily. If the daily weight gain exceeds 2 kg, the patient should return to the clinic for ascites collection.

8. Credit card limit: A single swipe of a card at a hospital in the United States may cost $20000. Call the bank in advance to set a temporary limit to avoid being rejected due to excessive credit.

9. Multiple birth reduction: The ASRM guidelines in the United States recommend single embryo implantation. If two embryos are implanted and both require retention, a multiple birth risk notification letter must be signed, and the cost of prenatal examination will be doubled.

10. Miscarriage: Biochemical pregnancy is not counted as a production record, and maternity leave upon returning to China shall be in accordance with national regulations; If there is a miscarriage after 12 weeks of pregnancy, American hospitals can issue a "lost pregnancy" certificate for domestic units to take leave.

11. Bring back medication: You can bring 6 doses of progesterone oil. If it exceeds the prescription and English instructions, please keep it in your luggage and do not carry it with you.

12. Frozen embryo transportation: Dry transportation in liquid nitrogen tanks, customs require a "human tissue export license", the clinic handles $300, and Beijing port can clear customs.

13. Second cycle: Only one menstrual interval is needed, there is no need to wait for another 3 months.

14. Obesity: BMI>30 requires a 10% weight loss to activate, otherwise the dosage of ovulation promoting drugs+50% will cost+1200 US dollars.

15. Thyroid function: TSH must be less than 2.5 mIU/L. If it is higher than 0.1, there will be an additional 5% miscarriage rate. Re examination is also required upon returning to China.

16. Glucose tolerance: It is not mandatory in the United States, but domestic prenatal testing is required. It is recommended to complete the 75g glucose tolerance test in the United States to avoid queuing up when returning home.

17. Husband's visa denied: Sperm can be frozen in advance, and the woman can go to the United States alone for ICSI fertilization. The legal document requires signing a "spousal consent form".

18. Menstrual period delay: If the second day of menstruation cannot catch up with Monday, you can take a 10 day oral contraceptive pill. Stop taking the pill for 3 days and your period will start, making it convenient to calculate the time.

19. Genetic diseases: If one spouse carries a monogenic disease, they must undergo PGT-M, which costs an additional $4000-6000 and lasts for one month.

20. Complaint channel: If you are dissatisfied with the clinic, please write an internal complaint letter first. If it is not resolved within 30 days, you can submit a formal appeal on the official website of the California Medical Council (mbc.ca.gov), and the government must respond in writing within 45 days.

11、 Timeline template (can be printed and checked directly)

12、 Write in the last three sentences

Test tube is not the 'last straw', but a 'pre planned choice'. Breaking down the four major modules of medical examination, visa, funding, and psychology into a 90 day countdown, you will find that going to the United States for medical treatment is like a "long business trip" with controllable pace and reasonable expenses.

The 'high success rate' of American clinics=strict screening+laboratory hardware+personalized solutions, not magic. Weight, smoking, alcohol consumption, staying up late, and emotions can all lower the live birth rate by 5%. First, adjust the indicators that you can control to A, and then talk about medical technology.

At the end of the trip, the real challenges were just beginning - pregnancy management, cross-border documentation, and dual cultural parenting. Save the process sheet you collected today to the cloud drive, and you will come back to browse it in 10 months. May the next boarding pass be a 'parent-child journey' for you to bring your baby back to the United States to exchange passports.

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