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)

注：1. 不含机票、住宿、保险、餐饮；2. 若需第二周期，诊所通常给 15% 折扣；3. 付款方式：美国境内支票、ACH、信用卡（2.8% 手续费）、国际电汇。

八、住宿与交通：把“住”变成“疗养”

1. 区域选择：Torrance 安全指数高，华人超市、中药房、月子中心密集，步行可达 INCINTA；Corona 房租便宜 25%，去 RFC 车程 10 分钟，但中餐少，适合自驾家庭。

2. 房型：一室一厅公寓月租 2 800–3 200 美元，含家具、水电、Wi-Fi、车位；带独立洗衣烘干再加 150 美元。 Airbnb 折扣价只给 28 天以上长租，下单前先问“医疗折扣”，可省 10%。

3. 交通：洛杉矶 Lyft/Uber 普及，但促排后期肚子胀，建议租一辆中大型 SUV，月租含保险 1 100 美元，停车场 5 美元/日，比天天打车省 400 美元。

4. 饮食：美国诊所营养师给出“高蛋白、低糖、适量好脂肪”模板，每天 90 g 蛋白、＜50 g 添加糖。 Whole Foods 买即食鸡胸肉、三文鱼、牛油果，10 分钟搞定。中餐馆少油少盐的只有“健康蒸菜”一家，可外卖。

九、法律与证件：孩子出生后如何带回中国

1. 出生纸：加州 6–8 周邮寄到家，可加急 3 天。姓名栏可写中文拼音，但姓在前、名在后，必须与护照一致。

2. 护照：中国驻洛杉矶总领馆要求父母双方到场，带出生纸原件、旅行证、结婚证、护照。若父亲缺席，需在国内公证“同意孩子申请护照”并做双认证，耗时 2 周。

3. 旅行证：等同中国签证，入境中国时用。办证 4 个工作日，加急 2 天。注意：旅行证有效期 2 年，回国后记得及时换发户口簿。

4. 疫苗：美国出生即打乙肝第一针，回国后在社区医院继续按中国免疫程序走，不需重新接种。

十、常见 20 问：赴美试管“避坑”速查

1. 语言：所有大诊所标配全职中文翻译，医疗文件同步双语，不会英语也能签。

2. 时差：洛杉矶比北京晚 15 小时，抽血日早上 7:30 到诊所，等于国内 22:30，基本不耽误国内工作微信。

3. 手机卡：T-Mobile 医疗签赠卡，无限流量 30 天，凭护照+医生预约信免费领取。

4. 促排药漏打：若延迟 ≤3 小时，立即补原剂量；＞3 小时跳过，次日照常，不要双倍。

5. 男方感冒：体温 38 ℃ 以下可正常取精；≥38 ℃ 需退烧 48 小时后重测，否则影响受精率。

6. 子宫内膜薄：＜7 mm 建议取消移植，冻胚后回国做宫腔镜+PRP，再来第二次，成功率可提 15%。

7. 腹水：取卵＞20 枚 30% 出现腹水，每天蛋白粉 40 g+运动饮料 1 000 mL，体重日增 ＞2 kg 回诊所放腹水。

8. 信用卡额度：美国医院一次刷卡可能 2 万美元，提前给银行打电话提临时额度，避免刷爆被拒。

9. 多胎减胎：美国 ASRM 指南推荐单胚胎，若着床 2 枚且都要求保留，需签多胎风险知情书，产检费用翻倍。

10. 流产：生化妊娠不算生产记录，回国产假按国家规定；若孕 12 周后流产，美国医院可开“妊娠丢失”证明，用于国内单位请假。

11. 药带回国：黄体酮油剂可带 6 支，超出需处方+英文说明书，放托运行李，不要随身。

12. 冷冻胚胎运输：液氮罐干式运输，海关需出具“人类组织出口许可”，诊所代办 300 美元，北京口岸可清关。

13. 第二周期：间隔一次月经即可，不需再等 3 个月。

14. 肥胖：BMI＞30 需减重 10% 才能启动，否则促排药用量+50%，费用+1 200 美元。

15. 甲状腺功能：TSH 必须＜2.5 mIU/L，高 0.1 就多 5% 流产率，回国也要复查。

16. 糖耐：美国不强制，但国内产检要做，建议在美把 75 g 糖耐做完，省得回国排队。

17. 丈夫签证被拒：可提前冷冻精子，女方单独赴美，用 ICSI 受精，法律文件签“配偶同意书”即可。

18. 月经期延迟：若月经第 2 天赶不上周一，可口服 10 天避孕药，停药 3 天即来月经，方便算时间。

19. 基因病：若夫妻一方携带单基因病，必须做 PGT-M，额外 4 000–6 000 美元，周期+1 个月。

20. 投诉通道：对诊所不满，先写内部投诉信，30 天未解决，可上加州医疗委员会官网（mbc.ca.gov）提交正式申诉，政府 45 天内必须书面回复。

十一、时间轴模板（可直接打印打勾）

十二、写在最后的 3 句话

1. 试管不是“最后一根稻草”，而是“提前规划的选择”。把体检、签证、资金、心理四大模块拆成 90 天倒计时，你会发现赴美就医像一次“长版出差”，节奏可控、花费可算。

2. 美国诊所的“高成功率”= 严格筛选+实验室硬件+个性化方案，不是魔法。体重、烟、酒、熬夜、情绪，每一项都能把活产率拉低 5%。先把自己能控制的指标调到 A，再谈医疗技术。

3. 行程结束那一刻，真正的挑战才刚刚开始——孕期管理、跨境文件、双重文化育儿。把今天收藏的流程表存进云盘，10 个月后你还会回来翻它。愿下一张登机牌，是你带着宝宝回美国换护照的“亲子之旅”。

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