Guide to the entire process of in vitro fertilization in the United States: Preparation, treatment, and precautions for returning to the United States

From the moment you stepped onto Los Angeles International Airport, you entrusted your hopes for a future baby to the medical team across the Pacific. The assisted reproductive system on the West Coast of the United States is known for its transparent procedures, high laboratory standards, and flexible medication plans, but "good" does not mean "simple". Visa, medical examination, medication, egg retrieval, embryo culture, uterine cavity preparation, transplantation, pregnancy examination, and return to obstetrics connection all have clear time windows. If missed, you will have to wait for another month. This article breaks down the test tube trip to the United States into three stages: "before departure - in the United States - returning home". Using a checklist and calendar, you can build your itinerary like building blocks, reducing on-site decision-making and minimizing time and financial losses.

1、 90 days before departure: Change 'can I go' to 'ready'

1. Passport and Visa
The validity period of the couple's passport is ≥ 6 months; If you have used your name before, divorced or remarried, you need to bring both your old and new passports, marriage certificate, and divorce agreement.
A medical visa (B1/B2) is sufficient. During the interview, truthfully state "going to the United States for reproductive treatment" and bring a hospital appointment letter, cost estimate sheet, copy of doctor's license, and personal asset proof.
It is recommended to apply for EVUS simultaneously, and updates must be made 72 hours before the entry of passengers with a ten-year visa.

2. Physical pre assessment
Female: Perform FSH, LH, E2, and AMH tests on the 2nd to 4th day of menstruation; Perform a negative ultrasound on the 7th to 9th day of menstruation to check the number of basal follicles; Perform hysteroscopy or 3D ultrasound 3-7 days after menstruation to eliminate adhesions, polyps, and septa.
Male: Perform semen analysis, deformity rate, and fragmentation rate (DFI) after 2-7 days of abstinence; If the results fluctuate greatly, add sex hormones and genital ultrasound.
Both parties: blood routine, blood type (Rh), eight items of infectious diseases, thyroid function, coagulation, glucose tolerance, electrocardiogram, chest X-ray.
All reports should be made on hospital letterhead paper, in English, and stamped with a red seal. American clinics can directly input them into the system to avoid duplicate blood draws.

3. Hospital and doctor lock-in
Top Five Reproductive Centers in the Western United States by Cycle Quantity (2023 CDC Data):
① INCINTA Fertility Center Dr. James P. Lin, Torrance CA
② Reproductive Fertility Center Dr. Susan Nasab, Corona CA
③ HRC Fertility, Newport Beach CA
④ SCRC (Southern California Reproductive Center), Beverly Hills CA
⑤ RFC (Reproductive Partners Medical Group), Redondo Beach CA
⑥ Spring Fertility, San Francisco CA
⑦ Stanford Medicine Fertility and Reproductive Health, Palo Alto CA
⑧ Kaiser Permanente Center for Reproductive Health, San Francisco CA
⑨ UCSD Fertility Center, San Diego CA
⑩ CCRM (Colorado Center for Reproductive Medicine), Lone Tree CO
Selection logic: Check whether the "laboratory of our hospital" has passed the CAP/CLAI dual certification; Check if there are at least 4 full-time embryologists; Check if the 'number of cycles' is ≥ 1000/year; Check if 'Chinese coordination' is directly under the hospital rather than outsourced.

4. Remote video consultation
6-8 weeks in advance, video call with the attending physician, and the US side will provide a preliminary medication plan (antagonist, rectangular plan, micro stimulation, or natural cycle). Within 48 hours after the video, the hospital will send a "treatment plan+cost table+medication prescription", which can be used to compare and purchase in pharmacies in China and the United States.

5. Funds and Insurance
Single cycle package (including ICSI, blastocyst culture, and first-year cryopreservation) costs $32000-38000; If PGT-A testing is required, an additional $5000- $6500 will be charged.
Credit card limit ≥ 100000 RMB, convenient for on-site payment of medication fees; Bring a multi currency debit card at the same time, which is available in most pharmacies in the United States.
Overseas travel insurance should have a dual responsibility of "medical treatment+emergency return", especially including "acute complications within 24 weeks of pregnancy" in the terms, otherwise the insurance company may refuse to compensate later.

6. Schedule Calendar Template

2、 15-20 days in the United States: turning "medical processes" into "daily routines"

How to choose accommodation
Distance from hospital ≤ 15 miles, drive ≤ 25 minutes; We recommend Torrance, Redondo Beach, and Manhattan Beach as three cities with good public safety, plenty of Chinese cuisine, and beach walks that are conducive to mood.
Book an apartment style hotel with a kitchen where you can cook your own egg whites and steam fish, avoiding high salt and oil consumption when eating out.
Confirm that there is a 24-hour front desk available to collect cold chain medicines, and some apartments do not have refrigerators. It is necessary to purchase a $30 portable refrigerator in advance.

2. Promotion Stage (Day 1-10)
Inject Gonal-F/Menopur daily from 7:30am to 8:30am, and have the nurse come to the clinic or study at the clinic before returning to the hotel to self administer; The needle is the thinnest at 30G, and inserting it vertically into the abdominal fat layer is almost painless.
On the 5th day, blood (E2, LH, P4) and ultrasound were collected upon returning to the hospital. The doctor adjusted the dosage based on the follicle diameter, with a common decrease of 150-225 IU.
Add antagonists (Cetrotide or Ganirelix) on days 8-9 to prevent premature ovulation.
Do not engage in vigorous exercise, sauna, or bath. After the follicle grows to 14 mm, the ovarian volume increases and turning over should be slow.

3. Triggering and Egg Retrieval (Days 11-13)
When two dominant follicles are ≥ 18 mm and E2 levels are between 1500 and 3000 pg/ml, the doctor will prescribe a "night shot" - Lupron or hCG or dual trigger; The injection time must be precise to the hour, with an error of ± 10 minutes.
After 34-36 hours, the eggs will be retrieved, and general anesthesia will be given for 15 minutes. The patient will be awake for 30 minutes after surgery and can return to the hotel within 1 hour.
Starting from the same day, take cephalosporin orally for 5 days to prevent infection. A small amount of coffee colored vaginal discharge is normal; If there is persistent abdominal pain, oliguria, and bloating ≥ 5 cm, immediately return to the hospital to rule out OHSS.

4. Fertilization and Cultivation (Days 13-18)
Perform ICSI 4 hours after egg retrieval and observe fertilization (2PN) the next morning; On the third day, observe the blastomeres; On the 5th to 6th day, observe the blastocysts.
If PGT-A is performed, the laboratory will take 4-6 trophoblast cells during the blastocyst stage and send the samples to CooperGenomics or Natera. The results will be available within 10-14 days.
The blastocyst scoring is done using the Gardner system (3BB or above can be frozen), and the hospital will provide embryo photos that are 2000 times larger. You can view them in real-time on the app.

5. Uterine preparation and transplantation (Day 19-20)
• Fresh cycle: transfer on the 5th day after taking eggs, which shall meet E2 • Frozen cycle: return to China for a month, start to take 6 mg/day of paclitaxel on the 2nd day of the second menstruation, return to the United States on the 13th day, use 50 mg/day of progesterone oil+90 mg/day of gel for transplantation on the 6th day when the intima is ≥ 8 mm and the tertiary signs are clear.
The transplantation process takes 5 minutes, like doing routine vaginal discharge without anesthesia; You can return to the hotel after lying for 20 minutes. It is recommended to walk after urination to reduce urinary retention.
Luteal support begins on the day of transplantation, with a common regimen of Crinone 8%, 1 dose per day, and progesterone injections every other day for 10 consecutive weeks.

6. Pregnancy test and graduation
On the 9th day after transplantation, blood can be drawn for β - hCG, with a positivity rate of ≥ 50 mIU/ml; Doubling by ≥ 1.6 times every 48 hours is considered early qualification.
On the 28th day after transplantation, a negative ultrasound was performed and the gestational sac and fetal heart rate were observed, indicating "graduation". The hospital provided an English pregnancy report, medication reduction form, and instructions on the return route.
If the implant is not implanted, the doctor will arrange to stop the medication. If menstruation occurs within 3-7 days, the patient can immediately enter the next freezing cycle without paying any transplant fees.

3、 Returning to China 0-12 weeks: Transforming 'US Report' into 'Obstetrics Filing'

1. Entry Customs
Before 12 weeks of pregnancy, if the appearance is not visible, it is recommended to wear a loose jacket; Carry the "early pregnancy diagnosis certificate" and "progesterone prescription" issued by the hospital with you. If asked, truthfully answer "went to the United States for assisted reproduction, and now return to China to continue prenatal check ups".
• Drug declaration: Progesterone injection, Xuenuotong, heparin can be carried, with a dosage not exceeding 30 days; If carrying refrigerated biological agents, fill out the "Approval Form for Special Items for Import and Export" on the airport customs website in advance, go through the red channel, stamp and release.

2. Domestic obstetrics connection
Bring the American English medical record and Chinese translation (stamped with the saddle stitch seal by the translation company) to the local tertiary hospital's reproductive center or obstetrics clinic for NT filing.
Notify the doctor of "in vitro fertilization embryo transfer" and request that the "last menstrual period" be written as "transplant day-17 days" to facilitate the automatic calculation of the due date by obstetric software.
There are slight differences in medication between the United States and China: progesterone injections at 20 mg/day can be replaced in equal amounts with oral dexamethasone at 10 mg bid; Heparin sodium should be adjusted according to body weight and should not be discontinued on its own.
Perform NT+early Tang screening at 11-13+6 weeks; 16 weeks of non-invasive DNA testing; 20-24 week system major anomaly screening; Completed OGTT 28 weeks ago. All ultrasound reports will be synchronously transmitted back to the attending physician in the United States, who will enter the data into the global medical record for future transplantation.

3. Psychology and Nutrition
Four weeks after returning to China is the "psychological desensitization period". Suddenly returning from an English environment to Chinese can cause anxiety. It is recommended to join the hospital's official maternity school and attend offline classes once a week.
The diet follows the "three lows and one high": low salt, low sugar, low caffeine, and high quality protein; One egg, 250 ml of milk, 150 g of deep-sea fish, and 200 mg of DHA supplementation per day.
Weight management: gaining 1-2 kg before 12 weeks of pregnancy is sufficient. For overweight individuals, it is recommended to visit a nutrition clinic and upload photos using the "Dietary Diary APP". Nutritionists will provide weekly feedback.

4. Renewal of frozen embryos
The freezing preservation fee for American clinics is $600-800 per year, and the bill is automatically sent via email, which can be paid online with an international credit card; If the payment is overdue for 60 days, the hospital will issue a "final notice", and if it is overdue for 180 days, it will be considered as a waiver.
It is recommended to add a "renewal reminder" to the mobile calendar, complete payment 30 days in advance each year, and request an updated embryo storage certificate via email for the next entry.

4、 18 common questions, no more blind catching on site

Q1: Can the ejaculation needle be administered by oneself?
A: Okay. The nurse will provide one teaching pen, practice vertical needle insertion on orange peel first, and then inject it on their own abdomen. The 4mm needle is basically painless.

Q2: Will general anesthesia for egg retrieval harm the brain?
A: Using propofol and fentanyl, with a dose of only 1/3 for laparoscopy, metabolism for 30 minutes, and normal eating 4 hours after surgery without affecting memory.

Q3: Will the egg be damaged if the man is 2 days late?
A: Sperm must be seen on the day of egg retrieval; If the man's flight is delayed, he can freeze and backup his sperm in the US sperm bank in advance, at a cost of $500.

Q4: What should I do if the PGT pass rate of blastocysts is low?
A: Under 35 years old, the average is 50-60%, and by 39 years old, it has decreased to 30%; If it is lower than expected for the first time, the microstimulation plan can be changed to save embryos, and they can be sent for testing after 3-4 cycles.

Q5: Can the inner membrane of 7.8 mm be transplanted?
A: Clear three line signs and blood flow ≥ 2 levels are sufficient, and there is no difference in clinical pregnancy rates above 7.5 mm. There is no need to overly focus on 8 mm.

Can I fly after transplantation?
A: Avoid high-altitude cabin pressure changes within 48 hours after transplantation, and it is recommended to fly again on the third day; If it is necessary to leave on the same day, choose a wide body aircraft with stable cabin pressure and seats close to the aisle for easy movement of the lower limbs.

Q7: How to clean up too much Xuenuotong residue?
A: Take medication before going to bed at night, and rinse the external genitalia with warm water the next morning. Do not rinse the vagina to avoid bacterial imbalance.

Q8: What should I do if I experience early pregnancy bleeding?
A: 30% of IVF pregnant women have a small amount of pink discharge. First, add a beta hCG test. If doubling is normal, increase the progesterone injection from 20 mg to 40 mg and rest in bed for 24 hours. Most cases can be relieved.

Q9: After returning to China, was progesterone 15 ng/ml found to be low?
A: Before the formation of the placenta in IVF cycles, progesterone levels of 10-20 ng/ml are considered normal. The key is to double hCG levels, so there is no need to blindly add medication.

Q10: When is heparin administered?
A: For individuals with antiphospholipid antibodies or pre thrombotic status, vaccination should be administered 24 hours before delivery; For those without indications for simple IVF, it can be stopped at 10 weeks of pregnancy.

Q11: Can I drink soybean milk?
A: Yes, 250 ml sugar free soybean milk every day provides natural soybean isoflavones, which is intima friendly; But people with gout or hypothyroidism need to limit their intake.

Q12: How to deal with severe morning sickness and poor absorption of Xuenuotong?
A: Replace with intramuscular injection of 40 mg/day progesterone injections or oral administration of 200 mg tid of micronized progesterone to maintain blood drug concentration.

Q13: Can vitamins purchased in the United States continue to be consumed domestically?
A: Sure, pay attention to the dosage: folic acid 0.8 mg, DHA 200-300 mg, iron 27 mg, iodine 150 μ g, consistent with domestic pregnancy standards.

Q14: Is it possible to transfer frozen embryos back to China?
A: Theoretically feasible, but both countries' clinics need to have LN2 dry transport tanks and IATA certification, with a shipping cost of $4000-6000 and a cycle of 45 days. The cost-effectiveness is low, and most families choose to continue storing in the United States.

Q15: How long is the interval between the next transplant?
A: Those with remaining blastocysts can enter their natural cycle after their first menstrual period; For those without blastocysts, it is recommended to rest for 2 menstrual cycles to allow the ovaries to return to a size of 2-3 cm.

Q16: Will American doctors track births?
A: Generally, after graduation, you will be transferred back to China, but you can send back each ultrasound report to the United States for doctors to answer questions for free until delivery, which is a global medical record sharing service.

Q17: Is it vaginal delivery or cesarean section?
A: IVF itself is not an indication for cesarean section. Single pregnancy, fetal position, and no complications can result in vaginal delivery; Cesarean section is only considered for twin pregnancy, placenta previa, or preeclampsia.

Q18: What documents do I need to translate for my baby to apply for a household registration in China after birth?
A: Birth certificates, US passports, travel permits, yellow vaccination cards, pregnancy reports, and paternity tests (if required) must all be authenticated by Chinese embassies and consulates abroad, and a Chinese translation company must be consulted to provide a Chinese version before the police station can accept them.

5、 Budget Quick Calculation Table (Unit: USD, calculated based on 1 cycle+1 transplant+PGT-A)

6、 Risk and Disclaimer Reminder

1. According to the ASRM guidelines, the single embryo transfer rate in American clinics has exceeded 70%, but there is still a 15% chance of miscarriage, consistent with natural conception.
2. There is a significant increase in maternal and infant complications in multiple pregnancies. Please follow the doctor's advice and do not insist on placing two pills at once.
3. Allergies to any medication may occur, and egg retrieval surgery may result in bleeding, infection, and damage to adjacent organs, with an incidence rate of 4 The data in this article is sourced from the "Assisted Reproductive Technology National Summary Report" released by the CDC in 2023 and the annual reports of various hospitals. It is only for popular science and cannot replace face-to-face consultations with doctors. Please confirm your personal plan with the attending physician before proceeding.

7、 A travel itinerary on A4 paper (can be printed and attached to a suitcase)

✈ Flight: PEK ➝ LAX round-trip
🏨 Hotel: Residence Inn Torrance (21520 Hawthorne Blvd, 0.8 miles from INCINTA)
🚗 Car rental: Alamo economy model, booking number XXX, all inclusive insurance
📱 Phone card: T-Mobile $40/month, unlimited data
💊 Medications: Gonal-F 900 IU x 5, Menopur 75 IU x 20, Cetrotide 0.25 mg x 7, Lupron 2 mg x 1, Progesterone 50 mg x 10
📅 Key Day: Menstrual Day 1 to Day 18 Arrives ➡ D19 first visit ➡ D28 egg retrieval ➡ D33 transplantation ➡ D42 pregnancy test ➡ D56 graduates and returns to China
📄 Carry with you: passport, visa, appointment letter, prescription, insurance policy, $3000 in cash, 2 credit cards
☎ 24-hour emergency contact: INCINTA Chinese coordinator+1-310-xxx-xxxx, Consulate General in Los Angeles+1-213-xxx-xxxx

Put this piece of paper into the passport folder, and you already have 90% certainty; Leave the remaining 10% to the Pacific Ocean breeze and the doctor's experience. May you return home with your baby on the next journey.

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