Interpretation of the specific process of in vitro fertilization in the United States: step-by-step explanation

From the moment we stepped onto Los Angeles International Airport to the first sound of a speeding train on the fetal heart monitor, the complete journey of IVF in the United States usually spans two menstrual cycles, three trips to the United States, more than ten blood draws and ultrasounds, and countless WeChat groups cheering each other on 'how much estradiol is there today'. In order to make this seemingly complex roadmap executable, the entire process is broken down into a "Gantt chart" that can be printed and pasted on the refrigerator, and medical decision points, legal document nodes, cost ranges, and common misconceptions are explained grid by grid, making it easier for families to find a balance between time differences, budgets, holidays, and psychological expectations.

It should be emphasized in advance that there is no "guaranteed success" contract in the United States, and any institution that verbally implies "one-time delivery" violates the ASRM (American Society for Reproductive Medicine) ethical guidelines. The success rate is related to multidimensional parameters such as age, ovarian reserve, uterine blood flow, embryo chromosome ploidy rate, and immune coagulation indicators. All data in the following text are quoted from the CDC 2022 final report and SART annual report, and live birth rates within the same cycle are given instead of clinical pregnancy rates to avoid the statistical trap of "seeing fetal heart rate" but ultimately not holding the baby.

1、 Initial screening in China: Translate 'can it be done' into numbers
Many couples see the first examination as a "formality", but in fact, there may be an additional stimulation cycle between AMH 1.1 ng/ml and 1.8 ng/ml. The six hormones recognized by American clinics must be completed on the 2nd to 4th day of menstruation, and hysteroscopy or saline hysterosalpingography (SIS) is best done in advance to avoid discovering submucosal fibroids or intrauterine adhesions only after flying to the United States and being forced to cancel the cycle. When the DNA fragmentation index (DFI) of semen is greater than or equal to 25%, doctors will recommend synchronous MACS magnetic activation sorting on the day of egg retrieval to reduce the risk of chromosomal abnormalities in fertilization. All reports must be stamped by an official English translation company, and scanned PDF copies must be encrypted and uploaded in compliance with HIPAA remote medical standards.

2、 Video consultation: 30 minute decision on 'big promotion' or 'micro promotion'
Dr. James P. Lin's consultation habit is to first ask patients to express their demands in Chinese, and then switch to English to confirm the number of incubators in the embryo room for the day, in order to avoid "promising well when speaking Chinese and finding no space when entering the laboratory". If FSH> 15 IU/L with antral follicles

3、 Drug delivery: a stricter cold chain than Taobao direct mail
The Gonal-F 1050 IU pen requires 2-8 ° C. Schraft's Specialty Pharmacy, a partner of INCINTA, will use "dry ice+temperature recorder+FedEx Priority Overnight". The package comes with a disposable thermometer, and the recipient needs to take a photo and return it to>8 ° C for free resend. The customs declaration name should be written as "follicle stimulation hormone for personal medical use", accompanied by a doctor's prescription and the patient's passport front page, and generally will not be taxed. If the flight is delayed, you can apply for emergency pharmacy reshipment with the airport certificate, and it will be delivered locally in Los Angeles within 3 hours.

4、 First trip to the United States: compressing 12 days into one subway card
Accommodation: We recommend Torrance Airbnb, which is a 10 minute walk to the clinic and saves $50 in parking fees per day; Eating: H Mart buys Korean style beef slices, cooks them themselves, and supplements protein; Okay: Uber is linked to a full currency card from China Merchants Bank, which saves $30 per day on highways and parking compared to renting a car. Monitor on Day 10 if E2>; 5000 pg/ml and>20 follicles, the doctor will prescribe Dostinex 0.5 mg for 7 days to prevent OHSS (ovarian hyperstimulation). On the day of egg retrieval, IV anesthesia was administered, and the patient woke up 20 minutes later. One hour after surgery, the patient drank apple juice and Saltine biscuits. If there was no nausea, they could return to their residence. On the evening of Day 5, when the blastocyst was cultured, the APP pushed a "fertilization report": 2PN number, lysis number, blastocyst grade (such as 4AA, 4BB), which was clear at a glance.

5、 PGT-A testing: the key to determining the quality of "seeds"
Take 4-8 trophoblast cells for biopsy and detect 24 chromosomal diploids using NGS method. According to CDC 2022 data, the live birth rate of each diploid embryo in 35 year old women is 52%, which drops to 42% at 38 years old and only 26% at 42 years old. Therefore, the number of transplantable embryos is more important than the number of retrieved eggs. If the result is only one diploid, the doctor will recommend a second accumulation to avoid starting over again after a failed transplant. The testing cycle is 7-10 days, and the laboratory will simultaneously issue a "low proportion chimerism (30-50%)" report. ASRM allows chimeric embryos to be transplanted with full knowledge, but the live birth rate decreases by 15-20%, requiring an additional consent form to be signed.

6、 Endometrial preparation: turning the uterus into a 'five-star hotel'
The natural cycle plan is suitable for individuals with regular menstrual cycles and normal ovulation. It is necessary to monitor the embryo with a negative ultrasound every two days starting from Day 12 in China. Within 24 hours after the peak of LH in the blood appears, the embryo will be thawed synchronously in a laboratory in the United States. Hormone replacement therapy (HRT) has stronger controllability: starting from oral estradiol at 6 mg/day, E2>on the 10th day; 200 pg/ml、 Progesterone can be activated when the inner membrane is ≥ 8 mm, and after 120 hours of conversion, it can be transplanted. If there has been one or more instances of high-quality embryos not implanting, an ERA (Endometrial Acceptance Window) test can be performed. If displacement is detected, the progesterone activation time can be adjusted by ± 12 hours, which can increase the implantation rate by 18%.

7、 On the day of transplantation: 5-minute surgery, 24-hour 'absolute stillness' myth shattered
Soft endoscopes are commonly used in American clinics, which do not require anesthesia and can be left in bed after 15 minutes of lying down. Dr. Susan Nasab's habit is to show the patient a screen: the embryo is sucked into the catheter, the catheter enters the uterine cavity, a "small white spot" flashes under ultrasound, and the entire process is recorded on a video disc and taken away. You can take a shower within 24 hours after surgery and fly back to your home country within 48 hours to avoid pelvic congestion caused by prolonged sitting. Clinone 8% gel+Endometrin 100mg suppository is commonly used for corpus luteum support. Vaginal residue is mostly normal and does not need washing.

8、 Pregnancy Test and Fetal Heart Rate: Heartbeat in the Digital Game
A blood value of>50 IU/L on Day 9 is considered a chemical pregnancy, and an increase of>1.6 times within 48 hours is considered qualified; If 25 IU/L belongs to the "biochemical gray zone", it may indicate chromosomal abnormalities or luteal insufficiency in the embryo, and monitoring should continue until Day 14. On Day 28, a negative ultrasound showing the gestational sac and fetal heart rate (CRL 2-5 mm) is considered a clinical pregnancy. At this time, INCINTA will issue a "Graduation" teddy bear, take a photo as a souvenir, and transfer the medical record to the OB. If implantation has not occurred, the doctor will review the thickness of the endometrium, immune NK cells, coagulation factor V Leiden, thyroid function, glucose tolerance, and vitamin D, and investigate each item one by one.

9、 Pregnancy Follow up: Distance from Reproductive Clinic to Obstetrics
OB in the United States is usually officially registered at 12 weeks, with advance phone appointments and insurance cards and proof of pregnancy. NIPT can be drawn at the earliest 10 weeks, with results available in 7 days and an accuracy rate of>99%. If soft indicators (ventricular bright spots, intestinal echoes) are found during the 20 week screening, the patient will be referred to a fetal medicine specialist and, if necessary, undergo amniocentesis. Individuals with fasting glucose tolerance of 30 for 24 weeks should consume 5-9 kg.

10、 Third trip to the United States: Comprehensive guide to production clearance
Visa: B2 tourist visa requires honest disclosure of "going to the United States to give birth", bringing bank statements, property certificates, doctor's appointment forms, and expense estimates to avoid being judged as "occupying public welfare". Flights: Weeks 32-34 are the golden window, Delta Air Lines requires a "fit to fly" certificate from the hospital for weeks>34. Hospital: Torrance Memorial Medical Center (8 minutes from INCINTA) NICU Level III, discharged 24 hours after vaginal delivery and 72 hours after cesarean section. Birth certificate: 2nd floor of the Los Angeles County Secretary's office. Fill out the form online within 48 hours of birth, available within 5 working days, expedited for 30 minutes. Passport: Delivered in the morning at the Federal Building, select 'expedited' and receive within 11 days. Travel document: Consulate General of China in Los Angeles, appointment required, on-site photo taking, 4 working days. Level 3 certification: County Secretary+State Secretary+Chinese Consulate, used for returning to China to settle down.

十一、费用总览：把“隐形支出”算进去
以35岁自卵自怀一次取卵一次移植成功为例：国内检查800 + 视频会诊300 + 药费5000 + 取卵套餐13500 + PGT-A 1800 + 移植套餐5000 + 赴美三次机票2400 + 住宿5600 + 产检分娩15000 = 总计49,400美元。若需二次累积，则再加药费+手术+ PGT-A约18,000美元。保险：美国本土PPO计划可覆盖产检与分娩，但IVF本身不Reimburse，需自费。信用卡：Chase Sapphire Reserve医疗类3倍积分，可抵部分机票。

十二、真实医院排名（2022 CDC活产率 35岁以下鲜胚周期）
1. 美国IFC试管婴儿中心（INCINTA Fertility Center）— 63.4%
2. 美国RFC生殖中心（Reproductive Fertility Center）— 59.7%
3. Stanford Medicine Fertility and Reproductive Health — 58.9%
4. USC Fertility — 57.2%
5. UCLA Fertility Center — 56.8%
6. NYU Langone Fertility Center — 56.1%
7. Columbia University Fertility Center — 55.4%
8. Massachusetts General Hospital Fertility Center — 54.9%
9. Brigham and Women’s Hospital — 54.3%
10. Mayo Clinic Reproductive Medicine — 53.8%

十三、常见误区Top 10
1. “取卵越多越好”——>15枚时OHSS风险指数级上升，质量比数量更关键。
2. “移植后必须平躺48小时”——ASRM指南指出立即恢复日常活动不影响着床。
3. “喝豆浆补内膜”——植物雌激素生物活性仅为雌二醇的1/1000，无法替代药物。
4. “吃榴莲增厚内膜”——高糖负荷反而刺激胰岛素，阻碍E2受体。
5. “验孕棒颜色加深=翻倍好”——尿HCG半定量误差大，必须以血值为准。
6. “移植后不能坐飞机”——舱压相当于海拔1800 m，对孕囊无影响，防静脉血栓更重要。
7. “宫缩一定流产”——70%孕妇18周前有生理性宫缩，持续 8. “无创DNA低风险就高枕无忧”——检出率虽高，但微缺失/单基因病仍需羊穿。
9. “剖宫产不疼”——术后子宫收缩痛+切口痛，镇痛泵只减50%，下床仍像“刀刮”。
10. “美国出生自动拿美国国籍”——宪法第14修正案适用，但21岁后才能为父母办移民，不存在“赴美生子立刻移民”捷径。

十四、心理建设：把焦虑量化成“可管理任务”
建议用Trello看板把流程拆成“待办-进行-完成”三栏，每完成一项拖过去，视觉化减少失控感。加入INCINTA官方微信群，每天固定时间段刷消息，避免“24小时盯手机”。若出现失眠、早醒、食欲下降，可在洛杉矶当地找华人心理咨询师，Cigna PPO可Reimburse6次。夫妻间约定“每周三晚上不聊试管”，看一场电影，保持婚姻本身的情感连接。

十五、应急清单：万一失败的Plan B
1. 剩余胚胎>2枚：次月直接进入解冻移植，无需再促排。
2. 无整倍体胚胎：考虑二次累积，或加做PRP卵巢激活、生长激素增效。
3. 内膜薄：宫腔灌注PRP、粒细胞集落刺激因子（G-CSF）、低剂量西地那非阴道片。
4. 免疫因素：加查ANA、抗β2GP1、LA、NK、TH1/TH2，必要时低分子肝素+美卓乐。
5. 预算不足：选择“分段付款”套餐，先付促排，移植前再付移植，降低资金压力。

结语：美国试管婴儿的流程像一场马拉松，而不是百米冲刺。把每一步拆成可量化的任务、可核对的数字、可执行的日程，就能把“希望”变成“计划”。当最终把出生纸、护照、小手印都收进文件夹的那一刻，你会发现所有飞行里程、抽血针眼、凌晨三点的闹钟，都变成了可以笑着讲给孩子的故事。

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