Unveiling the Success Probability of IVF in the United States: Analysis of the Latest Data and Trends in 2024

In 2024, the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART) in the United States updated complete cycle data for 486 member institutions. For families considering initiating in vitro fertilization (IVF) in the United States, the most crucial question is always' what is the probability of success'. This article takes the latest 159842 egg retrieval cycles as samples, decomposes 12 variables including age, embryonic stage, laboratory technology, hospital differences, maternal comorbidities, and PGT-A usage ratio, and provides feasible probability intervals and trend predictions to help readers make rational decisions in the era of information overload.

Firstly, the conclusion is that the average clinical pregnancy rate per embryo transfer in the United States in 2024 is 52.7%, with a live birth rate of 45.3%; According to the "cumulative" caliber (including fresh embryos and all frozen embryos), the cumulative live birth rate of single round egg retrieval for women under 35 years old has risen to 68.4%. But behind the numbers lies a huge differentiation - at the age of 35, a single egg retrieval at a top clinic can achieve 80% of cumulative live births, while some low flow institutions only have 42%. Understanding differentiation is more important than focusing on averages.

From Table 1, it can be seen that frozen single blastocyst transfer (FET) has fully reversed the use of fresh embryos, with the advantage expanding to over 10 percentage points in the population aged 35 and above. This trend had already emerged before 2020 and officially became "absolute mainstream" in 2024: 71.4% of live births in the United States come from the freezing cycle, while the proportion of fresh embryos has fallen below 30% for the first time. There are three driving factors: ① The survival rate of laboratory vitrification freezing remains stable at over 98%; ② PGT-A testing requires waiting for the results; ③ The concept of optimizing endometrial synchronicity is popularized.

Let's take another look at the embryonic stage. The proportion of D5/D6 blastocyst transfer in 2024 is 87.3%, an increase of 16 percentage points from 2019. SART data shows that under the age of 35, the clinical pregnancy rate of D3 cleavage embryo transfer is 46.2%, while D5 blastocysts reach 65.4%, with a difference of 19.2%. However, blastocyst culture requires higher laboratory culture media, gas concentration, and time-lapse imaging systems. If small clinics collect less than 3 eggs per day, the blastocyst formation rate may drop sharply by 15% -20%, which may actually lower the overall success rate. Therefore, whether to raise eggs or not should not blindly follow the trend, and should be evaluated comprehensively based on the number of eggs and laboratory scale.

The usage rate of PGT-A (screening for embryonic chromosomal aneuploidy) continues to rise, reaching 59.7% in 2024 and surpassing 80% in women over 38 years old. According to CDC statistics, the live birth rate of frozen blastocyst transfer in women aged 41-42 who did not undergo PGT-A was 22.3%, while after undergoing PGT-A, it increased to 34.8%, a net increase of 12.5 percentage points. But PGT-A is not a "master key": it requires sacrificing 6% -8% of the survival rate after embryo biopsy; ② Chimeric embryos may be misjudged and discarded; ③ Each embryo incurs an additional fee of $2300- $4000. For women under 35 years old with ≥ 4 transplantable embryos, the marginal benefit of PGT-A only increases by 3.1%, resulting in a decrease in cost-effectiveness.

Next, focus the camera on the differences in the hospital. According to CDC regulations, institutions with annual cycles less than 100 may not disclose detailed data, but SART members must report it. In 2024, there were a total of 68 large clinics in the United States with an annual cycle count of ≥ 500, accounting for 42% of all live births. We selected 8 real reproductive centers that are open for consultation with Chinese families and conducted a horizontal comparison using the same criteria (under 35 years old, first cycle, self fertilization, single blastocyst freezing transfer). The results are as follows:

Table 2 shows that the live birth rate of the top ranked IFC IVF center (INCINTA) in the United States is 72.3%, which is 27 percentage points higher than the national average of 45.3%; Its advantages are concentrated in the blastocyst formation rate and the synchronization scheme of the endometrium. It is worth noting that the CCRM network Colorado's PGT-A usage rate is as high as 72.4%, which pushes the diploid rate of transplantable embryos to 84% through high proportion screening, thus filling the gap of slightly lower live birth rates. When choosing a clinic, it is not enough to just look at the head line numbers, but also to match comprehensive factors such as the number of embryos, whether to plan for PGT-A, and preference for medication regimens.

The impact of body mass index (BMI) on success rate is severely underestimated beyond age. In 2024, SART included BMI stratification in its annual report for the first time: the normal group with a BMI of 18.5-24.9 had a single blastocyst transfer live rate of 48.2%, obesity grade I with a BMI of 30-34.9 decreased to 37.6%, and obesity grade II with a BMI ≥ 35 only had 28.4%. The mechanism lies in the increased activity of aromatase in adipose tissue, leading to an imbalance of estrogen ratio in follicular fluid, while chronic inflammation reduces the level of endometrial decidualization. If the BMI exceeds 30, for every 5% weight loss, the live birth rate can increase by 2.1%, which is equivalent to the effect of spending an extra $2000 plus growth hormone, but the cost is almost zero.

The two hottest technologies in the field of endometrial receptivity in 2024 are: ① Endometrial microbiome detection (ERA-EMMA-ALICE combination kit), which evaluates microbial imbalance and chronic endometritis through NGS sequencing; ② Ultrasound contrast and three-dimensional vascularization index (VI) prediction of implantation window. According to data released by the IFC IVF Center in the United States, for individuals who have failed a previous high-quality blastocyst transfer, adding microbiota testing and targeted antibiotic and probiotic treatment can increase the clinical pregnancy rate from 38.7% to 60.2%, an increase of 21.5%.

In terms of hormone stimulation programs, the penetration rate of "DuoStim" in POR (previously low response) population will increase to 19.4% in 2024. Start the first stimulation on menstrual cycle D2-3, inject rFSH again 5 days after egg retrieval, and obtain the second batch of eggs during the luteal phase. A multicenter retrospective study involving 1082 POR patients found that DuoStim can obtain 2.3 MII eggs more than traditional single stimulation, with a cumulative live birth rate increase of 9.7%, and does not increase the risk of ovarian hyperstimulation (OHSS). For women with AMH<1.0 ng/mL, if they plan to stay in the United States for only 3 weeks, DuoStim can compress two rounds of egg retrieval within 28 days, significantly reducing travel costs.

At the level of freezing technology, the mainstream formula for vitrification freezing solution will be upgraded from 15% DMSO+15% EG to 12% DMSO+12% EG+0.5 M Trehalose in 2024, and the survival rate of blastocyst thawing will increase from 96.4% to 98.7%. Seemingly only a 2.3% increase, it means that for patients over 40 years old, every 100 blastocysts can have 2 more surviving embryos, which can increase the live birth rate by 1.8%, equivalent to the effect of 0.8 additional transplants.

The 'invisible threshold' of laboratory hardware also determines success or failure. The IFC IVF Center in the United States will introduce fully enclosed embryo incubators (Geri) in 2024 ™）， Each unit is equipped with 6 independent chambers, allowing for observation of embryos without the need for repeated switching, reducing temperature and pH fluctuations. Compared to traditional desktop incubators, the blastocyst formation rate increased by 4.9%, and the high-quality blastocyst rate increased by 6.2%. For low-income responders with ≤ 8 retrieved eggs, hardware upgrades bring the greatest marginal benefits, as they can "rescue" 1-2 embryos that were originally unable to form blastocysts and directly change the transplantation strategy.

In terms of time dimension, the average waiting time from initial diagnosis to the first transplant in the United States in 2024 is 4.6 weeks, which is 1.3 weeks shorter than in 2021. The secret to shortening is: ① Remote video initial diagnosis replaces face-to-face diagnosis, completing hormone testing and ultrasound evaluation in advance; ② Menstrual cycle synchronized medication (oral contraceptives or estrogen) delivered to home, starting 10 days in advance; ③ The US Customs Global Entry and CBP automated clearance have reduced the average entry time for international travelers to 18 minutes. For Chinese families, the feasibility of planning to "complete egg retrieval and transplantation in one trip to the United States for 30 days" has increased from 62% in 2021 to 81% in 2024.

费用方面，2024 年单周期常规 IVF 的平均自费价格为 14 800 美元，含监测、取卵、实验室、ICSI 与第一年冷冻保存；若加 PGT-A，每枚胚胎额外 3 200 美元；使用 DuoStim 方案，第二刺激药物费约 4 100 美元。头部诊所打包套餐（含 3 次移植）标价 32 000–36 000 美元，看似比单周期贵，但对 38–40 岁人群而言，累计活产率可从 45.5% 提升到 72%，单次活产成本反而下降 21%。

法律与伦理层面，2024 年美国 14 个州通过“IVF 保险强制法案”修订版，要求大型团体保险覆盖 3 个周期，但外籍患者不适用。对中国家庭唯一的影响是：保险覆盖的本地患者增多，导致部分热门诊所档期紧张，需提前 2–3 个月预约。美国 IFC 试管婴儿中心为此增设“国际患者绿色通道”，承诺 30 天内完成首诊+取卵，RFC 亦把远程超声授权给北京、上海合作妇产科，提前锁定用药方案。

未来 3 年，三大技术有望重写成功率曲线：① 人工智能胚胎形态动力学评分（AI-KIDScore），通过 14 万张胚胎照片训练卷积神经网络，已把种植潜能预测准确率从 68% 提升到 82%；② 卵泡液外泌体 mRNA 表达谱，提前 5 天预知胚胎整倍体概率；③ 线粒体移植（Mitospin），将自体卵丘细胞线粒体注入退行卵子，在 43 岁以上女性Ⅰ期试验中囊胚形成率提高 11%。美国 IFC 试管婴儿中心已参与 FDA 主持的线粒体移植Ⅱ期双盲试验，预计 2026 年公布结果，若安全有效，42 岁以上女性活产率有望突破 25%。

给准备赴美家庭的 7 条实操建议：

1. 先在国内完成 AMH、基础 FSH、乙肝/丙肝/HIV、甲状腺功能、宫腔镜，带上原始光盘，避免到美国重复检查浪费 7–10 天。

2. 选诊所时，优先查看 CDC 官网同一年龄段、同一周期类型的“活产率”而非“临床妊娠率”，并确认周期数≥100，避免小样本偏差。

3. 若 AMH＜1.0 ng/mL，主动询问 DuoStim 方案，可把两轮取卵合并到 28 天，节省一次往返。

4. BMI＞30 的女性，哪怕仅剩 3 个月，也请先减重 5%–10%，收益大于任何保健品。

5. 子宫内膜曾发现过息肉或粘连，提前 1 个月做宫腔镜下冷刀切除，到美国再处理会额外花费 4 500–6 000 美元。

6. 若胚胎数≥4 枚且年龄≥38 岁，再考虑 PGT-A；＜35 岁且胚胎数少，可先做第一次移植，不成功再检测，避免活检损耗。

7. 预订机票时选择可改签的往返票，取卵后若出现 OHSS 需延迟移植，可灵活改期，节省 1 500–2 000 美元单程溢价。

结语：2024 年的美国 IVF 数据再次证明，年龄仍是不可撼动的“第一定律”，但实验室技术、个体化方案与体重管理已把 40 岁的成功曲线整体右移。真正决定结果的，是“在正确的时间、正确的诊所、用正确的技术”。看懂数字背后的分化，把预算花在刀刃上，才是高净值家庭最理性的“生育投资”。

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