What is the success rate of in vitro fertilization in the United States? Complete analysis of authoritative data

What is the success rate of in vitro fertilization in the United States? "- This is a question asked by almost all families preparing to go to the United States for assisted reproduction during their first consultation. The answer may seem like a percentage, but it affects all subsequent decisions: is it worth crossing the ocean? How many cycle budgets should be prepared? Which hospital should I choose? In fact, the "ART Success Rates Report" jointly released annually by the Centers for Disease Control and Prevention (CDC) and the National Surveillance System for Assisted Reproductive Technology (NASS) is regarded as the most authoritative and complete public database by peers worldwide. This article takes the latest complete annual report released in December 2022 (including the 2020 launch cycle) as the core, combined with the proceedings of the American Society for Reproductive Medicine (ASRM) 2023 conference and the peer review of the journal Fertility and Sterility, to dissect the calculation logic behind the "success rate", hospital differences, age thresholds, laboratory variables, and common misconceptions in cross-border medical treatment. It helps readers understand the official table within 10 minutes and establish their own "expected value model".

1、 How does CDC define 'success rate' - four common indicators

Open the CDC official website, and each hospital page will display four data items simultaneously: 1 Live Birth per Egg Retrieval; 2. Live Birth per Embryo Transfer rate per transplantation cycle; 3. Live Birth per Initiated Cycle; 4. Singleton Term Live Birth Rate. Their denominators are different, and the results can differ by nearly twice. For example, in a well-known center in 2020, the live birth rate of autologous test tubes under 35 years old was 63.4% per egg retrieval cycle, while the live birth rate per initiation cycle was only 55.1%. The difference comes from the cancellation of cycles (low ovarian response, premature ovulation, sudden endometrial abnormalities, etc.). Therefore, if you only receive a promotional flyer with a "success rate of 70%", ask the corresponding denominator first, otherwise it is easy to develop an overly optimistic attitude of "holding a baby for the first time".

2、 US Average: 2020 Fresh Cycle Statistics

In 2020, a total of 194358 cycles were initiated in the United States, including 132988 for fresh egg retrieval and 61370 for thawing transplantation. The overall data was affected by COVID-19, with a brief shutdown in March and April, but the completion rate for the whole year still reached 92%. The CDC divides age into five categories:<35, 35-37, 38-40, 41-42, and>42, with each category further distinguishing between autologous/allogeneic eggs and fresh/thawed eggs. The most relevant "autologous egg+fresh+singleton" curve for middle and high-income cross-border patients is as follows:

Interpretation: 1 The live birth rate decreases in a stepwise manner with age, with 38 years old being a clear watershed; 2. Under the age of 35, nearly half of women still need two egg retrieval attempts to hold their babies; 3. The rate of single full-term pregnancy is about 10 percentage points lower than the total live birth rate, which means that multiple pregnancies account for about 10%; 4. The average number of embryos transferred should be controlled between 1.2-1.8, reflecting the strict limitations of the ASRM guidelines in reducing the risk of multiple pregnancies in the United States.

3、 Thawing cycle: catching up with freshness

After the popularization of vitrification freezing technology, the survival rate of thawed embryos is ≥ 95%, and the endometrial preparation plan is more flexible. The thawing cycle accounted for 47.8% of the total number of transplants in 2020, and its live birth rate per transplant was better than that of fresh cycles in different age groups, with an average increase of 6-8 percentage points. There are two reasons: 1 After chromosome screening (PGT-A), only diploid embryos are implanted; 2. The synchronization between endometrial and embryonic development is better. For cross-border patients, if genetic testing is required or they need to wait for uterine surgery recovery, the "egg retrieval complete freezing subsequent thawing" plan has become mainstream.

4、 Laboratory technical dimensions: blastocyst culture PGT-A、Time-lapse

The CDC table does not directly disclose the "blastocyst rate", but ASRM will disclose in 2023 that the average blastocyst formation rate in the United States was 52.6% in 2020, with top centers reaching up to 70%. Embryo transfer increases the live birth rate of the<35 year old group to over 65%. The prevalence rate of PGT-A in women over 35 years old is 42%, and its detection rate of diploid embryos decreases with age: about 60% at 35 years old, 40% at 40 years old, and only 28% at 42 years old. Although Time lapse incubators have not been proven to independently increase live birth rates, they can reduce the number of embryo retrieval observations and improve laboratory efficiency. When choosing a hospital, you can check the "Laboratory Technology" section on the SART (Society for Reproductive Medicine) official website to confirm if the above configuration is available.

5、 Real hospital ranking list: 2020 CDC data (autologous eggs+fresh+<35 years old)

The following ranking is based on the live birth rate per egg retrieval cycle and only includes hospitals with an annual cycle of ≥ 100 and complete reports publicly available to the CDC to avoid "small sample outliers".

Note: The live birth rate does not necessarily mean success once, nor does it represent individual probability; The larger the number of cycles, the higher the statistical reliability. If the hospital does not appear on the CDC list or the number of cycles is less than 20, careful verification should be carried out.

6、 Five individual factors beyond age that affect success rate

1. Ovarian reserve: When AMH<1.0 ng/mL, even at the age of<35, the live birth rate per egg retrieval cycle will decrease to around 30%. 2. Uterine structure: Submucosal fibroids ≥ 4 cm, uterine septum, T-shaped uterus, and uncorrected intrauterine adhesions all significantly reduce implantation rate. 3. Hydrosalpinx: Fluid reflux can be toxic to embryos. After hysteroscopic ligation or resection, the live birth rate can be increased by 15-20 percentage points. When the sperm DNA fragmentation index (DFI) exceeds 30%, the rate of high-quality blastocysts decreases and the risk of miscarriage increases. 5. Basic diseases: uncontrolled diabetes, thyroid dysfunction, and positive autoantibodies may interfere with placental formation. Before cross-border patients go to the United States, it is recommended to complete the above assessment in China and undergo surgery or medication intervention if necessary to reduce their stay time and expenses in the United States.

7、 Common misconceptions in cross-border medical treatment

误区1：只看活产率，忽视取消率。有的中心为维持“高数字”，对卵巢反应差的患者提前取消周期，导致“分母变小”。应同时查看“每启动周期活产率”。误区2：把PGT-A当“万能钥匙”。PGT-A仅能筛查染色体数目，不能检测单基因病，也不能改善胚胎质量本身；若本身囊胚少，可能出现“无胚可检”窘境。误区3：认为美国没有法律风险。各州对胚胎处置、剩余胚胎归属、配子使用范围规定不一，签署合同时要明确冷冻保存年限、续费标准、弃置方式。误区4：忽略实验室质控。美国CAP/CLIA每年对实验室进行盲样抽检，但仍有小机构因人员流动出现波动。可在SART官网查询该实验室历年“胚胎师持续教育小时数”。误区5：把“最高成功率”当成“我的成功率”。个体化预测应使用SART Patient Predictor（免费在线工具），输入年龄、AMH、BMI、既往周期数、是否使用ICSI等十余项参数，系统会给出5档概率区间，比单纯看榜单更贴近现实。

八、如何建立个人期望值模型

步骤1：取得自身关键指标——年龄、AMH、AFC（基础窦卵泡数）、BMI、子宫评估、精子DFI。步骤2：在SART Predictor输入数据，记录“单胎足月活产率”基准值X。步骤3：根据拟选医院与CDC差距进行修正：若该院同年龄组平均活产率高于全美平均10%，则个人概率可上调5–7%；若低于平均，则下调。步骤4：考虑胚胎检测因素——若计划做PGT-A，且囊胚数≥5，可将最终概率再上调3–5%。步骤5：按“累积”思维计算：35岁女性单周期活产率55%，两次累积达80%，三次达90%。把预算、身体承受度、心理阈值一并纳入，决定预备几枚周期。

九、费用与成功率之间的边际效应

美国单周期自体试管平均费用12,000–14,000美元，不含药费。药费因卵巢反应差异，2,500–6,000美元不等。PGT-A按胚胎数计费，5–7枚约5,500美元。若首次移植未成功，第二次解冻移植约4,000美元。以35岁、单周期活产率55%为例，预期抱婴成本=（14,000+4,000）/0.55≈32,700美元；若需两次取卵，则成本升至约50,000美元。与成功率对应的“边际增益”在顶级中心体现明显：当活产率从55%提升到65%，同样50,000美元预算，累积成功率从90%提升到96%，可减少患者心理与时间折损。对38岁以上女性，差距更显著，故高年龄组家庭在预算允许时，倾向选择实验室技术更前沿的机构。

十、2024展望：技术迭代与数据透明化

1. AI胚胎评估：2023年多中心随机对照试验显示，深度学习模型对囊胚着床预测AUC达0.93，比传统形态学评分提升8%，预期2024年进入商用。2. 无创PGT-A：通过胚胎培养液游离DNA检测染色体倍性，避免活检对胚胎的潜在损伤，已有三项前瞻性试验注册，2024年底或公布初步结果。3. 子宫内膜 receptivity 基因谱（ERA）大规模再评估：ASRM正牵头万人队列，验证ERA对首次移植患者是否真正提高活产率，结果将改写临床指南。4. CDC数据公布提速：原计划滞后2年的报告，拟缩短至1年，2025年春季即可查询2022全年数据，降低患者信息滞后。5. 远程监测：美国FDA已批准多款家用激素微针贴片，跨境患者可将药代数据实时上传，美国医师在线调整剂量，减少在美停留3–5天。

conclusion

“美国试管婴儿成功率”不是一个简单数字，而是一条由年龄、卵巢储备、子宫环境、实验室水平、胚胎检测策略与个人预算共同绘制的概率曲线。CDC与SART的公开报表为这条曲线提供了迄今为止最可靠的坐标系，但坐标系无法替代理性判断。学会在官方数据与个体化预测工具之间来回校验，才能将“群体概率”翻译成“个人期望”，避免被营销话术带偏。赴美之路并不轻松，但当您能用专业视角拆解数字、用科学模型管理预期，就已经把最大的不确定性变成了可评估、可承受、可调整的风险。愿每一位读者都能在数据光照亮的轨道上，做出最适合自己的决策。

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