My 90 Days at an IVF Hospital in the United States: Complete Record from Initial Diagnosis to Embryo Implantation

I am writing this long article to record the complete 90 days of IVF in the United States in an objective, detailed, and warm manner. There are no ups and downs in the plot, nor is there a myth of "one shot is enough", only the real rhythm of daily blood draws, ultrasound, injections, waiting, and waiting again. I hope to provide a "comparable" reference for those who are hesitating, preparing, and on the road, as well as a souvenir for myself to look back on in the future.

1、 Preparation before departure: Break down anxiety into a list

Before deciding to go to the United States, my husband and I spent three months doing homework: hospital rankings, laboratory qualifications, doctor backgrounds, medication plans, accommodation and transportation, insurance laws... information explosion, but no one told you "what to do first". Later on, we created a 'reverse timeline' for ourselves, starting from 'when do we want to transplant' and finally piecing together the fragments into a path.

Reminder: When entering the country, it is best to keep the original packaging and a copy of the prescription for drugs. Liquid drugs (such as progesterone oil) should be placed separately in transparent bags and declared voluntarily. We will go through LAX Customs in Los Angeles, which takes less than ten minutes.

2、 Hospital selection: Breaking down 'success rate' into visible data

Both the CDC and SART official websites in the United States disclose the number of cycles, live birth rate, singleton rate, and multiple pregnancy rate, but behind the numbers are "hidden parameters" such as laboratory size, average years of embryologists, PGT testing platform, and whether there is an independent operating room. We ultimately identified two on-site visits: INCINTA (IFC IVF Center in the United States) and RFC (RFC Reproductive Center in the United States).

On the day of the on-site visit, INCINTA's embryo room was viewed through glass, with three incubators arranged in a "cross" shape, labeled with different colors to distinguish patient codes, and all petri dishes covered with double-layer independent grooves. Dr. James P. Lin turned the computer screen around and showed us the photos of the newly examined blastocyst, explaining the degree of expansion, density of inner cell clusters, and arrangement of the trophoblast layer one by one. At that moment, the abstract success rate suddenly took shape.

3、 Initial diagnosis: Quantify the body in one hour

On March 11th at 7:30 am, we arrived at 21545 Hawthorne Blvd Pavilion B as scheduled. Please provide a "Cycle Day 1" wristband at the front desk, draw 8 tubes of blood, and check six hormone levels AMH、 Thyroid function, coagulation, and infection. The ultrasound room adopts a "dual authentication" mode: the doctor personally performs the procedure, and the embryologist synchronously records the number of basal follicles to avoid secondary probe stimulation.

During the face-to-face consultation, Dr. Lin used a marker to draw three curves on the whiteboard: follicle growth slope, estrogen rise slope, and LH surge threshold. He said, 'Your values are not extreme. A standard rectangular plan is sufficient. Take 12-15 pieces as the target, wait until the 5th/6th day, send for PGT-A testing, and then choose one whole polyploid implant.'. ”Frame the next 30 days into traceable coordinates in one sentence.

4、 Boosting Diary: Beating the Stomach into a Honeycomb is also a Romance

On the first day of promoting ovulation, the nurse taught the rotation method to knead the stomach to avoid local hardening of the oil. I have set myself the "three fixed": a fixed time of 8 pm, a fixed position in the upper left quadrant, and a fixed order of starting with Gonafen and ending with Menopur. On the 5th day, upon returning to the hospital, the largest follicle in the right ovary was 11 mm, while in the left ovary it was 10 mm. The estrogen level was 412 pg/mL. Dr. Lin reduced the dosage from 225 IU to 187.5 IU, "allowing the follicles to grow uniformly and avoiding speeding.

36 hours after the night needle, the egg retrieval surgery is scheduled for 7:00 am in the morning. Before the general anesthesia, the anesthesiologist asked me to count "10, 9, 8..." until it reached 5, and the piece was broken. Waking up in the recovery room, the nurse handed over a small card: 14 eggs, including 12 MII. At that time, the husband was also completing sperm extraction next door. The laboratory conducted IMSI on the spot and enlarged it by 6300 times to select the most agile sperm.

5、 48 hours in the laboratory: egg → embryo → blastocyst

At 9:30 am on Day 1, the embryologist called: 12 embryos were successfully fertilized (2PN). On Day 3 follow-up, 7 cells split into 8A, 3 cells split into 7B, and 2 cells split into 6C. The laboratory adopts the "continuous cultivation method" without changing dishes to reduce temperature fluctuations. On the morning of Day 5, Dr. Lin sent an email stating that a total of 7 blastocysts were developed, including 4AA2, 4AB2, and 3B3; Biopsy 3-5 trophoblast cells and send PGT-A.

During the 7-day wait for the test results, we treated Los Angeles as a tourist attraction: Disneyland, Getty Center, and Highway 1. However, we searched for Wi Fi at each location to avoid missing the lab call. At 3pm on the 8th day, the report arrived: 4 out of 7 were diploid, with a male to female ratio of 2:2 (the United States allows disclosure of embryonic genetic sex). We have decided to transplant one 4AA grade first and freeze the remaining three.

6、 Endometrial regulation: turning the uterus into a "velvet runway"

My endometrium can only reach a maximum thickness of 7.2 mm in domestic natural cycles, and the echo is uneven. Dr. Lin proposed a plan of "increasing estrogen+long-acting progesterone conversion": starting from the second day after egg retrieval, the dose of Jiale will be supplemented every three days, and on the tenth day, 25 μ g of vaginal sildenafil will be added every night to improve blood flow. On the 12th day, B-ultrasound showed clear three lines of endometrium with a thickness of 8.6 mm and a blood flow rating of A.

At the beginning of Progesterone Day 0, 1 mL of progesterone oil and 90 mg of vaginal gel were injected intramuscularly every day, accurate to the time window of "120 hours before transplantation". The nurse used a purple marker to draw small circles on her belly, reminding her to change sides daily to avoid hardening.

7、 On the day of transplantation: 10 minutes, insert the 'possibility' into the uterus

On May 8th at 7:40, Enya's "Only Time" was played in the transplant room, with the lighting set to 2700 K warm yellow. The bladder is filled with 500 mL, and under ultrasound, the endometrium shows a high vocal fold. The embryologist first performs a "simulated trajectory" of the catheter to confirm that the path is not bent; Subsequently, the Cook catheter loaded with embryos was gently inserted along the cervical canal and stopped at a distance of 1 cm from the uterine floor. The entire process lasted for about 30 seconds. The small white dots on the screen flickered, like shooting stars falling on the screen. Dr. Lin said, "Welcome home." At that moment, my nose suddenly became sour.

After lying flat for 30 minutes, the nurse brought the "progesterone small gift package": continued oil+gel, plus 0.2 mL of daily low molecular weight heparin (because my D-dimer is too high). Before leaving the hospital, the front desk presented a "Good Luck" card filled with words in different languages that read "Wishing you a happy pregnancy".

8、 Waiting for 14 days: Set heartbeat to silent mode

For the first 3 days after transplantation, I strictly stayed in bed, but every day I got out of bed and walked slowly for 10 minutes to prevent blood clots. Starting from the fourth day, return to a normal routine, but avoid lifting heavy objects, taking baths, and staying up late. On the early morning of the 7th day, I secretly took early pregnancy test strips and whiteboards; On the 9th day, the whiteboard remained blank. My husband forbade me from taking another test, 'Don't let urine ketones skyrocket.'.

At 4am on the 10th day, I dreamed of a small blue fish swimming into my arms. When I woke up, I couldn't help but test it again, with a faint pink mark. At that moment, I dared not shout, so I stuffed the test paper into the drawer and continued to sleep. On the 12th day, blood was drawn with HCG 147 mIU/mL and Progesterone 28 ng/mL. Dr. Lin's email only had two words: Nice!

9、 Cost List: Break down "sky high prices" into visible receipts

Over the course of 90 days, the total cost is approximately $24300, including $18700 for medical expenses and $5600 for accommodation, transportation, and meals. The maximum variables are the dosage and number of PGTs, while the rest are mostly transparent.

If the first attempt fails, the subsequent thawing and transplantation will only cost about $4000 (including medication, surgery, and monitoring), which is 70% cheaper than re promoting ovulation.

10、 Psychological construction: wrapping the "glass heart" in a sponge

Before going to the United States, I joined several groups and browsed through posts about "implantation symptoms" and "how many days were detected" every day. The more I read, the more anxious I became. Later, I withdrew from the group and only recorded three things every day: weight, body temperature, and mood, with scores ranging from 1 to 10. I found that the body temperature curve is more honest than forum posts, and the day with the lowest mood score is often because I spent too much time on my phone.

INCINTA has a dedicated psychologist who charges $120 for 30 minutes. I have made two appointments. She taught me a "5-4-3-2-1" landing technique: say 5 objects you can see, 4 things you can touch, 3 sounds you can hear, 2 smells you can smell, and 1 smell you can taste. The anxiety level drops from 8 to 4 in just 90 seconds.

11、 Companion: Those who are also waiting for their health in the hallway

The waiting area is like a mini United Nations: Claire from Shanghai doing trade, Anna from Beijing doing venture capital, Lily from Shenzhen doing industrial design, and Roy from Taiwan flying in from Melbourne. Everyone doesn't know each other, but they can exchange three lines of resumes in 10 minutes, including "which hospital, what plan, and how many times". Roy said that men also need to get growth hormone injections, and if their bellies are full of bruises, they should 'just go fat with their wives'.

After the transplant, in the hallway, everyone tacitly lowered their voices, as if guarding a fragile item together. A Tianjin elder sister shared her homemade five spice quail eggs with me, saying, 'Tonifying protein without bloating the stomach.'. At that moment, language, nationality, and occupation all retreated to the background, leaving only the mutual understanding in the same trench.

12、 Eight small suggestions for future generations

1. Completing hysteroscopy, fallopian tube, immune, and coagulation tests in advance in China and bringing an English report to the United States can save a $700 repeat examination.
2. Medications that promote ovulation can be purchased at pharmacies in the United States, but obtaining a doctor's prescription in advance can result in a price difference of $300-400 compared to Costco, CVS, and Integrity.
3. The morning and evening rush hour in Los Angeles is terrifying, with a scheduled blood draw at 7:30 and leaving at 6:00; Living in Torrance or Costa Mesa saves one hour compared to living in downtown.
4. Priority should be given to homestays with kitchens. Progesterone oil should be refrigerated, and light meals in the morning and evening can be cooked by oneself to reduce high salt consumption when eating out.
5. Record medication, dosage, and location daily, take photos for backup, and in case of missed injections, the nurse can provide remote guidance for needle replacement.
6. After transplantation, there is no need to stay in bed all the time. Poor pelvic blood flow can actually reduce the success rate. Get up and walk slowly for 3-5 minutes every hour.
7. Buy a foldable luggage scale in advance. Adding ice cubes to medication when returning to China may cause overweight, and on-site payment is 40% more expensive than online payment.
8. On the day of blood draw, wear loose sleeves to promote blood vessel greening in the later stage. You can bring a warm baby patch to the forearm to dilate the veins.

13、 Epilogue: Write the endpoint as a new starting point

On the 14th day of re examination, HCG doubled to 1380, and B-ultrasound showed a 5mm gestational sac without fetal heart rate. Dr. Lin said, "The data is good. Continue taking the medication and come back in a week." I know that the story is not over yet, and there are still unknowns ahead, but in the past 90 days, I have achieved the best in every controllable aspect: from injecting at a fixed time every day to accurately cutting sildenafil into half pieces to milligrams; From recording every B-ultrasound image to drawing one's own estrogen curve using Excel.

IVF does not guarantee success, but it can break down the "letting fate take its course" into countless verifiable small steps. When medicine puts probability in front of you, the only thing you can do is to respond with 100% seriousness in every one percent. May all of you who are reading this text also find your own conviction and tenderness in the next injection, next ultrasound, and next wait.

——Recorded on the return flight to Los Angeles at an altitude of 38000 feet

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