ICMART 2017 reports that the top three countries in the world for total ART (total number of in vitro fertilization) out of 79 countries are China, Japan, and the United States.

1) A high ART total represents a clinically experienced physician with a lot of trial and error, and does not necessarily mean that the country or clinic has a high live birth rate;

2) Conversely, with a low ART total, most people would probably not believe it if they said that the country or clinic had a high live birth rate. It’s like the same thing: a few people participating and then rating it as good is not enough to convince everyone; it’s only really good if more people participate and the vast majority of people think it’s good.

Therefore, both the high number of participants (high total number of ART) and the high rate of live births (high percentage of ART that results in a healthy child) are very much a test of a country’s overall health care and the skills of all its doctors.

So, let’s explore the reasons for the high live birth rate of IVF in the United States, using only the three countries with high ART totals as examples.

Note: ICMART is an independent, non-profit organization that plays a leading role in the development, collection and distribution of accurate and comprehensive global assisted reproductive technology (ART) data.

1. Male-induced infertility is valued and addressed in the United States.

ICMART reports that the rate of using intracytoplasmic monosperm injection ICSI technique is 79.2% in North America, 62.1% in Asia, and only 29.2% in China, which means that a lot of male-caused infertility goes unaddressed in China. In fact, male factor causes a very large proportion of infertility:

(1) Data from the Chinese Society of Reproductive Medicine (CSRM) showed that in 2019, infertility factors were mainly tubal (49.47 %）、男性因素（36.62% ) and both sides (21.02%), followed by ovarian hypoplasia (13.58 %）、排卵障碍（11.60% ), endometriosis (6.57 %）、不明原因（6.43% );

(2) Infertility factors reported by the CDC 2019 were mainly decreased ovarian reserve function (28.6 %）、男性因素（27.5% ).

The above two sets of data show that male infertility occupies a large factor among the causes of infertility, and most clinics and doctors rarely mention it. The United States defaults to the ICSI technique of intracytoplasmic sperm injection, which cleans sperms in vitro and then selects active sperms for injection and fertilization, which can greatly increase the potential for embryo development.

2. Third-generation IVF (PGT) technology, which is doubly valued in the United States.

1) The application of PGT technology is limited in Japan and China.

As of the end of 2019, there were 517 medical institutions approved to carry out assisted human reproduction technology in China, and 70 medical institutions approved to carry out PGT technology, accounting for only 13.5% of the total number of assisted reproduction institutions in the country, according to a report by the Chinese Center for Disease Control and Prevention in 2021-02.

In Japan, PGT technology is only allowed in some clinics or when there are special requirements; in Thailand, some clinics only check a few pairs of chromosomes (humans have 23 pairs of chromosomes) for PGT in order to give women transferable embryos. In the U.S., on the other hand, 100% of PGT techniques are allowed (see “Blastocysts or PGT, Which is More Important” for a detailed description of the techniques).

2) Let’s look at demand again: data proves that 50-70% of miscarriages are the result of a chromosomal imbalance (too few or too many chromosomes) in the embryo.

When there is an imbalance in the number of chromosomes in the embryo, it can lead to non-attachment, spontaneous abortion, fetal arrest, and genetic disorders (e.g., many chromosomal abnormalities such as chromosome 8, 13, 22, etc., can lead to fetal arrest or miscarriage; chromosomal abnormality of chromosome 12 can lead to short stature, cleft palate, and deafness; and chromosomal abnormality of chromosome 21, Down’s Syndrome, affects mental and physical developmental delays, and other genetic disorders).

In the U.S., selecting more active sperm for fertilization through 2nd generation intracytoplasmic single sperm injection ICSI, then culturing them into day 5-7 blastocysts with more developmental potential, followed by sending them to a genetic testing company for PGT testing, which will result in transfer failure, failure to develop to live birth, and elimination of embryos with congenital familial genetic disorders, and selection of healthy embryos for transfer, can dramatically increase the live birth rate ( First-degree blastocysts that have undergone PGT-A usually have a live birth rate of 70% and above).

3. The United States has the highest rate of live births in a single egg retrieval (24%), double that of other countries.

We have often heard two schools of thought: one says that China has a high success rate, and the other says that the United States has a high success rate, in the end, which one is higher? Let’s analyze it systematically.

The following data were obtained from, respectively, the National Health Commission of China on December 13, 2022, 2020 data from the Japanese Society of Obstetrics and Gynecology, and 2020 data from the CDC of the Centers for Disease Control and Prevention in the United States.

At first glance, China has the highest live birth rate: 30% in China >24% in the United States >13% in Japan. In fact, according to the 2018 Annual Assisted Reproductive Technology Data Report of the Reproductive Medicine Branch of the Chinese Medical Association, the proportion of two embryo transfers in China is still more than 50%, while the rate of multiple pregnancies from fresh embryo transfers has increased. If you put aside the factor of live birth rate due to multiple embryo transfer, the United States has the highest live birth rate for single egg retrieval!

So, some may ask: Why does the US recommend transferring only 1 embryo? Because of the mature technology in the U.S., and the PGT-A first-degree blastocyst transfer live birth rate is 70% and above, without the need to transfer more than one to increase the risk of the woman (such as fetal decompensation, cesarean section recovery time is long, bleeding in labor, pregnancy complications, low weight babies, unable to full-term, and even preterm birth, etc.); and, since 2008, many countries around the world have developed the “single embryo transfer” regulations, this point in the United States patients know very well. Patients in the United States know this very well, most clinicians only allow the transfer of a single healthy blastocyst that has passed PGT-A; in China, only 13.5% of clinics offer PGT, and because of the low live birth rate, multiple embryo transfers are the only way to increase the live birth rate in most cases.

When would the US transfer multiple embryos? In the vast majority of cases it will not! When a patient has gone through multiple IVF attempts and finds that the embryos are not able to latch on, have recurrent miscarriages, and the day 3 embryos do not develop properly to blastocysts (embryos with insufficient developmental potential) or multiple PGT-A failures. It is usually recommended to change the protocol of ovulation promotion first (ultra-long protocol, long protocol, short protocol, antagonist, micro-promoter, luteal promoter, micro-promoter, enhanced micro-promoter, natural cycle, etc.), and as long as you find the right protocol of ovulation promotion and the best doctors in the field, you can get pregnant and give birth under normal circumstances. Transferring multiple day 3 embryos is only an option when there are very few older eggs or when multiple attempts at sac retention have failed, but this is rare.

Why are fresh embryos or fresh sacs rarely transferred in the United States? During ovulation, women are injected with medications, and the residue of these medications can affect the thickness of the uterine lining and the body’s hormones, which can affect the embryo’s ability to latch on; at the same time, a large amount of data proves that the success rate of transferring frozen embryos is far greater than that of fresh embryos.

Therefore, considering the distance reason, we often suggest that young people can choose TOP clinics that carry out PGT-A technology in mainland China or try in Hong Kong; older people, they can choose Japanese microstimulation for ovulation. But in either case, the United States is still preferred when financial conditions and time allow, which is why IVF in the United States continues to be hot.

4. The live birth rate of single-fetus transplantation in the United States is as high as 70%.

In IVF in the United States, if you need to transfer, first of all, you need to have healthy blastocysts, to get healthy blastocysts need to go through egg retrieval, egg maturation, fertilization, raising the third day embryo, the fifth day blastocysts, and then sent to the PGT test to pass, and so on, layer by layer, screening, and then selecting the healthy blastocysts to transfer, the rate of live births is naturally much higher.

For example, a mother of 32 years old with 18 basal follicles, 28 eggs were retrieved after ovulation, 19 matured, 15 were fertilized, 9 blastocysts were retrieved, and finally 8 blastocysts passed PGT-A, and all of these 8 blastocysts were first class with a live birth rate of 70% and above, so it is hard not to get pregnant. Therefore, in the United States, the live birth rate is not the primary issue, the primary issue is to find the right doctor to promote ovulation program, to promote more high-quality eggs, and to cultivate more high-quality and PGT-A blastocysts.

5, the United States not only all-age single egg retrieval live birth rate is the highest, older patients single egg retrieval live birth rate is also very high.

The above data were obtained from the Japanese Society of Obstetrics, Gynecology and Reproduction and the CDC in the U.S. The data show that: the rate of live births with their own eggs is higher in older patients in the U.S. than in Japan (Note: Japan, as the originator of the older age-friendly Ovulation Program <Micropropagation Ovulation >, has played a great role in leading the way in the individual segments of the Ovulation Program.

6, America’s top fertility doctors, and doctors who allocate the most time to their patients.

In addition to having the world’s top medical school educational resources in the U.S. (e.g., Johns Hopkins, Harvard, Yale, etc.), fertility doctors require multiple medical technology certifications in gynecology, endocrinology, etc. Some of our doctors, even, have certifications related to embryology.

At the same time, American doctors allocate more time to each patient. Taking the following official data as an example, assuming that 1 cycle represents one patient, American doctors are 2.5 times more likely than Chinese doctors to allocate time to a single patient, and have more time to focus on the individual patient’s situation, to research and to provide better treatments.

7, the U.S. legal egg freezing, surrogacy, egg and sperm sales, and protected by law, which is very friendly to many difficult families, career women, enjoying life for the time being do not consider having children, same-sex families.

Therefore, in summary, the overall level of IVF live birth rate is highest in the U.S. If financial income and time allow, the U.S. is preferred;

If you can’t go to the United States, you can choose a doctor in Japan or Hong Kong who has excellent treatment results.