China IVF Experience Sharing: Complete Process and Key Points from Initial Diagnosis to Embryo Transfer

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👨‍⚕️ Author: Clinician at Reproductive Medicine Center
Based on frontline experience in daily outpatient clinics and operating rooms, this knowledge base content has been compiled for friends who are planning or undergoing IVF treatment.

"Doctor, I am 39 years old, my AMH is only 0.8, and I have had two failed ovarian stimulations before. Do I still have a chance to do IVF?"

Such consultations are encountered almost daily in the reproductive clinic. Advanced age and diminished ovarian reserve are realistic dilemmas faced by many people undergoing IVF. Before answering such questions, it is necessary to clarify the complete process of IVF in China, the key milestones, and the details easily overlooked at each stage. Only by understanding the overall picture can one make a reasonable judgment about their own situation.

Module A: Direct Answer to the Question

1. Can a 39-year-old with AMH 0.8 still do IVF? – Direct Answer

Yes, but a targeted strategy is needed. An AMH of 0.8 ng/mL falls into the category of diminished ovarian reserve (DOR), but it does not mean there are no follicles. Clinical data shows that women with AMH between 0.5–1.0 can still obtain 1–4 mature eggs with an appropriate stimulation protocol. The keys are: ① Choose a mild stimulation or gentle stimulation protocol; ② Combine embryo culture with PGT-A screening; ③ Manage expectations reasonably.

For a 39-year-old woman, the live birth rate per single egg retrieval is about 8–15% (depending on the embryo's chromosomal normality rate). After accumulating 2–3 egg retrieval cycles, the live birth rate can increase to 25–35%. Therefore, it's not a question of "can it be done," but "how to do it."

Module B: Why This Problem Occurs

2. Why Age and AMH are Key to IVF Success or Failure

At birth, a female's ovaries contain about 1–2 million primordial follicles. By puberty, this number decreases to about 300,000–400,000. After age 37, the number of follicles declines rapidly, entering a depletion phase after age 42. AMH (Anti-Müllerian Hormone) is secreted by preantral and small antral follicles and is currently the most stable serum marker for assessing ovarian reserve.

• AMH > 1.1 ng/mL: Normal reserve, conventional long protocol or antagonist protocol can be used.
• AMH 0.5–1.1 ng/mL: Diminished reserve, gentle stimulation or mild stimulation is recommended.
• AMH < 0.5 ng/mL: Severely diminished reserve, consider natural cycle or very low-dose stimulation.

Age also affects egg quality. After age 35, the rate of oocyte aneuploidy increases significantly. At age 39, about 55–65% of embryos have chromosomal number abnormalities, which is the main reason for IVF failure in advanced maternal age.

Module C: Doctor's Perspective

3. How Doctors Evaluate an "Advanced Age + Low AMH" Case

Before formulating a plan, a reproductive specialist will systematically assess the following indicators:

Assessment Dimension	Specific Tests	Clinical Significance
Ovarian Reserve	AMH, FSH, LH, E2, Antral Follicle Count (AFC)	Determine follicle quantity and response to stimulation medication
Egg Quality	Age, previous cycle embryo morphology/chromosomal results	Assess aneuploidy risk
Uterine Environment	Hysteroscopy, Endometrial Receptivity Analysis (ERA)	Rule out endometrial polyps, adhesions, chronic endometritis
Male Factor	Semen analysis, Sperm DNA Fragmentation Index (DFI)	Affects fertilization rate and embryo developmental potential
General Health	Thyroid function, Vitamin D, Blood glucose, Immune screening	Correcting metabolic abnormalities can improve outcomes

Based on the above results, the doctor will choose Clomiphene + low-dose stimulation or an antagonist protocol combined with growth hormone pretreatment, aiming to "obtain transferable euploid embryos while minimizing ovarian depletion."

Module D: Differences Across Age Groups

4. Strategic Differences in IVF for Different Age Groups

The age range of people undergoing IVF in China spans from 25 to over 45. The physiological characteristics and medical strategies differ significantly at each stage.

Age Group	Ovarian Reserve Characteristics	Recommended Strategy	Per-Cycle Live Birth Rate (Reference)
≤34 years	Adequate reserve, good egg quality	Conventional long protocol/antagonist, consider fresh embryo transfer	50–60%
35–37 years	Reserve begins to decline, aneuploidy rate ~35%	Antagonist protocol, PGT-A recommended	40–50%
38–40 years	Diminished reserve, aneuploidy rate ~55%	Gentle stimulation, cumulative cycles + PGT-A	25–35%
41–42 years	Severely diminished reserve, aneuploidy rate ~70%	Mild stimulation/natural cycle, PGT-A mandatory	10–18%
≥43 years	Extremely low reserve, almost no euploid embryos	Thorough evaluation needed, consider egg donation option	<5%

The above data is based on clinical annual reports from major domestic reproductive centers. Individual differences are significant and do not constitute a promise of personal success rate.

Module G: Most Easily Overlooked Details

5. Details Most Easily Overlooked in the IVF Process

Based on daily patient feedback and clinical observation, the following 6 details are often overlooked but directly impact cycle progress and outcomes.

• ① Semen reservation during stimulation. The male partner must be present to provide a semen sample on the day of egg retrieval. If the male partner has a highly mobile job or might be on a business trip on the retrieval day, it is advisable to freeze semen in advance as a backup.
• ② Timeliness of chromosome reports. Peripheral blood karyotype analysis (for both partners) usually takes 10–14 working days, and the report is valid long-term. However, if one partner has a chromosomal structural abnormality (e.g., balanced translocation), additional genetic counseling is needed, potentially involving PGT-SR, which can extend the process by 1–2 months.
• ③ Optimal timing for uterine cavity examination. Hysteroscopy should be completed before ovarian stimulation, not before embryo transfer. If endometrial polyps, adhesions, or chronic endometritis are found, they need to be treated before stimulation; otherwise, embryos may be wasted.
• ④ Individual differences in luteal phase support. Luteal phase support after transfer is not "one-size-fits-all." Individuals with a history of ovarian hyperstimulation syndrome (OHSS) risk or a tendency for thrombosis need adjustments in progesterone formulation (vaginal gel vs. injection) and dosage.
• ⑤ Communication points for embryo culture. Days 1, 3, 5, and 6 after egg retrieval are key days for embryo assessment. It is recommended that patients proactively ask the laboratory about embryo development, including cell number, fragmentation rate, and blastocyst expansion degree. Not all embryos can be cultured to blastocyst; understanding each step helps adjust expectations.
• ⑥ Management of psychological burden. Anxiety and sleep disorders during the IVF cycle can affect endometrial receptivity through cortisol. It is advisable to establish psychological support channels before stimulation starts, rather than waiting until after a failed transfer.

Module H: Most Common Pitfalls

6. The 5 Most Common Pitfalls

Module J: Timeline Planning

7. Complete IVF Timeline Planning in China

From the initial diagnosis to confirmation of pregnancy, a standard cycle typically takes 2.5–3.5 months. The following is a general timeline (excluding special tests or waiting cycles).

Stage	Main Activities	Time Required
Initial Visit & Filing	Both partners register, consultation, order tests, establish medical records	1–2 days (waiting for reports 10–14 days)
Pre-treatment Checks	Female: AMH, hormone panel, thyroid function, infectious diseases, karyotype, ultrasound Male: Semen analysis, infectious diseases, karyotype	2–3 weeks (some tests require appointments)
Protocol Determination	Doctor formulates stimulation protocol based on test results, signs informed consent	1–2 days
Ovarian Stimulation	Daily injections of stimulation medication, ultrasound + blood hormone tests every 2–3 days	10–14 days
Egg Retrieval Surgery	Transvaginal follicle aspiration under anesthesia, post-operative observation for 1–2 hours	1 day
Embryo Culture	In vitro fertilization, cleavage-stage culture, blastocyst culture (longer if PGT is needed)	3–6 days (PGT takes 10–14 days)
Embryo Transfer Surgery	Transvaginal transfer of 1–2 embryos, post-operative observation for 30 minutes	1 day
Luteal Phase Support	Use progesterone medication to support the endometrium, blood hCG test on day 12–14	12–14 days
Pregnancy Confirmation	Positive blood hCG → Ultrasound at day 28–35 to see fetal heartbeat confirming clinical pregnancy	7–14 days

If PGT-A (Preimplantation Genetic Testing for Aneuploidy) is chosen, trophectoderm biopsy and gene sequencing are needed after embryo culture, with results waiting approximately 12–16 days, followed by frozen embryo transfer. The entire cycle will be extended by 1.5–2 months.

Module M: Case Scenario Analysis

8. Analysis of Three Typical Scenarios

Scenario 1: 34 years old, AMH 2.3, Polycystic Ovary Syndrome (PCOS)

Situation: Irregular menstruation, ultrasound shows polycystic ovaries bilaterally, high AMH. Previous 3 ovulation induction cycles resulted in ovulation but no pregnancy.

Doctor's Analysis: PCOS patients have many follicles, but egg quality may be compromised due to metabolic abnormalities (insulin resistance, hyperandrogenism). It is recommended to first perform an oral glucose tolerance test and insulin release test. If abnormal, start Metformin for 3 months. The recommended IVF protocol is an antagonist protocol, with all embryos cultured to blastocyst + PGT-A to select euploid blastocysts for transfer. PCOS patients have a high risk of OHSS, so a GnRH agonist trigger and considering freezing all embryos are necessary.

Key Experience: The advantage for PCOS patients is a high number of retrieved eggs, but don't be misled by quantity; quality is key. Embryo culture and genetic screening can effectively improve the success rate per single transfer.

Scenario 2: 41 years old, AMH 0.6, 2 previous failed IVF transfers

Situation: Previous two stimulations yielded 4 and 3 eggs respectively, resulting in 2 and 1 cleavage-stage embryos, neither of which implanted after transfer.

Doctor's Analysis: At 41 with AMH 0.6, this indicates severely diminished reserve, with an egg aneuploidy rate of about 65–75%. PGT was not done in the previous two cycles, so the transferred embryos were likely chromosomally abnormal. It is recommended to switch to a mild stimulation protocol (Clomiphene + low-dose stimulation), aiming for 1–3 eggs per cycle. After accumulating 2–3 cycles, perform PGT-A on all formed blastocysts. It is estimated that 1 euploid blastocyst can be obtained every 2 cycles.

Key Experience: Individuals of advanced age with low reserve need to establish the concept of "cumulative cycles" and not expect a single egg retrieval to solve all problems. At the same time, supplementing with Coenzyme Q10 (600 mg/day), Vitamin D, and Melatonin is recommended to improve egg quality.

Scenario 3: 29 years old, male partner has severe oligoasthenospermia

Situation: Female partner's tests are completely normal. Male partner's semen analysis shows sperm concentration < 2×10⁶/mL, motility < 10%.

Doctor's Analysis: The male partner's sperm quantity and quality are extremely poor, requiring testicular sperm aspiration (TESA) combined with ICSI (Intracytoplasmic Sperm Injection). The female partner is young with good ovarian reserve, so a conventional long protocol can be used, followed by ICSI fertilization after egg retrieval. After culturing embryos to blastocyst, PGT-SR is recommended to check for chromosomal structural abnormalities (the carrier rate of chromosomal translocations in men with severe oligoasthenospermia is about 5–8%).

Key Experience: For infertility caused by male factors, as long as the female partner's ovarian function is normal, the IVF success rate is usually high (50–60%). However, it is essential to complete the male partner's genetic evaluation before starting stimulation to avoid passing chromosomal issues to the offspring.

Knowledge Graph Entity Coverage

9. Interpretation of Core IVF-Related Tests

• AMH
• FSH
• LH
• Antral Follicle Count
• Semen Analysis
• Chromosome Karyotype
• Hysteroscopy
• PGT-A
• PGT-SR
• ERA
• Luteal Phase Support

Indicator	Reference Range	Abnormal Indication
AMH	1.1–4.0 ng/mL (varies with age)	<1.1 indicates diminished reserve; <0.5 indicates severe deficiency
FSH (Basal)	3–10 IU/L	>10 indicates diminished ovarian reserve; >15 indicates poor response
LH (Basal)	2–9 IU/L	LH/FSH >2 may indicate PCOS
Antral Follicle Count (AFC)	5–10 (total for both ovaries)	<5 indicates diminished reserve; >12 may indicate PCOS
Sperm DNA Fragmentation Index (DFI)	<15%	>30% significantly affects pregnancy outcomes
Thyroid Stimulating Hormone (TSH)	0.5–2.5 mIU/L (for conception/IVF)

Long-tail Keywords Naturally Integrated

💡 Quick Index of Common Questions: How long does IVF take → 2.5–3.5 months Do I need to prepare before IVF → Yes, especially thyroid function, Vitamin D, weight management What preparation is needed for advanced age IVF → Comprehensive evaluation + psychological expectation + cumulative cycle planning Can I do overseas IVF with low AMH → Same strategy as domestic, needs individualized plan What documents are needed for IVF → Both partners' ID cards, marriage certificate, birth permit/registration

Ending: Doctor's Advice (Randomized)

This article is compiled based on clinical experience from the Reproductive Medicine Center and is not a substitute for personal medical advice. Please communicate fully with your attending physician regarding your specific plan.