IVF Process, Costs & Considerations at the First Affiliated Hospital of Kunming Medical University

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I. Department Overview & Technical Scope

The Reproductive Medicine Department of the First Affiliated Hospital of Kunming Medical University is one of the earliest institutions in Yunnan Province approved by the National Health Commission to provide human assisted reproductive technology. Currently, it offers conventional in vitro fertilization-embryo transfer (IVF-ET), intracytoplasmic sperm injection (ICSI), frozen-thawed embryo transfer (FET), assisted embryo hatching, sperm cryopreservation, and oocyte cryopreservation. The department includes a reproductive endocrinology clinic, an embryology laboratory, an andrology laboratory, and a genetic counseling clinic, providing a complete chain from infertility cause screening to embryo genetic testing.

II. Suitable Candidates & Contraindications

Indications for IVF/ICSI

• Tubal factor: Bilateral tubal blockage, severe adhesions, or post-salpingectomy.
• Male factor: Oligospermia, asthenospermia, teratospermia, or obstructive azoospermia (sperm can be obtained via testicular aspiration).
• Ovulation disorders: Polycystic ovary syndrome (PCOS) with no pregnancy after ovulation induction therapy.
• Endometriosis: Moderate to severe endometriosis causing infertility.
• Unexplained infertility: No pregnancy after other treatments.
• Genetic diseases: Need for preimplantation genetic testing (PGT) to avoid transmission of genetic disorders.

Contraindications or Conditions Requiring Cautious Evaluation

• Severely diminished ovarian function (small bilateral ovaries, AMH < 0.5 ng/mL, FSH > 20 IU/L), with difficulty obtaining eggs and extremely low pregnancy rate.
• Uncontrolled systemic diseases such as thyroid dysfunction, diabetes, or hypertension.
• Severe mental illness preventing cooperation with treatment.
• Severe uterine malformation or untreated intrauterine adhesions.
• Uncontrolled acute or chronic reproductive tract infections.

III. Detailed Process Explanation

Step 1: Pre-operative Examinations (About 1-2 Weeks)

Both partners must complete examinations simultaneously to confirm indications, rule out contraindications, and assess fertility potential.

Some test results have a validity period; infectious disease screening and chromosome karyotype are typically valid for six months to one year. Re-examination scheduling depends on the actual cycle timeline.

Step 2: File Creation & Protocol Formulation

After all test results are complete, the couple brings original and copies of their ID cards and marriage certificate to the hospital to create a file. The doctor formulates an individualized ovulation induction protocol based on the woman's age, ovarian reserve (AMH, AFC), medical history, and previous treatment response. Common protocols include: antagonist protocol, early follicular phase long protocol, short protocol, and mild stimulation protocol.

Step 3: Ovulation Induction (About 10-14 Days)

Starting from menstrual cycle days 2-4, gonadotropins (Gonal-f, Puregon, Lishenbao, etc.) are injected. Follicular development is monitored every 2-4 days (transvaginal ultrasound + sex hormones) to adjust medication dosage. When the leading follicle diameter reaches 18-22 mm, human chorionic gonadotropin (hCG) or a GnRH agonist is injected to trigger final oocyte maturation, and egg retrieval is scheduled 36 hours later.

Step 4: Egg Retrieval & Sperm Collection

Egg retrieval is performed under intravenous anesthesia, with transvaginal ultrasound-guided follicle aspiration, lasting about 15-20 minutes. The male partner provides a semen sample (by masturbation or surgical extraction) on the same day. The laboratory processes oocytes and sperm, choosing conventional IVF or ICSI for fertilization based on sperm parameters.

Step 5: In Vitro Fertilization & Embryo Culture

Pronuclei are observed 16-18 hours after insemination to confirm fertilization. Embryos are cultured in an incubator for 3-6 days. The transfer timing is chosen based on embryo morphological grading or blastocyst formation. If PGT is performed, 5-10 trophectoderm cells are biopsied at the blastocyst stage for genetic testing.

Step 6: Embryo Transfer

Transfer usually occurs on day 3 (cleavage stage) or day 5-6 (blastocyst) after egg retrieval. Endometrial thickness (optimal 7-14 mm) and morphology are assessed before transfer. The procedure is performed without anesthesia, with the embryo placed into the uterine cavity via the cervix. The patient rests for 30 minutes after the procedure and can then leave the hospital.

Step 7: Luteal Phase Support & Pregnancy Confirmation

Luteal phase support (progesterone injections, vaginal gel, or oral preparations) begins immediately after transfer and continues until 12-14 days post-transfer. A blood test for β-hCG confirms pregnancy. If pregnant, luteal support continues until 10-12 weeks of gestation; if not, menstruation occurs after stopping medication.

IV. Timeline & Cycle Planning

A complete fresh cycle from starting stimulation to pregnancy test takes about 1.5-2 months. For frozen embryo transfer, 1-2 cycles of rest are needed after egg retrieval, and transfer is performed when endometrial conditions are suitable.

V. Cost Breakdown & Influencing Factors

The cost for one IVF cycle at the First Affiliated Hospital of Kunming Medical University is typically between 30,000-50,000 RMB, varying based on the following factors:

• Ovulation induction protocol & medication: Imported gonadotropins (Gonal-f, Puregon) are more expensive than domestic urinary hormones, with total medication costs around 10,000-20,000 RMB.
• Fertilization method: ICSI (intracytoplasmic sperm injection) adds approximately 4,000-6,000 RMB compared to conventional IVF.
• Embryo culture duration: Blastocyst culture (day 5-6) incurs an additional culture fee.
• Frozen-thawed embryo transfer: If FET is needed, additional costs for embryo freezing and thawing/transfer apply (approximately 5,000-8,000 RMB).
• PGT genetic testing: Testing costs about 3,000-5,000 RMB per embryo, typically requiring testing of 5-8 embryos.

Costs do not include pre-operative examinations, consultation fees for both partners, or accommodation and transportation. It is recommended to consult the financial office of the Reproductive Medicine Department for the latest price list during the initial visit.

VI. Age-Related Differences & Strategies

Age is the most critical factor affecting success rates. Patients under 35 have a lower rate of embryonic chromosomal abnormalities and a higher blastocyst formation rate. For patients over 40, even if eggs are obtained, the rate of embryonic aneuploidy increases significantly; PGT-A screening before transfer should be considered.

VII. Most Easily Overlooked Details

• AMH testing timing: AMH is not affected by the menstrual cycle but must be completed within 3 months before ovulation induction.
• Sperm DNA fragmentation index: Normal routine semen analysis does not guarantee a normal DNA fragmentation index; a fragmentation index > 30% may affect fertilization and embryo development.
• Uterine cavity evaluation: Patients with repeated implantation failure must undergo hysteroscopy; about 30% have polyps, adhesions, or endometritis not detected by ultrasound.
• Vitamin D levels: Vitamin D deficiency is associated with infertility and miscarriage; testing and supplementation are recommended before attempting pregnancy.
• Weight management: Women with BMI > 28 require higher ovulation induction medication doses, have lower egg retrieval rates, and reduced embryo implantation rates. Losing more than 5% of body weight can improve outcomes.
• Male medication history: Certain antibiotics, antidepressants, and antihypertensives may affect sperm quality. All current medications must be disclosed to the doctor during the visit.

VIII. Frequently Asked Questions

Q1: Is hospitalization required for IVF?

The entire process is primarily outpatient-based. Egg retrieval is performed in a day surgery unit; patients can be discharged after 2-4 hours of observation if no abnormalities occur. Hospitalization is not required, but frequent hospital visits for monitoring are needed in the late stage of ovulation induction.

Q2: How long should I rest in bed after transfer?

Patients can get up and move around 30 minutes after transfer. Prolonged bed rest does not improve implantation rates and increases the risk of thrombosis. Normal daily activities are fine; avoid strenuous exercise.

Q3: How many transfers can be done from one egg retrieval?

If multiple high-quality embryos are formed, the remaining embryos can be cryopreserved. Frozen embryos from one retrieval can be thawed and transferred in separate cycles (usually 1-3 transfers, depending on the number and quality of embryos).

Q4: Can the sex of the baby be selected for IVF?

In mainland China, sex selection for non-medical reasons is prohibited. It is only permitted when one partner has a sex chromosome-linked genetic disease, allowing PGT technology to screen embryo sex to avoid transmitting the disease.

Q5: Is there any difference between IVF babies and naturally conceived babies?

Large-scale follow-up data show no significant difference in birth defect rates between IVF and natural pregnancies. However, the rate of multiple pregnancies is higher (about 20%-30%), which increases the risks of preterm birth and low birth weight. Single embryo transfer is an effective measure to reduce multiple pregnancy risks.

IX. Management of Special Situations

Poor Ovarian Response (POR)

Patients meeting Bologna criteria (age ≥ 40, AFC < 5, AMH < 0.5) typically yield ≤ 3 oocytes during stimulation. Options include mild stimulation protocols, natural cycles, or follicular wave stimulation. Ovarian follicle activation technology or egg donation may be considered if necessary.

Repeated Implantation Failure (RIF)

For patients who have not achieved pregnancy after ≥ 3 transfers of good-quality embryos, investigations should include: endometrial receptivity (ERA), chronic endometritis (CD138+), chromosomal abnormalities in the couple, embryonic aneuploidy, immune factors, and thrombophilia. Combined assessment with hysteroscopy + endometrial biopsy + PGT-A is recommended.

Male Azoospermia

Obstructive azoospermia can be treated with testicular or epididymal sperm aspiration for ICSI. Non-obstructive azoospermia requires microdissection testicular sperm extraction (micro-TESE), with a success rate of about 30%-50%. If no sperm is found, donor sperm or adoption are options.

X. Hospital Characteristics: Features of the First Affiliated Hospital of Kunming Medical University

• Public tertiary hospital background: As a large comprehensive tertiary hospital in Yunnan Province, it offers multidisciplinary consultation support (reproductive, genetic, endocrine, psychological, nutritional, etc.), suitable for infertility patients with other internal medical conditions.
• Embryology laboratory: Equipped with time-lapse imaging incubators (EmbryoScope) and laser-assisted hatching systems, allowing dynamic monitoring of embryo development and improving the accuracy of high-quality embryo selection.
• Genetic counseling clinic: Staffed with genetic counselors and a PGT technology platform, suitable for couples with a family history of genetic diseases or recurrent miscarriage.
• Clinic flow: Implements an appointment-based system to reduce on-site waiting times. The Reproductive Medicine Department has dedicated ultrasound and blood draw areas, so patients do not need to travel between different hospital buildings.

XI. Required Materials & Precautions

It is recommended to schedule a general or specialist appointment at the Reproductive Medicine Department for the initial visit. The doctor will assess and issue examination orders. All test results should be complete before scheduling file creation to avoid cycle delays due to missing items.

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