更低价更温和的试管婴儿方案

With the number of babies born through in vitro fertilization at an all-time high, some doctors are trying an alternative that potentially could be less expensive and less taxing on a woman's body.

随着试管婴儿的数量创下历史最高纪录，部分医生开始尝试有可能花费更低、对女性身体的损害也较轻的替代方法。

Some fertility clinics are offering a gentler version of IVF that uses fewer, milder drugs and requires less frequent medical visits.

一些妇产医院推出了更温和的试管受孕方案，它采用的药物更少更温和，患者也可减少去看医生的次数。

Success rates aren't well established. The American Society for Reproductive Medicine says pregnancy rates from minimal-stimulation IVF are likely to be lower than with traditional IVF. Indeed, if the milder kind doesn't succeed and women return for additional cycles, the cost can quickly approach or exceed traditional IVF, some doctors say.

不过，该类方案的成功率还不确定。美国生殖医学协会(American Society for Reproductive Medicine，简称“ASRM”)称，微刺激试管受孕方案的妊娠率有可能低于传统方案的妊娠率。有些医生指出，假如温和方案没有成功，患者又重新开始新一轮治疗的话，其费用会很快接近甚或超过传统方案的花费。

For the first time, the organization that publishes clinics' success rates, the Society for Assisted Reproductive Technology says it will break out success rates for minimal-stimulation cycles in its 2017 statistics, which will be released in 2016. The odds of successfully having a baby after any form of IVF averaged about 37% per cycle in 2017. The odds vary by factors including a woman's age and the number of eggs retrieved.

各医院试管婴儿成功率的发布机构――美国辅助生殖技术协会(Society for Assisted Reproductive Technology)表示，该机构将在2017年的数据中首次公布微刺激方案的成功率。该数据将于2016年出炉。2017年，在接受任一类型试管受孕治疗后，患者每周期成功生育的平均几率约为37%。成功几率依受孕女性的年龄及取出的卵子数量等因素而有所变化。

Babies conceived using IVF made up 1.5% of all births in 2017, according to the ASRM. Those bundles of joy come at a cost -- an average of $12,400 per IVF cycle not including drugs that can add thousands more. Insurance coverage varies.

ASRM的数据显示，2017年试管婴儿数量占到新生儿总数的1.5%。这些新生命带来的喜悦也是有代价的――每个治疗周期的平均费用为12,400美元，这还不包括可能达数千美元的药费。保险的报销额度各有不同。

In general, the cost of minimal stimulation could be 50% to 60% of the cost of a full stimulation cycle, says Suheil Muasher, a reproductive endocrinologist at the Duke Fertility Center in Durham, N.C.

北卡罗来纳达勒姆(Durham)杜克生育医学中心(Duke Fertility Center)的生殖内分泌科医生苏海勒・马阿谢尔(Suheil Muasher)称，总体而言，微刺激方案的费用可能要比充分刺激治疗周期的费用低50%到 60%。

In conventional IVF, a woman typically is prescribed injectable drugs to stimulate her ovaries to make more eggs than they would without medication. Eggs are harvested, combined with sperm in a laboratory and the embryos later transferred into a woman's uterus in the hopes they'll successfully produce a pregnancy.

在传统的试管婴儿治疗周期中，医生通常会给患者注射药物来刺激她们的卵巢排出比不注射药物要更多的卵子。他们会把卵子采集起来，在实验室中对它们进行受精处理，然后把培育出的胚胎移植入患者的子宫，期望借此让她们成功妊娠。

There is no universal definition for mild or minimal-stimulation IVF. Terminology developed by the International Society for Mild Approaches in Assisted Reproduction defines it as a protocol consisting of milder doses of injectable drugs, oral drugs or a combination of both that aims for the collection of two to seven eggs, based on published research. Conventional IVF aims for more eggs.

温和刺激或微刺激试管受孕方案没有通用的定义。根据已发表的研究，国际辅助生殖温和技术协会(International Society for Mild Approaches in Assisted Reproduction)制订的术语对它的定义是：一种由温和剂量的注射药、口服药或注射药加口服药构成，以采集两至七个卵子为目标的治疗方案。传统试管婴儿方案的卵子采集目标要更高。

The minimal approach requires fewer doctor visits for blood work and ultrasound monitoring. The medication savings from this approach can be between $3,000 and $8,000, says Dr. Muasher. 'It's more patient-friendly, it's less costly and for some patients it has fewer complications,' he says.

如果采用微刺激方案，患者去看医生进行血检或超声波检查的次数会减少。马阿谢尔医生称，采用该方案可节省3,000 至8,000美元的费用。他说：“它更利于患者的身体，费用更低而且对某些患者来说引发的并发症更少。”

Proponents say it is a particularly good option for patients who have a very strong response to fertility drugs and are at high risk of ovarian hyperstimulation syndrome, a potentially dangerous complication. Women can be at high risk due to previous IVF history or risk factors like polycystic ovary syndrome or being young with irregular cycles.

其支持者称，对于对促孕药反应非常强烈以及患卵巢过度刺激综合征（一种潜在的危险并发症）风险较高的患者，它是一个特别好的选择。之前有过做试管婴儿的经历、多囊卵巢综合征之类的风险因素或年轻时经期不规律等原因都会让女性面临高风险。

They also say it is an alternative for women, including many older ones, who produce just a few eggs in response to drugs, regardless of the dose. It is also appropriate for women who don't want to be faced with a decision about what to do with embryos they don't use.

他们还表示，它是一个替代方案，适用于无论用于刺激的药物剂量有多大都只排出几个卵子的女性，其中包括年纪较大的女性。它也适合不想面对未使用胚胎处理问题的女性。

Neeburbunn Lewis, a 35-year-old nurse living near Portland, Maine, and her husband spent between $20,000 and $25,000 for the single cycle of conventional IVF that produced her first child. When the couple wanted a second child, 'financially, going through another cycle was not feasible,' she says. She also experienced ovarian overstimulation that put her in the hospital when she went through IVF. 'I could not put my body through that again,' she says. She heard about minimal-stimulation IVF from her OB-GYN and did one cycle at the Maine location of Boston IVF. Her cost this time: $5,000. She is eight months pregnant with her second child.

今年35岁的护士尼伯本・刘易斯(Neeburbunn Lewis)家住缅因州波特兰附近，她与丈夫在一个周期的传统试管受孕治疗上花了20,000 到25,000美元，这给她带来了她的第一个孩子。她说，在他们二人想要第二个孩子时，“从经济状况上说，再进行一轮治疗是不可行的。”此外，她还得过卵巢过度刺激综合征，并因此在试管受孕期间入院治疗。她说：“我不能让我的身体再经受一次了。”她从自己的妇产科医生那儿听说了微刺激试管受孕，于是在波士顿人工受孕医疗中心(Boston IVF)的缅因分部接受了一周期治疗，这一次的花费是5,000美元。现在她怀第二胎已经八个月了。

Ms. Lewis's reproductive endocrinologist, Benjamin Lannon, says he sees minimal-stimulation IVF as an option 'where cost is the primary barrier' to access. But patients need to understand their chances of getting pregnant per cycle are lower than with conventional stimulation, he says.

刘易斯的生殖内分泌科医生本杰明・兰农(Benjamin Lannon)说，他认为微刺激试管受孕是“费用为主要障碍”时采取的选择，但是患者需明白该方案每周期的受孕几率要低于传统刺激方案。

To perform a milder course of IVF, Sherman Silber, director of the Infertility Center of St. Louis, uses an inexpensive oral drug and low, infrequent doses of injectable drugs to stimulate women to produce only a modest amount of eggs at one time, which he says increases their average quality. In some cases, if enough embryos aren't produced in one cycle, they are frozen and the cycle is repeated until there are several more embryos to transfer.

为了实施温和刺激试管受孕方案， 路易斯不孕症医疗中心(Infertility Center of St. Louis)主任舍曼・西尔伯(Sherman Silber)采用了平价口服药，并以较低频率为患者注射少量药物，以此刺激她们一次只排出数量适中的卵子。他说此举可提高卵子的平均质量。在某些情况下，如果医生在一个周期内没有培育出足够的胚胎，便会把它们冷冻起来，接着重复治疗周期直到有更多胚胎可供移植为止。

Dr. Silber's research, presented at the October ASRM meeting, found it was more effective, with a higher pregnancy rate per egg, and less expensive than traditional IVF for women 40 and older and for women with low ovarian reserve. Dr. Silber is preparing to submit his data to a peer-reviewed journal.

西尔伯医生在10月份ASRM会议上提交的研究发现，该方案更为有效，每个卵子的受孕率更高，对于年龄在40岁及以上的女性以及卵巢储备较低的女性来说，它的费用也更低。西尔伯医生还准备向一家同行评议的期刊提交他的数据。

Still, the likelihood of needing to repeat minimal-stimulation IVF for success has some doctors concerned. 'I would argue that the evidence speaks against it,' says Norbert Gleicher, medical director of the Center for Human Reproduction, a fertility center in New York. He was an author of a 2017 study published in Reproductive BioMedicine Online that compared 14 women under age 38, with normal ovarian function who underwent low-intensity IVF to 14 who had regular IVF. The low-intensity regimen 'reduced pregnancy chances without demonstrating cost advantages,' the study found. Dr. Gleicher is now trying to get funding for a randomized trial to compare the two approaches.

尽管如此，为了成功妊娠需重复微刺激试管受孕治疗的可能性也让部分医生感到担忧。纽约一家生殖中心――人类生殖医学中心(Center for Human Reproduction)的医务主任诺伯特・格莱谢尔(Norbert Gleicher)说：“我认为证据是不利于它的。”他是2017年发表于《生殖生物医学在线》(Reproductive BioMedicine Online)的一项研究的作者之一。该研究将14名年龄在38岁以下、卵巢机能正常并接受了低强度试管受孕治疗的女性，与14名接受了常规试管受孕治疗的女性进行了比较。该研究发现，低强度方案“降低了受孕几率，而且没有表现出成本优势。”现在格莱谢尔医生正尝试为一项比较这两种方案的随机性实验筹集资金。

Zev Rosenwaks, director of the New York-Presbyterian/Weill Cornell Medical Center for Reproductive Medicine, says while minimal stimulation might work for some women, his own experience suggests that moderate stimulation -- with nine or 10 eggs as the ideal and using the lowest dose of drugs possible -- produces the most success with the lowest risk of complications. He says he has seen 'too many [women] to count' who have tried and failed with minimal stimulation at other clinics.

纽约-长老会/韦尔康奈尔生殖医学中心(New York-Presbyterian/Weill Cornell Medical Center for Reproductive Medicine)主任泽夫・罗森瓦克斯(Zev Rosenwaks)指出，尽管微刺激方案或许对某些女性有效果，他自己的经验则表明适度刺激――以九至10个卵子为理想目标并尽可能采用最低剂量药物――可带来最高的成功率，而且引发并发症的风险最低。他说，他见过的曾在其他医院尝试微刺激方案但最终失败的女性“多到难以计数”。