更低價更溫和的試管嬰兒方案大綱
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.
隨着試管嬰兒的數量創下歷史最高紀錄，部分醫生開始嘗試有可能花費更低、對女性身體的損害也較輕的替代方法。
Some fertility clinics are offering a gentler version of IVF that uses fewer, milder drugs and requires less frequent medical visits.
一些婦產醫院推出了更溫和的試管受孕方案，它採用的藥物更少更溫和，患者也可減少去看醫生的次數。
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.
不過，該類方案的成功率還不確定。美國生殖醫學協會(American Society for Reproductive Medicine，簡稱“ASRM”)稱，微刺激試管受孕方案的妊娠率有可能低於傳統方案的妊娠率。有些醫生指出，假如溫和方案沒有成功，患者又重新開始新一輪治療的話，其費用會很快接近甚或超過傳統方案的花費。
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 2014 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 2012. The odds vary by factors including a woman's age and the number of eggs retrieved.
各醫院試管嬰兒成功率的發佈機構――美國輔助生殖技術協會(Society for Assisted Reproductive Technology)表示，該機構將在2014年的數據中首次公佈微刺激方案的成功率。該數據將於2016年出爐。2012年，在接受任一類型試管受孕治療後，患者每週期成功生育的平均機率約爲37%。成功機率依受孕女性的年齡及取出的卵子數量等因素而有所變化。
Babies conceived using IVF made up 1.5% of all births in 2012, 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的數據顯示，2012年試管嬰兒數量佔到新生兒總數的1.5%。這些新生命帶來的喜悅也是有代價的――每個治療週期的平均費用爲12,400美元，這還不包括可能達數千美元的藥費。保險的報銷額度各有不同。
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.
北卡羅來納達勒姆(Durham)杜克生育醫學中心(Duke Fertility Center)的生殖內分泌科醫生蘇海勒・馬阿謝爾(Suheil Muasher)稱，總體而言，微刺激方案的費用可能要比充分刺激治療週期的費用低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.
在傳統的試管嬰兒治療週期中，醫生通常會給患者注射藥物來刺激她們的卵巢排出比不注射藥物要更多的卵子。他們會把卵子採集起來，在實驗室中對它們進行受精處理，然後把培育出的胚胎移植入患者的子宮，期望藉此讓她們成功妊娠。
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.
溫和刺激或微刺激試管受孕方案沒有通用的定義。根據已發表的研究，國際輔助生殖溫和技術協會(International Society for Mild Approaches in Assisted Reproduction)制訂的術語對它的定義是：一種由溫和劑量的注射藥、口服藥或注射藥加口服藥構成，以採集兩至七個卵子爲目標的治療方案。傳統試管嬰兒方案的卵子採集目標要更高。
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.
如果採用微刺激方案，患者去看醫生進行血檢或超聲波檢查的次數會減少。馬阿謝爾醫生稱，採用該方案可節省3,000 至8,000美元的費用。他說：“它更利於患者的身體，費用更低而且對某些患者來說引發的併發症更少。”
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.
其支持者稱，對於對促孕藥反應非常強烈以及患卵巢過度刺激綜合徵（一種潛在的危險併發症）風險較高的患者，它是一個特別好的選擇。之前有過做試管嬰兒的經歷、多囊卵巢綜合徵之類的風險因素或年輕時經期不規律等原因都會讓女性面臨高風險。
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.
他們還表示，它是一個替代方案，適用於無論用於刺激的藥物劑量有多大都只排出幾個卵子的女性，其中包括年紀較大的女性。它也適合不想面對未使用胚胎處理問題的女性。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歲的護士尼伯本・劉易斯(Neeburbunn Lewis)家住緬因州波特蘭附近，她與丈夫在一個週期的傳統試管受孕治療上花了20,000 到25,000美元，這給她帶來了她的第一個孩子。她說，在他們二人想要第二個孩子時，“從經濟狀況上說，再進行一輪治療是不可行的。”此外，她還得過卵巢過度刺激綜合徵，並因此在試管受孕期間入院治療。她說：“我不能讓我的身體再經受一次了。”她從自己的婦產科醫生那兒聽說了微刺激試管受孕，於是在波士頓人工受孕醫療中心(Boston IVF)的緬因分部接受了一週期治療，這一次的花費是5,000美元。現在她懷第二胎已經八個月了。
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.
劉易斯的生殖內分泌科醫生本傑明・蘭農(Benjamin Lannon)說，他認爲微刺激試管受孕是“費用爲主要障礙”時採取的選擇，但是患者需明白該方案每週期的受孕機率要低於傳統刺激方案。
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.
爲了實施溫和刺激試管受孕方案， 路易斯不孕症醫療中心(Infertility Center of St. Louis)主任舍曼・西爾伯(Sherman Silber)採用了平價口服藥，並以較低頻率爲患者注射少量藥物，以此刺激她們一次只排出數量適中的卵子。他說此舉可提高卵子的平均質量。在某些情況下，如果醫生在一個週期內沒有培育出足夠的胚胎，便會把它們冷凍起來，接着重複治療週期直到有更多胚胎可供移植爲止。
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.
西爾伯醫生在10月份ASRM會議上提交的研究發現，該方案更爲有效，每個卵子的受孕率更高，對於年齡在40歲及以上的女性以及卵巢儲備較低的女性來說，它的費用也更低。西爾伯醫生還準備向一家同行評議的期刊提交他的數據。
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 2012 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.
儘管如此，爲了成功妊娠需重複微刺激試管受孕治療的可能性也讓部分醫生感到擔憂。紐約一家生殖中心――人類生殖醫學中心(Center for Human Reproduction)的醫務主任諾伯特・格萊謝爾(Norbert Gleicher)說：“我認爲證據是不利於它的。”他是2012年發表於《生殖生物醫學在線》(Reproductive BioMedicine Online)的一項研究的作者之一。該研究將14名年齡在38歲以下、卵巢機能正常並接受了低強度試管受孕治療的女性，與14名接受了常規試管受孕治療的女性進行了比較。該研究發現，低強度方案“降低了受孕機率，而且沒有表現出成本優勢。”現在格萊謝爾醫生正嘗試爲一項比較這兩種方案的隨機性實驗籌集資金。
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.
紐約-長老會/韋爾康奈爾生殖醫學中心(New York-Presbyterian/Weill Cornell Medical Center for Reproductive Medicine)主任澤夫・羅森瓦克斯(Zev Rosenwaks)指出，儘管微刺激方案或許對某些女性有效果，他自己的經驗則表明適度刺激――以九至10個卵子爲理想目標並儘可能採用最低劑量藥物――可帶來最高的成功率，而且引發併發症的風險最低。他說，他見過的曾在其他醫院嘗試微刺激方案但最終失敗的女性“多到難以計數”。
