更低价更温和的试管婴儿方案

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 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.
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2012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”。