本文摘要：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 womans body.随着试管婴儿的数量刷新历史最低纪录，部分医生开始尝试有可能花费更加较低、对女性身体的伤害也较重的替代方法。

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 womans body.随着试管婴儿的数量刷新历史最低纪录，部分医生开始尝试有可能花费更加较低、对女性身体的伤害也较重的替代方法。Some fertility clinics are offering a gentler version of IVF that uses fewer, milder drugs and requires less frequent medical visits.一些妇产医院发售了更加保守的试管生育方案，它使用的药物较少更加保守，患者也可增加去看医生的次数。

Success rates arent 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 doesnt 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认。美国生殖医学协会(American Society for Reproductive Medicine，全称“ASRM”)称之为，微性刺激试管生育方案的胎儿亲率有可能高于传统方案的胎儿亲率。有些医生认为，假如保守方案没顺利，患者又新的开始新一轮化疗的话，其费用不会迅速相似甚或多达传统方案的花费。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 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 womans age and the number of eggs retrieved.各医院试管婴儿成功率的公布机构――美国辅助生殖技术协会(Society for Assisted Reproductive Technology)回应，该机构将在2014年的数据中首次发布微性刺激方案的成功率。

该数据将于2016年揭晓。2012年，在拒绝接受任一类型试管生育化疗后，患者每周期顺利生育的平均值几率大约为37%。顺利几率依生育女性的年龄及放入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 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的数据表明，2012年试管婴儿数量占到到新生儿总数的1.5%。这些新生命带给的喜乐也是有代价的――每个化疗周期的平均值费用为12,400美元，这还不还包括有可能约数千美元的药费。

保险的缺席额度各有不同。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)称之为，总体而言，微性刺激方案的费用有可能要比充份性刺激化疗周期的费用较低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 womans uterus in the hopes theyll successfully produce a pregnancy.在传统的试管婴儿化疗周期中，医生一般来说不会给患者静脉注射药物来性刺激她们的卵巢排泄比不静脉注射药物要更加多的卵子。他们不会把卵子采集起来，在实验室中对它们展开受精卵处置，然后把培育出的胚胎移植进患者的子宫，希望借以让她们顺利胎儿。

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.保守性刺激或微性刺激试管生育方案没标准化的定义。根据已公开发表的研究，国际辅助生殖保守技术协会(International Society for Mild Approaches in Assisted Reproduction)制定的术语对它的定义是：一种由保守剂量的静脉注射药、口服药或静脉注射药特口服药包含，以收集两至七个卵子为目标的化疗方案。传统试管婴儿方案的卵子收集目标要更高。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. Its more patient-friendly, its less costly and for some patients it has fewer complications, he says.如果使用微性刺激方案，患者去看医生展开血检或超声波检查的次数不会增加。

马阿谢尔医生称之为，使用该方案可节省3,000 至8,000美元的费用。他说道：“它更加有利于患者的身体，费用更加较低而且对某些患者来说引起的并发症更加较少。”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.其支持者称之为，对于对促孕药反应十分反感以及患卵巢过度性刺激综合征（一种潜在的危险性并发症）风险较高的患者，它是一个尤其好的自由选择。之前有过做到试管婴儿的经历、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对高风险。

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 dont want to be faced with a decision about what to do with embryos they dont use.他们还回应，它是一个替代方案，限于于无论用作性刺激的药物剂量有多大都只排泄几个卵子的女性，其中还包括年纪较小的女性。它也合适想面临并未用于胚胎处置问题的女性。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)同住缅因州波特兰附近，她与丈夫在一个周期的传统试管生育化疗上花上了20,000 到25,000美元，这给她带给了她的第一个孩子。她说道，在他们二人想第二个孩子时，“从经济状况上说道，再行展开一轮化疗是不不切实际的。

”此外，她还得过卵巢过度性刺激综合征，并因此在试管生育期间入院化疗。她说道：“我无法让我的身体再行遭受一次了。”她从自己的妇产科医生那儿听闻了微性刺激试管生育，于是在波士顿人工受孕医疗中心(Boston IVF)的缅因分部拒绝接受了一周期化疗，这一次的花费是5,000美元。

现在她思第二胎早已八个月了。Ms. Lewiss 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)说道，他指出微性刺激试管生育是“费用为主要障碍”时采行的自由选择，但是患者须要明白该方案每周期的生育几率要高于传统性刺激方案。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 arent produced in one cycle, they are frozen and the cycle is repeated until there are several more embryos to transfer.为了实行保守性刺激试管生育方案， 路易斯不孕症医疗中心(Infertility Center of St. Louis)主任舍曼西尔伯(Sherman Silber)使用了平价口服药，并以较低频率为患者静脉注射少量药物，以此性刺激她们一次只排泄数量高的卵子。

他说道此举可提升卵子的平均值质量。在某些情况下，如果医生在一个周期内没培育出充足的胚胎，之后不会把它们冷藏一起，接着反复化疗周期直到有更加多胚胎可可供重制为止。Dr. Silbers 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会议上递交的研究找到，该方案更加有效地，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，它的费用也更加较低。西尔伯医生还打算向一家同行评议的期刊递交他的数据。

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，为了顺利胎儿须要反复微性刺激试管生育化疗的可能性也让部分医生深感忧虑。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)说道：“我指出证据是有利于它的。”他是2012年公开发表于《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、卵巢机能长时间并拒绝接受了低强度试管生育化疗的女性，与14名拒绝接受了常规试管生育化疗的女性展开了较为。该研究找到，较低强度方案“减少了生育几率，而且没展现出出有成本优势。

”现在格莱谢尔医生于是以尝试为一项较为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)认为，尽管微性刺激方案也许对某些女性有效果，他自己的经验则指出有助于性刺激――以九至10个卵子为理想目标并尽量使用低于剂量药物――可带给最低的成功率，而且引起并发症的风险低于。他说道，他见过的曾在其他医院尝试微性刺激方案但最后告终的女性“多到无法计数”。

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