加拿大华人论坛 美国生活信息促排方案哪种好？“微促排”、“传统促排”你

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IVF小百科 什么是“促排” “促排”即是“促使排卵”的意思，一般是通过药物刺激到卵巢，然后诱发排卵。有了健康的卵子，试管流程才能顺利的进行下去，可以说成功的促排是“完美”的试管周期的最基础的条件。 为什么要“促排” 女性的自然排卵过程，首先是下丘脑作用于垂体，垂体作用于卵巢轴，然后卵巢排卵。这当中需要各种身体激素参与协作，其中任何一个部位功能障碍都可能导致不排卵或者卵子不健康的情况发生。所以当有这种情况的女性想要进行试管，使用药物调节激素水平促发排卵就是非常必要的手段了。 但是，正如上面所讲，导致排卵异常的因素很多，如何促排才是最安全又有效的方案呢？美国Gen 5生殖医疗中心创始人、知名生殖医学专家Dr.Wood，与我们的分享了他关于“微促排”与“传统促排”方案的一些看法，希望为纠结于促排方案的准妈妈们解疑答惑。  以下为原文 翻译： “The phrase “Mini-IVF” is one commonly heard in fertility centers. While many centers virtually never recommend mini-IVF to their patients because they believe such cycles to have little or no value, others almost exclusively offer such cycles because they believe them to be of the greatest value for the vast majority of patients.   These conflicting opinions have led to much confusion among infertile patients. We hope that this brief article will result in a clearer understanding.   “微促试管周期”在生殖领域并不陌生，许多生殖中心对其运用却是微乎其微的，因为他们认为这样的周期产生的效果和价值不尽人意。而另一些生殖中心则将其作为最重要的促排方式推荐给多数客人，认为其优势和价值无法比拟媲美。这种巨大的冲突观点常常令试管客人感到困惑，我希望这篇言简意赅的文章可以为大家解惑。   The first thing to know is that no one really knows what “mini-IVF” is. There are numerous definitions available with no consensus. The phrase is an abbreviation of “Minimally Stimulated IVF.” What that means is that patients using mini-IVF receive less stimulation than is typical in IVF cycles. How much less? That varies tremendously, ranging from no stimulation at all to stimulation levels that are very close to those seen in standard IVF cycles. Here are three of the most commonly used terms describing the range of cycle options: “Natural Cycle ART,” “Modified Natural Cycle,” and “Mild Ovarian Stimulation for IVF.”   那首先什么是“微促试管周期”？事实上，在业界并没有得出一个严格官方统一的定义。mini-IVF是Minimally Stimulated IVF的缩写，直译为最小量剂的促排。那么这个量是多少？我们不可一概而论，因为从无促排到接近传统促排的用量都属于微促的范围，其中比较常见的三类为：自然周期；微促自然周期和微刺激周期。   In general, when mini-IVF is done, the number of eggs retrieved in reduced, sometimes markedly so. Logically, one would think that retrieving fewer eggs would be a negative outcome for patients. And for many patients, that is certainly the case. Initially, it was believed that using no or reduced doses of stimulation would result in higher quality eggs because the cycle was more “natural.” However, the available evidence does not support that idea, which incidentally makes little sense since the majority of couples do IVF precisely because “natural” methods of becoming pregnant have been unsuccessful. But, are there some patients for whom, mini-IVF makes sense? The answer is yes.   一般来讲，使用微促，相对应的会取到较少的卵。有人会觉得取卵少便是一个较失败的结果，一些患者这样理解也无可厚非。但早期试管有个理念是：最小限度的使用促排药物甚至不使用有可能会提高卵子的质量，因为这更贴近我们的“自然生理周期”。诸多数据显示并不能让此原理成立，例如一般夫妻正是因为在自然周期里没有成功才来求助于试管辅助啊！那微促是否对一些患者有效呢？答案是肯定的。   Given that egg quality is no better with mini-IVF and the total pregnancy rate using all eggs is much higher when using typical IVF, why should anyone ever do mini-IVF? There are a few potential reasons. Some women are very low responders and using an increased dose of medication does not increase the number of eggs that they produce. Other women have an underlying medical problem that requires that few eggs be produced. There are potential benefits to mini-IVF: each cycle costs less, the amount of medication and the number of injections used is lower. Since there is less stimulation, there may be less abdominal discomfort, and little or no anesthesia can sometimes be used for egg retrievals. The risk of ovarian hyperstimulation is also reduced although it is very rare for any type of patient using newer protocols.   Conversely, since pregnancy rates are lower, patients frequently must undergo additional cycles and egg retrievals. I have seen many new patients that have undergone over 10 IVF cycles at centers specializing in mini-IVF, each cycle obtaining only 0-2 eggs. Because not every egg fertilizes and many fertilized eggs (embryos) are genetically abnormal and thus not useable, in many cases, patients end up with nothing for their efforts in many of these types of cycles.  如果微促可得到的卵子数量少，其整个的受孕成功率又不及传统促排高，那为什么还要使用微促呢？这是几个潜在的原因： 有一些女性对促排药物不耐受，即使加大用药量也无法帮助生成更多的卵子； 有一些女性身体本身原因，并不允许使用过多的促排药物，亦不允许一个周期内生成多个卵子；  同时，微促的优势： 费用低 周期费用低，用药少，针剂也少，从而痛楚感减轻。 风险低 促排剂量低卵泡数量少，相对腹部不适感减弱，取卵时可酌情减少或不用麻醉。 副作用低 虽然新的试管技术已经很少出现卵巢过度刺激症，微促更是将此风险降到最低。   微促的劣势： 微促的受孕率低，通常客人需要进行多个周期才能接近理想结果。例如我接触过一些在专门推崇微促诊所就诊的客人，由于每次只能获得0-2个卵子，而且并不是所有的卵子都具备受精能力，又或者虽然受精养囊到囊胚状态，但因为染色体异常又不能进行移植，即使她们前后有尝试超过10次以上的周期，但最终却是徒劳无果。  At Gen 5 Fertility, we sometimes do mini-IVF for patients, either because it’s the right treatment for them or because the patient specifically requests it. We have developed a new protocol that we call “Mini-IVF Plus” that dramatically improve the number of eggs retrieved from each cycle for most patients. Such cycles have resulted in many babies and I’m pleased they are available for our patients.   在Gen 5 生殖医疗中心，从自然周期到微促周期，从传统周期再到超长周期，我们都有使用。量身定做、做每个人适合的合适方案—是我们秉承的医疗态度和准则！ 另外，我们潜心研发的“优化促排周期”绝对是一股全新的方案，它是在传统微促的基础上，调整用药，从而大大提高了取卵的数量。临床显示，一些接受此方案的客人效果显著，优化微促宝宝们也已经诞生。我很欣慰它的存在并非常期待将其用于更多的受众！ 看完了Wood医生的介绍，大家对促排是不是有了更加专业的认知呢？促排方案没有优劣之分，在详细检查认真分析后，医生制定出适合自己身体情况的方案，相信才是最有效和安全的。  Gen 5 生殖医学中心“优化促排周期”方案 量身定做 更加适合！ V:（Irvine-Liyong2018）

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