SART 生育专家 - 解释试管婴儿附加项目：它们能提高成功率还是仅仅增加费用？

大家好。

Hi, everyone.

欢迎收听新一期的SART播客。

Welcome to another SART podcast.

我是马克·特罗利斯，佛罗里达州奥兰多市的生殖内分泌科医生，也是不孕不育专科医生。

I'm Mark Trollis, a reproductive endocrinologist and infertility specialist in Orlando, Florida.

今天和我一起的是迈卡·希尔，他在马里兰州的Shady Grove生育中心工作，同样是生殖内分泌和不孕不育领域的专家。

I am here with Micah Hill, who is a reproductive endocrinology and infertility specialist in Maryland at Shady Grove Fertility.

要是想给你介绍希尔医生的履历，那这期播客的时间都不够用。

I would give you a bio on doctor Hill, but it would take the entire length of this podcast.

他在我们美国生殖医学会里几乎参与了所有方面的工作。

He is involved in every aspect of our society, the American Society for Receptive Medicine.

他是教育和指导年轻医生的榜样，同时也非常注重患者教育。

He is a role model for education and mentoring younger physicians as well as educating patients.

今天能请到迈卡来，我真的很高兴。

I'm I'm delighted to have Micah here with us today.

欢迎，我的朋友。

Welcome, my friend.

能来这里我很高兴，马克。

It is a pleasure to be here, Mark.

谢谢你的邀请。

Thank you for inviting me.

我也很高兴。

My my pleasure indeed.

我们现在正在圣安东尼奥的美国生殖医学学会年会上进行现场录制。

We are recording live, at the American Society for Receptive Medicine annual meeting here in San Antonio.

这里的热情很有感染力。

The enthusiasm is infectious.

我真希望你们能看到我们录制时的现场。

I I wish you all could be able to see us, live when we are recording this.

今天的话题对学者和实践循证医学的人来说都很重要，叫做试管婴儿附加疗法。

So today's topic is one that is of of importance to academicians and and those that practice evidence based medicine, and it's called IVF add ons.

我们这个领域传统上一直是技术先行，有时候会本末倒置。

Our field has traditionally been one that advances technology, sometimes putting the cart before the horse.

迈克尔，你能跟我们说说你的理解吗？让患者知道IVF附加治疗到底是什么意思。

Michael, could could you tell us what your understanding of it for the patients to know what IVF add ons really mean?

我觉得“附加治疗”这个词本身就带有贬义，或者说……

I think the very nature of the word add ons is is pejorative or or...

从定义上讲，这意味着我们没有证据支持它，因为那些有证据支持的治疗，按定义就不再是附加治疗了。

And by definition means we don't have evidence for it because the things that we have evidence for are, by definition, no longer an add on.

它们就是必要的治疗。

They're they're a necessary treatment.

所以我认为，我们甚至需要讨论附加治疗，而且ERA还制定了整套指南来评估这些附加治疗，这本身就反映了我们IVF实践的现状。

And so I think that the fact that we even have to have this discussion about add ons and that ERA has developed this whole guideline to give us, to evaluate these add ons, does give us a bit of a view of the state of affairs of how we practice IVF.

我觉得这跟选择进入我们领域的医生类型有关。

I think it's inherent to the type of physicians that are attracted to our field.

我们这个领域非常年轻。

Our field is very young.

我们是非常前沿的。

We are very cutting edge.

我们在不断创新。

We are innovating.

我们一直在学习和推进新科学。

We're learning and advancing new science all the time.

所以，我们被吸引到这个领域，是因为我们想突破界限，帮助人们怀孕。

And so by definition, we're attracted to this because we wanna push the boundaries to help people get pregnant.

但这也可能是个问题，当我们过早采用新技术，比如在还没有试验证据证明ERA有效之前就加上它，然后等到做了成千上万次之后，我们才说，哦，现在有研究表明它其实没用。

But that can also be a negative when we adopt things too early, when we add things like the ERA before we have, trial evidence that shows that it works, And then we wait till there's hundreds of thousands of those that have been done, and then we say like, oh, now we have the studies that say we don't have it.

所以，作为早期采用者的风险——我觉得我们这个领域容易这样——就是我们最终给病人的东西对他们没有好处，而且这样做可能带来一些伤害。

So the risk of being an early adapter, which I think is a field is what we're prone to do, is that we end up giving things to our patients that aren't to their benefit, and there could be some harms in doing that.

它们并不总是无害的。

They're not always no harm.

说得好。

Well said.

而且还有经济方面的顾虑。

And and there are financial concerns.

手术本身有实际风险，但还有伦理上的担忧。

There's actual risks of of procedures, but then there's also the ethical concern.

在没有充分证据的情况下，向患者提供非循证医学的治疗，而患者可能并不知情，这合适吗？如果这不是标准治疗，那它多少有点实验性质。

Is it appropriate to be offering non evidence based medicine to patients without, certainly, their knowledge, the fact that it is somewhat experimental if it's not standard of care.

我们先来定义一下这些概念。

Let's define some of these.

在深入讨论之前，我们先明确一下这些术语。

Before we go too far into that, let's define some of these.

你提到了ERA，所以我们来为患者具体解释一下。

You mentioned ERA, so let's be more specific for our patients.

有哪些附加治疗目前证据不足，还不能成为标准治疗？

What are some examples of these add ons that are not yet proven enough to be standard of care?

好的。

Sure.

我觉得子宫内膜容受性检测肯定是其中之一。

I think the endometrial receptivity assay was certainly, one of those.

就是做冻融胚胎移植周期的时候。

That's where they do a frolic frozen embryo transfer cycle.

不是在那天移植胚胎，而是做一次活检。

Instead of transferring the embryo on that day, they do a biopsy.

他们检查当时子宫内膜中某些基因的表达，这些基因已知对胚胎着床很重要。

They look for the expression of certain genes in the endometrium at that time that are known to be important for implantation.

如果这些基因表达过多或过少，就可以调整孕酮的暴露时间。

And if they're either too much of that or too little of that, you can adjust your progesterone exposure.

理论上，根据一些初步证据，这个想法很吸引人，也很棒，但实践中并没有真正得到验证。

In theory, and based on some of the preliminary evidence, fascinating, wonderful idea, but in practice, it didn't really bear out.

另一个有时是附加项、有时不是的例子是ICSI，即胞浆内单精子注射。

Another example that can sometimes be an add on and sometimes not is ICSI, intracytoplasmic sperm injection.

就是取一个精子直接注射到卵子里。

That's where they take a single sperm and inject it into an egg.

我们有很好的数据表明，对于患者，尤其是那些有严重男性因素的患者，这是有益的。

We have pretty good data that for patients, especially those with severe male factor, that's beneficial.

对于精子活力有问题、游动和寻找卵子有困难、无法结合并穿透卵子的男性，帮助两个DNA包（可以这么说）相遇，有助于受精的发生。

For guys where the sperm has issue with motility, for swimming and finding the sperm, being able to bind to the sperm and penetrate it, Helping the two DNA packets, so to speak, get to each other can help for fertilization to occur.

但我们却走到了另一个极端，说那就对每个人都做吧。

But we've taken that to the other extreme and say, let's just do it for everybody then.

如果对某些人有效，可能对其他人也有效。

If it's good for some, it could be good for others.

但事实是

And that's

已经证明这是无效的。

been shown to not be effective.

已经非常明确地证明这是无效的。

It has been quite clearly shown to not be effective.

现在有几项临床试验显示没有益处。

There's a couple clinical trials now that show no benefit.

观察数据量非常大，涉及数万到数十万人，都显示没有益处。

The observational data sets are huge, tens of thousands to hundreds of thousands of people showing no benefit.

而且有些数据集实际上显示有害，自然选择可能有一些优势。

And some of those data sets, they actually show harm, and there may be some advantage to that natural selection.

也许我们天生如此，或者进化成这样，取决于你怎么看，这样最好的精子才能找到卵子并成功受精。

Maybe we were designed this way or evolved this way, depending on your perspective, so that the best sperm finds it and gets there and fertilizes it.

也许我们通过将针插入卵子，破坏了卵子的透明带、细胞质或纺锤体，即减数分裂纺锤体。

Maybe we're disrupting the zone of the egg or the cytoplasm of the egg or the spindle, the meiotic spindle by putting that needle into it.

我们可能正在造成伤害。

We could potentially be doing harm.

所以理论上，我们有理由认为可能造成伤害。

So in theory, there are reasons that we could be doing harm.

所以我认为这些是最近几个关于附加技术的例子。

So I think those are a couple recent examples of these add ons.

正如你所说，这涉及费用，而且当费用成为患者接受治疗的主要障碍时，增加费用是不好的。

And as you say, there's cost, and certainly, when cost is such a barrier to care for our patients, adding costs is bad.

以ERA为例，可能会多花几个月的时间，而时间真的很重要。

In the case of the ERA, you can be adding a couple months of time, and time is really important.

对David Sable来说，这是他提高试管婴儿成功率的三大支柱之一，时间就是怀孕的时间，成本就是怀孕的成本。

For David Sable, it's one of his three pillars of how we improve IVF, time is to pregnancy and cost for pregnancy.

这些附加技术可能会违背这两点，还有你提到的，我们这样做可能涉及的伦理问题。

Some of these add ons can violate, both of those things as well as what you said, the potential ethics, of how we do this.

另一个在我们领域存在很久的技术是辅助孵化，就是在胚胎外壳上切一个小口，这听起来很直观。

Another one that has been hanging around our field for a long time is assisted hatching, where you make a little incision around the shell of the embryo intuitively.

我觉得其中一些技术是出于直觉上的希望，就是希望我们能得到更好的结果。

And I think some of these were spurred on by intuitive hope, essentially, that we're going to get better outcomes.

但做这个小切口并没有被证明能改善结果。

But making that little incision has not been shown to improve outcome.

我们换个话题，聊聊人工智能吧。

Let's let's switch over to AI.

现在这个领域探索的东西太多了。

There's so much that's being explored now in that field.

虽然大家热情很高，但我们还不确定它真的能改善结果。

And while there's tremendous enthusiasm, we're not really clear that it's going to improve outcome.

比如，延时胚胎成像技术。

Like, for example, time lapse embryo imaging.

给我们讲讲这个吧。

Tell us a little bit about that.

延时成像就是在培养箱里放一个摄像头，更频繁地拍摄胚胎的图像。

So time lapse imaging is where they put a camera inside the incubator, and they actually take images of the embryos more frequently.

以前，我们有时每天都会把胚胎取出来，尤其是在早期阶段。

So historically, we've taken the embryos out sometimes every day at the start of it.

现在有些人只在受精那天和囊胚形成那天取出胚胎。

Some of us now only take the embryos out the day of fertilization and not until the day of blasculation.

所以我们只把胚胎取出来两次。

So we only take the embryos out twice.

但延时成像理论上可以让胚胎一直待在培养箱里，同时获得更多关于胚胎发育的图片。

But the time lapse in theory leaves it in there and gets us a whole bunch more pictures of what that embryo does.

这应该给我们带来一些希望，也许我们能从胚胎的生长过程中学到一些东西，从而帮助我们预测哪个胚胎最适合移植。

And this should give us some promise that maybe we'll learn some things from how that embryo grows that would then help us predict the best embryo to transfer.

所以，与其在第五天只拍一张照片，如果我们五天里拍一千张照片会怎么样？

So rather than one image on day five, what if we have a thousand images over five days?

如果这能帮助我们预测该移植哪个胚胎呢？

And what if that helps us predict which embryo to transfer?

听起来又是一个绝妙的主意，就像ERA一样。

It sounds like another wonderful idea, just like the ERA.

但不幸的是，研究再次表明，这并没有改善为患者选择最佳移植胚胎的结果。

But, again, unfortunately, the studies have shown us that has not improved the best embryo to transfer for the patient.

而且你不需要把胚胎取出来。

And you don't have to take the embryos out.

就像我说的，在我的实践中，我们只在囊胚形成的那天取出胚胎。

Like I said, in my practice, we only take them out on that day of blastulation.

所以，理论上说，让胚胎在不受干扰的培养环境中待着，你不需要延时成像也能做到这一点。

So, the theory that leaving it in undisrupted culture, you can do that without time lapse imaging.

那么问题来了，AI能不能发现一些我们没发现的东西呢？

Now the question, can AI maybe figure out something that we haven't?

这是有可能的。

That's potential there.

AI真正擅长的是模式识别。

Like what AI is really good at doing is pattern recognition.

比如在放射科，看一百万张X光片，它能不能检测出肺癌的早期模式，而我们放射科医生可能会漏掉？

So in things like radiology where you're looking at a million X rays, can it detect a pattern for lung cancer, early lung cancer that we might miss as the radiologist?

也许我们胚胎学家在看这些成千上万的时间推移图像时，AI能发现一些我们没注意到的模式。

Maybe there's something that we as the embryologists looking at these thousands of time lapse images of MIST that AI can detect.

有可能，但也可能不行。

Maybe, but maybe not.

所以AI这个话题挺有意思的。

And so the AI question is interesting.

我觉得这方面潜力很大。

I think there's a lot of promise there.

我还没看到它在任何已发表的研究中真正起到实际作用。

I have yet to see it move the needle practically in any of the studies that have come out.

但是当你考虑一项可能值得采用的技术时，我们真的必须坚持一个标准，那就是我们必须证明它有效。

But when you look at a technology that that could make sense to employing, we really have to hold ourselves to the standard that we have to prove that.

而且，不幸的是，如果我们无法证明这一点，至少需要更充分的知情同意，而不是直接尝试。

And and, unfortunately, if we can't prove that, at least much more informed consent as opposed to just trying it.

我认为财务风险在于，如果诊所投资了重大的技术，那么就会有……

And I think the financial risk is that if the clinics invest in significant technology, then there's going to be...

谁来为此买单？

Who's gonna pay for that?

所以这可能会转嫁给患者，但我们却没有证据表明它能改善结果。

So that could be passed over to the patient, yet we don't have the evidence that it's gonna improve outcome.

你知道，在英国，这些附加服务是有广告的。

You know, in The UK, these add ons are advertised.

他们研究了延时摄影。

They looked at time lapse.

67%的网站都在宣传延时摄影技术。

67% of websites were advertising time lapse.

47%宣传的是PGT，这个我们还没深入聊，那本身就是一个大麻烦，然后辅助孵化大约占28%。

47% PGT, which we haven't gotten into too much, and that's a bag of worms right there, and then assisted hatching about 28%.

所以我就提了这件事。

So I did bring it up.

我们会把PGT算作附加项目吗？

Would we consider PGT an add on?

我觉得，如果你说的是对所有患者的标准护理，那是的，我会把PGT算作附加项目，因为我认为我们没有证据表明它应该成为所有患者的标准护理。

I I think if you're saying what should be standard of care for all patients, yes, I would consider PGT an add on because I don't think we have the evidence, that it should be standard of care, for all patients.

我想退一步说，因为你提到了一个非常重要的问题。

And I just wanna step back because I think you touched on something that's really important.

当诊所投资这些技术，而我们又没有证据表明它们能改善患者结局时，在我看来，这应该由诊所承担成本，同时他们进行研究来证明这些技术能改善患者护理。

When clinics invest in these technologies, when we don't have evidence that it's gonna improve patient outcomes, to me, that is on the clinic to bear that cost while they're doing the research to prove that it's going to improve the patient care.

花钱买更贵的培养箱，然后提高试管婴儿周期费用，把这转嫁给患者，而你又不知道这是否有帮助，在我看来，这不是道德的医疗行为。

To spend money on more expensive incubators and then raise your IVF cycle fees and put that on the patient when you don't know that it's going be helpful, to me would not be ethical medicine.

有些胚胎学家会说这能提高他们的胚胎学工作流程，但在我看来，这仍然应该由诊所来承担，因为你是在节省胚胎学家的时间，这样你就能用更少的胚胎学家，让他们有更多时间去做其他需要胚胎学家完成的劳动密集型工作。

Now some embryologists will argue that it improves their embryology workflow, but to me that still should go on the clinic because you're trying to save embryologists time, so you have fewer embryologists who have more time to do other labor intensive tasks that an embryologist needs to do.

但再说一次，在这种情况下，不应该把成本转嫁给患者。

But again, in that scenario, it should not be passed on to the patient.

所以我觉得你提到了这些附加项目最关键的一点。

So I think you touched on what's really key with these add ons.

如果你要做这些项目，我认为诊所应该承担责任。

If you're going to be doing them, I think the clinic bears the responsibility.

如果你要向患者提供这些项目，我觉得你需要和他们进行深入的沟通。

If you are going to be offering them to patients, I think you need to have a long conversation about it.

我刚刚还在跟一个人聊。

I was just talking to someone.

我的患者咨询时间是六十分钟。

I get a sixty minutes for my patient consult.

其中十分钟花在PGT-A上。

Ten minutes of that is spent on PGTA.

那挺多的。

That's a lot.

那是六分之一的时间。

That's one sixth of the time.

但这事太复杂了。

But it's such a complex thing.

我觉得我没法把它的利弊都跟他们讲清楚，而且我也不会引导我的病人往哪个方向走。

I don't think I can share the pros and cons of it to them, and I don't steer my patients in one direction or another.

我们确实知道它有一些好处，但也有一些已知的风险，或者说是潜在或理论上的风险。

We have we have some known benefits to it, but there are some known risks to it or some potential or theoretical risk to it.

我觉得病人需要充分了解这些风险，有时候病人的决定让我挺惊讶的。

I think patients need to be well informed to what those risks are, and sometimes I'm surprised with the decisions patients make.

有些人我以为根本不会考虑做PGT。

Some I thought would not want PGT at all.

他们听完介绍后，就说，对。

They hear the chat, and they're like, yeah.

好的。

Okay.

现在我真的非常想做这个。

Now I I would really like to do it.

其他人听了之后会说，你知道吗，我宁愿把钱花在未来的冷冻胚胎移植周期上，而不是现在做PGT。

Others hear it, and they're like, you know, I'd much rather spend my money towards a future frozen embryo transfer cycle rather than doing PGT now.

ASRM的最新指南指出，我们仍然没有确凿的证据表明它能提高每个周期的活产率。

The the latest guidance from ASRM is that we still don't have definitive evidence that it's going to improve live birth per cycle.

我一直觉得这是一项强大的技术，但还在寻找最适合的应用指征。

And I've always felt that it's a robust technology that's still looking for the absolute perfect indication to apply.

当然。

Sure.

但这还有待观察。

But it remains to be seen.

这就像，我们有一个胚胎，不知道它是否正常，那就检测一下，这样就能改善结果，这很直观。

It's one of those things where it's intuitive that we have an embryo, we don't know if it's normal, let's test to see if it's normal, and that's gonna improve outcome.

这个前提可能是出于好意，但这是一项昂贵的科技，患者需要知情。

And the premise is probably good intention, but it is a costly technology and patients need to be aware.

我觉得无论我们做什么，不管有没有确凿的证据，知情同意对患者做出是否继续的决定至关重要。

I think whatever that we're doing, of course, whether it is definitively proven or not, informed consent is what's vital for the patient to be able to make that decision of whether they wanna proceed with that or not.

完全同意。

Absolutely.

我前几天在这里开会时，不幸听到一位医生说，对于PGTA，只有患者主动提出才选择退出。

I I was in a meeting the other day here where, unfortunately, I heard a physician say for PGTA, it's only opt out and only if the patient brings it up.

所以对我来说，那不应该成为我们的实践方式。

So, like, to me, that would not be the way that we should be practicing.

但不幸的是，有些诊所就是这样做的。

But, unfortunately, for some clinics, that is the way.

这不是你或我对患者采取的方法，不仅对PGTA，对所有这些都是一样。

That's not the approach that I think you or I take with our patients, not just for PGTA, but but for any of these.

现在有...

Now there is...

你知道，我们的时间有限，所以只能选择那些值得花时间的主题。

You know, we only have so much time, and so we have to choose what topics we can afford to spend that amount of time on.

但我完全同意你刚才说的。

But I completely agree with with what you said.

对。

Yep.

这……

It...

根据我的经验，这可能是附加项目。我也想知道你的看法，但就我而言，当病人经历了多次周期后，绝望有时会促使医疗提供者去做一些非标准的事情，因为他们已经尝试了所有其他方法。

It's add ons probably in my experience, and and I'd love to know yours, but in my experience, when you have a patient that's gone through multiple cycles, the desperation can sometimes compel the healthcare provider from wanting to do things that are not standard, but they have tried everything else.

我觉得这就是一个滑坡。

And I think that's the slippery slope.

是的，确实如此。

Yeah, that is.

最近有几篇不错的论文，研究了连续三次移植和连续五次移植的情况。

We've had a couple nice papers that have come out recently looking at three consecutive transfers, then five consecutive.

我们有一篇摘要，讲的是连续六次移植的情况，而且这些都是整倍体胚胎，所以排除了其他导致胚胎失败的原因，不是基因层面的非整倍体问题。

We have an abstract looking at six consecutive, and these are euploid, so you're ruling out other causes of embryo failure, So it's not genetic aneuploidy.

五次之后，怀孕率能达到百分之九十七、九十八。

And the pregnancy rates after five are ninety seven, ninety eight percent.

六次之后，甚至更高。

After six, it's even higher.

所以，你知道，有病人跟我说，爱因斯坦说过，疯狂的定义就是重复做同一件事。

And so, you know, I've had patients say, well, Einstein said the definition of insanity is doing the same thing.

我就说，那不对。

And I say, that's not true.

如果一对夫妻，二十五岁刚结婚，同房一个月后跑来跟我说，我没怀孕。

When a couple has sex and they're 25 and just married and they have sex one month and they come and say, I didn't get pregnant.

你会怎么说？

What are you gonna say?

继续试，然后再来找我。

Keep trying again and come back and see me.

有时候，正确的做法就是再做一次移植。

Sometimes what is the right thing to do is doing another transfer.

当然，作为医生，我们肯定要仔细检查她们的周期、子宫内膜，以及所有已知可能导致着床失败的因素，这些都有充分的证据支持。

Now, of course, we want to have looked as the physician at their cycles, at their uterine lining, at all the things that we know that can cause implantation failure that we have good evidence for.

我们要确保没有忽略这些方面。

We wanna make sure we haven't ignored those things.

但有时候，问题就出在患者尝试的次数还不够多。

But sometimes it is just a matter of the number of attempts that, patients have had.

对我们这个领域来说，我觉得这是我们需要深入探索的方向之一。

For us as a field, to me, this is one of the areas that we really need to explore.

为什么即使是整倍体胚胎，活产率最多也只有百分之六十？

Why is it that with euploid embryos, we get sixty percent live births at best on the other side of it?

这说明我们在胚胎和子宫内膜方面都还有未解之谜。

We're missing something on the embryo and something on the endometrium.

这其实挺令人兴奋的，因为在你辉煌的职业生涯中，我们已经取得了很大的进步，马克。

That's actually exciting because we've come a long way over your illustrious long career, Mark.

但我觉得我们仍然……

But I I think we still...

下一代人有很多边界需要去突破，才能搞清楚这些问题。

This next generation has a lot of boundaries that they get to push forward to figure this stuff out.

我很想知道，在没有强制要求试管婴儿的州，嗯……

I would be interested to know if in states that don't mandate IVF Mhmm.

医生们是不是更倾向于尝试非标准治疗？

Are physicians more compelled to try nonstandard of care?

因为，你知道，我们看到的研究表明，三到六个周期的整倍体染色体正常胚胎成功率非常高，但在没有强制要求的情况下，这需要付出巨大的代价。

Because, you know, we look at the studies that show three to six cycles of euploid chromosomal in normal embryos having very, very high success, but that comes at a dramatic cost when it's not mandated.

是的。

Yes.

这就让事情变得有点困难了。

And that makes it a little bit more difficult.

说得好。

That's a good point.

对。

Yep.

我想总结一下关于试管婴儿附加治疗那些尚未解答的问题。

I I I wanted to sort of summarize in in terms of the unanswered questions about IVF add ons.

也就是说，患者应该问哪些问题，以及我们如何告诉听众，在他们认为不属于标准治疗的情况下，他们需要知道什么。

Is that the questions for patients to be able to ask and how would you be able to provide our audience as to what they need to know before what they think is not standard of care.

如果他们打算使用这种治疗，他们应该向医生问哪些问题？

If they're going to use that, what kind of questions do they want to ask their provider?

是的，如果我要问我的医生关于我在网站或博客上看到的一些患者说他们在做的事情，我首先想知道的是，这真的能提高我的成功率吗？证据有多可靠？

Yeah, if I was going to ask my doctor about things that I've maybe read on a website or on a blog that the patients are saying they're doing, the first thing I want to know is does it actually improve my chances, and how good is that evidence?

因为很多这类事情都缺乏高质量的证据，你的医生应该明白这一点。

Because a lot of these things just lack quality evidence, and your physician should be able to understand that.

不是所有东西都没有风险，有时候风险就是费用。

Not everything is risk free, and sometimes the risks are cost.

有时候风险是时间。

Sometimes the risks are time.

但有些干预胚胎的操作，实际上可能会有伤害胚胎的风险。

But some of these things where we're intervening in the embryo may actually have the risk of harming the embryo.

我们的胚胎学家技术确实很好，但他们在做活检和孵化时，是在对微小的生物体进行显微手术。

Our embryologists are really good, but when they're doing biopsies and hatching, they're doing microsurgery on a tiny organism.

可能有一些小的风险。

Maybe there's some small risks.

这会花我多少钱？

How much is it going to cost me?

还有，做这个有什么替代方案吗？

And what are the alternatives to to doing this?

我觉得，当医生把这些信息告诉你之后，和他们共同做出决定很重要，还要问问这些操作在他们诊所的表现如何，他们内部的数据是怎样的，这些都是和医生沟通的好方法。

And I think, you know, coming to a shared decision with your physician once they share that information to them is important, and asking how those things perform in their clinic, what their internal data is on that, think all those are good approaches to your physician.

说得太好了，Micah。

Excellent points, Micah.

还有，对于……

And for for the...

各位听众，当你们在寻找诊所时，真的希望那家诊所能够理解你们的问题。

For our listeners out there, when you're searching for clinics, you you really want that clinic to buy into your problem.

如果一家诊所能够回答你们的问题，进行真正的对话和讨论，让你们感到充分知情并有能力做出决定，那么你们就找到了合适的诊所。

If you have a clinic that can answer your questions to have a true dialogue discussion so that you feel fully informed and empowered in being able to make this decision, then you have the right clinic.

完全同意。

Absolutely.

这里是SART播客，我是SART的即将卸任的主席。

And this is the SART podcast, and I'm the outgoing president of SART.

马克一直是SART董事会的领导者。

And Mark's been a leader in...

在SART董事会中。

On the SART board of directors.

所以我们只想说，当你们选择诊所时，寻找SART会员资格，从那里开始。

And so, we would just say, you know, look for that, SART membership when you're choosing a clinic and start there.

这样你们就能找到最高质量的诊所，开始提出这些问题。

That'll get you to the highest quality clinics to start asking these questions with.

谢谢你，Micah。

Thank you, Micah.

各位，非常感谢大家的收听。

Everyone, thank you so much for your attention.

今天很高兴能邀请到Micah Hill医生，和我们一起聊聊试管婴儿的附加项目。

It's been my pleasure to have, doctor Micah Hill, joining us today, to talk about IVF add ons.

下次再见，我是Mark Trollis医生。

Until next time, this is doctor Mark Trollis.

保重。

Take care.

本播客中表达的信息和观点不一定代表ASRM及其附属机构的立场。

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and its affiliates.

这些内容仅供参考，不能替代医生的专业咨询。

These are provided as a source of general information and are not a substitute for consultation with a physician.