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Friday, September 26, 2014

Embryo Transfer (7th IVF cycle)

Transferred embryo (Grade 2AA)

Embryo transfer to Rita 

Embryo transfer TO MANJU!

Let me explain. When I told Dr. Malpani that I will do one more ovarian stimulation cycle he said, “Manju, I suggest that you transfer one blastocyst to your uterus". He also said, “If that doesn't work, we will transfer the supernumerary embryos, we freeze, to Rita". Until that day nobody was able to convince me for having an embryo transfer again. I was adamant that I cannot go through another pregnancy. But, when my Dr said so, I didn't have any second thoughts. He is my Dr and if he says so, there must be a valid reason behind it. We all have a person in our life whom we admire and respect a lot, whom we look upon as our inspiration. He is one such person for me and I immediately agreed to what he suggested. But, I was not as optimistic as Dr. Malpani was. I thought, first let the stimulation start, let my ovaries respond to the drugs; let me produce eggs and embryos! After seeing my AMH value I became even more pessimistic. I was not even sure whether I will have embryos which will grow to blastocyst stage and whether we will have blastocysts to freeze. If I am left with less than 3 blastocysts, there is no point of transferring them to me. I was very confused. I thought, let me decide whether to transfer the embryo to my uterus or not after the day 5 fertilization report. As you all know now that I had 7 blastocysts at the end, we decided that I will have one (two?) transferred to my uterus. The happiest person about my decision was of course my husband. His positive spirit has always amazed me. His only complaint was that, I didn't budge to his words and when Dr said so I listened to him. But he was like, “atleast you listen to someone’s words in your life!” :)

Dr. Anjali asked me during one of my scans, "What have you decided regarding embryo transfer, how many embryos are you planning to transfer?" I had no answer then, I told her that I was very confused. I said, "Ma'm, sometimes I think I want to transfer two, sometimes one and sometimes nothing at all". This is how my mind was until the very last moment.

The day of embryo transfer came. I went to the clinic. My mind was unable to decide between how many blastocyst to transfer - one or two? I am 36 years old. For my age, chance of having aneuploidy in the resultant blastocyst is more than 50%. If it is so, 3 (minimum) of my 7 blastocysts might have chromosomal abnormality. If that is the case, isn't it wise to transfer two instead of one? On the other hand, I was scared to death of another twin pregnancy. After going through so much, I couldn't understand how my heart was greedy to even think of transferring more than one? Human mind is strange, it forgets pain so quickly! I thought, Dr. Sai will be there, Dr will be there, I will ask them both before coming to a conclusion.

In the clinic, we both entered our allotted room; I wore that wonderful hospital gown and waited eagerly for my turn :). I was also very eager to meet Dr. Malpani. I had met him only for 5 seconds during my entire stay there. I find embryo transfer stress free when he performs it. He keeps on talking something funnily and I forget that I am laying there in the most uncomfortable position, allowing people to poke and prod my private parts. If I am not comfortable during such procedures, I could feel my vaginal muscles tightening, my legs shivering uncontrollably. Sometimes because of getting so tensed, I get cramps in my leg muscles too; if that happens the whole ET episode could become very painful and scary. 

First, we were lead to the embryology lab. Dr. Sai was waiting for us. He showed us our embryos. He also showed the one which will be transferred to me. He said, “this is ahead of other embryos in its growth, so we decided to transfer this to you". I slowly asked him, “Dr. Sai, can I transfer two embryos, will it give me a better chance of success rather than transferring one?" He couldn't give me a conclusive answer. Who will suggest me something after knowing my history of twin loss? I said him, "Ok, I will ask Dr. Malpani, is he in his room? Should I meet him there or can I ask him when he comes for embryo transfer". He said, ask him when he comes to the embryo transfer room. So, I entered the ET room and saw Sister Mary and Vinayak (he works as an assistant). Both are very nice people. On seeing them I felt much comfortable. I just sat there on the ET table and started chatting while they were getting ready with the necessary items for embryo transfer. Vinayak asked, "can I call ma'm" and I looked at him shockingly!

I asked Vinayak, “Isn't Dr around?". He said, I don't know but ma'm said she will come to do the transfer. I was about to cry, my face was becoming grim. I told Vinayak, “will you please look whether Dr is in his room, if he is not going to do the transfer, I will not undergo this embryo transfer at all”. I know it was not very nice on my part. Vinayak looked at me as if his eyes would pop out. I actually ordered him, “go and look whether Dr is in his room", my intention was not to order, but, then, that was how I could react. He left the room. Sister Mary was listening to all this silently and she spoke. “Manju, ma'm will be upset if she hears this. She does embryo transfers very well. Do you know that women come from many different places in order to have embryo transfer done by her? She does embryo transfers equally good" On hearing this I felt guilty. True, how will ma'm feel if she hears what I said. How stupid I was! But I couldn't accept that Dr will not do the embryo transfer. I thought, “he didn't even care for me the least”. I wondered whether he even remembered that I have my embryo transfer on that day! I brought with me my children's foot prints (they gave them to me in the clinic after their birth) to show to him, I wanted him to hold it for some time, he only transferred them to my uterus and above all he is my Dr whom I shared my happiness and pain during my twin pregnancy. He was patient and kind enough to give me a shoulder to cry on during my very difficult times. It was hard to accept that he will not do my embryo transfer this time. It was very hard to accept the fact that my last chance for meeting him was no more viable. He didn't even wish me good luck! I remembered a patient e-mail where she asked whether Dr. Malpani will treat patients like me who writes blog like a VIP, I thought sarcastically, "yea, he does!" Vinayak came back. He said, " Dr is not there, only ma'm is there."

Dr. Anjali came. I always say that she has lucky hands. I think that expression is very unfair, and it somehow underplays her talents. She is the most talented person around. Several years of experience and her dedication has sharpened her skills a lot. Since Dr. Malpani is net savvy people know him better than Dr. Anjali, but, she is the best in the clinic :) The first question I asked her, as soon as she entered the room was "Ma'm, where is Dr?". She said, "He is busy nowadays, he went somewhere out". From that moment onwards till the embryo transfer all I did was to cry. Not just tears I was sobbing!

Dr. Anjali asked me, "Manju, how many embryos do you want to transfer?" I asked her, " how many should I transfer, can I transfer two?" She was not able to suggest me something too. She said, “you must decide". I was baffled. Lying down with legs on the stirrup and trying to think logically was not an easy task. I looked around and said, "I will ask my husband, where is he?" Normally, when Dr. Malpani transfers the embryos, Rajender will be with me. I wondered why he is still not there. Dr. Anjali told me “I don't want husbands inside the embryo transfer room". Even at that moment I actually appreciated her. I always felt that Rajender was more tensed than I was during embryo transfers. Instead of him trying to keep me calm, I have to hold his hand tightly to give him some assurance that all will be fine. Even after coming out of the embryo transfer room, he will be replaying several times in his mind whether all went well. He would say, “I saw some blood in the catheter after transfer, is that OK. Doctor was taking long time, he was moving something here and there, and would he have done it correctly?” His questions and doubts are enough to send me to a panic mode destroying the joy and peace of having a little embryo inside. So, Rajender was not available too to get an answer for the most important question - should I transfer one or two embryos? My mind was racing, I had only few minutes to decide, I was angry with Dr. How to decide, I had no clue! And, then an idea flashed inside me.

Vinayak, was near my eyes reach. Sister Mary and Dr. Anjali were preparing my nether region for transfer. I called Vinayak. He looked at me with little fear, “what is this stupid woman going to order me now was the question in his eyes” :) He was tensed. I showed him two of my fingers and said (ordered!) touch one of the two. He was totally clueless. He blinked for a moment and touched both my fingers. I really went mad for a moment, that's my last effort and he is trying to spoil that too. I said, "Vinayak, touch only one". People in that room were looking at that drama. He reluctantly touched one of my fingers. I calmed down. I looked at Dr. Anjali and said very confidently, "ma'm please ask Dr. Sai to bring only ONE embryo".

Dr. Anjali proceeded to transfer the embryo. She realized that I was crying. She asked me several times why I was crying. She was saying, “See, at one point we were wondering how many embryos you might get; now you have many. I thought you will be so happy and smiling today, why are you crying?" I gave no answer; all I did was to cry dutifully. Dr. Anjali asked me to breathe like the way when we do pranayama. She said, “I must see your stomach moving up and down”. All I did was to sob. She asked, "aren't you happy Manju?" I couldn't answer. She asked this for few times until Sister Mary interfered nervously. She said, “Oh, she is happy, heyna Manju”, she asked. I realized I am behaving stupidly. I said, "yes ma'm, I am happy". Dr. Anjali before transferring the embryo asked me to visualize it. I could see that she was saying a little prayer when she pressed the piston of the embryo transfer catheter. The transfer went on smoothly. I didn't feel any pain or I was not in a mood to feel what was going down there. She did it very carefully and with so much ease. After the transfer I thanked her amidst tears. I could see a very frustrated look in Dr. Anjali's face (due to all my tears!). She said, "I have to leave now, I will meet your husband and then leave"

After Dr. Anjali left, Sister Mary was telling me, “during transfer you were crying, because of all your sobbing I could see the cervix moving up and down". I just gave a blank expression. She said again "do not worry ma'm did the transfer very well". I was still on the crying mode. Vinayak on seeing this was trying to console me. He said, "There was a patient, her name is Manju too. She now has twins after many failures. This time all will go well for you" This further increased my sobbing. He was near my head. He kept his palm on my forehead and said, "Don’t cry Manju". That was such a compassionate gesture. I felt instantly better. I told him with smile on my lips and tears on my eyes, “if I do not get pregnant, for sure I will come and kill you, you are the one who said that I must transfer only one embryo".

Ten minutes I was there in the transfer room. Sister Mary and Vinayak made me feel so comfortable with all their pep talks. Sister Mary never fails to ask me a question whenever we meet, "your husband seems to be a very nice person, isn't he?" :) Previous time she even said, " when I fist looked at you, I thought you were proud but after talking to you I understood that you were not like that" :) Thank God! Mary Sister goes on talking and talking, she talks in Hindi, I reply in English, language doesn’t really matter!

I was allowed to go to my room after 10 minutes. Rajender was eagerly waiting for me. If he sees my tears he will panic, so I wore a smile on my lips. I told him that everything went on well and lay down. I said that ma'm did the transfer and that is why he was not allowed in the embryo transfer room. Before telling him that Dr was not there, tears once again appeared. He said, "please do not start again Manju, atleast not now". He looked at me for some time and said, "who knows I am not there in the transfer room and that might be your lucky charm". I looked at him angrily, didn't want to respond. I just closed my eyes. I thought, "Where will this decision of mine take me to? Why can't I have a crystal ball to predict my future?"

After half-an-hour I was ready to go. Rajender wanted me to rest for some more time but I wanted to leave. I said good bye to everyone. When I was about to leave, Shonali told me, “Manju, you should never come here again". I was very thankful for those words. I knew she meant well. With a heavy heart I came out, I thought, "I will never ever talk to Dr again, and if this embryo doesn't implant then I will see" :(

Where did my decision take me to? Will it lead me to happiness and bliss or to sadness and grief once again? Keep reading!

Friday, September 19, 2014

We met Rita for the first time

One day, in the clinic, we met Rita. I was excited to meet her. Rajender was a bit reluctant; I could see it in his eyes. When Shonali came and told us that Rita was waiting for us in a particular room, I became a bit nervous too. What should I talk to her; I haven't prepared anything in my mind. I was wondering how she will look in person! Will she look undernourished, sad, and mature-looking for her age? Somehow that is the image I had about her in my mind. I was even afraid to find a woman whom my heart will reject on the very first look. I am a very intuitive person and I normally develop an impression about someone on the very first look.  As I went closer to that room, I could hear my heartbeat in my ears very clearly, I was excited and nervous too. I eagerly opened the door to have a first look of the woman who will carry our child and I must say I felt very relieved.

The moment I looked at her all my anxiety vanished. There stood a younger-looking, healthy, humble, friendly woman with a warm smile. She looked just like my sister.  There is of course a tinge of anxiety in her eyes too. I held her hand to make her feel comfortable and to make myself less anxious too. I asked Shonali to stay in that room so that she could help us in communicating with Rita, I was not so confident about Rajender's Hindi language skills :) I asked Rita how she was, her family etc.., the normal conversation which could bring some ease between us.  I could understand Hindi, (thanks to Doordharshan, our only entertainment when I was young) so I was following what she was saying. After the initial introduction, she told us that she was sorry about what happened to our pregnancy. She said, 'I was careful enough but somehow it happened'. Before she finished those words her eyes were tearing up. I told Rajender, 'please tell her that it was not her fault. Such things happen to many early pregnancies and she was not responsible for what happened'. When saying this I saw Rajender's face for the first time after we entered that room. I could see that his face has softened. He told Rita what I told him. This conversation brought much more closeness between us. Rita's body language became much friendlier, her face appeared relaxed. She started to open up much more. She was talking about her children. She said that she was married at a younger age and her son was now 12 years old. Her daughter was around 8 years of age. She showed her family pictures which she had in her cell phone. They all looked so healthy and happy. Her eyes were beaming with pride and happiness. She said that her children go to English medium school. I asked her about her husband, whether he takes care of her well. I was trying to read her face. Definitely there was a genuine happiness and content when she said that her husband loves her so much. She paused for a moment. Her face showed some pain.  She lowered her head and said, my husband was doing business; we faced lots of loss in it. We need money now. That is why I decided to work as a surrogate. Even my mom doesn't know this (I was not happy with this statement!). She also said, 'I do not stay idle at home, I do work. I run a small canteen at home'. I could understand that she was feeling humiliated, wondering what I was thinking about her! I told her that she must be proud of herself for coming forward to support her family and help us too. I explained her how priceless is the help she will be doing for us. I told her why we needed surrogacy. I showed my children's picture to her, my 5 months old twins ( our children whom we lost at 20 weeks of pregnancy ), the ones whom I will love and cherish forever. I couldn't stop my tears. Those pictures are very personal ones but I thought I must share it with her, after all, it will tell her clearly about my inability, our situation. I could see her eyes getting wet too and her grip tightening around my hand. 

I gave her a saree which I brought for her and chocolates for her children. Rajender gave her some money and he was thanking her again and again. I could understand him. He was totally overwhelmed by that meeting. He said, ‘we are sorry that you have to go through this trouble because of us, sorry that you have to go through that miscarriage’. I was happy that he was empathetic enough to think about Rita's pain.  I was so proud of my husband as usual.

It was time for my scan. I had to leave. Rita gave me a very warm hug. She said, ' I like you both a lot, I will be very happy to carry your child. When I become pregnant again I promise that I will be extra careful. Do not worry '. She said, 'I wanted to meet you both. I was always asking Dr. Malpani when I could meet you and I am so happy now'.

When I and Rajender came out of that room we felt a lot more happy and confident. Dr was after all very correct in saying ' Manju, you must meet Rita and you will feel a lot better’ 

The day of embryo transfer came. On that day I was present in the clinic too and ...

Tuesday, September 9, 2014

The much awaited fertilization report

Blastocysts which were frozen on day 6

Growth arrested embryos

This post is going to be easy for me. I will just copy and paste Dr. Sai’s emails.

On day 1, I had 15 embryos. I guess one egg matured in the lab, so there were totally 15 mature eggs out of 19 retrieved, and all were in the 2 PN stage on day 1. This means all ICSIed eggs fertilized, a 100% fertilization rate! This is just awesome and clearly shows the technical expertise of Dr. Sai.

The Day 2 gradings of your embryos are as follows:
2x 5-cell grade A
4x 3-Cell Grade A
6x 2-Cell Grade A
3 Embryos got arrested at 2pn Stage.

There are total 8 Top Quality Embryos on day 3.
Day 3 Grading is as follows:
5 x 8-cell grade A
3x 7-Cell Grade A
1x 6-Cell Grade A
1x 5-cell Grade A
3x 4-Cell Grade A

Day 4 Grading of your Embryos as follows:
2X 6-CELL Grade A
1X 4-CELL Grade C

Day 5 Grading of your embryos as follows:
1x blastocyst grade 1AA
2X 8-CELL Grade A 
1X 6-CELL Grade A
1X 4-CELL Grade C

Day 6 (One must keep in mind that, on day 1, fertilization of eggs were done during late evening!)

We are Freezing Total 6 Blastocysts today on day 6.

All morulae Stage Embryos have Become Blastocysts.

Although Exp Blastocyst in image Cap1020 doesn't have great Trophectoderm (the last blastocyst in the above collage) we are freezing it becauze it has got a good Inner Cell Mass.

Altogether I got 7 blastocysts out of 12 cleaving embryos, this means 50% blastocyst formation rate. This is  a great result ! Normally women below 35 years old can expect a blastocyst formation rate of 40%
I am already getting queries regarding how it was possible to get so many eggs. I have no clue too. My AMH was infact low but my AFC count was high. Honestly, I didn’t expect such a good outcome. But, I had lots of faith in Dr. Malpani’s team. Dr. Malpani designed the protocol, Dr. Anjali monitored me very closely and decided when to give the trigger shot, ofcourse, as always, she did a great job during egg retrieval, Dr. Sai was excellent in doing his part of the job and my ovaries cooperated too well! I didn’t take any supplements. Two and a half years ago, when I had my first IVF cycle with Dr. Malpani’s clinic I took DHEA 75mg for 6-7 months and I thought might be DHEA helped me to get many eggs. But this time I took nothing and I do understand now that DHEA might  not have contributed to the improved outcome previous cycle. My first five cycles which I had in Germany were terrible ( I was much younger at that time, had great AMH value, yet, I had only very few eggs to work with.In short, I am very thankful to God and to everyone who helped me to get 7 blastocysts. In the beginning, prognosis of this cycle looked very bleak, but it ended up much pleasant and successful than expected.
There were 6 blasts frozen on day 6. What happened to the remaining one? :) Was it transferred to Rita and what happened thereafter? Keep reading ! :)
Dr. Sai was kind enough to provide the pictures of embryos which got arrested during its development. I have given the pictures of blastocysts frozen on day 6 and the ones which stopped growing in the above collage.

Tuesday, September 2, 2014

Egg retrieval and Rajender’s sperms

I am sure Rajender will not be so happy to read the title :) Anyhow, let me keep this one, it sounds interesting. On the day of egg retrieval I was so happy for no reason. I was not even a bit worried, might be all the good hormones were at play! I went to the clinic, the nurses started to prepare me for the retrieval. In Malpani clinic they have a gown; you need to wear it when you go for egg retrieval and during embryo transfer. I have gone there four times and not even a single time I tied the gown correctly. Rajender couldn’t succeed too in helping me! If someone of you who go to Malpani clinic, wear that gown and tie it properly, I would easily agree that you are one of the intelligent person in this universe, a genius :) This time I and Rajender wanted to do our best to tie it correctly. We tied it; Rajender did it actually and gave me a very proud smile. I looked at him with great admiration until sister Lizzy came, looked at me, removed the knots and retied it properly :) When sister Lizzy entered the room she told Rajender that Dr. Sai was looking for him. So he left the room. I was wondering what for Dr. Sai called! Usually the sperm collection cup is brought to the room where we are. During our first IVF, in Malpani Infertility Clinic, a nurse came with a big cardboard box into the room where I and Rajender were. I was wondering what it was! She looked at us both, smiled coyly and kept that box in the table, left quickly with a much shyer body language. I was amused by her behavior and when we opened the box there was a sperm collection cup. I still remember that smile and I guess she was new there at that time. Her shy, naughty smile did make that room very romantic ;) 

After Rajender left, Sister Lizzy gave me enema (how much I hate that!) and I was lying down. Few minutes later Rajender entered the room and looked at me as if he would burn me to ashes. I asked him what happened. He burst out – ‘what do you think of yourself? Is it very important to see the sperms?’ I was totally clueless for a moment and then I understood what happened. Actually, I was the one who mailed Dr that I would love to watch the sperms live under the microscope. He must have told Dr.Sai. Sister Lizzy instead of sending me, sent Rajender. I was excited. I asked Rajender whether he saw the sperms. He said with a very rough look, ‘no, I didn’t’. I asked, ‘why?’ He said, Dr. Sai asked me whether I wanted to have a look but I said no. That appeared very ridiculous to me. They were kind enough to let him into the embryology lab inspite of their busy schedule; they were ready to show him the sperms and why should someone be angry for that! Rajender continued to talk, actually he spitted out. He said, I went to Dr. Sai and he asked me whether I want to see the sperms. I said no and came out. Shonali came and she asked the same question to me. Everyone sitting there was watching me (the patients probably!). When I was about to come out, another Sister came and she asked me the same question. I felt very embarrassed, and it is all because of you. This blaming got me too irritated. Instead of seeing the sperms, what for he is coming and shouting at me! I couldn’t really understand at that moment about how he felt, and the reason for his anger, but now I could. He was already too tensed about the sperm giving part. He prepared himself for that five minute job for days (abstinence, healthy food). When Dr. Sai called, he must have gone thinking that he must give sperms and all the little drama that happened there made him very irritated; especially, he couldn’t tolerate the fact that everyone was watching him when he was being asked whether he wanted to see the sperms. Whenever I think of this incident I smile, a happy memory! I dare not talk to him about that incident after that.

When this fight was going on between us, Dr entered the room. I had no clue that he would come. He smiled and asked ‘are you ready to give lots of eggs’. I said, ‘I hope so’. Before I could start the next conversation, he wished us good luck and he was gone. Dr. Malpani talks so fast, and if there is a Guiness record challenge about who speaks the maximum words per minute, I am sure he will easily win! :)  I needed some time to talk to him, I had some questions in mind and more importantly I had something with me to show to him. He just came like a lightening and left. All I could think thereafter was, 'I need to talk to him!'

After sometime, they called me for egg retrieval. I went, and there stood the anesthesiologist. He asked me whether I was afraid and I replied very happily that I love anesthesia and I am not a bit afraid. He again asked whether I am nervous about injections. I said, ‘I have gone through 7 IVFs (as if it was the most proud happening in my life!), I am not afraid of needles’. I saw Dr. Anjali sitting there. As soon as the needle entered my vein I lost consciousness. Someone woke me up, don't know after how long! I felt I am being disturbed from the most happy, peaceful sleep. I said, ‘I had beautiful dreams’. The next question I heard was, 'do you remember them’. I said, ‘no’. Then I asked them, 'please give me more anesthesia, I want to sleep' :) I wish death is similar to going under anesthesia - a long, deep, peaceful sleep. If it is so, I am sure death will be an amazing experience! Then I remember someone asking, most probably Dr. Anjali - 'do you know how many eggs you got?' I kept quiet. Dr. Anjali said 19 eggs. I couldn’t open my eyes but I thanked her and said, ‘ma’m you have the luckiest  pair of hands’. Then I said, ‘I want to talk to Dr’. Someone asked me which Dr. I was angry, I thought very hard (it was very difficult to use my brain!) and said ‘big Dr’:)  I could feel that I was back to my bed, heard Rajender’s voice, said to him that they retrieved 19 eggs and again repeated ‘I want to talk to Dr’, I dozed off. I heard Dr. Anjali’s voice, Rajender’s voice and then after one or two hours I woke up. I could see my husband’s face eagerly looking at me. Obviously it must have been boring and he was waiting for me to get up so that we can go to our hotel room. Happiness is waking up from anesthesia to see the love of your life waiting anxiously for you! I smiled at him and said, ‘I am very hungry’. 

After getting dressed up, I said to Rajender, ‘just wait for a moment; I will be back in few minutes’. I told Sister Mary that I want to see Dr. Sai. I was still in half-sleeping mode. I held my forehead with my hands and sat in the waiting room until Dr. Sai came out. I asked him, ‘can I see the sperms?’ He said, ‘wait a moment’, he went inside the lab and called me after some time. He asked, ‘do you want to see your husband’s sperm?’ I said any sperm sample would be fine. He took a sample from Rajender’s sperm, mounted them on a slide and showed those little swimmers. I was so happy to see them live. They are like tadpoles and were moving constantly, at least most of them were. I thought, if Rajender could see this too it would be wonderful, but, I had no guts to start the sperm topic again to him :) I looked around the embryology lab; Dr. Sai must have been busy working there. In the music system, which he had in that room, devotional songs about Sai Baba was oozing out making that place much more peaceful and desirable. I did feel comfortable that Dr. Sai will be handling our eggs and sperms and creating our embryos. He actually does the most important job, the job of Lord Brahma – the creator!

Yes, I got 19 eggs. I learned soon after that, 14 out of 19 eggs were mature. I and Rajender were happy. We have crossed one hurdle successfully! Will I get enough embryos on day 5 so that we could do ateast 2-3 transfers to Rita; this was the nagging question in my mind! I thought, I will be very happy to transfer my embies to Rita. We met her during one of our follicle growth scan and we liked her instantly. More on that soon!
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