One day at a time

I wish I knew the secret to fixing a broken heart… But I don’t. Instead, I’m here with my heart shattered all over, trying to collect all of the pieces and put them back together; trying to make sense of this mess around me and the uncertainty of my future; trying to keep functioning, despite feeling broken, confused, and lost.

The embryo transfer after our IVF cycle did not result in a pregnancy. The grief resulting from this disappointment has been overwhelming, and I have had some really, really hard days since my negative pregnancy test last week. I knew going into IVF that I wasn’t guaranteed a pregnancy, but our odds were good and I was so hopeful… so ending up not pregnant has been a major blow.

IVF is such a huge undertaking. It’s an enormous and risky investment — emotionally and financially — and it’s very physically demanding. And standing on the other side of IVF, not pregnant, is… well… devastating.

In between episodes of intense grief, I feel numb. I go through the motions of my day, without real awareness or any enthusiasm I might normally have. I make jokes with my clients and try to smile… then I come home and stare at the wall. Friends offer to talk, and I decline. At this point in time, I simply have nothing to say and making small talk is unbearable. (Bear with me, loved ones; I won’t feel like this forever.) Matt does his best to accommodate me, asking what I need and how he can help. I’m so lost in my own grief, I rarely even think to ask how I might help him.

It’s almost easy to forget how hard bad days can be once they are over… I’ve had a lot of ups and downs during infertility (and in life…), and now that I’m having really, really hard days again I’m amazed that I’ve made it through days like this before. I look back at previous dark days and I wonder how the hell I got through them?

The only answer I can come up with is: one day at a time.

I don’t know the secret to getting through bad days. I don’t know the secret to fixing a broken heart. I don’t know the secret for surviving grief. But I know that all of these are experiences I must work through. There’s no detour for getting around this stuff. There are things I can do to help myself along the way… but in the end, the only way out of a hard experience is through it — one day at a time.

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Observations and Fun Facts

  1. During the stimulation phase of IVF, my cat and I were taking the same steroid. It was even the same dosage.

  2. I like to wear fun socks to amuse my doctor and nurses (and myself). During IVF there are many, many appointments, and my socks have been giving me something fun to look forward to each day… “What kind of conversation will my socks start today while I’m in the stirrups?”

  3. Human eggs hatch. I’m serious. After the egg is fertilized and begins to divide and grow, it needs to hatch in order to attach to the endometrium in the uterus. We employed the technique of assisted hatching to help the embryo implant after the transfer.

  4. It hurts a lot when an injection hits a nerve. Heating pads help.

  5. Bedrest doesn’t have to be boring. My mom has been a wonderful activity director during my bedrest — keeping me occupied with a rotation of activities like looking through magazines, watching Friends and movies, reading out loud to me, and taking time for phone calls, texting, and looking at kitties on instagram. And Matt has been a great chef, preparing yummy and healthy foods for me, in addition to making sure I have enough chocolate!
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More Books

Here are a few more books that I’ve read since my first book list post:

Infertility:

  • Silent Sorority: A (barren) Woman Gets Busy, Angry, Lost and Found; Pamela Mahoney Tsigdinos
    This memoir was fantastic. She writes about her infertility, treatment, considering adoption, and coming to terms with her childlessness. For anyone wanting to know what infertility feels like, I highly recommend this book — she is so honest, and so many times times I felt like I was reading things on the page that I had been thinking myself. And for anyone experiencing infertility, I still highly recommend this book — it’s very validating, and gives me hope that we will survive this and be okay whether we have children or not.
    5stars

 

  • The Art of Waiting: On Fertility, Medicine, and Motherhood; Belle Boggs
    In addition to being a memoir, this book is also a study on fertility, treatment, and family building options. She shares her experience with infertility and her success with IVF, but she spends much of the book discussing research, data, literature and cultural observations that surround pregnancy, families, and parenthood. It was very interesting. It’s also very up to date — it was published in 2016, so the research she presents is current.
    4stars

 

  • Infertility Sucks! Keeping It Together When Sperm and Egg Stubbornly Remain Apart; Beverly Barna
    This one is funny and sarcastic, and does a pretty good job of bringing some humor to the experience of infertility, but I definitely had to be in the right mindset to read it — some days I couldn’t even pick it up. When I was in the mood for a laugh, some parts of the book were really funny and made me laugh out loud; other parts weren’t as funny to me, and even made me cringe a little… but I think that’s to be expected in a dark humored book about infertility.
    3stars

 

 

Pregnancy & Baby Loss and Trying to Conceive After Loss

  • Empty Cradle, Broken Heart: Surviving the Death of Your Baby; Deborah L. Davis
    I have some mixed feelings on this book. Some parts were really good. It had some really good chapters on grief, recovery, resolution, and trying again, as well as a good chapter specifically targeted at men. However, it also had a big emphasis on healing through having subsequent children, which was hard for me to get behind… It’s not always so easy or possible to just go get pregnant again; for some of us, it’s most important to find healing outside of another baby, whether or not we try again.
    3stars

 

  • Trying Again: A Guide to Pregnancy After Miscarriage, Stillbirth, and Infant Loss; Ann Douglas and John S. Sussman, M.D.
    Trying Again covers a lot of ground… It begins by discussing many reasons why a pregnancy might be lost, why a baby might die before it’s born, or why an infant might die after birth. It then addresses fears and anxieties, and provides coping tips for couples who are trying again after having experienced a loss. Although reading about these things might terrify a lot of people, to me it felt right to learn more about the things that can go wrong, to prepare myself with coping tips moving forward, and to share in the understanding of others who know what it’s like to try again. I thought this book was very informative and helpful.

 

 

In Vitro Fertilization (IVF):

  • The Couple’s Guide to In Vitro Fertilization; Liza Charlesworth
    This was a very helpful guide for preparing for IVF. It was published in 2004, so some of the statistics are out of date, but for the most part the process is still the same. I’ve done a lot of research for IVF already, but I thought this book would be worth reading too, and it was. It was very thorough and informative, answers a lot of questions, and shares a lot of advice and anecdotes from the author and couples she interviewed.

 

  • The IVF Journal; Stephanie Fry
    To be honest, I’m still working my way through this one, but I still wanted to include it. This one is kind of like an IVF workbook, and I’m not finished with it because we’re not finished with IVF yet! It includes some helpful information at each step of the way through IVF and has many, many pages of charts and notes ready to be filled in by the IVF patient. There are so many medications, dosages, times, appointments, and other things to keep track of during IVF, and this journal provides an organized space for everything to be recorded. I’m finding it quite useful so far, although I am wishing it had better binding (perhaps a spiral)!
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Due Date

After shrieking with joy and sharing the news with Matt, one of the first things I did after finding out I was pregnant last summer was calculate the due date for our baby: February 6, 2017. This date has been imprinted on my heart from that day. And after months of waiting, it’s finally here.  

But our months of waiting didn’t unfold the way we expected. After finding out that my pregnancy was ectopic, the dreams of our future child were crushed and our hearts were shattered. Our months of waiting for a baby’s due date turned into months of grief, recovery, more fertility treatments, and waiting for another pregnancy.

Back in June when I first imagined February 6th, I pictured meeting my child today. But that’s not happening; I’m not holding our child in my arms, listening to her cry, or watching her open her eyes. I’m not going to be awake all night tending to her or memorizing her every feature while she sleeps.

Instead, today I’m reflecting on life, loss, and love. I’m grieving our loss and feeling the emptiness in my arms and my quiet home. Tonight we lit a candle in memory of our pregnancy, of a child we never had the chance to meet. I’m remembering the joy I felt and dreams I had when I was pregnant. And I’m feeling love. I feel my love for Matt and the love that urged us to want to become parents together. I feel my love for the child I carry in my heart instead of my arms, and love for a future child I hope to still bring into our family.

We begin the egg stimulation phase of IVF soon, and today (of all days) I had my final check-up and lab work before the injections begin. When I first saw the date for the appointment I was a little freaked out, but I’ve decided to take it as a sign of love and good luck that we were given the green light to proceed today, on my due date. We’re moving forward with love and science in the hope that soon we’ll have a new due date to look forward to, one that will turn into a birthdate of a living child.

Today we’re honoring our due date with memories of my pregnancy, hope for the future, and love for each other and our family — family who live among us and family who live in our hearts.

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Women’s Reproductive Health Care

According to the World Health Organization: “Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years.” Considering all of the possible health issues in humans, one third for sex and reproduction is a lot. And what’s more upsetting is that we know quite a bit about preventing and treating sexual and reproductive health problems, but too often women still do not receive or have access to the care they need. Too often women do not have the power to choose what’s best for them and are told what to do instead.

It is important to note that this statistic is for women worldwide, but we can’t just sit back and think to ourselves that the US has it all figured out either, because we don’t — women in our country are suffering from problems related to sexual and reproductive health.   

In this day and age, we have the science and medicine available to help women take control of their reproductive health, and they should always have the opportunity to choose what’s right for them. In order to fully exercise their rights guaranteed in the US — life, liberty, and the pursuit of happiness — women need to have reproductive freedom. We should be able to choose if and when we become mothers. We should have complete access to reproductive health care choices — everything from preventative health care to screenings to treatment; from contraceptives to assisted reproductive technologies; from prenatal care to maternal care; to pregnancy termination.

Fortunately in this country, the Affordable Care Act had started to address some of these problems; it made historic gains regarding women’s health care, both in terms of more people receiving coverage and in terms of what services are covered by insurance.

The Affordable Care Act (ACA) tightened regulations in the insurance business in order to better protect and serve the patient. As a result, health care coverage was expanded to many Americans who were previously not covered, including young adults who preferred to stay on their parents’ plans. The ACA made it illegal for insurance to be denied to people with pre-existing conditions, helping all kinds of people receive insurance, including women who were previously denied coverage for pre-existing conditions such as having had a c-section or being the victim of domestic violence or sexual assault. The ACA made gender rating illegal — insurance companies can no longer charge women more for insurance than they charge men.

And under the ACA, insurance companies are now responsible for covering an impressive list of preventative health services. For women specifically, services that are now covered by insurance include:

  • “Well-woman visits.
  • Gestational diabetes screening.
  • Domestic and interpersonal violence screening and counseling.
  • FDA-approved contraceptive methods, and contraceptive education and counseling.
  • Breastfeeding support, supplies, and counseling.
  • HPV DNA testing, for women 30 or older.
  • Sexually transmitted infections counseling for sexually-active women.
  • HIV screening and counseling for sexually-active women.
  • Mammograms and Colonoscopies”

As this new coverage rolled out, US women and girls finally began to have access to and coverage for some of the health care they needed.

However, even with all of these positive changes, women’s health care still has room for improvement (e.g., cancer, mental health, violence against women)… but I am very afraid that our health care situation is about to get a lot worse, instead of better. Right now, many of the reproductive choices that we currently have in the US are at risk of being taken away — the new administration does not support women’s rights or women’s health. The combination of the new administration, the new congress, the rise of Catholic hospitals, and the increase in Targeted Regulation of Abortion Providers (TRAP laws) have all put women’s healthcare in the US and abroad in serious peril.

Under the new administration, the Affordable Care Act is at risk of being repealed, and no one has any idea of what it might be replaced with, if anything. This means that in the future women’s health care plans could again become more expensive than men’s, people could be denied coverage, preventative services and medications may not be covered anymore, and so on. This is scary. And women know it. After Trump was elected, women were rushing to obtain long acting birth control in the fear that contraceptives will no longer be covered once the new administration gets their hands on the ACA.

On top of that, the House of Representatives is currently considering a personhood law (H.R. 586) which defines human life and personhood beginning at the moment an egg has been fertilized, and it states that all laws pertaining to people should apply to the fertilized egg. This law would ban abortion, major forms of contraception (including IUDs, Plan B, and possibly the ring, injectables, the patch, and even the pill), and potentially IVF. It could also open the door to prosecuting women who have experienced a pregnancy loss, and since about ¼ of confirmed pregnancies end up in miscarriage or stillbirth, that’s a horrifying prospect. Personhood laws like this are a major attack on women’s health and reproductive choices.

Every woman should have the right to choose whether or not to pursue pregnancy. For those who want to avoid pregnancy, contraception should continue to be available to each and every woman who would like it. If the ACA is repealed, new regulations and coverage must continue to provide this vital type of care. Choosing if and when to become a mother is critical for women to thrive.

And for those of us who would like to be pregnant, we should have the right to pursue it, even if we suffer from the disease of infertility. In the case of infertility, pursuing pregnancy may require assisted reproductive technology (ART) (e.g., IUI, IVF, and/or third party reproduction). Therefore, personhood bills should never be passed because they will interfere with ART, and insurance companies should be held responsible for assisting with fertility treatments. Currently, fertility assistance and ART are not covered by most insurance policies. We, for example, have no insurance coverage for fertility treatments. Those of us struggling with infertility should be able to count on insurance to assist us in building our families. And before getting upset about the high costs of fertility treatments, please keep in mind that pregnancy and delivery carry an extremely high cost, at times even far exceeding that of an IVF cycle. Insurance companies could certainly cover ART, but they won’t until someone makes them.

In addition to choosing if and when to pursue pregnancy, women should be able to access the comprehensive care they need. Unfortunately however, in some areas of the US, access to some types of care is a major problem due to Catholic hospitals and TRAP laws.

In places where Catholic hospitals are the only option, many women are denied the care they desperately need because it conflicts with religious beliefs of the hospital system. Catholic hospitals are notorious for refusing medical treatment to women requesting services like contraception or sterilization, or who urgently need pregnancy termination due to dangerous miscarriages or ectopic pregnancies. While some hospital systems are bound to be worse than others, it is never responsible or humane to treat women like our reproductive health is something that doesn’t deserve medical attention.

In general, access to pregnancy termination is a problem in the US, even though abortion has been a legally protected right in the US since 1973. In some states increases in restrictions through TRAP laws have made it extremely difficult for women to terminate unwanted, problematic, or dangerous pregnancies. In addition to TRAP laws, a personhood law and/or a new appointment to the supreme court could tip the balance away from the court’s continuing to uphold the right to have an abortion. As a result, access to pregnancy termination could be eliminated, putting many women at risk of everything from an unwanted pregnancy to a life threatening situation — there are many reasons why a woman may seek an abortion and she should have access to one if it’s the right choice for her. A pregnancy should not be more highly valued than the life and decisions of a woman.

Sometime after my ectopic pregnancy, I realized that there were people who didn’t support my right be treated and even hospitals who would have turned me away. I realized that if I still lived in my hometown where the local hospital system is Catholic, I would not have been allowed to terminate my ectopic pregnancy with methotrexate. Instead, they may have waited for the pregnancy to grow to the point of rupturing my fallopian tube, putting my life in danger, or they may have removed my entire fallopian tube prior to a rupture. The Catholic church and other anti-choice supporters actually believe that I murdered my child; but I completely disagree: I humanely ended a pregnancy that would never have been able to survive in my fallopian tube, while protecting my own health and safety — ectopic pregnancies can be extremely dangerous. It’s terrifying to me that some people controlling healthcare value a non-viable pregnancy more than the life and well-being of a woman. Sometimes pregnancy termination is the right choice for a woman to make. It was for me. And it has been for others too. (e.g., here and here)

Unfortunately, the problems with women’s reproductive health care that we are seeing here in the US are not in isolation; Trump has already reinstated the Mexico City Policy which affects healthcare providers and women around the world. The Mexico City Policy prohibits recipients of US foreign aid (even if it’s private) from providing any and all abortion related services, even information about abortion. Health care providers who refuse to sign the agreement will lose all US funding and all donated contraceptives, including condoms. This policy adversely affects women around the world by taking away their reproductive choices in multiple ways. After Bush reinstated this policy in 2001, affected countries saw a more than doubling of the abortion rate due to a decrease in comprehensive care. Our president should have nothing to do with restricting the health care choices of any woman, in our country or abroad.

It is also likely that the new administration will cut funding for the Violence Against Women Act (VAWA). This isn’t exactly reproductive health care, but it is certainly a part of women’s health, so I’ve decided to include it as well because it’s important and close to my heart. Programs under the VAWA include services for preventing intimate partner violence and supporting survivors of violence, sexual assault, and stalking. Cutting these programs would have a disastrous effect on the 1 in 4 women in the US who are victims of intimate partner violence. We need to end violence against women, not leave victims to suffer at the hands of their perpetrators.

I am so disappointed and horrified that women’s health is being so viciously assaulted. These organizations and politicians have no respect for women’s lives or decisions. As someone who has used contraceptives, terminated an ectopic pregnancy, and is about to undergo IVF treatment, I feel personally attacked by these people who are trying to take away my reproductive choices — they should have NO SAY on what happens inside my body or anyone else’s.

I know I’m not alone in feeling like this — on January 21, women in the US and around the world marched and demonstrated to protest the president and to demand equal rights, health care, and reproductive choices, in addition to many other things. It was the largest protest in US history and I hope elected and appointed officials were paying attention. I hope they heard our voices. And if not, I’m prepared to march again, and again, if necessary. I am prepared to write to my representatives again, and again. I’m prepared to demand equal rights and reproductive freedom.

I truly hope that one day we live in a world where everyone has the healthcare they need and the power to make the choices they want, but we are not there yet… We need to keep moving forward and build on what we have. We need to work together and make our voices heard, and our elected and appointed officials need to listen and represent us the way they are supposed to. We are counting on them to empower everyone with health care options and reproductive freedom — they are vital to fully exercising our rights to life, liberty, and the pursuit of happiness.

 

To write to your Representative, please visit: http://www.house.gov/representatives/find/

To write to your Senator, please visit: https://www.senate.gov/senators/contact/

To write to the president, please visit: https://www.whitehouse.gov/contact

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Mixed Emotions

As we prepare to begin the stimulation phase of IVF in a few weeks, I have been thinking hard about all of the things I’m feeling… and it’s certainly a mix. Many people assume that I’m feeling very excited and optimistic, and while I certainly do feel those things right now, I also have some darker feelings that I need to acknowledge. It’s most important for me to acknowledge them to myself, but I figured it can’t hurt too much to share some of them here for anyone seeking validation on their IVF feelings or anyone wanting to know how I am really feeling.

So I won’t lie. I’ll be honest. I’ll admit my feelings — the good and the bad.

I’m feeling scared about IVF. Scared of the numerous needles, injections, and blood draws. Scared of surgery. Scared of all of the side effects that might occur. I had to sign 44 pages of consent forms, and while not all of those were related to the medications and procedures, many of them were. I’m scared of how I’ll feel when I know the final mature egg count, the fertilization count, and healthy embryo count. Mostly I’m scared of what we’re going to do if IVF doesn’t work.

I’m feeling disappointed. There was a little hope inside me that a miracle would occur between October (when we signed up for IVF) and now and I’d get pregnant naturally. I was hoping I’d be one of those people who’d sign up for IVF and my lucky pregnancy would happen and there’d be no need for IVF. I’ve known for months and months that our chances of natural conception are ridiculously small, but it’s hard to silence the little internal voice that hopefully whispers to me, “what if this is the month?”

I’m feeling a little surprised that we’re going to do IVF. The surprise feeling is two fold. First: I’ve written about how I never thought I’d do IVF, but here we are. Second: we fully expected IUIs to work. My ectopic pregnancy was the result our first IUI after all, but in the three IUIs following my pregnancy, our male factor infertility problem was confirmed and there’s some concern about how much damage my ectopic pregnancy might have actually caused. Therefore, even though I’ve come to terms with our decision to pursue IVF, it’s still a little surprising to me that we’re actually going to do it — we thought we’d already found a successful treatment.

I’m feeling a little angry. And before anyone judges me and thinks that I shouldn’t be angry — bear with me, because infertility truly sucks. How could it *not* cause some anger? How could my pregnancy loss *not* cause some anger? These experiences are horrible. They are heartbreaking and difficult. They are unfair. They happen to good people who don’t deserve it. So yes, I’m feeling a little angry that we’re at the point where the challenging process of IVF is our best option. Natural conception aside, we were *so hopeful* that the other treatments we’ve tried would work, but they didn’t. After nearly two years of treatments, we’re very frustrated, and a little angry, to still be without a living child in our arms.

Luckily I also have some good feelings about IVF — I’m starting to feel excited about the possibility of success. I am starting to feel optimistic. Right now IVF looks like our best chance for bringing a baby into our family. Dr. Two believes that our odds for success are good, and that is exciting.

I’m also feeling grateful that we’re good candidates for IVF and that we’re able to move forward and give it a try. Not everyone who experiences infertility is eligible for or able to do IVF and I’m thankful that we are. I’m glad for the opportunity and so grateful for the support we have as we pursue it.

All of that said, the emotion that’s really ruling the day right now is feeling ready for IVF. At least as ready as I can be. How can one truly prepare for this anyway? I believe I’ve done as much as I can to prepare for what’s ahead. I have read and read and read; I have showered my medical team with questions; I have asked previous IVF patients about their experiences. And I am ready to give this treatment all we’ve got. I’m ready for needles, blood draws, and injections. I’m ready to keep track of hormone levels and dosage amounts. I’m ready to handle the bruises and manage side effects. I’m ready for ultrasounds. I’m ready for surgery and transfer.

We’ve been waiting and waiting for some good news and we’re ready for it. I’m ready to become pregnant and bring home a healthy baby in the end. And if the outcome of our IVF cycle is bad, I’m not sure that any amount of preparation would have been adequate… so we’ll take it one day at a time, and survive together — good news or bad. I am scared and disappointed and surprised and even a little angry. I am excited and optimistic and full of gratitude. But I’m also ready, and at this point, I think that’s what matters the most.

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Coming to Terms with IVF

I’ll admit it: I used to say that I’d never do IVF if I couldn’t get pregnant. I used to tell myself I’d accept that pregnancy wasn’t in the cards for me and I’d stop pursuing it.

But then again, I never imagined that I would actually have any difficulty getting pregnant, and I never imagined that I would lose a pregnancy either. I used to assume that I would be able to get pregnant easily, naturally, and when I wanted, and further, that every baby of mine would come home with me alive and well.

However, life doesn’t always unfold the way we think it’s going to, and I’ve learned just how naive I used to be. Since I never truly expected to be infertile, I think it was easy for me to pretend like I knew exactly what I would do if I were. But I was wrong. Back then I knew nothing about infertility. I knew nothing about all of the reasons why someone might pursue IVF or other fertility treatments. And I knew nothing about the deep love that’s possible for a child who doesn’t even exist yet.

As it turns out, it’s a lot harder to make decisions when it’s your reality instead of a hypothetical situation. At every step of the way during our infertility journey I’ve had to let go of expectations, and at times re-examine old opinions. Infertility has reminded me how important it is to try to keep an open mind, and to be more accepting of my own decisions and others’ decisions too… because it’s quite hard to know what we would do in a certain situation until we’re actually in it ourselves, facing the facts and handling our emotions.

There are many things I didn’t know about infertility until we were infertile, and learning them has definitely given me a new perspective on fertility treatments. To start: infertility is random bad luck. No one I know deserves their infertility — it just happens. And it sucks. On top of that, infertility can strike in so many different ways. In our case, I have some problems, Matt has some problems, and our infertility is also a bit unexplained… which leads me to another thing that I’ve learned: there are many things about infertility that the medical community has yet to understand.

But just because we have some medical problems, maybe even some undiagnosed ones, it doesn’t necessarily mean that a biological child “isn’t in the cards” for us. Like we would do with most diseases, we are attempting to treat the disease of infertility. At this point in our journey, treating our infertility and doing what we can to attempt a pregnancy still feels like the right choice. Doctors and scientists have worked hard to come up with some ways to correct reproductive problems or work around them, and luckily for us, there is still a treatment that we’re good candidates for trying: IVF.

While this may not be the right choice for everyone, right now IVF is the right choice for us, so we’re moving forward with it. It definitely took a lot of thought and preparation to get there, but it feels right. We’re hopeful that IVF will help to bypass some of the problems that are preventing us from conceiving, and bring us the good news we’ve been waiting so long to hear.

I’ve also come to realize through infertility that my old self didn’t fully appreciate all of the ways in which people can enter into parenthood. For most people, their route is through natural conception. For others it is adoption. For some it is through assisted reproductive technologies like IUI or IVF, and may also include third party sperm donors, egg donors, and/or gestational carriers. There are so many ways to build a family, and all of them are valid and beautiful… And as long as Matt and I attempt to build our family out of love, I think we’re headed in the right direction. Sure, this particular direction may not have been in our original plan, but directional changes in life are expected… after all, isn’t that what happens when we live and learn, and love?

From where I’m standing now, I can see that IVF provides us an opportunity for a chance at conception that we might not otherwise have. We’ve explored other options. We’ve tried other methods of conceiving. Now we’re to the point where our best chance for bringing home a baby lies in pursuing IVF. So we’re all in. We’re going to embrace the science, hope for the best, and continuing loving each other and the child we’re trying so hard to bring to our lives.

For more thoughts on IVF, please visit:

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