Two failed transfers, trying to figure out why


#1

Hi, everyone. First I want to say, as a newbie to this forum, that this is the coolest place I’ve found! There’s so much information here and I really like the genuine and sympathetic atmosphere — exactly what I need when Im going through this devastating IVF…

So, here’s my story.

Me: age 30, Male factor infertility. AFC 20, FSH 4.5, Hydrosonography and endometrial biopsy comes back completely normal.

DH: age 35, low sperm count. Karyotype test and genetic test normal.

After 4 failed IUIs, we proceeded with the first IVF cycle at our local clinic, which I like very much.

My protocol was the long lupron one:

11/5/2012 Lupron Shot
11/30/2012 Start Stim: Gonal F 225 IU, Menopur 1amp

I felt like I was bit over-suppressed by the lupron, as my E2 was lower than they want for the first 3 days, and my RE upped the dose to Gonal F 250 IU and Menopur 2 vials, then changed it to an even higher Gonal F 300 and Menopur 3 vials. After day 4, my E2 started climbing well and by the HCG trigger shot, I had 9-10 follies between 18-22mm.

My E2 right before the trigger shot was 1224. (Still on the lower side than what I was hoping for…)

12/12/2012 Egg Retrieval

My RE got 9 eggs, 7 of them were mature, and 6 fertilized through ICSI.

On Day 3 we transferred 2 A grade 8 cell embies, and… I had a chemical on Christmas. It felt like a cruel joke. :grr:

There were 3 embies that developed into AB and BB grade blastocysts on day 5 and 6, and they were frozen.

2/18/2013 We woke up two of the frozen blastocysts and did a transfer. This time, both my RE and us thought it’s my lucky turn… and I got a BFP again!

But, at 6 weeks’ first U/S, we didn’t hear the heartbeat. The gestational sac was too small. I had a miscarriage around week 8.

I bursted out in tears in the U/S room. The emotional roller coaster was getting to be too much… My RE was super compassionate and gentle, like he has always been, and for that I appreciate so much.

At this point I’ve been getting advise from friends and family to consider another clinic. But I really like my RE, both as a person and as a doctor, and his staff are friendly and caring, the location convenient… After all this hardship, he and his clinic already felt like a family to me.

So my questions are: based on my numbers, protocols and results, do you think I should give my RE anther try? (He had talked to me about varying the protocol next cycle during our counseling) Based on my fertilization rate and blastocysts rate, what do you think of his lab?

And of course, the last question is, WHYYYYYYY? I had a recurrent miscarriage panel done, the results come back all fine. If it’s just due to random chromosome abnormality, why am I so unlucky? :grr: :grr: :grr:


#2

Hi, I’m so sorry to hear that it hasn’t worked for you yet. I do want to share my story, though, and show you that it can happen. I had to have my tubes out before even thinking of having kids and knew that the only way to have them would be through IVF. So, luckily we got to skip all the other options. My first cycle (long lupron) was canceled before the retrieval, because I had basically no follicles growing. We then tried antagonist, which was a chemical. We did micro flare next, which ended in a BFN. Then tried antagonist again, which resulted in a missed miscarriage around 7.5 weeks, similar to yours. There was no heartbeat. Finally, we did an FET which resulted in my 9 month old daughter. We went through a lot to get her and even the pregnancy wasn’t easy, but it was all worth it. I want to tell you to keep trying and will happen! I just have bad eggs and my husband has slow sperm. We are trying for #2 now and have gone through a fresh cycle, which was a BFN and then did a freeze-all at blast stage cycle. We are doing the FET next month. We added saizen to the antagonist protocal and did a uterine biopsy during the retrieval, which will help with implantation for the FET. My RE will also squirt HSG directly into my uterus 5 min before the transfer. All of these are changes that we hope will help. I really hope that next time is YOUR time!!! Also, I stuck with my RE, because she is always willing to try new things I’ve loved both her and the staff. Plus, the lab has great stats. If you are really happy with your RE, then I’d stay there. I liked that my RE already knew what we’d tried and knew me well…if I had gone somewhere else, it’d be like starting over. I can’t tell you why it hasn’t worked yet, but want to wish you good luck!


#3

[quote=Pookiepook]Hi, everyone. First I want to say, as a newbie to this forum, that this is the coolest place I’ve found! There’s so much information here and I really like the genuine and sympathetic atmosphere — exactly what I need when Im going through this devastating IVF…

So, here’s my story.

Me: age 30, Male factor infertility. AFC 20, FSH 4.5, Hydrosonography and endometrial biopsy comes back completely normal.

DH: age 35, low sperm count. Karyotype test and genetic test normal.

After 4 failed IUIs, we proceeded with the first IVF cycle at our local clinic, which I like very much.

My protocol was the long lupron one:

11/5/2012 Lupron Shot
11/30/2012 Start Stim: Gonal F 225 IU, Menopur 1amp

I felt like I was bit over-suppressed by the lupron, as my E2 was lower than they want for the first 3 days, and my RE upped the dose to Gonal F 250 IU and Menopur 2 vials, then changed it to an even higher Gonal F 300 and Menopur 3 vials. After day 4, my E2 started climbing well and by the HCG trigger shot, I had 9-10 follies between 18-22mm.

My E2 right before the trigger shot was 1224. (Still on the lower side than what I was hoping for…)

12/12/2012 Egg Retrieval

My RE got 9 eggs, 7 of them were mature, and 6 fertilized through ICSI.

On Day 3 we transferred 2 A grade 8 cell embies, and… I had a chemical on Christmas. It felt like a cruel joke. :grr:

There were 3 embies that developed into AB and BB grade blastocysts on day 5 and 6, and they were frozen.

2/18/2013 We woke up two of the frozen blastocysts and did a transfer. This time, both my RE and us thought it’s my lucky turn… and I got a BFP again!

But, at 6 weeks’ first U/S, we didn’t hear the heartbeat. The gestational sac was too small. I had a miscarriage around week 8.

I bursted out in tears in the U/S room. The emotional roller coaster was getting to be too much… My RE was super compassionate and gentle, like he has always been, and for that I appreciate so much.

At this point I’ve been getting advise from friends and family to consider another clinic. But I really like my RE, both as a person and as a doctor, and his staff are friendly and caring, the location convenient… After all this hardship, he and his clinic already felt like a family to me.

So my questions are: based on my numbers, protocols and results, do you think I should give my RE anther try? (He had talked to me about varying the protocol next cycle during our counseling) Based on my fertilization rate and blastocysts rate, what do you think of his lab?

And of course, the last question is, WHYYYYYYY? I had a recurrent miscarriage panel done, the results come back all fine. If it’s just due to random chromosome abnormality, why am I so unlucky? :grr: :grr: :grr:[/quote]
I am sorry for your loss. I had an ectopic around Christmas and I know how difficult it is. I also know how awful it is to go to the 1st ultrasound and get devastating news.

It is hard to comment on your clinic based on just your results. Do you know their stats on SART? If they are good for your age group, then their lab may be okay. But, they may weed out the hard patients so that is still not a sure bet.

In my opinion, you have a good response to the meds. I would consider going to a clinic who does advanced genetic testing. It is expensive, but this can help find a chromosomally normal embryo which has the best chance of implanting. It also needs to be done at a lab with advanced freezing, or vitrification. I don’t know what area you live in, but I know CCRM has a lab that does this, as well as some others across the country.

I believe CCRM has the best lab in the country and would probably give you the best chance of success. I believe it is the best clinic for patients like you that have a lot of embryos to choose from. It is expensive, but in my opinion, worth it. If I ever made a lot of embryos, I would never mess around with another clinic. Of course, there may be a good lab in your area that also offers these services.

I am glad you like your doctor, but being a great doctor for your paticular issue and having a great bedside manner are two different things. I’m not saying there is anything wrong with your doc b/c I cannot tell from the information provided, but I would look at his stats and also do genetic testing. If he does not do this at his clinic, I would move elsewhere.


#4

Have they done advanced testing on your husbands sperm, such as a sperm DNA fragmentation test?

[QUOTE=Pookiepook]Hi, everyone. First I want to say, as a newbie to this forum, that this is the coolest place I’ve found! There’s so much information here and I really like the genuine and sympathetic atmosphere — exactly what I need when Im going through this devastating IVF…

So, here’s my story.

Me: age 30, Male factor infertility. AFC 20, FSH 4.5, Hydrosonography and endometrial biopsy comes back completely normal.

DH: age 35, low sperm count. Karyotype test and genetic test normal.

After 4 failed IUIs, we proceeded with the first IVF cycle at our local clinic, which I like very much.

My protocol was the long lupron one:

11/5/2012 Lupron Shot
11/30/2012 Start Stim: Gonal F 225 IU, Menopur 1amp

I felt like I was bit over-suppressed by the lupron, as my E2 was lower than they want for the first 3 days, and my RE upped the dose to Gonal F 250 IU and Menopur 2 vials, then changed it to an even higher Gonal F 300 and Menopur 3 vials. After day 4, my E2 started climbing well and by the HCG trigger shot, I had 9-10 follies between 18-22mm.

My E2 right before the trigger shot was 1224. (Still on the lower side than what I was hoping for…)

12/12/2012 Egg Retrieval

My RE got 9 eggs, 7 of them were mature, and 6 fertilized through ICSI.

On Day 3 we transferred 2 A grade 8 cell embies, and… I had a chemical on Christmas. It felt like a cruel joke. :grr:

There were 3 embies that developed into AB and BB grade blastocysts on day 5 and 6, and they were frozen.

2/18/2013 We woke up two of the frozen blastocysts and did a transfer. This time, both my RE and us thought it’s my lucky turn… and I got a BFP again!

But, at 6 weeks’ first U/S, we didn’t hear the heartbeat. The gestational sac was too small. I had a miscarriage around week 8.

I bursted out in tears in the U/S room. The emotional roller coaster was getting to be too much… My RE was super compassionate and gentle, like he has always been, and for that I appreciate so much.

At this point I’ve been getting advise from friends and family to consider another clinic. But I really like my RE, both as a person and as a doctor, and his staff are friendly and caring, the location convenient… After all this hardship, he and his clinic already felt like a family to me.

So my questions are: based on my numbers, protocols and results, do you think I should give my RE anther try? (He had talked to me about varying the protocol next cycle during our counseling) Based on my fertilization rate and blastocysts rate, what do you think of his lab?

And of course, the last question is, WHYYYYYYY? I had a recurrent miscarriage panel done, the results come back all fine. If it’s just due to random chromosome abnormality, why am I so unlucky? :grr: :grr: :grr:[/QUOTE]


#5

I’m sorry to hear about your chemical and your miscarriage. That must be very difficult. If you like your doctor and s/he explains things well to you then I don’t see any reason why you should change.
I’d like to point out a couple of things: 1) more than half of women undergoing IVF don’t have any embryos that make it to freeze. So in that regard, you are above average. 2) the average number of cycles a woman has before success is between 2 and 3 cycles.
I know this probably doesn’t sound reassuring, but I just want to put things in perspective…

Also, are you sure you’ve tested everything in the recurrent miscarriage panel including blot clotting factors, thyroid disorders, chromosomal translocations (for both you and your husband), endometriosis, thalassemia…

Another thing, there was a study done showing that acupuncture right before or right after transfer increased implantation success. I would recommend finding an acupuncturist who has experience with infertility.


#6

Thanks so much for your kind reply!

Geneen3, what you said gave me so much courage. You have been though much more! I should be reminded that IVF is a method that works with nature and on chance, and the best we could do is to have courage and patience. And of course, many congrats on your precious baby girl!!! You deserve it girl!

Houston, thanks for the advice! My clinic offers PGD, but they can’t do it themselves, the blastocysts are sent somewhere else.

Also, my clinic started in 2009 and has only one doctor. They are not a SART member, but I did find their stats on CDC ART list. In 2010 my RE had about 20 patients younger than 37, and his live birth rate per transfer was higher than 50%.

I have heard so many awesome things about CCRM. The only thing is we live in Southern California, and I can’t quite make up my mind to travel that far… maybe I will in the end.

Right now I have scheduled two counseling sessions in April just to get a second opinion: one with Dr. Yelian at LIFE (specializes in mini and natural cycle), one with HRC (Hungtinton Reproductive Center) near LA, they do traditional IVF and seem to have really good numbers on SART.

But having talked with my RE yesterday, I’m also considering staying with him for another cycle before moving on. He was so open and thorough for all my questions, and was so ready to improve the protocol and accommodate my concerns – all this without a word of pushing me to stay, or blaming my egg quality, that I simply feel horrible jumping ship on him…

Any thoughts on LIFE’s mini cycle program? I heard they’re one of the best in mini and natural cycles on the west coast. Their price is attractive, and I like the idea of minimum stimulation. Guess I’ll find out more after the free seminar.

Or should I just stick with my RE for one more cycle and if that fails, switch to CCRM directly? Houston, from what you’re saying and from what I heard, it sounds like CCRM’s lab is significantly better than the ones in California.


#7

To KTB: no, they haven’t. My RE said that DNA fragmentation would more likely result in fertilization issue than early miscarriage. But maybe we will get that test done anyway.

Careen: yes, my miscarriage panel included all that. Everything cept for my karyotype came back fine, karyotype result will come in another week or so. (fingers and toes all crossed) PS: My mom is actually an acupuncturist :slight_smile: Will keep getting treatment from her for my future tries!


#8

First- I am so sorry you are going through this.

I think your RE sounds great. I would probably tweak your protocol. But out of the 6 fertilized eggs 4 were great. Thats awesome. You did get pregnant both times. I would run an RPL panel tbh. Other ladies also mentioned chromosome testing. You could elect to have them tested at day 3 (if you’re in Southern California you won’t have any issue shipping them off to a local DNA lab) and transfer 2 normals back on day 5 and freeze the rest. I changed RE’s this year and he convinced us to do chromosome testing at day 5, freeze and transfer 2 normals 2 months later. We have MFI issues (I have no issues except for tubal).

I also think your RE’s right about DNA fragmentation in regards to your husband’s sperm. Did you do ICSI?

Lastly, there is a pregnancy loss forum here. The ladies talk in depth about their issues and it might be a place to find some answers from ladies who have been through it.

Good luck- and I hope your next IVF is your BFP+ 9months of healthy pregnancy.

Rach


#9

First off, sorry to hear of your losses. I can relate. We went through three losses before finally having our miracles. The first was an early chemical, the second we were able to see heartbeat at 6 weeks but the baby was measuring behind and didn’t make it past about 8 weeks, third was another early miscarriage.

After the third we would have likely given up but we still had embryos frozen (donor embryos), so we moved forward without much (if any) hope for success. To our surprise our 6th cycle, fourth time getting pregnant, was a success.

Reading your story I was almost having flashbacks at how similar your story is to ours. We have MF infertility, and I was said to be “perfect” but did not respond all the great, was oversupressed our first cycle, only made about 5 eggs (at age 23) on a pretty high dose of meds. We too love our RE, he is a great guy, always flexible, helpful, etc. He even saved us thousands of dollars along the way. We also considered numerous times leaving him, but in the end he was getting us pregnant…we just were not staying pregnant. In our mind his job was to get us pregnant after that it was mostly out of his hands (just our thoughts…I am sure others would disagree).

What made us successful…I think it was a combination of two things: donor embryos (likely the biggest factor), and using lovenox ( although I was never diagnosed with a clotting factor. Through all the years that we went through infertility and I continued to learn, I heard over and over how embryo quality was determined by the eggs and the sperm really just needed to fertalize the egg. Not saying this to scare you, but I have came to the conclusion that the sperm has a lot more to do with embryo quality than most RE’s seem to admit. I have seen so many women on here with MF infertility and repeated miscarriages, but with that being said I have seen many women with severe male factor be able to conceive even after miscarriages with their own embryos.

I hope I am not saying anything wrong here, just wanted to share our story. You CAN go on to have your miracle baby, just don’t give up!!!


#10

So sorry to hear that it’s been so difficult. I think you’re asking the question so many of us ask every day, every cycle - Why? And the answers aren’t easy, even for those that have been able to conceive.

A general rule of thumb that I’ve noticed on the threads is that most women look for a second opinion after their 2nd IVF. Even if they return to their old doctor, it can be helpful to at least have a consultation, either with a doctor in their area or the famous CCRM in Denver.

Brit makes a good point. We often hear that male infertility is easier to address, but I’ve also noticed quite a few women on here that have to try IVF multiple times with MFI before it works. There is so much reason to have hope, and it’s hard to go through cycle after cycle. I’m so sorry you have to go through this.

We’ve done 4 transfers of 6 embies and the best we’ve gotten is a miscarriage with no heartbeat at 8 weeks. Our new RE recommended genetic testing on our 5 remaining embryos, and though it was expensive, it’s worth the cost as we were able to rule out 2 embryos with chromosome issues that never would have turned into pregnancies. Prior to pursing PGS, I asked around on the boards, and lots of women who have had the genetic testing said it’s worth it.

There are quite a few women on this board from California so definitely ask around for RE recommendations. I did my first two cycles in San Diego, but not sure I would recommend the clinic. They were wonderful, but weren’t as good with protocol for diminished ovarian reserve, so not a fit for me. Not sure how they are with MFI. There are several great recommendations in the OC area. PM me if you live there and I’ll send you the names of the girls on the board that I’ve seen and their comments.

More than anything, good luck and have faith. Most of us assumed that once we moved onto to IVF then we’d get pregnant on the first try. Four cycles later and I’m still shocked that IVF isn’t a guarantee on the first go-round, but there are more than enough BFPs to show that it can and will happen, it just takes time.

Good luck!!


#11

[QUOTE=Pookiepook]Hi, everyone. First I want to say, as a newbie to this forum, that this is the coolest place I’ve found! There’s so much information here and I really like the genuine and sympathetic atmosphere — exactly what I need when Im going through this devastating IVF…

So, here’s my story.

Me: age 30, Male factor infertility. AFC 20, FSH 4.5, Hydrosonography and endometrial biopsy comes back completely normal.

DH: age 35, low sperm count. Karyotype test and genetic test normal.

After 4 failed IUIs, we proceeded with the first IVF cycle at our local clinic, which I like very much.

My protocol was the long lupron one:

11/5/2012 Lupron Shot
11/30/2012 Start Stim: Gonal F 225 IU, Menopur 1amp

I felt like I was bit over-suppressed by the lupron, as my E2 was lower than they want for the first 3 days, and my RE upped the dose to Gonal F 250 IU and Menopur 2 vials, then changed it to an even higher Gonal F 300 and Menopur 3 vials. After day 4, my E2 started climbing well and by the HCG trigger shot, I had 9-10 follies between 18-22mm.

My E2 right before the trigger shot was 1224. (Still on the lower side than what I was hoping for…)

12/12/2012 Egg Retrieval

My RE got 9 eggs, 7 of them were mature, and 6 fertilized through ICSI.

On Day 3 we transferred 2 A grade 8 cell embies, and… I had a chemical on Christmas. It felt like a cruel joke. :grr:

There were 3 embies that developed into AB and BB grade blastocysts on day 5 and 6, and they were frozen.

2/18/2013 We woke up two of the frozen blastocysts and did a transfer. This time, both my RE and us thought it’s my lucky turn… and I got a BFP again!

But, at 6 weeks’ first U/S, we didn’t hear the heartbeat. The gestational sac was too small. I had a miscarriage around week 8.

I bursted out in tears in the U/S room. The emotional roller coaster was getting to be too much… My RE was super compassionate and gentle, like he has always been, and for that I appreciate so much.

At this point I’ve been getting advise from friends and family to consider another clinic. But I really like my RE, both as a person and as a doctor, and his staff are friendly and caring, the location convenient… After all this hardship, he and his clinic already felt like a family to me.

So my questions are: based on my numbers, protocols and results, do you think I should give my RE anther try? (He had talked to me about varying the protocol next cycle during our counseling) Based on my fertilization rate and blastocysts rate, what do you think of his lab?

And of course, the last question is, WHYYYYYYY? I had a recurrent miscarriage panel done, the results come back all fine. If it’s just due to random chromosome abnormality, why am I so unlucky? :grr: :grr: :grr:[/QUOTE]

Pook, you’ve been given a lot of good advice so far. There could be some lurking fertility problems (that may well be easily treatable) or you may just be unlucky. 50 percent chance of live birth is good, but it’s all a matter of how the dice fall. My wife’s first pregnancy ended in miscarriage merely because of random chance and the second embryo WAS viable, but interstitial ectopic. Double bad luck. So yeah, the best thing you can do is keep informed and stay persistent.


#12

[quote=Pookiepook]
Also, my clinic started in 2009 and has only one doctor. They are not a SART member, but I did find their stats on CDC ART list. In 2010 my RE had about 20 patients younger than 37, and his live birth rate per transfer was higher than 50%.[/quote]

Red flag. Personally I would never go to a clinic that wasn’t a SART member, because who knows how the clinic is choosing to report its results if it’s not required to follow SART guidelines? I figure if a clinic has nothing to hide, they’ll be on SART. A good relationship with your doctor is a great thing, but what if it means you will spend tens of thousands more dollars and wait more years to have children than you would if you went somewhere else?

I would also really hesitate to use a clinic that had started so recently, unless the way it starts is that some (not just one) experienced IVF doctors go off on their own to start a clinic. Otherwise I would have serious reservations. Everyone’s got to start somewhere, but let the inexperienced clinics treat patients who have insurance coverage for IVF. Those of us with limited funds need to use them wisely.

CCRM is fantastic (I’ve been there), but you also have a clinic in your area that’s very well thought of. Look into the San Diego Fertility Center (SDFC). I can’t remember what their SART numbers are for own-egg IVF, but they are famous for donor-egg IVF, with amazing rates, so their own-egg rates must be pretty good too. Your consult plans sound good. Definitely get informed before you make a decision on what to do for your next cycle.

And yes, CCRM’s lab is amazing. If you want to feel a personal connection with your doctor, if you want someone emotionally invested in you and more “touchy-feely” than the average doctor, then when you go to CCRM, choose Dr. Minjarez. You’ll love her. She’s my doctor. You can actually set up a phone appointment with her, sort of a “test drive” before you decide to go ahead and fly there. She will look over all your results for your other cycles and tell you what she thinks you need. You can then either go with her, or take her advice and ask a local clinic to do what she said to do–she’s not just giving advice to get you to come to CCRM.


#13

Thanks guys, for so many great replies! Yes, I have gotten a bunch of good advice, and asides from my two counseling session near LA, I’m also planning on dialing CCRM up.

Trixicat, you are right my insurance don’t cover any IVF cost :grr: And the second try is about all we can afford in the next couple years… which definitely made staying with my current RE a lot harder. I never doubt he’s doing all he can to help us get pregnant, and he’s fighting with chances as much as we are. But how many more chances can I afford?

Gosh how I wish money was less of an issue for us, so we can easily give him another try before moving on to CCRM. If I were to leave after one failed cycle, when nothing he did seems wrong, I feel it’s not fair for our RE, and I feel guilty guilty guilty, even when I know switching to a nationally renowned place would maximize our chance… Am I being stupid here?


#14

[quote=Pookiepook]Thanks guys, for so many great replies! Yes, I have gotten a bunch of good advice, and asides from my two counseling session near LA, I’m also planning on dialing CCRM up.

Trixicat, you are right my insurance don’t cover any IVF cost :grr: And the second try is about all we can afford in the next couple years… which definitely made staying with my current RE a lot harder. I never doubt he’s doing all he can to help us get pregnant, and he’s fighting with chances as much as we are. But how many more chances can I afford?

Gosh how I wish money was less of an issue for us, so we can easily give him another try before moving on to CCRM. If I were to leave after one failed cycle, when nothing he did seems wrong, I feel it’s not fair for our RE, and I feel guilty guilty guilty, even when I know switching to a nationally renowned place would maximize our chance… Am I being stupid here?[/quote]

In my opinion, you need to move on to another RE. He does not report to SART, which I agree with the poster above is a huge red flag. Also, it does not seem he does a lot of cycles. Another red flag. If you have enough money left for another cycle, go to CCRM or a clinic in your area that sees a lot of patients, has good success rates, and reports to SART.

Minimizing your chances of having a child by continuing to go to the same RE in my opinion is not a good idea. Your doctor should want what is best for you, and if going to another RE is best, he should support that decision. I have been to a lot of REs, not one doctor has been upset because I chose to go elsewhere. My 1st doctor suggested I go to CCRM after a very poor cycle with her clinic. Ultimately, your doctor will probably not even consider that you went to a new clinic at all. If he does, he will have forgotten it by the next day. This decision could impact your entire life. I would personally never put a doctor’s feelings over recieving the best medical care possible for me and my future child.

As you get older, your chances of having a child decrease. Why pass up your best chance when you are as young as you will ever be in this fertility journey?

I apologize if I am being a little too direct, but I just hate to see when people put a personal relationship with a doctor over getting the best care possible.

I am really glad you are considering CCRM. If you have 1 shot left before having to save up more money, go to the best. The travel is a pain, but it will all be worth it in the end.