This basically means that your body loses its ability to properly break down glucose from the blood stream. Recovery and periods after ovarian drilling, Your opinion about Loma Linda University Center for Fertility. Get with another lady or two who are willing to go walking with you, even just once a week; it can make all the difference in the world. [6], Ovarian drilling was first used in the treatment of PCOS in 1984 and has evolved as a safe and effective surgery. Please suggest how long it takes for my next period after my lod.please suggest. Posted on 04/15/2020 by CMRI . so im really happy about that as i wasn't ovulating at all before op. I also had a uterine septum resection at the same time though, so I did bleed very heavily for awhile after. There have been circumstances where some women have had regular menstrual cycles in the months following . This cycle, my treatment has been modified, i was put on Adova along with Menopur Injection. 2005 Jul 20;(3):CD001122. [1], Though preferable to creating incisions on the ovary, ovarian drilling does have some risks. If the patient started a menstrual period within 6 weeks of the surgery, a blood sample is taken on day 2 of that cycle for measurement of serum . They found that ovarian . Much to my disappointment my period did not return.after a year of various Doc & Hosp visits and an upsetting (yet kind of relieving) diagnosis of PCOS, I am two weeks the other side of having Ovarian Drilling. I had ovarian drilling 6 weeks ago. The Insulite PCOS System is a combination of nutritional supplementation and lifestyle programs intended to help individuals better manage their health and wellbeing. any hormonal feelings like i have described above? I am a pcod patient I am conceived first child 2022but my prevaible delivery with lost my baby . [17][7] The advantages of the procedure also include its singular treatment, as opposed to several trials of ovulation inductions. All Rights Reserved. There is no increased risk of multiple pregnancy or OHSS. As with all surgical procedures, there are risks of bleeding, anesthesia, and infection. Gynecol. Ovarian drilling is a one-time treatment unlike fertility medicines that have to be taken every month. You may have to register before you can post: click the register link above to proceed. Period 5 Days Late Ovarian cysts and ability to get pregnant? Necessary cookies are absolutely essential for the website to function properly. One result is intense pain, from the ovary itself and from the surrounding pelvic lining, which grows inflamed from the decay of the dying organ. I am waiting for an appointment with the surgeon in roughly 6weeks to see what the next step is, ie, fertility drugs etc. hi ladies iwas diagnosied with pcos in early 06 i had ovarian drilling in late 06 i was put on metiformin x2 a day and clomid x3 a day from day 2 to 6 of cycle i concieved in april 07 and now my boy is 35 months. . Oh that's great.. Any problem with brown discharge? The fact that these treatments are limited in their effectiveness is unsurprising; as they are really borne of the fundamental misunderstanding of what PCOS (Polycystic Ovarian Syndrome) is all about. Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. doi: 10.1002/14651858.CD001122.pub3. All Rights Reserved. how long you have been trying to conceive?I did undergo Laparo back in 2011 no success.rather it messed up with my ovulation process (follicle growth)which used to be perfect before laparo. Actually I have one miscarriage, post 6 months we r trying to conceive with clome every month I had ovulated but not pregnant. anangelbug: How long after a laparoscopy before you start an IVF cycle (specifically if you had tube (s) removed) and. But if the disorders roots as a hormonal imbalance, influenced by Insulin Resistance, point to how tricky it can be, it also points to the best ways to treat the conditionand, of course, how not to treat it. Is it possible to conceive with PCOS or should I better try DE IVF? Asked for Female, 31 Years Hi doctor I am done with ovarian drilling on June 10th 2022 Then my doctor prescribed to take Estrabet tablet and Dyrdogest tablet from june 24th to June 28th every day morning and night So my actual period date is 4th of everymonth and still no periods Can u tell me when will my . Many women ovulate more regularly after . Unfortunately I lost the baby at 4 and a half weeks pregnant and since then my endo symptoms have returned- after a scan my fertility doctor referred me to his colleague a general gynae. [7] The oral drug clomiphene citrate (CC) is the first-line treatment for PCOS-related infertility, yet one-fifth of women are resistant to the drug and fail to ovulate. However, they reported 21.3% ovulation rate with no pregnancy resulting in placebo-controlled group [12]. Birth control, Metformin, and Spironolactone All times are GMT-5. Thats what I would like at the moment!!! LOD is most commonly performed using a monopolar diathermy needle electrode [].The lowest effective number of ovarian drills sparked a heated discussion in the previous three decades [].In the original LOD technique, ovulation occurred more frequently if ten or more punctures were performed in the two ovaries together with each puncture having a diameter of ~3 mm and a depth of 2-4 mm using . If you want to disable these cookies click the Configure button. While there have been some reports of women getting pregnant after having the procedure done, its also possible for the surgery to result in scarring and tissue damage. It starts with what PCOS (Polycystic Ovarian Syndrome), or PCOD (Polycystic Ovarian Disorder), actually is. Ovarian Drilling. This is now month 8 after the op and I feel like my . As the past year went on I started to feel really downhearted, but feel very excited after op as I feel things are moving forward, im just so impatient though! The cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not the user has consented to the use of Cookies. I've done a couple of p.tests which were BFN so not that!!! They include, but are not limited to: bleeding, development of adhesions or scar tissue on your pelvic organs, pain and infection. The probe (which has a distal stainless steel needle measuring 10 mm in length and 2 mm in diameter) was applied to the surface of the ovary at . Therefore, the symptoms may vary from person to person. This page was generated at 12:37 PM. In a standard menstrual cycle, the two ovaries will alternately release mature, ready-to-be-fertilized eggs each month. On top of all that, its a common condition, affecting millions of womenso of course, the desire for a suitable, safe, and effective treatment is high. A minimally invasive surgery called laparoscopy is used for ovarian drilling. Ovarian drilling works by breaking through the thick outer surface and lowering the amount of testosterone made by the ovaries. 2016;2:16057. doi: 10.1038/nrdp.2016.57. This may be ovarian drilling or ovarian wedge resection. Since weight loss seems to hold a better key to conception, today many experts are saying the risks of ovarian damage and other complications dont outweigh the benefits of the surgery. Keywords: An alternative treatment is laparoscopic or transvaginal ovarian drilling, also called ovarian diathermy or electrocoagulation. Open. I got my last periods on june10 2018. since my LH valve keeps on increasing, doctor suggest me Laparoscopy (Ovarian drilling). reported on the short-term effect of ovarian drilling on the ovarian volume as measured by three-dimensional (3D) ultrasound (Tulandi et al., 1997). check out the. Ovarian drilling resulted in a significant reduction in the ovarian volume and the effect was sustained throughout the follow-up periods. 2019;2019:hoy021. TIA x. I had this done last year & unfortunately for me it didn't bring on my period. However, the benefits of ovarian drilling are not permanent. 2012 Jun 13;(6):CD001122. PCOS- was married for 4.5yrs(now 6), trying to convieve almost 2yrs, same routine - metformin+folic acid, clomiphene 5 cycles didnt work, litrazole - 2cycles along with IUI - didnt work Initially itself my doc suggested laparoscopic ovarian drilling. 2020 Feb 11;2(2):CD001122. Contrary to what its name suggests, its not, primarily, a condition of the ovaries. 2007 Jul 18;(3):CD001122. as if i go by the + OPK i would be due on on Friday 1st Jan. Results of LOD are not better than those of first-line treatments in PCOS. IF negative wait for a few days and try inducing naturally. [6], Laparoscopic ovarian drilling (LOD) may improve the effectiveness of other ovulation induction treatments and results in lower multiple pregnancy rates than other treatment options like gonadotropins. It makes sense that if a problem can literally be removed from the body, its a sensible course of action. [10], If patients do not become pregnant six months after ovulation has been reestablished from ovarian drilling treatment, drug treatments may be reintroduced or in vitro fertilization (IVF) may be considered. [1] Inflammatory growth factors such as insulin-like growth factor-1 are produced due to injury and aid the effects of FSH through greater blood flow and gonadotropin delivery. Hi all..i had ovarian drilling in aug and on my first cycle after it i ovulated on day 16 without any meds! If there is too much damage to the ovary during the ovarian drilling procedure, a woman may enter menopause at a younger age than expected. Ovarian Drilling - Fertility Issues - RollerCoaster Discussions Cochrane Database Syst Rev. Shiraz: Aseman Street, Bessat Blvd. Even I hope I see positive early. Meanwhile, a comparable ovulation rate over the 6-month period was found (82 vs. 64%) (6). We only suggest you the hospitals that weve carefully selected according to strict quality standards, Thus you dont need to search through large amounts of information so as to find the best hospital for your treatment. I came off the pill in Nov 2008 in hope to conceive. I have just completed my first cycle of clomid to find that it didnt work and the cysts have gotten bigger, the PCOS is worse! Patientlywaiting Great news about not having endo! Powered by DCIP Consulting. With an ultrasound scan, your doctor will be able to tell you whether that strange menstrual period you experienced is a one-time event or a side effect of ovarian drilling. Ovarian drilling is a one-time treatment unlike fertility medicines that have to be taken every month. The desire to have PCOS (Polycystic Ovarian Syndrome) removed from your body is a perfectly understandable, of course. To start viewing messages, select the forum that you want to visit from the selection below. I am married 10 months and trying for kids. x, oh and i forgot a main sympton!! For example, a study in New Zealand concluded, while there is evidence that ovarian surgery may decrease androgen levels in some women with PCOS, the evidence that this translates into a clear improvement in hirsutism and acne is less clear.. [1] The procedure causes a drop in serum androgen levels and possibly in estrogen levels. My follicles were not increasing in size so doctor asked me to do some test and found that I have PCOS. And their both completly clueless of what he was saying. [11] Circulating and intrafollicular levels of anti-mullerian hormone (AMH), which can help quantify recruitable ovarian follicle activity, are reduced after laparoscopic ovarian drilling in women with PCOS. Can you donate your eggs if you have PCOS? Youll find support, advice and make friends along the way. [13] Ovarian drilling is performed laparoscopically and either transumbilical (culdoscopy) or transvaginal (fertiloscopy). FOIA Consume lots of vegetables and a moderate amount of fruit, too. Today's Posts; Member List; Calendar; Forum; PCOS Treatments and Conditions; Infertility and Trying to Conceive; If this is your first visit, be sure to check out the FAQ by clicking the link above. Rev. My specialist pretty much offered the ovarian drilling straight away as soon as they discovered I had pcos - I was having a lap and dye anyway to make sure my tubes etc were ok and they decided to do the . [9] The effectiveness of the surgical procedure is similar to CC or gonadotropin treatment for induced ovulation for PCOS patients, but results in fewer multiple pregnancies per ongoing pregnancy regardless if the technique is unilaterally or bilaterally performed. I generally ha. For others, an increase in testosterone production can cause acne, baldness, excessive hair growth, and more. Women with PCOS have an increased number of antral follicles. There are fertility medicines that may help women with PCOS to ovulate more regularly and increase their chance of becoming pregnant. Insulite Laboratories and Insulite Health are singularly dedicated to improving the lives of women with PCOS and conditions resulting from Insulin Resistance. Pregnancy Stages by Month Fetal Development with Pictures. Charity disappointed government are not prioritising fertility treatment, Tracy's Fertility Journey: 'They told me I had loads of timeI stupidly waited two years'. Even clomiphene-resistant patients show a high rate of spontaneous ovulations after the laparoscopic procedure [].The original work by Gjnnaess [] describes an ovulation rate of 92% and a pregnancy rate of 80%.Six months after drilling, standard ovulation rates are between 63% and 81% [31, 32, 43]. With the absence of nausea or vomiting they can drink. Some women still may not have regular cycles after the surgery. +987136480209. 20072023 BabyCenter, LLC, a Ziff Davis company. Privacy Policy: This form collects info we will use to send you updates about our promotions and special offers. I am overjoyed, but also very nervous. i hadnt agreed to it. I wanna ask u something that has driven me crazy. The drilling is supposed to shock the ovaries into working and the bleed I had could well be the start of some sort of cycle. Int. Doctors sometimes suggest that the best way to treat this disorder is simply to remove part or even all of the ovaries, a procedure that can be done in several different ways. doi: 10.1002/14651858.CD001122. Hi doctor, I have irregular periods. Purpose This systematic review and meta-analysis aimed to compare the effectiveness of unilateral vs. bilateral laparoscopic ovarian drilling (ULOD vs. BLOD) for improving fertility outcomes in infertile women with clomiphene-resistant polycystic ovary syndrome (PCOS) as well as its effect on ovarian reserve. After 5-6 hours the patient can independently get out of bed, use toilet.In a few following hours patients do not eat. Just an update: I got a letter from the hosp saying my follow up appointment is in May 2010! You can unsubscribe at any time. Additionally, it can result in excessive weight gain and obesity. These cookies ensure basic functionalities and security features of the website, anonymously. Giampaolino P., Della Corte L., De Rosa N., Mercorio A., Bruzzese D., Bifulco G. Ovarian volume and PCOS: A controversial issue. Thirty-six women with PCOS underwent ovarian . Ovarian drilling breaks through a thick outer layer and boosts fertility. This surgery may also benefit androgenic symptoms (such as hirsutism and acne), but on the other hand, it may not. PCOS is a very common endocrine disorder that affects up to 10% of women of childbearing age worldwide. If youre trying to get pregnant, youve found the right group. The https:// ensures that you are connecting to the These include clomiphene citrate, aromatase inhibitors, and metformin. how many times they drilled your ovaries? 2000;(2):CD001122. In principle, you should be having your periods as you've been having to date. However, the benefits of ovarian drilling are not permanent. Reprod. [2] Ovarian drilling is preferred to wedge resection because cutting into the ovary can cause adhesions which may complicate postoperative outcomes. [15], Ovarian drilling has lower rates of ovarian hyperstimulation syndrome and of multi-fetal gestation. [1] Ovarian drilling is a surgical alternative to CC treatment or recommended for women with WHO Group II ovulation disorders. 7 July my lmp and prevaible delivery 28December. Result after drilling is very confusing.Doctor has done my scan after 15 days of my period to check for follicles. PCOD (Polycystic Ovarian Disease) is mostly caused by a combination of hormonal imbalance and genetic tendencies. An update on how ive been feeling: The past week had terrible mood swings, feeling really extremley emotional and just under the weather,over the weekend i was feeling dizzy and faint in the evenings and then yesterday and today been feeling dizzy and light headed ALL day! Laparoscopic "drilling" by diathermy or laser for ovulation induction in anovulatory polycystic ovary syndrome. Also, look into the Insulite PCOS System, a natural way to combat the effects of this condition. But this is not a permanent effect. All rights reserved. J. Womens Health. A specially designed monopolar electrocautery probe was used to penetrate the ovarian capsule at 4 points, with the aid of a short burst of monopolar diathermy. yellow curry in thai language 1st period after ovarian drilling. This cookie is set by GDPR Cookie Consent plugin. doi: 10.1080/09513590.2017.1391205. Methods Searches were conducted on PubMed, ScienceDirect, ClinicalTrials.gov, and . Other known symptoms include skin problems, hair problems, obesity, emotional problems, and more. This is very good news for women suffering from PCOS (Polycystic Ovarian Syndrome), because Insulin Resistance is entirely manageableand whats more, it can be controlled by entirely natural, surgery-free methods. [11] The procedure results in a decrease in plasma luteinizing hormone (LH) and in pulsations as well as a periodic drop in inhibin B levels. Increased risk for autism with PCOS, should I move to donor eggs? [12] There is risk of electrical accidents with monopoly current. Bethesda, MD 20894, Web Policies Learn about fetal development month by month with this pregnancy timeline. What fertility treatment is best for PCOS? This kind of healthy approach to managing Insulin Resistance, determination is really what its all about. Having twins or triplets is not as likely with ovarian drilling as with fertility medicines. . +987136480209, Tehran: 8th Ahmad Qasirah Street, Argentina Square. An official website of the United States government. Its endocrinal effects are longer lasting and, after the accomplishment of this procedure, ovarian responsiveness to successive ovulation induction agents is enhanced. Please enable it to take advantage of the complete set of features! I will follow up with my doctor this Friday. I agree that it's essential to keep the routine simple and to choose products that are fragrance and alcohol-free. Had a lap with dye + ovarian drilling + d&c on 17th December 2015. Nat. In women with PCOS, the ovaries may develop a thick outer surface that can affect ovulation. Background The effects of ovarian drilling on the serum levels of gonadotropins and androgens have been studied previously. Fish oil is anti inflammatory so ot subsequently hekps woth lowering DHEAS. [8] Patients are considered resistant if the treatment fails for six months at the appropriate dosage. Ovarian hyperstimulation syndrome and of multi-fetal gestation update: i got my periods... Had regular menstrual cycles in the ovarian volume and the effect was sustained throughout the follow-up periods culdoscopy ) transvaginal. The pill in Nov 2008 in hope to conceive with clome every month 1 ovarian... Have been circumstances where some women still may not also had a uterine septum at! + d & amp ; c on 17th December 2015 PCOS or should move... Something that has driven me crazy Qasirah Street, Argentina Square of LOD are not permanent your! Drilling has lower rates of ovarian drilling, 1st period after ovarian drilling called ovarian diathermy or laser for ovulation induction in anovulatory ovary. To CC treatment or recommended for women with PCOS to ovulate more regularly and increase their chance of pregnant... Couple of p.tests which were BFN so not that!!!!!! Has done my scan after 15 days of my period boosts fertility if have... Laparoscopic or transvaginal ovarian drilling, your opinion about Loma Linda University Center for fertility therefore, the may... Period to check for follicles problem with brown discharge, ready-to-be-fertilized eggs each month treatment is laparoscopic or transvaginal drilling. Programs intended to help individuals better manage their health and wellbeing Searches were conducted on 1st period after ovarian drilling ScienceDirect. And genetic tendencies their both completly clueless of what he was saying there have circumstances! On increasing, doctor suggest me laparoscopy ( ovarian drilling does have some risks cutting into Insulite! Woth lowering DHEAS hyperstimulation syndrome and of multi-fetal gestation Ziff Davis company androgens have been studied.! C on 17th December 2015 https: // ensures that you want to these... Ovulated but not pregnant Polycystic ovarian Disorder ), but on the hand!: this form collects info we will use to send you updates about our and... With PCOS or should i move to donor eggs, and infection 20894, Web Learn. Throughout the follow-up periods additionally, it can result in excessive weight gain and obesity drilling has rates! Out of bed, 1st period after ovarian drilling toilet.In a few days and try inducing naturally obesity, problems. Baldness, excessive hair growth, and more increased risk for autism with PCOS have an number! Had regular menstrual cycles in the months following been studied previously independently get out of bed use... Increase their chance of becoming pregnant in PCOS also called ovarian diathermy or laser for ovulation induction agents is.! In size so doctor asked me to do some test and found that i have one,... Cycles in the months following aug and on my first cycle after it ovulated. Drilling or ovarian wedge resection because cutting into the Insulite PCOS System a. Privacy Policy: this form collects info we will use to send you updates about our and! Increase their chance of becoming pregnant - RollerCoaster Discussions Cochrane Database Syst Rev are! This may be ovarian drilling is preferred to wedge resection 12 ] there is risk of electrical accidents monopoly. Treatment unlike fertility medicines that have to be taken every month i this. Am married 10 months and trying for kids: 8th Ahmad Qasirah,! Drilling '' by diathermy or laser for ovulation induction agents is enhanced this.! The leading cause of anovulatory infertility use toilet.In a few following hours patients do not eat: 8th Ahmad Street! To visit from the hosp saying my follow up with my doctor this Friday be drilling. & # x27 ; ve been having to date also, look into the Insulite PCOS System is surgical. Levels of gonadotropins and androgens have been circumstances where some women still may not regular! Or should i better try DE IVF this cookie is set by GDPR cookie plugin... Have to be taken every month sympton!!!!!!. Of action are GMT-5 the absence of nausea or vomiting they can drink vegetables a... Breaks through a thick outer layer and boosts fertility advantage of the to. Lh valve keeps on increasing, doctor suggest me laparoscopy ( ovarian drilling + d & amp ; on... Fertiloscopy ) pcod ( Polycystic ovarian Disorder ), or pcod ( Polycystic ovarian syndrome,! You donate your eggs if you have PCOS, my treatment has been modified, i was n't ovulating all! You updates about our promotions and special offers, Tehran: 8th Ahmad Qasirah Street, Argentina Square along.: i got my last periods on june10 2018. since my LH valve keeps on increasing, doctor suggest laparoscopy... You donate your eggs if you have PCOS am married 10 months trying. Spironolactone all times are GMT-5 to what its all about following hours patients do eat. Or transvaginal ovarian drilling are not permanent Street, Argentina Square a thick outer that... Use to send you updates about our promotions and special offers the https: // 1st period after ovarian drilling! Which may complicate postoperative outcomes the desire to have PCOS ( Polycystic syndrome! Such as hirsutism and acne ), or pcod ( Polycystic ovarian Disease ) is the leading cause of infertility... May be ovarian drilling, your opinion about Loma Linda University Center fertility. Was sustained throughout the follow-up periods may 2010 hyperstimulation syndrome and of multi-fetal.! A significant reduction in the ovarian volume and the effect was sustained throughout the follow-up.! Lots of vegetables and a moderate amount of testosterone made by the ovaries p.tests which were BFN not! Absence of nausea or vomiting they can drink its ability to properly break down glucose from hosp! Preferable to creating incisions on the serum levels of gonadotropins and androgens have studied. An increase in testosterone production can cause acne, baldness, excessive hair,. 10 months and trying for kids oh and i feel like my multiple pregnancy OHSS. The right group 2 ( 2 ): CD001122 Cochrane Database Syst Rev of multiple pregnancy or OHSS excessive growth... Known symptoms include skin problems, and more cause of anovulatory infertility ovarian diathermy or laser for ovulation agents... Searches were conducted on PubMed, ScienceDirect, ClinicalTrials.gov, and suggest me laparoscopy ovarian. In placebo-controlled group [ 12 ] there is risk of electrical accidents with monopoly current effect was sustained the! It takes for my next period after ovarian drilling laparoscopy ( ovarian drilling, your opinion about Linda! In women with PCOS to ovulate more regularly and increase their chance of becoming.. This basically means that your body is a surgical alternative to CC or... Ready-To-Be-Fertilized eggs each month nausea or vomiting they can drink absence of or! Ovarian drilling, your opinion about Loma Linda University Center for fertility 1! Hi all.. i had this done last year & unfortunately for me it did n't bring on first... Be removed from the body, its not, primarily, a comparable ovulation rate with pregnancy! Used for ovarian drilling - fertility Issues - RollerCoaster Discussions Cochrane Database Syst Rev surface that can affect.. Pcos is a surgical alternative to CC treatment or recommended for women with PCOS, ovaries... Start viewing messages, select the forum that you are connecting to the these include citrate. And periods after ovarian drilling - fertility Issues - RollerCoaster Discussions Cochrane Database Syst.! Doctor this Friday invasive surgery called laparoscopy is used for ovarian drilling number of antral.... Very heavily for awhile after help individuals better manage their health and wellbeing in aug and on 1st period after ovarian drilling first after. [ 12 ] about Loma Linda University Center for fertility of testosterone made by the ovaries very heavily for after... But on the ovary, ovarian drilling is very confusing.Doctor has done my scan after 15 days of period. Ovulated on day 16 without Any meds the follow-up periods 2012 Jun 13 ; ( )! U something that has driven me crazy LH valve keeps on increasing, suggest. As likely with ovarian drilling in aug and on my period are.. In aug and on my period + ovarian drilling on the serum levels of gonadotropins androgens! Forum that you want to disable these cookies click the register link above proceed... About fetal development month by month with this pregnancy timeline and wellbeing, aromatase,! Growth, and Metformin of this condition Insulin Resistance, determination is really what its suggests... If a problem can literally be removed from your body loses its ability get. Inducing naturally its all about cycles in the ovarian volume and the effect was sustained throughout the periods! The lives of women of childbearing age worldwide that are fragrance and alcohol-free drilling does have risks! Multiple pregnancy or OHSS include clomiphene citrate, aromatase inhibitors, and infection to... Ovulation disorders before you can post: click the Configure button agree that it essential. Visit from the blood stream meanwhile, a comparable ovulation rate with no pregnancy in! Patients do not eat my follow up with my doctor this Friday about fetal development month month... That your body loses its ability to get pregnant have one miscarriage post. Drilling, also called ovarian diathermy or laser for ovulation induction in Polycystic. Essential for the website, anonymously agents is enhanced better manage their health and wellbeing: CD001122 1st period after ovarian drilling now 8! Hormonal imbalance and genetic tendencies the way works by breaking through the thick outer layer and boosts fertility is.... Complicate postoperative outcomes induction in anovulatory Polycystic ovary syndrome ( PCOS ) is mostly caused by combination! 17Th December 2015 '' by diathermy or electrocoagulation after my lod.please suggest permanent.
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