Fertility Journey

Do you know what you are getting into I asked? “No, came the reply”, I don’t and I don’t care.

The only thing I care about is that a baby comes out at the end of it all. This was the conversation I had with a colleague a few weeks ago.

2 months into her treatment, she was exhausted, miserable and, an emotional wreck. She was broken in more ways than she ever thought possible.

She has had 3 failed cycle and became pregnant on the 4 try.

Little did she she know what she was getting into. If only someone had told me, she recalled months after giving birth:

So, how can you prepare for Treatment? How do you ensure that you are some how ready and have some insight into what you are about to embark on.

First you need to understand the stages of fertility treatments and what is involved.

According to the NHS websites there are 3 types of fertility treatments. 

Today’s post will focus on Medicines. 

  1. medicines
  2. surgical procedures
  3. assisted conception – including intrauterine insemination (IUI) and in vitro fertilisation (IVF)

Medicines

Common fertility medicines include:

clomifene – This is a drug given to stimulate ovulation. It encourages the monthly release of an egg (ovulation) in women who do not ovulate regularly or cannot ovulate at all. 

tamoxifen: This is an alternative to clomiphene that is also an ovulation stimulating drug offered to those with ovulation problems. 

metformin – is particularly beneficial for women who have polycystic ovary syndrome (PCOS).

Other ovarian stimulating drugs are 

gonadotrophins – can help stimulate ovulation in women, and may also improve fertility in men

gonadotrophin-releasing hormone and dopamine agonists – other types of medicine prescribed to encourage ovulation in women

These drugs are prescribed if your doctor thinks you need them.

Some of these medicines may cause side effects, such as nausea, vomiting, headaches and hot flushes.

So it is important to speak to your doctor for more information about the possible side effects of specific medicines.

Watch out for next post where we continue on Surgical procedures

Your partner in Hope

D’Ebi

Sources

stages of treatment @nhs.uk

related post

IVF PROCESS: Step by Step

Add ins to fertility treatment

IVF:Stages to egg implantation


How to Cope With the Stress of Infertility

How to cope with the stress of infertility

One of the worse things a couple can learn is that they are unable to have children. This very discovery can either make or break a relationship.

Having spoken with so many couples about their experiences I have discovered that everyone is affected in a different way, but one common factor is stress.

This post brings you ways of coping with the stress brought on by infertility.

The feeling of helplessness and hopelessness is real to the infertile couple, this feeling if left unchecked can wreak more havoc.

The commonest forms of stress are depression, feelings of anxiety, and mental health problems.

Here are 5 ways you can adopt to deal with stress

1. Identify your feelings: Sometimes it is very difficult to know which feelings you are exhibiting so it is important to identify your feelings. It might hep to Talk to a professional to help you get in touch with your feelings. Identifying how you feel is the first step in dealing with other emotions like anger, guilt, fear, jealousy and shame.

2. Seek Help for your situations : there are a lot of resources on fertility options. (see sources below) rather than waste precious energy on negative emotions, busy yourself by seeking help. Find out all you need to know about your issues. Your doctor should be your first point of call as they will kick start the treatment process.

3. Consider the options available to you. Your research should include cost, the type of treatment available IVF, IUI, Intracytoplasmic sperm injection, other alternatives such as adoption, fostering, surrogacy should be considered also. Advancement in medicine has made possible the impossible.

4. Have a support net work. It is much easier to cope with a stressful situation by talking to someone than by coping alone. Your support net work can be a close friend, who will not be judgemental or a family member like a mum or sister. It can consist of a group or an individual. Be sure they they are people you can count on to be discreet and to always be supportive. There are lots of support groups on social media You can join but only share if you comfortable doing so.

5. Take on a hobby: Find something to do to take your mind off the situation. It can be a passion you had packed away, hiking, fund raising for a good cause, cooking or writing poetry etc. The very act of being engaged in something rewarding frees your mind from the stress of infertility.

Finally always look on the bright side. No matter how worse or bad a situation feels believe it can get better.

So I encourage you to hope for the best.

Believe the best

and expect the best to happen.

Your Partner in Hope

D’Ebi

Read More »

The 2 weeks wait

Those who got pregnant naturally may not have heard of the two weeks wait.

I certainly was not anxiously waiting two weeks after falling pregnant with our second child to see if there was a positive test or not. It was 12 weeks after, I noticed I was late.

For those who have embarked on IVFs, the period immediately after egg transfer can be the most stress-filled days, it certainly was for me.

I was plague with questions like, what if this fails?

Endless questions like, why don’t i feel anything?

Every twinged was analyzed.

Every symptoms is interpreted as meaning something… a loss, especially having suffered miscarriage

So how do you survive this wait, how do you wait while you wait?

This post gives tips on what to do while waiting:

Do not obsess over every twinge, feelings and changes you notice.

You will feel differently from day to day, so save yourself the stress of ringing up your doctor whenever you think something is wrong.

I know this is a difficult task, but doing the next few steps will help.

  1. Take up an interest, this may seem like the most unlikely time to start something new, but doing something new can has focus your mind and in the process reduce the anxiety of having to constantly fixate on what is happening during the wait. There are lots of sites offering short courses on a varied range of interests .
  2. Walks: This is not the time to go for intensive exercise classes, but you can go for short walks in the woods and admire nature’s beauty.
  3. Yoga: IVF takes so much out of you and yoga is a great way to center your senses.It is great for relaxing and also focuses your mind on being calm as you concentrate on your breathing. Yoga relaxes you into calmness which lingers afterwards.
  4. I took up reflexology during my wait and often come away feeling relaxed. There are great work out videos on youtube.
  5. Learn how to cook a new dish. The process of researching, selecting, preparing the ingredients, peeling, cutting, cleaning the ingredients, engages the mind and also fills you with a sense of achievement. The very motion of cooking engages a different part of the brain. Invite friends over and share the meals with them. laughter and banter with others will do you a world of good.
  6. plan a date with your partner: Fingers crossed everything will go well and this maybe the last few weeks of being alone before your little baby comes. So enjoy the moment and do little stuff together.
  7. Start your diary and begin to write about your IVF experiences, you never know who this may help in future. I kept a dairy of my fertility journey which has formed the basis of this blog.
  8. Get going on that to do list you have been meaning to get to, be careful not to do any heavy lifting. Dusting and tidying of drawers and wardrobe are simple chores to get busy with.
  9. Adult doodle is a great way to pass the time. There are lots of inspirational doodle books around, these are great for lifting your spirits and as you color in the pages imagine your life being beautified by your little one.
  10. positive affirmation. this a way of focusing on the positive and a good practice to engage in, long after IVF. Simply refuse to dwell on the negative, you have nothing to loose and everything to gain by being positive so be full of hope.

Above all hold on to hope, you have come this far there is no need to worry now.
Seek out your support net work, it may be that one friend or a group you are path of, be in constant communication with them so as not to allow your self to drift off into negative and panicking territory.

The journey stared with that first push of the needle and will end with a beautiful baby.

Your Partner in Hope

D’Ebi

Relevant Post

https://faithfulwait.com/2019/09/27/ivf-process-step-by-step/

https://faithfulwait.com/2019/05/29/the-pain-of-miscarriage/

https://faithfulwait.com/2018/08/13/single-women-and-ivf/

https://faithfulwait.com/2017/12/06/fearful-wait/

IVF:Stages to egg implantation

  1. Meeting with Team: this is the initial consultation with the clinic to go throughout process.
  2. The process: The woman will be given medication to suppress her normal menstrual cycle. This is usually given for 2 weeks. My first cycle was a nasal spray but the final cycle was an injection which I learned to inject myself. After which step 3 begins
  3. Boosting the egg supply: This will include stimulation of the ovaries to produce more eggs than usual, to increase the number of eggs for fertility. You will be given a fertility hormone called follicle stimulating hormone (FSH). This is also a daily injection you give yourself or your partner can assist if they want to be involved and feel connected to the process. It’s usually for 10-12 days.
  4. Monitoring. you will be monitored while on the FSH, some clinics will scan every 2 days while others maybe twice weekly during the process. The monitoring may be ultrasound scans to monitor the size of the ovaries, blood test or both. The ovaries are usually measured to see how big the eggs are and a final hormone boost may be given 34-38 hours prior to collection.
  5. Collecting the eggs: Eggs are usually collected on days 10 or 12 depending on the sizes/ how well the ovaries have been stimulated. collecting is usually done under local anesthetic where you will be sedated. A needle is passed through the vagina into each ovary under ultrasound guidance. This procedure may take 15-20 minutes. You may experience cramp or light bleeding afterwards.
  6. Fertilizing the eggs: Once the eggs are collected they are mixed with your partners or the donor sperm in the lab. They are checked after 16-20 hours to see if Fertilization has occurred.
  7. In some cases the eggs may be injected individually with a sperm called ICSI.
  8. Egg Monitoring: The embryos are left to continue to grow for 6 days before being transferred into the womb. The best 2 are usually selected to be transferred.
  9. Embryo Transfer: The embargo’s are transferred into the womb using a thin tube called a catheter passed into the vagina. The procedure is quite simple and doesn’t involve any sedation.
  10. Then began the 2 weeks wait. see next post for how to cope.

Your Partner in Hope

D’Ebi

Related post

https://faithfulwait.com/2016/05/11/a-woman-in-waiting/

https://faithfulwait.com/2016/07/11/surviving-treatment/

https://faithfulwait.com/2016/09/22/exploring-other-options/

https://faithfulwait.com/2016/10/26/choosing-an-ivf-clinic/

https://faithfulwait.com/2018/03/31/it-only-takes-one-egg/

Treatment and COVID-19

IVF AND COVID-19.

The Outbreak of Covid-19 has sadly affected all aspects of our lives and more importantly our health.

As the spread of the virus continues Governments across the globe have had to take difficult decision in an attempt to protect the human race.

I have bee watching the trend and listened keenly to the news being shared. One thing that have been overlooked in all the main stream media outlet is the impact it has on IVF treatment. Once again infertility and IVT treatments takes bottom page on the list of important illness.

Stories being shared around the world shows that it is becoming increasingly difficult to access IVF treatments presently. Ash Mogg and her partner had waited almost a year to a publicly funded list in Ontario and were about to begin the process in two weeks, but their hospital has suspended the treatment indefinitely.

Health Authorities across the world have taken the decision to halt all IVF treatment. The Times of Isreal reported that Isreal has stopped all new IVF treatments over the coronavirus fears. Due to the fear that it could spread in clinics and potentially harm foetuses.

Similar decision has also been taken by the European Society of Human Reproduction and the Embryology and the American Society for Reproductive Medicine.

These decisions were no doubt taken seriously with the safety of everyone affected.

The risk involve with continuing is too great to take. Apart from the risk for the medical technical performing the treatment, there is an increased risk for the patients undergoing the treatment due to the delicate nature of the process and close monitoring during the egg transfer phase, blood testing phase.

The waiting rooms of many IVF clinics are often small and holds between 30 to 40 women and their spouses at any given time. And, given the guidelines on social distancing, enforcing this will be difficult.

Furthermore, there is the added risk during the transferring of the embryo requiring extreme hygiene measures. This is a new virus and it is still unclear what effect if any it may have on foetuses.

the way it is spreading calls for urgent and severe measures to be taken. Never before has the world been shut down even in times of war.

Although the severity of the situation has left many couples heart broken, as their dreams of becoming parents are further, put on hold.

It is especially painful and heart wrenching for those who have had to stop their treatment mid-way. For some women, age is not on their side making this extremely hard to deal with.

I cannot imagine being in your place, I can only encourage you to keep your eyes on the goal. Now more than ever, stay strong. This too shall pass.

Practical things to do to as you wait.


If you must follow the news, limit it to specific times of the day.

Engage your mind with positive messages. Limit your exposure to social media, news outlets and other sources of negativity that may cause you to worry and panic.

  • Keep up to date with what is happening in the world of fertility treatment. Your hospital will also be sending out communications during this time to keep you updated on the developments.

Do something you have always wanted to do. If your city is locked down, take up gardening spring is here clear out the shed and bring out the flower pot

Plant some potted herbs or your favourite flower, watch it grow and bloom and as it does, say a prayer of hope faith that you too will grow and bloom soon with your own baby.

Take an online course learn a language, cooking skill, book club, dance class. The list is endless.

Iife must go on because here there is life, there is hope. My prayer through this is that we will all

I find our true purpose and embrace the real meaning of life.

Your partner in Hope

D’Ebi

Surrogacy: I call it a helping hand.

Gone are the days, when having a baby means you have to be pregnant. While pregnancy is a beautiful experience. Sadly many women have suffered needlessly without success. With surrogacy, hope is restored and couples can now experience the joys of being parents.

I am so glad about the attention surrogacy is getting thanks to some high profile births via surrogates.

Like Candy from the Real Housewives of Atlanta and Kim and Kanye West.

To me, surrogacy means fighting to defeat infertility, doing whatever it takes to hold that precious soul in your hands.

It means not being ashamed to asked another to be the womb that holds your jewels, to trust someone with your heart.

It means exploring what is possible.

To be an expectant mother without the visible sign, but knowing that your heart is pregnant and bursting with love and gratitude.

Surrogacy, it is indeed the helping hand we all need.

In March we I’ll explore more on the topic.

Stay tuned

Kick Start Your Fertility in 2020

It’s the beginning of the year and often we have goals and resolutions to adhere to.

Here at faithful wait we are guessing yours is to fall pregnant.

To bring you closer to your dream, we have complied a list of 10 activities or changes to embark on as you work on your desires.

1. Reduce your stress level: stress is now the most commonly diagnosed illness right now. It is especially stressful if you fail to fall pregnant after several tries. If this is you, do simple things to reduce your stress level. this can be planning 10 mins daily walk around the block or at lunch break, practice slow breathing techniques as part of a meditation exercise.

2. Keep a positive attitude, this will involve actively choosing to ignore the negatives. Fill your mind with thoughts that promotes good feeling. I find reading a daily motivation book or quote and meditating on this helps to feel my mind positive thoughts and actions.

3. Practice meditation. This will aid in stress reduction, practice calm breathing sessions, you can find helpful videos on YouTube and other health sites. If cost is no issue, join a gym where you can take part in Pilates and yoga classes.

4. Read. What’s your situation? What do you know about it? Research on it and find alternatives ways to achieve those goals. Exploring other option

5. Alternate medicine: take a daily supplement or vitamins. Folic acid is recommended for those trying to conceive. Discuss with your doctor on what the best medicine to take is.

6. Take up new hobbies. We are often so engaged in

Trying to get pregnant we forget to love life. Take up a new skill like gardening, sewing, knitting, drawing, or learning a language. This l will refocus your mind and take the focus off trying to conceive as well as shift the focus off the issue and release you to enjoying life while you wait.

7. Adopt a healthy lifestyle. This will involve healthy eating and daily exercise. Doctors recommend 30 minutes of moderate exercise. Take a brisk walk, daily swimming or running, whatever suits your you.

9. Hold no grudges. Yes life seems cruel, you may feel you’ve been dealt a bad hand. Let go and look on the bright side. It could be worse.

10. Seek help. To fall pregnant requires action. If you have tried unsuccessfully in the last year and still not pregnant. Find out why. Talk to your doctor. Explore the options available to you. The IVF PROCESS

Do something to get you started.!

These are just a few steps towards achieving your dream of becoming a parent. Find out more for yourself on this site.

Get started today and I wish you every success in 2020. Don’t call it quit

Partner in Hope

D’Ebi

2020: The Year Where the impossible, becomes Possible.

As the 2019 draws to a close, I want to remind us of some impossible feats which became possible.

Humans have achieved so many remarkable things and are still capable of achieving more.

So here we are, the end of 2019.

You may be left disappointed because your hopes and dreams are still what they are hopes and dreams. And may even feel further from the goals you set as even more odds are stacked against you.

What’s the point? you ask yourself.

Well a reminder of great feats accomplished by fellow humans, may encourage you to keep the fire of your dreams and hopes burning to continue to stir the oar and to stay the course.

The four minute mile:

In 1954 at the age of 25, Roger Bannister became the first runner to break the 4 minute mile mark.It was a feat thought impossible at that time. He ran 4 miles for the first time in 1954 with his time at 3:59:4.

This single feat unlocked the possibilities of what men and women went on to achieve in track and field events. what was once deemed impossible has since become the standard for middle distance runners.

Moon landing:

The first moon landing was on 13th September 2013 by the Soviet Union’s Luna.

However on 20th July1969, the United States became the first country to send a manned mission to the moon. Again this was another accomplishment on the feathers of history. And several manned missions have since been embarked upon.

The longest Ice bath.

Wim Hof, holds the world record for the longest Ice Bath. He sat for 1 hour 12 mins in a bath of ice without His core body temperature failing. This was considered medically impossible, yet he proved it can be done.

Consecutive Marathons

In 2013, the Guinness Book of record,recorded that three hundred and sixty six full consecutive marathons was run by Jeannette and Alan Murray-Wakelin. No one has ever attempted this consecutively.

Electronic devices:

The world of technology has come a long way. You only have to look around you to know that humans have accomplished so much in the last century, a feat thought impossible, were imagined and today we have various means of communication.

Our telephones, our TV screens, smart home appliances, have changed the way we do things. The world has become smaller and impossible dreams have become possible.

The first flight.

The Wright Brothers made History when they became the first to achieve a short flight in 1903. This revolutionized the air travel and is regarded as one of the great technical achievements of all times

The development of Vaccines:

For a long time (centuries) life expectancy was low. Then came the great medical advances in the 19th and 20th centuries. As a result, many in the developing world have much longer life expectancy.

The first vaccines to be developed was by Edward Jenner. He developed the smallpox vaccine. And Louis Pasteur developed the Rabies vaccines

The development of vaccines have led to the decline and in some cases eradication of some deadly diseases

Climbing Mount Everest

On May 29th Edmund Hillary and Sherpa Tensing Norgay climbed Mount Everest the highest peak in the Himalayas. This paved the way for so many others to attempt other daring adventures.

The first test tube baby.

On the 10/11/1977 IVF was born in the person of Louise Brown. She was born at Oldham and District Hospital in Greater Manchester weighing 5lb 12oz.

Since then, millions of babies worldwide have been born via IVF bringing joy to couples the world over and making their dreams come true.

Earlier today, while still lying in bed, I received a text message about a family member who had her first child,a beautiful baby girl at 52 years of age.

She had two blocked tubes and for years thought it was impossible to have a child, age was of course a factor, but thanks to IVF she is now the mother.

As you scroll down this list of achievements, be encouraged, let hope rise within you.

Doubt if you may, but never ever give up your hopes and dreams of becoming a parent.

Let 2020 be the year you rekindle your zeal and trust in God. If you have stopped trying for lack of funds find out if help is available where you leave .

Whatever you do.. trust, belief, and hope for hope is the confident expectation that something good will happen.

I pray it happens this year for you.

Happy New Year.

Your Partner in Hope

D’Ebi

Relevant liRead More »

The Egg Freezing process

There are so many things couples faced with infertility have to consider, also single women and those undergoing chemotherapy also have to consider how to deal with their verity. 

Freezing one’s eggs is the best option to secure ones future as parents or to at least keep one’s hope of being a parent alive.

 

UK law allows you to store your eggs for up to 10 years.

In the UK, egg freezing costs on average between £3,500 and £4,500 for one cycle of treatment. In addition to this price, you’ll have to pay an annual fee to keep your eggs stored (from £200 to £360).

What is Egg Freezing?

Egg freezing is a method of preserving a woman’s fertility so she can try and have children at a later date.it involved collecting a woman’s egg, freezing them to allow her to have a baby later on when she’s ready. 

With marriage at an all time low and women finding the right partner much later it makes sense to freeze one’s eggs to ensure that when the time comes one can still have a baby. 

There are other medical reasons for freezing one’s eggs.

To embark on chemotherapy or If a woman  is due to undergo other medical treatment involving some potent drugs.

Also a woman’s chances of conceiving naturally falls as she gets older, becomes the egg quality decreases egg freezing ensures that the best quality eggs are frozen and preserved which can be thawed at a later date.

Key facts:

In 2017, 19% of IVF treatments using a patient’s own frozen eggs were successful.

It’s becoming more successful but by no means a guarantee of having a baby.

Funding may be available if you’re having treatment that affects your fertility. (Source hfea.co.uk)

Is egg freezing for you?

You might be wondering if egg freezing is for you. 

It may be, if you fall into any of the following.

  1. You currently have a medical condition or intend to undergo a treatment for a medical condition which can affect your fertility. 

  2. You are getting on in age and have not met the right partner to start a family with and worried about your quality of egg decking as you get older 

  3. Members of the armed forces who bring deployed to a war zone.

Process

Before egg freezing, you will be tested for HIV and Hepatitis, to ensure that affected samples are stored separately from unaffected samples. 

Once collected the eggs will  a crypto protectant which is a freezing solutions will be added to the eggs. The eggs will be frozen either by cooking them down slowly or by fast freezing called vitrification. 

The fast freezing is regarded as the best methods to adopt for preservation given its success rate. 

When you are ready to use your eggs, they will be thawed and fertilised with the sperm. 

THE COST 

The process of freezing eggs is expensive. On average the cost of having the eggs collected is about £3,350.

Egg storage cost between £125 and £350 per year. 

There maybe unexpected cost added in by the clinic, so It is important to get a full cost of the treatment plan.

Thawing eggs and transferring them to the womb costs an average of £2,500. So, the whole process for egg freezing and thawing costs an average of £7,000-£8,000.

Egg freezing is becoming more popular as more people are freezing their eggs.

In 2017, there were 1,463 egg freezing cycles (in comparison to almost 70,000 IVF treatment cycles overall). Between 2010 and 2017, around 700 babies were born through frozen eggs in the UK.

If you do decided to freeze your eggs be sure to carry out some background checks on the clinic before embarking on the process. Be sure to check out the success rate for women in your age bracket.

Summary.

Eggs can only be kept for 10 years unless exceptional medical circumstances, where you can be allowed to store the eggs up to 55 years. 

To use frozen eggs for fertility process it has to be thawed, the eggs are fertilised via a fertility treatment proves known as ICSI. 

This is because the freezing process makes the outer coating around the egg tougher making fertilisation via turn normal IVF process harder. 

You must update your records at the clinic they do change. This is so that you can be contacted before the 10 years limit for destroying the eggs. 

Your Partner In Hope 

D’Ebi

Related links

https://faithfulwait.com/2019/09/27/ivf-process-step-by-step/

https://faithfulwait.com/2018/08/13/single-women-and-ivf/

https://faithfulwait.com/2018/04/15/exploring-other-options-icsi/

Sources

NHS

HFEA

IVF PROCESS: Step by Step

Do you know what you are getting into I asked, no I don’t and I don’t care. The only thing I care about is that a baby comes out at the end of it all. This was the conversation I had with a colleague a few weeks ago. 

2 months into her treatment, she was exhausted, miserable and an emotional wreck. She was broken in more ways than she ever thought possible.

She has 3 failed cycle. Before finally conceiving on the 4th.

So what can we do to prepare for Treatment.

First we need to understand the process. What is involved and the help available to you.

Below are 9 steps to be aware of before embarking on treatment 

  1. IVF treatment requires a lot of doctors visit, this is for the clinic to find out the cause and commence the appropriate treatment. After this comes the shots 

  2. The shots: These are administered for 10 to 12 days to stimulate the woman’s ovaries. During a normal cycle, a woman produces one or two eggs. During an IVF cycle the ovaries are stimulated to produce lots of eggs to increase the chances of success. You will be monitored daily or every other day. This will involve ultrasound to measure the size of the eggs as well as ensure that the ovaries are not over stimulated.

  3. After the stimulation phase comes the egg retrieval from the ovaries. This is done under general anesthesia. It is then put in a dish (usually in the lab) to be mixed with the sperm.

  4. Then comes the monitoring stage. 3 to 5 days after the egg retrieval if fertilization occurs, the embryos will be placed back into your uterus. 

  5. Sometimes the eggs maybe abnormal and no fertilization will occur, where this happens it means the cycle has failed. 

  6. The transfer only occurs where the eggs have been fertilized by the sperm. 

  7. You may have some embryos left over and decide to freeze them for later. 

  8. Two weeks after the implantation: you will be invited for a blood test by your clinic to see if you are pregnant. 

  9. This is a very stressful time and you may want to occupy yourself during these 2 weeks wait. 

  10. Pray, believe and rest. 

This is a summary of the IVF process. 

You maybe wondering if it will work, there are no guarantees in life, but we can only try, pray hope and believe.. 

Your Partner in Hope 

D’Ebi 

Related links

https://faithfulwait.com/2019/07/14/what-if/

https://faithfulwait.com/2018/08/13/single-women-and-ivf/

https://faithfulwait.com/2018/07/17/the-uk-commissioning-groups-decides-who-gets-funding-for-ivf-there-are-some-factories-they-take-into-consideration-i-deciding-who-gets-funded-this-post-looks-the-criterial-for-funding/

https://faithfulwait.com/2018/04/15/exploring-other-options-icsi/