Helping Small Miracles Happen

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WORLD-CLASS MEDICINE, sensitive care HOW IVF works ON THE ROAD TO parenthood ‘he’s our special gift’ PARENTS TELL THEIR STORIES Reproductive Science Center of NJ happen S mall helping

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A supplement by Reproductive Science Center of New Jersey 2011

Transcript of Helping Small Miracles Happen

Page 1: Helping Small Miracles Happen

World-class medicine, sensitive careHoW IVF workson tHe road to parenthood‘he’s our special gift’Parents tell tHeir stories

Reproductive Science Center

of NJ

happen

Smallhelping

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Reproductive Science Center of NJ

WELCOME to the reproductive science center of new

Jersey (rscnJ). as a father, i recognize the strong desire

to bear children, guide their growth and dream of their

accomplishments. that is why every morning, there is no

greater professional joy for me than to come here and share

my patients’ excitement as they hear their baby’s heartbeat

for the very fi rst time.

reproductive endocrinology and infertility medicine is a

fi eld that is ever evolving, which is why dr. Bromer, dr. salas

mann and i fi nd it so exciting and rewarding. our entire team

of fertility treatment specialists brings years of experience,

expertise and research innovations to each patient/couple’s

unique circumstances. our mission is to provide our patients

with compassion and respect, plus offer them the services

they need to become parents.

at rscnJ, our philosophy of care is to create a

partnership with our patients—to give them all the

information they need to make the treatment decisions that

are best for their individual needs, values and timeframes. of

course, our ultimate goal is always the same: a healthy baby.

Within these pages, you will learn more about our

comprehensive medical, fi nancial and psychosocial services

and hear the stories of couples who

have made their dreams come true at

rscnJ. We welcome your calls and

invite you to learn more about us by

visiting www.fertilitynj.com.

Best regards,

William Ziegler, d.o., medical director

reproductive science center of nJ

WE’RE HERE for you

OUR financial SERVICESAT RSCNJ, our financial specialists

can help you work within your health

insurance coverage and personal

budget to obtain infertility treatment.

even before you come for your first

appointment, we will consult with you

on the phone to verify your insurance

information. Within a few days, we will

call you back to inform you of your

benefits, any co-pays and out-of-pocket

expenses you can expect, and any

referrals you may need. We will obtain

any authorizations or pre-certification

for your first visit. there will be no

financial surprises when you come here

for the first time.

“Patients have so many medical

issues on their minds that we make

every effort to take the financial stress

off them,” says rscnJ practice manager

donna a. riggio. rscnJ also offers

self-pay options and medical financing

through advanced reproductive care®

and can work within your employer’s

flexible spending account.

You can rely on us to help you

navigate the financial complexities

of infertility treatment. We encourage

you to keep in touch with our Billing

department at 732-918-2500 at every

step of your journey.

WILLIAM ZIEGLER, D.O.

HELPING SMALL MIRACLES HAPPEN is PUBlisHedBY Wainscot media, montVale, nJ. © 2011.

all riGHts reserVed.

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IF YOU ARE having trouble getting

pregnant, the physicians at the reproductive

science center of new Jersey (rscnJ) can

determine your best treatment option. First,

you’ll meet with one of our board-certifi ed

reproductive endocrinologists. You can expect

to spend 30 minutes to an hour discussing

your menstrual cycle and pregnancy

history, plus you and your

partner’s medical and surgical

histories, exposure to toxins,

environmental infl uences and

any chronic illnesses you may be

experiencing.

a physical examination

and a transvaginal ultrasound

exam may be performed next.

this non-invasive test can

help a woman’s physician

see the shape, anatomy and

endometrial lining of her uterus.

one can also see ovarian cysts, uterine

fi broids and polyps, as well as determine

the number of “resting” follicles within her

ovaries. the latter is called the antral follicle

count (aFc), which gives the reproductive

endocrinologist an idea of how many eggs a

woman has left that can be fertilized.

“as a woman ages, the approximately 1

to 2 million eggs she is born with decreases,

either because the eggs do not ripen for

ovulation and are absorbed into the body, or

because they are not fertilized after ovulation,”

says rscnJ reproductive endocrinologist

Jessica salas mann, m.d. “too few eggs may

indicate advanced age or a history of radiation

or chemotherapy, and can represent a sign of

poor ovarian reserve. too many eggs

could indicate that a patient may

not ovulate.”

in addition to the

aFc, specifi c blood

tests can be performed

in order to get a

sense of a patient’s

“ovarian reserve,” or

the number of eggs that

a patient has left. these hormones include

follicle-stimulating hormone (FsH), which is

produced by the brain and is menstrual-cycle

specifi c, and anti-mullerian hormone (amH),

which is produced by the ovaries and is not

cycle specifi c. other endocrinopathies such

as thyroid and prolactin disorders as well as

preconception blood work are

performed to better guide

patient-specifi c treatment.

an imaging test called a

hysterosalpingogram—during

which a radio-opaque dye is

injected through a woman’s

cervix, uterus and fallopian

tubes so they can be viewed

on moving X-rays—helps

physicians determine if there

are fi broids, polyps, scar tissue,

tubal blockages or any other

abnormalities that would

impede a fertilized egg’s journey from the

tubes to the uterine lining for implantation.

the male partner’s evaluation consists

of a discussion of prior vasectomy, hernia

repair, diabetes or other chronic

illnesses, toxic exposure, smoking,

ejaculatory dysfunction and any

other factors that might affect

fertility. a semen analysis

will be performed by one of

rscnJ’s andrologists. this will

indicate the quality and motility

(movement) of the sperm, as well

as how many sperm are produced.

if a man does not produce sperm

or produces a very low number of

sperm, he may be referred

to a urologist for further testing

or treatment.

once all tests are

completed, the patient

or couple usually

schedules a visit with

their reproductive

endocrinologist to

review all options.

WHAT TO expect BEFORE YOU’RE expectingFERTILITY SPECIALISTS HAVE SEVERAL WAYS TO FIGURE OUT HOW TO HELP YOU CONCEIVE

A PRE-APPOINTMENT PHONE CONSULTATION

WITH ONE OF OUR REPRODUCTIVE ENDOCRINOLOGISTS CAN ANSWER

MANY OF OUR PATIENTS’ MOST COMMON PRELIMINARY QUESTIONS BEFORE

THEIR FIRST VISIT. PLEASE CALL US AT

732-918-2500.

JESSICA SALAS MANN, M.D.

IN COUPLES EXPERIENCING INFERTILITY, PROBLEMS ARE TYPICALLY DUE TO:• FEMALE ISSUES 40% OF THE TIME • MALE ISSUES 30% OF THE TIME• COMBINED MALE AND FEMALE

FACTORS 10% OF THE TIME• PROBLEM CANNOT BE

DETERMINED 20% OF THE TIME

FIR

ST

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EP

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released, the greater chance of fertilization.

if conception does not occur after three

or four cycles using these oral medications,

injectable medications are usually next.

these medications, called gonadotropins,

bypass the woman’s pituitary gland

and send a signal directly to the ovaries

to produce more eggs. With frequent

ultrasound exams of the ovaries, ovulation

can be predicted to within almost an hour.

• Intrauterine insemination (IUI): With

this treatment, the sperm is washed and

prepared in the rscnJ andrology laboratory,

drawn up into a thin catheter and then

placed through the woman’s cervix and

into the uterus. iUi brings the sperm closer

to an egg, thus providing a greater chance

of fertilization. the doctors at rscnJ may

recommend iUi alone or in combination with

super-ovulation medications.

NON-INVASIVE/MINIMALLY INVASIVE PROCEDURESif the fi rst-line methods don’t result in a

pregnancy, further insight into the structure

and function of a woman’s reproductive

organs may be needed.

• Hysteroscopy: during this outpatient

procedure, the physician uses a lighted

scope placed through the cervix to view the uterine cavity and check for

abnormalities.

• Laparoscopic surgery: this minimally invasive procedure, which

is performed through several small incisions above the navel, is another

way to diagnose and treat abnormalities of the reproductive tract that can

impede conception, fertilization or implantation.

• daVinci™ Surgical System: this robotic system takes laparoscopic

surgery a step further by giving physicians greater precision and dexterity

in diagnosing and treating endometriosis, blocked fallopian tubes and

uterine fi broids, and in reversing tubal ligation sterilization surgeries.

rscnJ’s medical director, William Ziegler, d.o., and medical associate

Jason Bromer, m.d., performed the fi rst robot-assisted tubal reversal

surgeries in monmouth and ocean counties.

“the robot, with its high-defi nition fi beroptics, superb magnifi cation

of the surgical site and fl exible ‘arms’ that we manipulate through tiny

abdominal incisions, helps us perform intricate microsurgical techniques

that minimize tissue trauma and decrease the body’s infl ammatory

response during pelvic surgery,” says dr. Ziegler. “this gives us the ability

to treat endometriosis and unblock tubes without causing further pelvic

adhesions. We can also use the robot to remove up to 10 uterine fi broids

during one outpatient surgery or to reconnect the fallopian tubes’ tiny

blood vessels that were tied off during tubal ligation.”

robot-assisted laparoscopic surgery holds many advantages

over traditional “open” surgery. small centimeter-sized incisions,

instead of a large incision, mean patients experience less pain, blood

loss and surgical complications. the incisions may be covered by a

simple bandage or closed with a surgical adhesive. most robot-assisted

ONE IN SIX—that’s the number of couples who have diffi culty

conceiving. But with state-of-the-art methods utilized by highly skilled

reproductive endocrinologists, such as those at the reproductive science

center of new Jersey (rscnJ), 90 percent of all cases of infertility can be

treated. Here are some of the advanced diagnostic and treatment options

our board-certifi ed reproductive endocrinologists currently offer.

FIRST-LINE TREATMENTSdoctors often begin your fertility plan with one of these popular procedures.

• “Super-ovulation”: almost 50 percent of patients facing infertility may

be assisted by this treatment, which uses oral and injectable medications

to enhance ovulation and conception. to begin, the couple’s diagnostic

testing must indicate that the man’s sperm is healthy and mobile. in

addition, testing must show that the woman has an adequate number

of good-quality eggs in her ovaries, and that her reproductive organs are

structurally normal and do not contain any uterine fi broids, ovarian cysts,

endometriosis of the fallopian tubes, or other abnormalities.

most couples start with oral medications, called clomiphene citrate or

clomid, which signal the woman’s pituitary gland to produce more follicle-

stimulating hormone (FsH). this hormone causes the ovaries to ripen

and release more than one egg about 10 days into the woman’s

monthly cycle. the couple then plans intercourse

to coincide with ovulation. the more eggs

OUR CUTTING-EDGE PROCEDURES HAVE

HELPED THOUSANDS CONCEIVE

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WOMEN WITH A FAMILY history of early menopause or

who are undergoing medical care

that may be toxic to their eggs

or reproductive organs, such as

chemotherapy and/or radiation

for cancer, may choose to freeze

their eggs.

While embryos have long

been cryopreserved (frozen in liquid

nitrogen) and then successfully

thawed and used in iVF treatments,

the freezing and future use of unfertilized eggs is now gaining

momentum as new fast-freezing techniques (called vitrifi cation) are

able to protect delicate eggs from the formation of damaging ice

crystals. cryopreserving eggs also gives healthy women who wish

to delay childbearing the ability to freeze their eggs for future use.

research, including that of rscnJ’s Jason Bromer, m.d.,

reveals that pregnancy rates are rising with the use of both

cryopreserved eggs and embryos, but frozen eggs provide several

advantages over frozen embryos, particularly for women who want

to delay childbearing.

“Freezing eggs does not require sperm, which can make

this an attractive option for a single woman,” says dr. Bromer. “in

addition, it gives women the chance to use healthy, young eggs

later in life when the eggs in their ovaries may be older and not

viable. lastly, while there are many who are uncomfortable

with discarding frozen embryos, there are very few

people who have moral or ethical issues

with discarding frozen eggs.”

PRESERVING surgeries do not require an overnight hospital stay, and patients

usually return to their regular activities within a week.

ASSISTED REPRODUCTIVE TECHNOLOGIESFor many couples who are experiencing infertility or same-sex couples

who wish to build a family, an assisted reproductive technology may be

the best option.

• In vitro fertilization (IVF): With this treatment, fertilization of the

egg by the sperm takes place outside the woman’s body in rscnJ’s

state-of-the-art embryology lab at the eatontown facility. the three

major steps of iVF include:

1. Giving follicle-stimulating hormones to the woman to help her ovaries

produce extra eggs. medications are also given to suppress ovulation

until the timing is right. Just before ovulation, the woman’s reproductive

endocrinologist retrieves the eggs from her ovaries.

2. taking the eggs to the embryology lab, where they are fertilized with

a partner’s or donor’s sperm. there they grow in special cultures for

three to fi ve days.

3. transferring one or several of the fertilized embryos (the number depends

on the woman’s age and medical history) back into the woman’s uterus

on day three or fi ve, where, if successful, they will implant and grow into

a baby. if there are additional embryos remaining after the transfer, the

patient/couple can choose to have them frozen and stored for future use.

several other assisted reproductive technologies may be used at

rscnJ in combination with iVF. these include:

• intracytoplasmic sperm injection (icsi), which involves injecting one

single sperm into an egg. icsi can assist men who have a low sperm count

and women who have a low number of viable eggs.

• microepididymal sperm aspiration (mesa) or testicular excisional sperm

extraction (tese), during which a urologist obtains sperm directly from the

man’s reproductive tract

• assisted hatching, which involves opening the shell of the embryo to

improve implantation

• donor sperm, either fresh or frozen

• donor eggs and embryos

• Gestational carriers

• Pre-implantation genetic diagnosis (PGd) to screen embryos for genetic

disorders using comparative genomic hybridization (cGH), the latest

advance in PGd

• Fertility preservation and postponement with frozen eggs and embryos

(see sidebar)

JASON BROMER, M.D.

WILLIAM ZIEGLER, D.O., JESSICA SALAS MANN, M.D., AND JASON BROMER, M.D.

RSCNJ CAN SAVE YOUR EGGS

FOR FUTURE PREGNANCIES

fertility

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RSCNJ’S CARING AND WELCOMING STAFF WAS JUST WHAT THE DOCTOR ORDERED

THANKS TO AGGRESSIVE FERTILITY TREATMENTS, A TOMS RIVER COUPLE WELCOMES A BOUNCING BABY BOY

FEELING RIGHT ‘at home’ S

UC

CE

SS

ST

OR

IES

What makes a couple choose a

fertility center? although there

are several reproductive

treatment facilities in the

metropolitan area, sometimes the

decision comes down to a feeling.

such was the case for christie and

amanda Beyer of West allenhurst. “We had gone to another

center and did not feel a connection,” says christie. “But when we

came to the reproductive science center of new Jersey (rscnJ)

on the advice of friends, we instantly felt at home with dr. Bromer

and knew that he could help us build a family. We liked the fact

that being a same-sex couple was not an issue at this center;

everyone treated us respectfully.”

christie, 33, and amanda, 27, had been a couple for fi ve

years and had been joined in a civil union for one year when they

chose to pursue motherhood in January 2010. they decided that

christie, who had a strong desire to bear children, would be the

one to become pregnant and carry the baby.

“as a nurse, i was in favor of starting with conservative

ovulation medication treatments combined with insemination

using donor sperm,” recalls christie. “neither one of us had tried

to conceive before, and we thought it would be relatively easy.”

Unfortunately, two rounds of oral medications followed by

two rounds of medication injections failed to produce a baby.

diagnostic tests indicated that christie’s eggs were of

poor quality, and she was probably experiencing premature

ovarian failure syndrome. this condition, marked by the ovaries’

decreasing ability to produce viable eggs, can begin when a

woman is in her 20s. dr. Bromer recommended iVF, but there

were health insurance hurdles to overcome.

“dr. Bromer and his staff took all the insurance pressure off

of us so we could focus on becoming mothers,” says amanda.

christie also credits the nurses at rscnJ for making her feel

safe and comfortable during her fertility treatments and helping

both she and amanda handle the stress that accompanied the three

treatment cycles they underwent until christie became pregnant.

Finally, in august 2010, christie and amanda received the

happy news that they were expecting twins. on march 11, 2011,

after 34 ½ weeks of pregnancy, christie’s water broke. a boy,

Jace, was delivered at 5 pounds, 2 ounces. next came a girl, Julia,

weighing 5 pounds, 3 ounces.

christie and amanda are eager to one day have more

children. When they feel the time is right to add to their family,

they say they’ll go “home” to dr. Bromer and the rest of the

rscnJ staff.

elizabeth and robert Holligan of toms river don’t mind the sleepless nights that come along with caring for

their baby son, Justin. “after years of trying to conceive, all that matters are Justin’s smiles,” says elizabeth.

Justin was born on november 29, 2010, thanks to fertility treatments elizabeth received at the

reproductive science center of new Jersey (rscnJ).

the couple fi rst sought help from rscnJ in 2007 when elizabeth was 30. “everyone kept saying, ‘Just

relax, you’re young, you’ll get pregnant,’” recalls elizabeth. “But we were concerned because we

had been trying for a year.”

despite extensive diagnostic testing, it was unclear why the Holligans couldn’t conceive.

no matter: that didn’t mean there wasn’t a solution. “my best friend had just become

pregnant with iVF administered by dr. Ziegler of the center, so i was completely familiar and

comfortable with this treatment and wanted to try it.” the couple happily learned that their

insurance policy covered four iVF cycles.

But the road to parenthood was a bumpy one for the couple. the hormone medications and

injections necessary for producing extra eggs and timing ovulation made elizabeth experience hot

fl ashes, mood swings and weight gain. the Holligans’ fi rst iVF cycle was unsuccessful; neither of the

two embryos fertilized in rscnJ’s lab and transferred to elizabeth’s uterus had implanted.

Using frozen embryos saved from the fi rst iVF cycle, they tried a second time. But this attempt only

produced a “chemical pregnancy.” that meant that although early blood tests indicated that elizabeth was

initially pregnant by the count of certain hormones, neither of the embryos that had been transferred into her

uterus matured into a “clinical pregnancy,” which is defi ned as the presence of a gestational sac that can be

visualized on an ultrasound exam and a heartbeat that can be heard at about eight to nine weeks’ gestation.

“i was devastated because we had used up all the 30 eggs that had been retrieved during my fi rst iVF

attempt,” says elizabeth. “But dr. Ziegler was hopeful, so we started all over again.”

after two more attempts at iVF, elizabeth found out she was pregnant on april 3, 2010, after receiving a

call from a rscnJ nurse. she delivered Justin at a healthy 7 pounds, 5 ounces. “every day i look at Justin and

feel grateful for dr. Ziegler and his staff for the special gift they gave us,” says elizabeth.

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WORLD-CLASS MEDICINE isn’t all you’ll fi nd at the reproductive science

center of new Jersey (rscnJ). our staff is also dedicated to providing you with sensitive,

compassionate care throughout your journey toward parenthood.

rscnJ offers comprehensive diagnostic, treatment and research services

in two state-of-the-art facilities in eatontown and toms river. our reproductive

endocrinologists, physician assistant, registered nurses, on-site embryologists and

andrologist, medical assistants, fi nancial specialists, support staff and offi ce personnel

are committed to fi nding answers and developing an individual treatment plan.

Because infertility presents many physical, emotional and social challenges, we also

offer psychological counseling with a licensed clinical social worker.

our physicians are on the

medical staffs of seven hospitals and

one surgical center in monmouth and

ocean counties. rscnJ is a member of

the american society for reproductive

medicine and the society of assisted

reproductive technologies; was

named a center of excellence by

United Healthcare; was the fi rst

infertility practice in ocean and

monmouth counties to be approved

by the Better Business Bureau; and

received the Zenith award from

resolVe of new Jersey. our medical

director, William Ziegler, d.o., has been

named a “top doc” several times by

New Jersey Monthly magazine.

our eatontown and toms river

offi ces are open 7 a.m. to 4 p.m.

monday through Friday, select late

nights until 7 p.m., and on weekends

for cycling patients and new

patient appointments.

WHY RSCNJ?A D VA N C E D M E D I C I N E A N D P E R S O N A L I Z E D C A R E E Q U A L S R E S U LT S

MAKE five!

AND twins

IN VITRO FERTILIZATION HELPS A JACKSON COUPLE COMPLETE THEIR FAMILY

after conceiving her fi rst two children naturally

and easily, Jessica Podlas of Jackson didn’t

anticipate any diffi culties when she and her

husband, rich, decided to try for baby number

three in 2005.

However, after two years of trying to

conceive with home ovulation kits and other

over-the-counter products, nothing happened.

the couple sought help from the reproductive

science center of new Jersey (rscnJ).

diagnostic tests of both Jessica and rich

revealed that rich had a low sperm count,

possibly from handling chemicals during the

course of his work in a sewer division. Because

the couple’s health insurance plan covered in

vitro fertilization (iVF), they chose this method.

“We were successful after our fi rst iVF

cycle,” says Jessica. “our daughter, summer,

was born on december 3, 2007.”

satisfi ed that their family was complete,

Jessica underwent a tubal ligation, only to

change her mind two years later. the couple

returned to dr. Ziegler for iVF.

iVF is an ideal treatment option for

women who have undergone a tubal ligation

and then decide they want more children.

during iVF, the egg does not pass through the

fallopian tube, but instead is fertilized with

sperm by an embryologist in rscnJ’s lab and

then placed into the patient’s uterus, where it

implants and grows.

during Jessica’s third iVF cycle three

fertilized embryos had been implanted,

and when the Podlases went for their fi rst

ultrasound check-up, two distinct embryos

could be seen.

although Jessica experienced

complications that caused her to go into labor

at 29 weeks of pregnancy on January 29, 2011,

today her twins, richard Jr. (r.J.) and Gia ann,

are thriving. “dr. Ziegler and his entire staff

helped us build the family we always wanted,”

says Jessica. “We are grateful for the personal

touch of everyone at the center.”

YO

UR

CH

OIC

E

OUR SERVICES• Infertility evaluations and treatment• Advanced ultrasound pelvic examinations• Semen analysis• Super-ovulation with ultrasound

monitoring• Artifi cial insemination• Advanced robot-assisted and laparoscopic

reproductive surgery• Tubal ligation reversal• Hysteroscopy• In vitro fertilization (IVF)• Preimplantation genetic diagnosis (PGD)

with comparative genomic hybridization (CGH)

• Assisted hatching• Intracytoplasmic sperm injection (ICSI)• Blastocyst transfer• Cryopreservation of eggs and embryos• Medical and surgical treatment for tubal

pregnancies• Endocrinology and endometriosis

treatments• Donor sperm and donor eggs• Gestational carriers

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Reproductive Science Center of NJDR. WILLIAM F. ZIEGLER • DR. JASON G. BROMER • DR. JESSICA SALAS MANN

FERTILITYNJ.COM • TOMS RIVER, NJ • EATONTOWN, NJ • 732-918-2500

RSC-NJ is the first infertility practice inOcean/Monmouth

County to be approved with the BBB.

RSC-NJ is the first CAP/FDA

approved lab inOcean/Monmouth

County.

RSC-NJ is a member of SART, the primary

organization of professionals dedicated to

the practice of assistedreproductive technologies(ART) in the United States.

Dr. William Ziegler was voted Top Doc by New Jersey MonthlyMagazine in 2007.

RSC-NJ is proud to be a member of the AmericanSociety for Reproductive

Medicine (ASRM).

Dr. William F. Ziegler, Dr. Jessica Salas Mann and Dr. Jason G. Bromer

• COMPREHENSIVE FERTILITY CARE

• TREATMENT FOR RECURRENT PREGNANCY LOSS

• ADVANCED/ROBOTIC REPRODUCTIVE SURGERY

• INTRAUTERINE INSEMINATION (IUI)

• IN VITRO FERTILIZATION (IVF)

• INTRACYTOPLASMIC SPERM INJECTION (ICSI)

• DONOR EGG

• PREIMPLANTATION GENETIC DIAGNOSIS (PGD)

• IVF/DONOR EGG REFUND PROGRAM

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