All Rights Reserved. They found that 18.1 percent of peeps who took the shot got pregnant only 5.8 percent of . Cabergoline is marketed under the brand name Dostinex and like bromocriptine, its a dopamine receptor agonist (a drug that activates certain brain receptors) thats used to treat hyperprolactinemia. Consult your OB/GYN about whether or not Clomid may be an appropriate treatment for you. Cabergoline has been shown to help women ovulate regularly, and a small study found that for women treated with this fertility drug, approximately 85 percent had successful conceptions. If you ovulated while on Clomid, that means it worked. With IVF, youll aim for 10 to 15 eggs per egg-retrieval cycle, which means your dose of hormone shots will be higher (but not too high). If 50 mg doesn't work, your doctor may increase the medication. The effectiveness of Clomid varies depending on the cause of infertility. In-vitro fertilization may improve pregnancy chances. The "Clomid Crazies" are a bit like PMS mood swingsbut slightly worse. From there (unless youre using Clomid with a IUI or IVF cycle), you need to have sex timed to your fertile window, which is the six-or-so-day time period during your menstrual cycle that youre able to get pregnant. As stated above, current research shows letrozole may be more effective than Clomid in helping individuals with PCOS who are trying to conceive (i.e., theres a higher chance of pregnancy and live births). Women under 35 with PCOS should have about a 15% chance for pregnancy per month with Clomid treatment (for about 3-4 months) if they ovulate with Clomid (assuming the sperm and fallopian tubes are normal). This means if Clomid helps you get pregnant, just getting pregnant and having a baby will decrease your cancer risk. Lab results. For HMG and clomiphene + HMG cycles, pregnancy rates were twice the rates for CC before age 32, but declined sharply thereafter, and were the same as the pregnancy rates for clomiphene after age 37. I agree to receive the Forbes Health newsletter via email. Am Fam Physician. Yes, it's that simple. You have no idea who is selling you the drugs and no way to know if you're getting Clomid or something else. The success rates for Clomid are encouraging. The half life for Clomid (i.e., the time it takes for half of the medication to leave your system) is about five to six days, but traces of it have been found in the body after up to six weeks[6]Yilmaz S, Yilmaz Sezer N, Gnen M, et al. Clomid is an ovulatory stimulating drug used to help people who have problems with ovulation. So if it doesn't work, don't blame yourself. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. About three-fourths of women with PCOS that are not ovulating will ovulate on Clomid at some dosing level. 2015;42(3):106-10. doi:10.5653/cerm.2015.42.3.106, Choi SH, Shapiro H, Robinson GE, et al. He is experienced in indications including endometriosis, uterine fibroids, menopausal symptoms, vaginitis, sterilization and anemia. Another earlier study [8] looked at lesbian women ranging in age from 26-44 and single women age 29-47 using frozen sperm and found a clinical pregnancy rate of 57% in lesbians and 36% in single women. Please whitelist our site to get all the best deals and offers from our partners. Women under 35 with PCOS should have about a 15% chance for pregnancy per month with Clomid treatment (for about 3-4 months) - if they ovulate with Clomid (if sperm and fallopian tubes are normal). Taking Clomid increases the chance of carrying multiple babies. The age of the eggs is very important Femara is the brand name for letrozole one of the class of drugs called aromatase inhibitors. The main sign that Clomid is working is that it induces ovulationalthough that is not always easy to determine in the moment. I'm just kind of wanting some people's opinions. Consult your OB/GYN about whether or not Clomid may be an appropriate treatment for you. The most common side effects are hot flashes, breast tenderness, mood swings, and nausea. While this may influence where their products or services appear on our site, it in no way affects our ratings, which are based on thorough research, solid methodologies and expert advice. This drug is likely covered by most insurance plans, so check with your doctor. Several oral medications and hormone shots that your doctor might recommend have good success rates and relatively mild, temporary side effects. These statistics hold for about 3 months and after that success rates are much lower. Rachel uses her own experiences with infertility to write compassionate, practical, and supportive articles. Centers for Disease Control and Prevention. If you're also having a trigger shot (injection of hCG) during your Clomid cycle, your doctor will instruct you to have sexual intercourse on the day of the injection and the two following days. Clomid works by binding to the receptors in your brain that would typically bind with estrogen. Clomiphene for the treatment of male infertility. American College of Obstetricians and Gynecologists. Research on experiencing mood swings while taking Clomid indicates a much higher rate than in the initial clinical trials of the drug. This rate will be dependent upon a number of other factors, as well, such as the sperm, your fallopian tube status and your cervical mucus condition. The compensation we receive from advertisers does not influence the recommendations or advice our editorial team provides in our articles or otherwise impact any of the editorial content on Forbes Health. Increasing Clomid when you are already ovulating on a lower dose is not only unnecessary, but it could, in fact, decrease your chances of getting pregnant. You did NOT ovulate. In the 2014 NIH-funded study in the New England Journal of Medicine, 19.1% of patients taking clomiphene citrate achieved a successful pregnancy resulting in a live birth[5]Clomid: Information For Patients. But what if ovulation isn't an issue? Clomid is an ovulatory stimulant, which means it is used to help induce ovulation in individuals who wish to become pregnant. Keep in mind that the much-more-expensive IVF route has a success rate of 32.2% for women under 35, on their 1st round, and 20.8% for women aged 38 - 39. Journal of Chemical and Pharmaceutical Research. In fact, the average time to conceive for people between ages 30 and 36 is about a year. If you don't conceive after six months, it's time to move onto another treatment. You have a hormone-reactive tumor, which may grow with Clomid use, or you have a history of certain cancers. Triplets or quadruplets on Clomid are rare, happening less than 1% of the time. However, the medication isn't right for everyone. Clomiphene citrate at 50: the dawning of assisted reproduction. For women with PCOS under age 35, the success rate of IVF is about 70% for pregnancy with one IVF cycle and about 60% for live birth. As with Clomid, success rates are hard to predict and often decrease slightly with age. Women who have gone through several Clomid cycles may have thinner endometrial linings, which can impede with embryo implantation. (This will correct itself after time away from Clomid and is not a long-term adverse effect.). This drug may be covered by insurance and has a range of pricing, though it generally costs about $175 for 30 tablets or capsules (though it can go as low as around $120 for a generic version of the drug and as high as around $220). Clomid can cause an ovulation prediction kit to test positive even when the woman is not ovulating. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. doi:10.1002/14651858.CD000057, Bae SA, Joo JK, Choi JR, Kim SS, Lee KS. Home Advice for Patients Who Are Due to Undergo Clomifene (Clomid) Treatment. For example, if you have the injection on Monday, you should have sex on Monday, Tuesday, and Wednesday. In short, taking Clomid prompts your body to release hormones that increase the chances of your ovaries releasing a mature and ready-to-be-fertilized egg. Clomid is often prescribed for patients with: An aromatase inhibitor, which is a type of drug that prevents the formation of estradiol, a female hormone, letrozole is commonly used to treat breast cancer in individuals who have already experienced menopause. Only about 50% of women that ovulate with Clomid get pregnant with it. If after 6 months on Clomid youre still trying to get pregnant, youll likely move on to hormone shots and/or in vitro fertilization (IVF). Your best bet: Give your insurance plan a call to find out what is or isnt covered. Every womans cocktail of shots will be different a lot will depend on your situation, on your doctors preference and on how your body responds to the hormones. Since success rates are typically higher in the first few treatment cycles, reevaluating medication use every few months and concentrating on the treatments that have the most success appear to be appropriate. Am Fam Physician. Remember that your fertility naturally declines with age. Reliable success rates. Women who are obese may have better success with Clomid if they lose weight. Read our. Female infertility and its treatment by alternative medicine: A review. Because Clomid can be prescribed by a gynecologist and doesn't require a fertility specialist, it's usually the very first fertility treatment tried for most couples. Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. There are 20,183 active discussions happening now in our Fertility Treatments community group. The general pregnancy rate from Clomid use according to multiple studies is between 7 percent and 30 percent. There are several ways to find out if and when you ovulate: Read more about typical ovulation symptoms. The side effect you're probably most familiar with is the risk of multiples. November 23, 2016 | by kmunger13. Prioritizing a healthy lifestyle and preparing your body for pregnancy can help your chances of getting pregnant whether youre taking Clomid or not. Your health and wellness is unique to you, and the products and services we review may not be right for your circumstances. Accessed 8/22/2022. Ovulation rate and cycle characteristics in a subsequent clomiphene citrate cycle after stair-step protocol. Letrozole for patients with polycystic ovary syndrome: A retrospective study. Our. Clomid itself is relatively inexpensive, at least as infertility treatments go. You should improve his sperm count first. Letrozolewhich is a cancer treatment drug used off-label for infertilityhas been found to help people who are Clomid-resistant ovulate. For clomiphene cycles, pregnancy rates per cycle were constant from age < 28 to 41, and then declined dramatically (by 50%) from age 42 to 44. Yes, iui can succeed at our age - good luck to you! The cost of Femara is comparable to Clomid per cycle, with a month's worth of pills running around $120. To get pregnant when taking Clomid, you need to have sexual intercourse when you are most fertile. CLOMID (clomiphene citrate tablets USP). For couples who have no difficulty achieving a pregnancy, the natural chance of pregnancy per month of ovulation is largely dependent on the age of the woman. With IVF, Clomid may be used in conjunction with injectable ovulation medications to elicit a stronger response. . One, if Clomid hasnt helped you conceive after six months, the odds of it working on month seven or eight are very low. Your artificial insemination success rate will be at its best before you reach the age of 35. While there is generally no total number of cycles of Clomid that should be done before moving on to other fertility treatments, there are several variables involved in the decision about moving on to more aggressive therapy. That is because Clomid leads to multiple ovulations, and non-identical twins are twins resulting from separate eggs and fertilization with different sperm, while identical (or monozygotic twins) result from the splitting of a single fertilized identical egg and sperm. Youve reacted poorly to Clomid treatment in the past. Clomid should not be used indefinitely. Clin Exp Reprod Med. Hot flashes, mood swings and pelvic pain are the most common side effects in patients taking Clomid, says Abigail Mancuso, M.D., a reproductive endocrinologist with University of Iowa Health Care in Des Moines, Iowa. However, it's not nearly as common as you may think it is. 2023 Dotdash Media, Inc. All rights reserved, Verywell Family uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Learn more about Obiehere. In-vitro fertilization (IVF) will help you get pregnant. Additionally, for some people, a shorter protocol, such as using a 3-day protocol rather than 5-days, may be more effective. Clomid pregnancy rates are usually between 10-20% but can be as high as 60% after 6 cycles. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Evidence-based treatments for couples with unexplained infertility: a guideline. What happens when Clomid doesnt work? J Psychosom Obstet Gynaecol. Possible side effects of Clomid include: One of the more ironic side effects to comprehend is that Clomid can decrease the quality of your cervical mucus. Does it matter if your doctor suggests the Day 3 to 7 protocol or the Day 5 to 9 one? Leaving things to chance can be funbut also inefficient. Hormone shots will still be the first step if youre undergoing IVF. Our website services, content and products are for informational purposes only. Your success. In the best-case scenarios, success rates can range from a 20 to 50 percent chance of pregnancy over the course of a few IUI cycles. In addition to his current work, Dr. Amos is using his vast experience to launch Obie, a science-based app that offers personalized fertility advice. an adequate ovarian reserve, a partner with good sperm count, a healthy body weight and open fallopian tubes will be able to have a baby with Clomid treatment. By Rachel Gurevich, RN You may bleed or spot irregularly but it's not a menstrual period. It is usually given as a pill once a day for 5 days. When Clomid Works Best and When It Doesn't. Clomid is the brand name for the medication clomiphene citrate. Getting Ready for Pregnancy: Preconception Health. My 2nd iui was a success this past October. For consumption, the powder is pressed into small tablets, typically dosed at 50 milligrams per tablet. There are a few reasons for this. You ovulate and did get pregnant. 2013;98(5):1838-1844. doi:10.1210/jc.2013-1328, Wilcox AJ, Weinburg CR, O'Connor J, et al. The compensation we receive for those placements affects how and where advertisers offers appear on the site. Leyla Bilali, RN is a registered nurse, fertility nurse, and fertility consultant in the New York City area. We believe you should always know the source of the information you're reading. Its one of the least expensive and least invasive fertility treatments available, and most women experience minimal side effects. Clomid is sometimes prescribed to men as well because it may increase sperm count, but this article focuses on how Clomid affects female reproductive organs. Eighty percent of women taking Clomid will successfully ovulate and 10 to 12 percent will conceive per cycle. Clomid Success Rate at Inducing Ovulation for those with PCOS . During this process, an individual will release more than one egg a month, which can increase the possibility of pregnancy. While having twins certainly brings many benefits, it's important to note that twin pregnancies have higher risks of complications for both the expecting parent and the babies. Cabergoline targets prolactin to reduce too-high levels in the body and comes in a tablet thats taken orally a couple of times a week. Be aware that other medical costs (for bloodwork, monitoring and ultrasounds) will also factor into the full price per cycle depending on your doctor and your region, the treatment could cost anywhere from $500 to $2,000 per month. If Clomid hasnt worked for you, there are many other fertility treatments you can explore. N Engl J Med. Meanwhile, in the 2019 review of 42 trials in American Family Physician, 21.4% of patients taking clomiphene citrate achieved a successful pregnancy resulting in a live birth[2]LeFevre N. Aromatase inhibitors such as letrozole (Femara) vs. clomiphene (Clomid) for subfertile women with PCOS. Between 70% and 80% of women will resume ovulation from treatment with Clomid.. N Engl J Med. One study found that while 19.1 percent of women with PCOS who took Clomid had a successful pregnancy within five cycles, 27.5 percent of women with PCOS who took Femara had a successful pregnancy within five cycles. Clinical management of pregnancy in women with polycystic ovary syndrome: an expert opinion. Get the Forbes Health newsletter for helpful tips, news, product reviews and offers from a name you can trust. Even though superovulation is considered a low-risk process by some medical professionals, its important to talk with your doctor about all the possible side effects involved. Clomid (clomiphene citrate) tablets label. That means that a woman taking Clomid on days 5-9 will often ovulate on about day 16-20 of the cycle. Femara works in a similar way to Clomid, suppressing estrogen leading to an increase in FSH production, which stimulates the ovarian follicles to mature and triggers ovulation. Another byproduct of the increase in maturing eggs: more progesterone production, which builds a strong uterine lining for that fertilized egg to burrow into. Clomid is a synthetic chemical that induces ovulation by fooling your body into believing that there is less estrogen. Obviously, you can only get pregnant if you first ovulate. J Clin Endocrinol Metab. Clomid is very powerful and induces ovulation in over 50% of all women who take it. However, if you experience vision changes while on Clomid, it's recommended that you stop taking it. 1 Of course, ovulation is only step one. We do not offer individual medical advice, diagnosis or treatment plans. If you do ovulate on Clomid, then there is no need to increase it in the next cycle. This educational content is not medical or diagnostic advice. If necessary, the dose can be increased by 50 mg per day each month up to 150 mg, 200 mg, or even 250 mg (depending on your doctors protocol). A study of over 1,000 women looked at whether Clomid could help women who were having trouble getting pregnant but were not having ovulation problems. What Is the Clomid Success Rate for Ovulation and Pregnancy? FSHs primary function is fertility-relatedas the name implies, the hormone stimulates your ovarian follicles, encouraging them to grow. After the end of the 1960, he was cast in the popular movie The Wild One for his work in the film, and was soon able to put together a well-calculated "bikini" and be recognized as a Hollywood star. However, only about 10% to 13% of those will get pregnant per cycle. Many doctors will monitor you using ultrasound equipment and blood work to tell you the best time to try to conceive. Group Black's collective includes Essence, The Shade Room and Naturally Curly. Another option is to use an ovulation predictor test to detect your most fertile time. Cytotechnology. As a result, your brain thinks your estrogen levels are low and compensates by producing more FSH, or follicle-stimulating hormone, which can boost estrogen. As with all fertility treatments, Clomid success rates are highly dependent upon age. A mini-review, The Use of Aromatase Inhibitors for Ovulation Induction and Superovulation, Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective, A pilot study to prevent a thin endometrium in patients undergoing clomiphene citrate treatment, Uterine cancer after use of clomiphenecitrateto induce ovulation, Female infertility and its treatment by alternative medicine: A review, Ovulation induction with clomiphene citrate. 2005;161(7):607-615. doi:10.1093/aje/kwi084. However, most doctors either have you take Clomid on days 3, 4, 5, 6, and 7, or they have you take it on days 5, 6, 7, 8, and 9. The majority of womenwith polycystic ovarian syndromewho havean adequate ovarian reserve, a partner with good sperm count, a healthy body weight and open fallopian tubes will be able to have a baby with Clomid treatment. By acting like the neurotransmitter dopamine, which is a natural substance in the brain, this drug targets the pituitary gland and works to prevent excess prolactin and lower its production. He now focuses his practice exclusively on gynecology and gynecologic surgery, staying current with the latest medical research and developments. Before giving Clomid, patients should be checked to make sure she is: The following tests should be done before Clomid is given: Zero chances getting pregnant unless you take medication like Clomid to induce ovulation. The fertile window varies slightly from person to person, but most people with ovaries ovulate 7 to 10 days after the last Clomid pill was taken. Clinical management of pregnancy in women with polycystic ovary syndrome: An expert opinion. It makes no sense to take Clomid when he has a low sperm count! Aromatase inhibitors such as letrozole (Femara) vs. clomiphene (Clomid) for subfertile women with PCOS. (This is not the same as having the tiny cysts that accompany, Your ovulation problems would be better solved by other treatments. Most women start with 50 milligrams of Clomid per day for five days, beginning on day two, three, four or five of their cycle. Second, we also include links to advertisers offers in some of our articles; these affiliate links may generate income for our site when you click on them. Follow the treatment protocol they give you as it will be tailored to optimize your cycle. Clomifene citrate and intrauterine insemination as first-line treatments for unexplained infertility: are they cost-effective? Do a pregnancy test. University of Michigan, Michigan Medicine. When the blockage is closest to the ovary, the success rate of IUI is 11.7%. Clomid's (clomiphene citrate) primary purpose is to induce ovulation in women who are either not ovulating or ovulating irregularly. With over 99.9% accuracy, Bird&Be's Ovulation Tests predict when youre about to ovulate. . Clomid works well for many women but it does come with side effects like headaches, mood swings, hot flashes, weight gain, etc. However, fertility experts are now also using it to help treat infertility in individuals living with PCOS. Even if you do ovulate while on Clomid, you still need the egg and sperm to meet for fertilization to occur and then implantation. What is Hyperlactatemia and How Can It Affect Getting Pregnant? It does this by releasing hormones that help increase the chances of the ovaries producing a ready-to-be-fertilized egg. Some women experience mild dizziness and fatigue on Femara, but compared to Clomid, most women experience fewer side effects such as hot flashes. If your doctor wants to "enhance" ovulation, you'll likely take Clomid on Days 3 through 7. However, generally, Clomid increases the risk of having a multiple pregnancy and taking Clomid for an extended period may increase the risk of developing cancer. Clomid is often the first fertility treatment used if a person has irregular cycles or anovulatory cycles (menstruation without ovulation). 2005;20(8):2043-2051. doi:10.1093/humrep/dei042, Pavone ME, Bulun SE. In rare cases, these shots could induce ovarian hyperstimulation syndrome. Some insurance plans will cover all aspects of infertility treatments (including the cost of the medication, the monitoring and the bloodwork), while other insurance plans dont. Clomid - generic brand Clomiphene Citrate - is an oral fertility drug prescribed by fertility specialists to stimulate egg production in women who are unable to ovulate on their own. When it comes to pregnancy and ovulation success rates, however, studies have not found an advantage or disadvantage. About 50% of women that ovulate with Clomid get pregnant with it. National Institutes of Health, National Library of Medicine. It is important to note that 40% will conceive. This is unlike stronger fertility drugs, which require injection. It is generally accepted that after age 40, clomiphene citrate is not very effective. A Guide To Home Fertility Tests For Women, Nutrients You Need Before Getting Pregnant, 4 Fertility Myths DebunkedAccording To A Fertility Doctor, experienced journalists and medical experts, Nine tests per box so you don't miss your fertile window, Less plastic waste than traditional ovulation predictor kits, Visual symptoms, including blurred vision or floaters (small dark spots, lines or other shapes that seem to be floating in your line of vision). This site does not include all companies or products available within the market. Some of the hormone shots that you may be prescribed: While not all women taking hormone shots have side effects, those who do may notice breast tenderness, mood swings, headache, abdominal pain and nausea. Typically, ovulation occurs five to 12 days after your last Clomid tablet[5]Clomid: Information For Patients. Some women take Clomid and use ovulation predictor kits to time intercourse with ovulation. Safety of clomiphene citrate: a literature review. This means you are most likely to ovulate somewhere between days 14 and 19 of your cycle. Clomid may not be appropriate for you if: If you have problems with ovulation, Clomid may help you ovulate. The clinical trials reported that only 0.3% of women experienced mood swings or fatigue. Statistics indicate that when taken as directed, the success rate of clomid shows 80 percent of women will respond to the treatment and successfully ovulate on Clomid. If someone does not become pregnant during the first cycle of taking Clomid, they can continue the treatment for six cycles. Our editorial content is based on thorough research and guidance from the, Partner Offers feature brands who paid Forbes Health to appear at the top of our list. Take ourFertility Course! Bahri Khomami M, Teede HJ, Joham AE, et al. October, 2012, Hughes E, Collins J, Vandekerckhove P. Clomiphene citrate for unexplained subfertility in women. The bad news is that some studies have found that cancer risk goes up if youre treated with Clomid over an extended time, even when compared to other infertile women who dont conceive. A literature review published in Human Reproduction considered several studies on Clomid. Altogether, the Clomid success rates for just over 5,000 women were included. The most common starting dose is one tablet a day for five days, beginning on the third, fourth or fifth day of your menstrual cycle. Clomid offers good success rates and helps many people get pregnant. 2022 Aug;97(2):227-236. . The FDA recommends taking no more than six cycles of Clomid. Secondly, even though Clomid treatment is relatively simple, it is not for everyone, and it can be harmful. Your menstrual bleeding, your period will not arrive 15+ days after the day of ovulation. The idea is to try to increase the odds of sperm and egg meeting, says Kenan Omurtag, M.D., division director of the reproductive endocrinology and infertility department at the Washington University School of Medicine in St. Louis. But without insurance, you may have to pay about $100 a month for the pills. After a few months on bromocriptine, prolactin levels should be back to normal and ovulation can begin again. . The typical starting dosage of Clomid is 50 mg/day for 5 days, and it can be increased monthly by 50 mg a day. Your doctor will likely start you on the lowest dose first, which is 50 mg. With tests showing severely elevated FSH, Clomid unlikely to improve pregnancy chances. Before taking Clomid you should have some tests done to make sure you take it for the right reasons. Natural rate of conception varies from 5 to 25 percent based on maternal age. IVF is a complex and expensive procedure; only about 5% of couples with infertilityseek it out. All that it is supposed to do (and it doesn't do it all the time) is make you ovulate. For instance, if the medication is taken for 10 days, it is okay to start using the ovulation prediction kit on the 14th day. The most important thing to know is that Clomid is a medication to induce ovulation, not necessarily pregnancy. Between 70% and 80% of women will resume ovulation from treatment with Clomid. Thus, Clomid is not an infertility treatment cure-all. Youll take 2.5 mg of Femara per day on days five through nine of your cycle (though some fertility specialists give a higher dose 5 mg or 7.5 mg per day). Since the 1990s, birth rates in people aged 40-44 have gone up. Rachel Gurevich is a fertility advocate, author, and recipient of The Hope Award for Achievement, from Resolve: The National Infertility Association. Clomid blocks estrogen receptors causing the pituitary gland to produce more hormones needed to stimulate ovaries into producing egg follicles. Please see our, {{ tocState.toggleTocShowMore ? What might be on tap for you if youre using hormone shots? Psychological side-effects of clomiphene citrate and human menopausal gonadotrophin. For women with PCOS, the cancer drug letrozole (Femara) may be more successful at triggering ovulation than Clomid. Taking Clomid along with the diabetes drug metformin has also increased success rates for some women.. Youll want to call your insurance company to find out if Clomid is covered by your plan. Hum Reprod. It is the most commonly used fertility drug. Of course, ovulation is only step one.

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