Archive for October, 2011
By Tracey Minella
October 31st, 2011 at 11:59 pm
Thermos be a better knock knock joke than this.
Well, I couldn’t just let Knock Knock Joke Day go by without recognizing it somehow. But it’s the last day of the month, so today’s post is all about the guys. So let’s move on to something really interesting.
Dueling pee sticks? Well, not exactly. But one day soon you could conceivably (get it?) see a man and woman battling each other for bathroom space to take… and await the results of…their own stick-like fertility tests.
We’ve already got ovulation and pregnancy test kits for the ladies. But the latest thing to come down the pregnancy quest pike will be the male “fertility chip”.
Researchers are developing, with the intention of mass-marketing, a male fertility chip which is like a lab on a stick. A drop of male ejaculate onto this chip could test male sperm concentration (count) and sperm movement (motility)…reliably and in the comfort of your own home.
Imagine that, guys? No more embarrassing collection rooms. No more hurried home collections, messy cups, and quick deliveries to labs. Good-bye hand-off of awkward brown lunch bag to smirking nurse.
Now this is still in the early stages, so don’t run out to Walgreen’s just yet for your own kit. And the report did not mention that the test could determine the sperm’s size and shape (morphology), so a standard lab analysis, at least initially, may still be necessary. But 2 out of 3 ain’t bad. What a great development in the field of infertility!
Here’s the link for the details: http://www.sciencedaily.com/releases/2011/10/111028103306.htm
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If a home kit did become available to test male fertility as indicated above, would you trust it or would you stick to today’s lab testing? Would the convenience of a home test trump the embarrassment of a lab test?
Anyone want to share a funny (but printable) collection story? (Well, it is knock, knock joke day…) Yeah, I didn’t think so…
Photo credit: http://www.publicdomainpictures.net/view-image.php?image=2783&picture=toothbrushes
By Tracey Minella
October 28th, 2011 at 3:27 pm
Face it. Halloween without kids…well, bites. And I don’t mean in the neck.
Most of the fertile world misses the boat completely when it comes to sensitivity to our feelings on the holidays.
If we’re really lucky, we get some compassion for Mother’s and Father’s Days…sometimes for Christmas. Thanksgiving and New Year’s? Not really.
If you’re dreading facing Halloween without a baby dressed like a pea pod, here are some tips to get through the haunted happenings:
- Give yourself permission to be depressed, mad, or whatever it is you’re feeling. You don’t have to fake it for anyone. If you are open about your infertility journey, let people know it’s a hard day for you. This is one of those holidays fertile folks are usually clueless about when it comes to how bad we feel.
- If 85 bags of candy are not in the budget because you’re saving for fertility treatments, don’t sweat it. Turn the lights down low and pretend you’re not home. What you do in the dark is your business!
- If you want to give out treats, but can’t take the heartbreak each time a pack of princesses or ninjas come knocking, leave a big bowl with a “Please Take One” sign outside your door and let them help themselves.
- You want children and are still waiting. Why not spend the holiday brightening the day of children who are waiting for parents, or who can’t afford to celebrate Halloween? Contact your local social services department or place of worship and see if there is an orphanage or homeless shelter that could use some candy.
- Attend…or host…a “grownups only” Halloween party or dinner. Nothing will cheer you up faster than mummy dogs (hot dogs wrapped and baked in breadstick dough) and jello molds of brains and hearts. (Don’t forget the spiked witch’s brew!) Or go to a spooky play or movie.
- If you feel too guilty to do any of the above and are determined to face the parade of masked cherubs, then remember this… your day of ringing doorbells with Buzz Lightyear or Belle in tow is coming.
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How do you get through Halloween? Any tips or traditions?
For those who finally did have their babies….please share your best Halloween pics with us on our Facebook page at https://www.facebook.com/#!/ecfertility. (Feel free to LIKE our page while you’re there, and then tell all your friends and family to come see your baby’s picture on our Facebook page!)
Or, you can email them to email@example.com. Your success may encourage others.
By David Kreiner MD
October 27th, 2011 at 9:39 pm
As many as three out of ten women have fibroids, or uterine muscle tumors. Don’t get nervous about the word “tumor”. Often, they are not malignant. Sometimes they don’t need to be removed.
Everything you ever wanted to know about fibroids and your fertility is right here.
Dr. David Kreiner of East Coast Fertility gives you the facts about fibroids and how they may…or may not…be a factor in your fertility.
Fertility is dependent upon so many things!
We must have healthy gametes (eggs and sperm) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.
The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.
And you wonder why getting pregnant is so hard?
All too often patients, in some groups as many as 30% of women, are told that they have fibroids that may be contributing to their infertility. Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number, size and location in the uterus including; the outside facing the pelvic cavity (subserosal), the inside facing the uterine cavity (submucosal) and in between inside the uterine wall (intramural). Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.
The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.
Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels traveling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Surgery may be recommended when it is feared that the number and size of fibroids is great enough to have such an impact.
However, it is the submucosal myoma, inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.
To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.
Submucosal as well as intramural myomata can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.
Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.
Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.
The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally or at least with assisted reproduction.
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Anyone have a fibroid story to share?
By Tracey Minella
October 26th, 2011 at 12:00 am
(Nearly) Wordless Wednesday
It’s always interesting to see how different people interpret a photo.
This week, you can choose as a caption either of the following:
- What the new mom is texting out
- What YOU would text in to her.
Best entry winner gets Starbucks on us! It’s a fast, fun and free contest open to anyone, whether infertile or not, and whether a patient of our practice or not.
You can enter here or on East Coast Fertility’s Facebook page.
Either provide your email address with your entry or check back to see if you won and we’ll tell you how to email us so we can mail you your gift card.
Plus, if you “LIKE” us on Facebook at https://www.facebook.com/ecfertility#!/ecfertility, we can send you the prize as a Starbuck’s Card e-gift right through Facebook, so you could be sipping your winnings as early as on the day we choose the winner! (And as much as we’d love you to like us on Facebook, it is absolutely not required to either enter or win our contests!)
Photo credit: http://www.killmydaynow.com/2011/03/funny-pictures-of-bad-parenting-part-3-58-pics.html/
By Tracey Minella
October 25th, 2011 at 12:05 pm
For some couples, the stress of infertility drives them apart.
But for others, it brings them closer together. And, when they come through the experience, they feel an even deeper love and appreciation for each other for having struggled through such an intensely personal battle.
Call it the ultimate “soul-mate test”.
I read this week of a couple married 79 years. Imagine that?! I guess it’s heaven if it’s the right guy.
Well, this 90+ year old couple was inseparable…in life and, sadly, in death. Please click on this link to read the short story of their unique and tragic end and then come back for the surprise.
Here’s the link: http://www.kcci.com/r/29528191/detail.html
Done reading it? Teary eyed? Thinking about how much you love your partner, wouldn’t want to live without them, and romanticizing the idea of dying together holding hands in about 60 years?
Wondering about the people in the other car? Here you go: http://www.msnbc.msn.com/id/44960859/ns/health-aging/
What is the REAL story here?
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So, to all the loving couples who are passing the “soul-mate test” during this infertility journey, what is your reaction to the story? In the spirit of “a glass half empty or half full” debate: Do you see it as a love story or a horrific tragedy with a strange twist?
By Tracey Minella and David Kreiner MD
October 24th, 2011 at 9:51 am
“I’d rather stick needles in my eyes” is a phrase people use to describe something they desperately want to avoid. And those of us who’ve been stuck repeatedly for IVF blood work really “get” that reference!
But, hey, needles aren’t all bad!
In fact, needles in the hands of trained professionals can be a wonderful thing. Like Mike Berkley and Amy Podhurst for example. They are two acupuncturists who, along with East Coast Fertility’s great medical team, help patients get pregnant. When I first met them, I felt they had this “healing energy about them and I wished acupuncture was offered when I was doing IVF.
Since it’s Acupuncture Awareness Day, it’s time to read Dr. Kreiner’s post about how acupuncture, as part of your infertility action plan, may help you get pregnant. (Of course, you should discuss how acupuncture may fit into your personal infertility action plan with your particular doctor.)
Not many practices have forward thinkers, who practice Western medicine, but are open to the complementary approaches of Eastern Medicine. Fortunately, East Coast Fertility offers the best of both worlds.
Dr. Kreiner explains acupuncture’s role in family-building:
How might it work?
It has been proposed by many that acupuncture could positively impact the results of In vitro Fertilization – IVF. The mechanisms proposed for this effect are several.
Acupuncture affects the levels of pituitary and ovarian hormones as demonstrated in several studies. Other studies show that it may help improve blood flow to the uterus which might improve implantation.
Another explanation attractive to me is that acupuncture may "relax" the uterus at the time of embryo transfer. Several studies have demonstrated uterine contractions and that these contractions can expel transferred IVF embryos. If these contractions were reduced by acupuncture then that could improve IVF pregnancy rates.
Reducing stress and improving the general health and wellness of an individual undergoing IVF was scientifically demonstrated to improve our IVF success rates. If acupuncture is able to achieve some reduction in stress and/or some improvement in patient wellness than statistically it should improve the likelihood of achieving a pregnancy.
There are claims that acupuncture will help patients respond better to stimulation medication, get more eggs, even healthier eggs, and get higher pregnancy rates. Many women with diminished ovarian reserve and a high FSH level or history of miscarriages have been promised that acupuncture can cure these problems. The challenge has been to objectively prove these claims with scientific studies. Thus far, there have been a few studies examining the use of acupuncture as an adjunctive therapy to IVF. A study published in 2008, combined the results of many of these smaller studies, concluding that one additional live birth would be obtained for every 10 IVF embryo transfers performed when acupuncture was added to the therapeutic regimen.
Acupuncture and IVF Studies
The first published study, which received a great deal of attention, was conducted by Paulus and published in Fertility and Sterility.
The study looked at 160 women aged 21 to 43. In this study, IVF patients received acupuncture 25 minutes before and 25 minutes after the embryo transfer. No patients received acupuncture before or during treatment with fertility medications.
The acupuncture points chosen for the study were supposed to result in:
- Better blood perfusion and “energy” in the uterus
- Sedation of the patient
- "Stabilization" of the endocrine system
IVF patients who had acupuncture had a 42% pregnancy rate. IVF patients who did not have acupuncture had a 26% rate.
Some critics claimed that improvement was due to the placebo effect. To examine this Paulus presented a placebo-controlled study at the annual meeting of the European Society for Human Reproduction and Embryology. Two hundred patients with good embryo quality were randomized to receive either real or faked acupuncture for 25 minutes before and after ET. There were clinical pregnancies in 43% of the real and 37% of the faked acupuncture patients. Statistical analysis of the results was not significant but there was the trend towards improved success with the acupuncture.
The study was conducted on 300 couples and was randomized to one of three groups on the day of egg retrieval. After randomization, 27 patients were excluded for various reasons. Of the remaining 273 patients, 87 were allocated to no acupuncture (control group), 95 to acupuncture on the day of embryo transfer, and 91 to receive acupuncture on the day of ET and again 2 days later.
There was no difference between the three groups in the number of eggs retrieved or the number of embryos available to transfer to the uterus.
The ongoing pregnancy rate was higher in both of the acupuncture groups compared to the control group. The ongoing pregnancy rate in the group which received acupuncture once was 36%, in the group that received acupuncture twice, the rate was 33% and in the group that did not receive acupuncture at all it was 22%.
In this third acupuncture study, a total of 225 infertile patients were included: 116 women were randomized into group I (the acupuncture group), and 109 women were randomized into group II (the no acupuncture group). The physician who performed the embryo transfer was not aware of which couples were in which group. On the day of embryo transfer, the patients in the study group received acupuncture. At the same time, a special Chinese medical drug (the seed of Caryophyllaceae) was placed on the patient’s ear. The seeds remained in place for 2 days and were pressed twice daily for 10 minutes. Three days after the embryo transfer, the patients received a second acupuncture treatment. In addition, the same ear points were pressed at the opposite ear twice daily. The seeds were removed after 2 days.
The control group received a faked acupuncture. As in the treatment group, patients received the phony acupuncture treatment for 30 minutes. This placebo treatment was repeated three days after the embryo transfer. Equal numbers of needles were applied to the study and control groups. The placebo acupuncture treatment was designed not to influence fertility.
Both groups were similar in terms of age, weight, duration of infertility, cause of infertility, and number of previous IVF attempts. No differences were found in the specifics of the ovarian stimulation, the number of eggs retrieved, the fertilization rate, or the number of embryos transferred.
The real acupuncture group had an implantation rate per embryo of 14.2% whereas the faked acupuncture group’s implantation rate was only 5.9%. The ongoing pregnancy rate was 28.4% in the real acupuncture group compared to 13.8% in the control group.
This next acupuncture and in vitro fertilization study subjected the patients to three acupuncture treatment sessions. The first took place before the egg retrieval on the 9th day of ovarian stimulation, and the second and third acupuncture treatments were performed immediately before and after the embryo transfer. Women were randomly allocated to receive treatment with either real therapeutic acupuncture or with faked acupuncture.
Of the 228 subjects randomized, 15% were unable to complete the treatment protocol because their IVF cycle was cancelled prior to the embryo transfer. No difference in the grading of embryos was found between groups. The pregnancy rate, defined by a positive fetal heart beat, was 31% in the acupuncture group and 23% in the control group.
I am very proud that The Berkeley Center For Reproductive Wellness at East Coast Fertility opened it’s doors at East Coast Fertility. It’s our hope to support you in every way to build your family.
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Is acupuncture something you would…or have…tried?
If you already have tried it, please share your experience here.
If you haven’t tried it, what is stopping you?
Photo credit: http://www.publicdomainpictures.net/view-image.php?image=5109&picture=pin-points
By Tracey Minella and David Kreiner MD
October 21st, 2011 at 12:00 am
You may not know where you went wrong, but most infertile couples feel lost at some point along their infertility journey. And the longer the trail of treatment gets, the more it can feel like you’re on a road trip from hell without a map…and with a partner who won’t stop for directions.
If your own journey has got you stuck at the corner of IUI Rd. and IVF Blvd… wondering whether to continue with more IUIs or to move in a different direction like IVF or micro-IVF…East Coast Fertility’s Dr. David Kreiner may be the infertility GPS system you’re looking for.
Dr. Kreiner gives valuable insight on how to handle this tough question if you find yourself at that particular crossroads:
Wantababy asked: iui versus micro ivf versus IVF:
I had three negative IUI cycles. I was on clomid and ovidril which produced ample follicles. IVF is not covered under our insurance and 12,000.00 with no guarantee is very expensive. Is micro-ivf advisable? Is it advisable to do a fourth IUI which is covered under insurance? i had been going for acupuncture which I didn’t do for the first three IUI cycles.
Dr. Kreiner (The FertilityDoc) replied:
I prefer to have entire history which would influence my decision. Issues such as your age, duration of infertility, cause of infertility, your antral follicles count, AMH, day 3 E2, FSH all play a role. Personally, I weigh heavily a covered cycle vs. having to pay for uncovered cycle but at some point it does make sense to move to more aggressive treatment.
MicroIVF in general has about 3 times the success of an IUI and costs $3,900. Some groups, age, diagnosis do better with MicroIVF than others.
In addition, we do have income based grants and often studies which will significantly lessen the cost of a full stimulation IVF. If you prefer to discuss your personal situation directly email me at firstname.lastname@example.org or call 516-939-2229 for a consultation. Free consultations are available if you are not covered by insurance.
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How many IUIs did you have before moving on to IVF? What factors went into your decision to do more IUIs or to move on to IVF?
Photo credit: http://www.publicdomainpictures.net/view-image.php?image=1666&picture=signpost
By Tracey Minella
October 20th, 2011 at 11:51 am
It’s hard not to jump on the bandwagon and flat out say “Yes!” after hearing the news this week that reality TV star, Guiliana Rancic, 36, was recently diagnosed with breast cancer after her new RE insisted she have a mammogram before going forward with her third IVF cycle.
But even though many of us have been routing for her and her husband, Bill Rancic (of “The Apprentice”) since they courageously made their infertility battle public…and even though it happens to be breast cancer awareness month… we should be wary of getting swept up in our collective heartbreak for Mrs. Rancic and demanding pre-IVF mammograms for all patients.
Should the accepted standards of medicine regarding mammograms be modified because of her rare case? Is the exposure to radiation a risk worth taking in light of the slim chance of detecting cancer in younger patients without known risk factors?
In the general population, mammograms are not recommended by either the National Cancer Institute or the American Cancer Society for women under 40.
Further, with respect to women about to undergo IVF, neither the American College of Obstetricians and Gynecologists, nor the American Society for Reproductive Medicine (ASRM) recommends mammograms before age 40. Just a pap and breast exam.
Of course, if there is a family history or a patient has tested positive for the breast cancer gene mutation, screening may be indicated earlier.
Despite the continued lack of evidence after many studies, of a causal connection between IVF and cancer, there remains a skepticism or fear among some of the public. And it rears its ugly head in cases like these. For right on the heels of Monday’s announcement, the Today show had to do a follow up interview due to “hormone phobia”. Did Rancic’s first two IVF’s cause the breast cancer?
I wince when I see this because I see IVF taking an undeserved step backwards in the public eye. I can only hope people look past the sympathetic face of the beloved celebrity and really hear the answer from Dr. Nancy Snyderman: “Take this as a stand alone case.”
People have been taking IVF meds and birth control meds…both of which are hormones…for decades. Women tend to seek IVF when they are older. Women tend to get breast cancer when they are older. “There is an age relation, not a hormonal relation” between IVF and breast cancer, Dr. Snyderman reassured.
Rancic, who is recovering from Tuesday’s lumpectomies and will need radiation treatments, had been stimulating at the time of her diagnosis and underwent the retrieval, but no transfer. We wish her only the best in her recovery and in her future family-building efforts.
I loved her closing remarks in her interview on Today when she confirmed her plans to get pregnant through IVF after her cancer treatment. “I’m not going to give up. I want that baby. What’s amazing is… that baby will have saved my life.”
You can see both interviews…Guiliana’s announcement and Dr. Snyderman’s interview …here: http://vitals.msnbc.msn.com/_news/2011/10/17/8368474-doctors-ivf-not-to-blame-for-rancics-breast-cancer.
The bottom line is that you as the patient need to be comfortable. Please speak to your OB/GYN and your RE about your concerns and questions so they can help you determine if a mammogram is called for in your particular case.
Good luck, Guiliana and Bill. And good luck to everyone on their family-building journey.
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Do you think all IVF patients should get pre-IVF mammograms regardless of age? Do you worry about having or getting breast cancer as a result of IVF? Have you spoken to your RE about your concerns?
By Tracey Minella
October 19th, 2011 at 12:00 am
Anyone want to give this one a caption? Best caption wins a Starbucks gift card.
And is there …or should there be…limits on the part played by helpless babies in cultural traditions and rituals? One cultures’ abuse is another cultures’ idea of normal. Weigh in here. Would you let your baby do this?
Photo credit: http://izismile.com/2009/05/08/bad_parents_50_pics.html
By Tracey Minella and David Kreiner MD
October 18th, 2011 at 6:10 pm
IVF is hard on us women. After all, we’re the ones whose hormones have gone wild, whose butts have swollen bulls-eyes, whose wombs are empty.
But our guys have it hard, too. If it’s male factor, they have misplaced guilt. They have their own pain, but probably hide it so as not to further burden their partner. And in any case they likely have depression and frustration over not being able to fix the situation for their suffering partner. Their wives are in pain. Don’t most guys want to be their wife’s hero? The knight who rides in to save the day?
IVF is a team effort which extends beyond the man’s obvious contribution in the collection room.
Dr. David Kreiner of East Coast Fertility offers great suggestions on ways men can find their place in IVF and support their wives and partners in the process:
A husband’s experience when going through an IVF cycle varies depending in large part on how involved he gets. When a husband participates actively with the IVF process it helps to relieve much of the stress on the wife and on the relationship. The more involved he is, the more invested he will feel in the entire experience, and the more control he’ll feel over the outcome.
Many husbands pride themselves in their new found skills of mixing medications and administering injections for their wives. It helps many men who are used to caring for their wives to be in control of administering the medication for them. Successful IVF then becomes something he played a very active role in, and he’ll relate better to the experience, his wife and the resulting baby.
Despite a lack of prior experience, most people can learn to prepare and administer the medication. Whether it is the feeling of “playing doctor” or the knowledge that he is contributing significantly in the process and supporting his wife, most men relate that giving their wives the injections was a positive experience for them and for their relationship.
Along the same line of thinking, accompanying your wife at the time of embryo transfer can be most rewarding. This can be a highly emotional procedure. Your embryo/s is being placed in the womb and at least in that moment many women feel as if they are pregnant. Life may be starting here and it is wonderful to share this moment with your wife. Perhaps you may keep the Petri dish as a keepsake as the “baby’s first crib”. It is an experience a husband and wife are not likely to forget as their first time together as a family. I strongly recommend that men don those scrubs, hats and booties and join their wives and partners as the physician transfers the embryos from the dish into her womb. Nine months later, do the same at delivery for memories that last a lifetime.
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Guys: Would you (or have you) been present during the transfer? What was it like?
Girls: Would you want (or did you have) your husband present during the transfer? What was it like?
Photo credit: http://www.publicdomainpictures.net/view-image.php?image=2163&picture=young-love