Finding the right fertility doctor for you.

Finding the right fertility clinic and infertility specialist can make your journey towards pregnancy much smoother and easier! 

“You’ve been trying to conceive and it hasn’t happened. Maybe you’ve been aiming for pregnancy for six months, a year, or three years, Maybe you’ve talked about it with your partner, your doctor, your friends. Maybe you haven’t. Maybe you’re gung-ho about getting help and your partner is foot-dragging. Maybe you’re reticent, nervous, or scared. Everyone’s situation is singular. But there is one universal imperative binding all of us…the search for understanding.”

The right fertility clinic and specialist will give you understanding — and hopefully a baby or two!

here are some ways to find the right fertility doctor…

1.)Ask your friends, family members, and colleagues around about infertility specialists. The best way to start a search for fertility doctors is to talk with friends who have had a good experience with someone. Infertility can be an embarrassing thing to talk about, but if you can overcoming the stigma of infertility, you’ll dig up some invaluable and even fascinating information about getting pregnant! I’m always shocked at how many people I know who’ve dealt with or are coping with infertility issues…it’s more common than you think.

2.)Talk to several infertility doctors. Before you jump into the possible treatments at any fertility clinic, ask questions such as: What is your training? How much experience do you have? What is your philosophy or therapeutic approach? What’s your success rate? A good fertility specialist will be happy to give you information about their education and experience. Write down your questions and answers before you go into your appointments. Make sure the fertility specialist has experience with your particular type of infertility.

3.)Google or do an internet search for the terms “fertility clinic”, “infertility specialist”, and “fertility doctor” in your area. Many good fertility clinics advertise in the phone book or through their own website. Some fertility clinics have websites that allow you to send a blind email so you can remain anonymous. Ask for specific information about your specific issue – go beyond the “we can’t get pregnant because of female infertility or infertility.” Instead, ask about your polycystic ovarian syndrome or your partner’s low sperm count.

4).Google or do an internet search for a specific infertility specialist. After you get the name of a clinic or two, search for their specific name. You may find additional information from patients or friends or family members of patients. When you’re finding the right fertility clinic, it’s good to learn as much as you can. But, remember to take each opinion with a grain of salt. Everyone has different experiences, and yours might be better than the worst situation you read about. But still, it’s good to hear what others are saying – and it’s good to talk to your fertility specialist about what you learned.

5.)Trust your gut from Day One. If you’re not comfortable with or simply don’t like your infertility specialist, then walk away right away. Don’t stick around, hoping things get better or that your gut instincts are wrong. If you’re unhappy with your fertility clinic at the beginning, it won’t likely get better. Infertility — and all the fertility treatments and tests — are far too important to be treated likely, so don’t brush away your concerns or bad vibes! Trust your gut.

6.) If you are looking for cost effective treatments. Medical tourism is being much sought after now. Have considered visiting places like INDIAwhich has safe Laws and Highest technologies available while being very economical. Search for good fertility specialists in india and visit as a tourist to see yourself how the experience can be, before concluding on anything. check our website at www.fertilityindia.com for more information.

Life Style Factors and Fertility

If you are trying to become pregnant it might be a good idea to take a close look at your lifestyle. Certain lifestyle factors can interfere with a couple's ability to conceive. Environmental hazards, dietary practices, and poor overall health tend to have a negative influence on both female and male fertility. Sometimes, simple changes to your lifestyle can help to increase your fertility and help you to conceive.

Alcohol and Infertility
Most of us know by now that alcohol and pregnancy just don't mix. Alcohol consumption is not recommended at all during pregnancy and for good reason - it can cause serious birth defects and may trigger fetal alcohol syndrome. When you are trying to conceive, it is also important to limit your alcohol consumption or cut out those alcoholic beverages altogether. Alcohol can have detrimental effects on your fertility, making it more difficult to become pregnant.

Women who drink between one and five alcoholic drinks a week are actually associated with decreased conception rates. Women who regularly drink alcohol are also at increased risk for experiencing:

• irregular periods
• irregularities in ovulation
• early menopause
• miscarriage

Men who regularly drink alcohol are also at risk for experiencing fertility problems, including:

·       reduced testosterone levels

·        reduced sex drive

·       problems with sperm motility and morphology

Cigarette Smoking
Cigarette smoking can be a tough habit to quit, but if you are trying to become pregnant, now is a great time. Smoking is a big no-no during pregnancy anyways, and it can also impact negatively on your fertility. Female smokers are three to four times more likely to have problems getting pregnant. They are also at increased risk for:

• menstrual irregularities
• tubal factor infertility
• implantation problems

Men who are smokers are also compromising their fertility. Male smokers increase their risk for:

• erectile dysfunction
• chromosomal abnormalities within their sperm

There are a variety of aids available to help you quit smoking. From gum to patches to botanical supplements, these aids have made butting out easier than ever.

Drugs: It can affects woman’s ability to get pregnant.

Environmental Hazards
Sometimes the environment around you can actually interfere with your ability to become pregnant. Toxic fumes, lead, and other poisons can cause serious fertility problems, especially if you are exposed to them on a daily basis. Try to avoid:

• pesticides
• herbicides
• fungicides
• paint fumes
• radiation
• chemical cleaners or solvents

If you work in an industry that requires you to come into daily contact with any of these chemicals, speak with your health care provider about how your job may be affecting your future fertility.

Environmental estrogens can affect the hormone levels in your body, negatively influencing your fertility. Your body produces its own estrogen to help regulate ovulation and menstruation. However, it also gets extra synthetic or plant estrogens from food items, plastic containers, and other types of food packaging. Too much estrogen can throw your reproductive cycle out of whack. This can make conception difficult, so it is a good idea to try to limit the amount of environmental estrogens that you take in.

Nutrition
Nutrition is of the utmost importance when you are trying to become pregnant. A healthy and balanced diet can go a long way to boosting your fertility and increasing your chances of conception. A healthy diet that provides all the necessary vitamins and minerals will ensure that you are in proper physical health to have a baby. If your nutrition is lacking, your body may feel that it isn't prepared to become pregnant, and therefore you may experience infertility. Some foods to avoid while you are trying to conceive include:

• artificial sweeteners
• caffeine
• food additives, like MSG
• contaminated food or water

Stress
Stress can also play a role in fertility issues. If you are under extreme levels of stress, your body can begin to behave in irregular ways. Stress often triggers a change in the regular hormonal balance. This could make ovulation, menstruation, and conception more difficult. When you are trying to conceive, aim to be as stress-free as possible. Great ways to reduce your stress include exercise, yoga, and meditation.

Work place – hazards and fertility in women

Thousands of hazardous chemicals are produced and used in a wide variety of workplaces, all over the world. Some of these substances can have negative effects on the reproductive health of both male and female workers who are exposed to them. There are also a variety of physical and biological agents (such as radiation and bacteria) used in many workplaces that expose workers to additional reproductive hazards. Additionally, there are many work situations (such as work which is highly stressful, or shift work) that may cause negative effects on the reproductive systems of male and female workers.
For the millions of working women across the globe who are trying to get pregnant each year, it is imperative they know their workplace. A growing number of women hold jobs in industries that were once dominated by men—manufacturing, agriculture, and trades such as welding and printing. Working in such fields may expose them to chemicals and agents that can pose health risks.
Within the workplace, many women are likely to be exposed to some type of occupational hazard that may impair conception or risk the health of an unborn child. Excessive levels of exposure to the following hazards may increase the chance of birth defects and miscarriage and may lead to fertility problems in an otherwise healthy individual.
Environmental Hazards – Common everyday exposures we usually ignore should be recognized during pregnancy. These include air-pollutants, mold and asbestos, extreme temperatures, excessive noise levels, and second-hand cigarette smoke.
Chemical Hazards – The Centers for Disease Control & Prevention (CDC) recommends avoiding certain ethylene glycol ethers such as 2-ethoxyethanol (2EE) and 2-methoxyethanol (2ME) since they may cause miscarriage. Lead should also be avoided as exposure at certain levels may cause infertility, miscarriage, low birth weight, and developmental disorders. Homes and workplaces in the olden days also may contain lead paint. Other solvents, pharmaceuticals and metals such as mercury are of concern as well. Learn about the effects of the products with a label or data that carries the codes R46, R61, R63 and R64 to name a few.
At least one study has cited women who work in nail and hair salons, dry cleaning establishments, medical laboratories and manufacturing plants place their unborn child at risk of birth defects due to malodorous chemical solvents. Common everyday solvents and chemicals women who are pregnant or trying to get pregnant should limit their skin and vaporous odor contact to are bleaches, hair color, artificial nail powders, nail polish remover, aerosol hair spray and chemical depilatories.
Women who work with solvents called glycol ethers, present in some paints, have an increased risk of miscarriage. Other solvents also suspected of causing miscarriage and birth defects include oil-based paints and paint thinners. It is wise to remember that all paints; even water-based; include several ingredients of unknown safety. Use proper respiratory protection at all times to avoid hazardous vapors. Remain in a well-ventilated area.
According to reports, three out of four women are exposed to pesticides. The perfect scenario would be to avoid these pesticides, but limiting your exposure will decrease your chances of having it affect conception, pregnancy and delivery of a healthy baby. Additionally, it is wise to be cautious of “organic” pesticides as many are derived from the same plants as the non-organic pesticides; and they too are cause for concern.
Radiation – High doses of radiation are known to lead to miscarriage or embryonic damage. Laws have been put in place to protect unborn babies and their mothers. The laws state that radiation exposure cannot exceed 0.5 rem at any time during a woman’s pregnancy. Radiation from an x-ray is known to affect cell division and cause defects. Since cells divide quickly as an embryo develops, it is more vulnerable to radiation.
Exposure to natural radiation while flying is generally insignificant for the average person each year. For those who are flight attendants, pilots and business travelers who fly the skies hundreds of times a year, there is only a slightly higher risk to the developing fetus. Some experts however, recommend limiting flying time during the first trimester.
Biological Agents – Biological agents are most prevalent in the workplaces of hospitals, educational institutions and daycare. Women in these workplaces may be exposed to many harmful bio-agents including, influenza, rubella, tuberculosis, chickenpox, herpes simplex, HIV and Hepatitis B. Some of the above agents occur only once in a woman’s lifetime, so if a woman has experienced chickenpox for example, she normally will be immune to any reoccurrence.
Stress – The risks from job stress are well established and are associated with raised blood pressure which is dangerous for pregnant women and sometimes associated with infertility.
Millions of women each year work throughout their entire pregnancy and go on to deliver healthy babies. By being aware of hazards ahead of time and taking precautionary measures, women can usually remedy any potential hazard. Many workers are exposed to such hazards every day at work. Working with particular substances or under certain work situations may cause some workers to experience abnormalities in their sexual or reproductive health. Many workers may not know that such problems can be related to occupational exposures. Protective measures should be implemented to ensure that pregnant workers and workers (male or female) who may be planning to have a child are not exposed to known or suspected reproductive health hazards.

Sleep – Disorder & Fertility

The role of sleep is primarily to help repair and rejuvenate the body and its systems such as the reproductive system and the brain. If we do not get enough sleep for any extended period of time our mood, hormone balance, and our immune system will suffer. This not only wreaks havoc on our day-to-day lives and activities but it also interferes with our fertility. Sleep loss has also been associated with irregular menstrual cycles which can obviously affect your chances of getting pregnant.

 It has also been shown that gaining weight is directly linked to infertility. Studies have shown that lack of sleep is associated with weight gain and the body resisting insulin. Too much insulin is seen as a key factor in infertility because of all of the things that it can do to your body including increasing your risk of Type2 diabetes.

Something that you surely know is that when you don’t get you optimum hours of sleep you’re likely to end up suffering from stress. Stress has been directly linked to problems such as memory lapses, coordination problems, and yes, infertility. A lack of sleep can also lead to depression and a depressed person is not likely to be functioning at an optimal level in any area of their life which also leads to not taking proper care of their bodies.
The role of sleep in our lives is far too important for us not to get enough of it no matter how busy. It has been suggested that we need at least seven hours of sleep each day to help us stay healthy and have the energy to get through the day. To get the amounts of sleep you need when trying to conceive it’s advised that you stay away from overnight work as this is related to menstrual irregularities and pregnancy risks. Doing shift work when you’re trying to conceive is also not advised if it can be avoided. If you have to work on a shift then you need to ensure that you get enough rest when you are not at work and resist the urge to fill your free time with errands and chores as opposed to relaxation. To foster good sleep and increase your chance of being fertile, try to keep your sleep times consistent. The same goes for when you’re awake. Prior to going to bed, try to avoid doing anything like watching action television and eating spicy foods. These kinds of activities tend to cause your mind to race and not be in a relaxed mode, preventing you from getting a good night's sleep.

• Missing your required number of sleep hours a night can impact your ability to conceive.
• The average woman (30 to 60 years old) gets only 6 hours 41 minutes of sleep during the work week, according to the National Sleep Foundation, when she really needs 7 to 9 hours.
• Sleep has a powerful influence on the body’s hormonal system, which controls a woman’s cycle and regulates ovulation.
• Too little sleep leads to low leptin levels, the hormone responsible for appetite and which can impact ovulation.
• Insomniacs have a significantly higher level of the stress hormones cortisol and adrenocorticotropic, both of which can suppress a healthy fertility cycle.

The take-home message is clear: you could be doing “everything right” when it comes to preparing your body to conceive and bring a healthy baby to term. But with so much focus on external factors like your environment and what you put in your mouth, the time has come to add another aspect to this big equation: sleep.
All the healthy, pure food in the world and all the attention to getting your body into tip-top prenatal shape won’t cure a hormonal system gone awry from missing sleep. So if you’re thinking of having a baby, put sleep at the top of the list. And if you’re going to worry about your environment, remember to also think about the one in the bedroom.

Some suggestions to overcome this problem;

Meet your sleep requirements – [minimum 8 hrs/day]

Go outside- The suggested amount of sunlight on a daily basis is about an hour

Calm your mind- Before bed, avoid activities that keep your mind racing, and instead relax into a peaceful sleep

Age & Fertility

There are a variety of different factors that can affect your fertility. From uterine abnormalities, to poor sperm count, the list of fertility problems is almost endless. This can often make it quite difficult to determine the root cause of infertility. However, age is one factor that usually comes to mind when a couple faces pregnancy difficulties. This is because age actually plays a highly significant role in determining female fertility.

It is important to remember that fertility decreases with age, particular after age 35. Even though women today are healthier and taking better care of themselves than even before, improved health in later life does not offset the natural age related decline in fertility.

Women are most fertile between age 20-24. As women grow older the likelihood of getting pregnant falls steeply while the likelihood of infertility rises sharply.

Pregnancy Rates and Age

Studies of pregnancy rates and age support the idea that female fertility declines with age. If you have not considered age as a factor in your infertility, you may be unaware of these pregnancy trends.

• Pregnancy rates begin to decline slowly, beginning in the early 30s.
• Throughout the late 30s and early 40s there is an even greater decline in pregnancy rates.
• Few pregnancies are recorded after the age of 45.
• By the age of 30, 7% of couples are infertile.
• By the age of 40, 33% of couples are infertile.

Factors Involved in Female Fertility Loss

Menstrual cycle: irregularity in menstrual cycle is common with increasing age.

Lining of the womb: The endometrium may become thinner and less hospitable to an embryo

Mucus secretion: vaginal secretions can become less fluid.

Diseases affecting the reproductive system – some conditions can damage the reproductive organs as time passes or worsen if not treated properly, including endometriosis, PCOS and Chlamydia.

Chronic illness – some illness can have a negative impact on fertility.  

Egg Quantity as You Age
As you age, the number of eggs in your ovaries begins to decrease. By the time you begin menstruating you have only about 400,000 eggs available for fertilization. Each month you may produce several eggs for ovulation, but many will die before they are ever fertilized. By the time menopause arrives, most women only have a few hundred eggs left in their ovaries. Because the number of eggs that you have available for fertilization declines with age, this can make it more difficult to become pregnant as you grow older.
Egg Quality as You Age
Unfortunately, egg quality also changes over time. As you age, your eggs become weaker, and less able to form a healthy embryo. Your eggs also begin to decrease in number, leaving fewer and fewer quality eggs available for fertilization. A woman of 40 typically has lower egg quality than a woman of 20.This is not to say that your eggs are of poor quality just because you're aging. Many younger women have poor quality eggs while some older women have very high quality eggs. On average however, egg quality does decline with age.
Complications of Poor Egg Quality
Poor egg quality can lead to a variety of complications, including:

• unexplained infertility
• IVF or IUI failure
• repeated miscarriages
• chromosomal abnormalities

How long will it take to conceive? 

According to the Human Fertilisation and Embryology Authority, "At 35 you're half as fertile as when you were at 25; at 40 you're half as fertile as when you were 35". This means that it can suddenly take much longer to get pregnant when you hit your late thirties or early forties and you may have problems conceiving at all.

Most couples (92 per cent) will conceive within two years if they do not use contraception and have regular sex. That leaves 8 per cent of couples in the general population who do not conceive within two years. If you are over 35 and keep on trying for another year you may still get pregnant but in the next few years your chances of conceiving start to fall rapidly; 6 per cent of women aged 35 years and 23 per cent of those aged 38 years will not have conceived after three years of regular unprotected sex.

Getting Pregnant After Age 30

Statistically speaking, the chances of pregnancy for women over 30 start to decline by about 3.5% per year. This rate continues to increase after the age of 40. After 45, however, experts say it is virtually impossible for a woman to conceive using exclusively her own eggs.

That’s why women over the age of 35 will generally undergo a fertility evaluation if they do not conceive after 6 months of having unprotected sex.

In summary, age and infertility is an increasing problem due to general societal trends for women to delay childbearing until later ages. Despite these grim statistics, not everyone will have trouble getting pregnant after 35. However, if you are having trouble, and you’re older than 35, you shouldn't try on your own for longer than six months. The sooner you get help, the better your chances of treatment success.

weight and fertility in women

Weight and Fertility

A significant deviation from your normal body weight, whether overweight or underweight, can cause infertility in both women and men. In fact, one study suggests that 12% of primary infertility is due to weight issues. Studies also show that abnormal weight can reduce the chances of success with assisted reproductive procedures.
Body fat is related to the amount of hormones your body produces. So if you have too much or too little body fat, your body may produce too much or too little hormones, which interferes with your ovulation and menstruation. Specifically, your body fat affects the production of gonadotropin releasing hormone (GnRH), which is essential for regular ovulation in women and the production of sperm in men. GnRH in turn triggers the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), both critical to the development of eggs and sperm.
For women, very low weight can decrease GnRH production, which can result in irregular ovulation or a complete stop to ovulation. Too little GnRH can affect the development of the uterine lining and its receptivity to the implanting embryo. For men, low weight could lead to decreased sperm count or function.

Being overweight can also lead to an abnormal hormonal signal, impacting ovulation and possibly sperm production. It can cause an overproduction of insulin, which may result in irregular ovulation. There is also a link between obesity, excess insulin production and the infertility condition known as polycystic ovarian syndrome (PCOS). In fact, PCOS (polycystic ovarian syndrome), one of the more common causes of infertility, has been connected to trouble with gaining and subsequently losing weight. In other words, the very thing that is causing fertility problems may also be why you’re having trouble losing weight or maintaining a healthy BMI. If a PCOS diagnosis is made, treating the PCOS can help with the weight problem. Women with PCOS who have been treated with Glucophage (metformin), an insulin resistance medication used off label in the treatment of PCOS, may have an easier time losing weight while on the drug, than without.

There are number of diseases associated with obesity and one of them is being infertile. Obesity has also been associated with an increased risk of early pregnancy loss. In order to judge overweight or obesity BMI [Body Mass Index] is measured. BMI is calculated with the formula. Weight [in kilos] divided by height [in meters] squared. A high BMI indicates obesity. BMA 25-29.9 indicates overweight, whereas BMI over 30 indicates obesity.
A healthy return to normal body weight will often reverse hormonal irregularities, thereby restoring fertility. Not only that, but normal body weight is also the healthy way to prepare for pregnancy. Whether you have to shed or gain some pounds, changes in weight should be made before getting pregnant, since drastic changes can be detrimental to your developing baby. If the cause of obesity is related to PCOS, the use of insulin sensitizing drugs may be needed in addition to dietary changes.

Following fertility issues and pregnancy complications are associated with obesity.

Fertility issues with obesity:

-       Irregular or infrequent menstrual cycle

-       Increased risk of infertility

-       Increased risk during fertility surgery

-       Increased risk of miscarriage

-       Decreased success with fertility treatments.

Potential pregnancy complications with obesity:

-       Increased risk of high blood pressure

-       Increased risk of diabetes in pregnancy

-       Increased risk of birth defects and high birth weight infant.

-       Increase risk of cesarean section.

 Benefits of weight loss includes:

-       Weight loss of 5-10% may dramatically improve ovulation and pregnancy rates.

-       Improved health including reduced diabetes, high blood pressure and heart disease.

If you are overweight (BMI over about 28) and having trouble getting pregnant, try to lose weight. If you have irregular menstrual cycles (anovulation or irregular ovulation) and you are overweight, weight loss might make your cycle regular - thereby making you more fertile.

If you are obese (BMI of 30 or higher) and need IVF, you might have a significantly improved chance for success if you reduce your weight before going through the procedure.

The Rise of infertility

Rise of infertility

Infertility means that a couple are unable to conceive a child inspite of 12 months of regular sexual intercourse without birth control measures (pills, condom, copper’T’, safe period, withdrawal etc).

Many people may be infertile during their reproductive years. Survey says that on an average, in the world, about one in seven couples are infertile. Infertility may be due to a problem in the male or female or in both the partners and may even be unexplainable.

Key factor’s that affect’s fertility

Fertility can be a complicated affair and there is certainly some individual variation.  Beside medical problem, fertility can also be affected by so many other factors.

Medical reason that affect fertility are

-          Fertility history (contraceptive pills, genetics, age etc)

-          Male factor (Sperm quality)

-          Reproductive health.

-          Female factor (Uterine, Cervical, Ovarian and Tubal factors)

Women’s issues…..

General life style factors

If lady is trying to get pregnant now or planning to in near future, it’s wise to identify any potential risk factors.  The sooner you detect, address and treat problems that may affect fertility, the better your chances of achieving a successful pregnancy.

Here a few of more common health factors that can affect a woman’s ability to ovulate, conceive or carry a pregnancy to term.

Factors that affect Female’s fertility:

A.      Age: In today’s society, age-related infertility is extremely common. Women are most fertile between ages 20-24. As women grow older the likelihood of getting pregnant falls steeply while the likelihood of infertility rises sharply.

B.      Weight: over weight (obese):  Body fat levels 10 to 15% above normal can overload the body with estrogen, throwing off the reproductive cycle.

-          Under weight:  Body fat levels 10 to 15%. Below normal can completely shut down reproductive process.

C.  Medication:  Antidepressants, antibiotics, pain killers and other drugs used to treat chronic disorders may cause temporary infertility.

D.  Environmental or work place hazards

Prolonged exposure to high mental stress, high temperature, chemicals, radiation or heavy electromagnetic or microware emissions may reduce a woman’s fertility.

E.  Life Style Factors: It is essential to make healthy life style choices to avoid infertility. For instance, smoking, drugs, exposure to chemical and pesticides, dietary factors can impair conception.

G.  Sleep Disorder: Sleep is not only essential for quality of life and overall health, but it also plays important role on women’s fertility.

Men’s issue:

About 40% of fertility causes can be traced to a problem in man.  The following is partial risk factors that may contribute to male infertility.

A.  Smoking: Smoking impairs the ability of sperm to more (its motility)

B.  Alcohol:  Having more than one or two drinks can affect quality and quality of sperms, lower testosterone levels and contribute to erectile dysfunction.

C.  Drugs:  Cocaine or heavy marijuana use may temporarily reduce the number and quality of sperms on much as 50%.

D.  Medications:  Some medications such as these for ulcers or psoriasis, can slow or prevent the production of sperm.

E.  Job hazards:  Chronic exposure to elements such as lead, cadmium, mercury, hydrocarbons, pesticides, radioactivity and X-rays may have an impact on sperm count and quality.

F.  Exposing genitals to heat:  The frequent use of saunas, steam rooms, hot tubs can temporarily impair sperm production and reduce sperm count.

G.  Environmental Assaults: Exposure to toxins, chemicals, or infections may reduce sperm count either by direct effect on testicular function or by altering hormone systems.

H.  Lifestyle: Stress, malnutrition and nutrient deficiencies, obesity, bicycling, history of prostatitis or genital infection may also affect sperm quality and quality.

I.  Mobile use cuts sperm count: Men who use mobile phones more than 4 hours a day could be risking their fertility.

In conclusion, there are various factors that result in infertility. It is advisable that couples at risk try and mitigate all those factors that are in their control. Science is well-advanced in this field and hence once afflicted by infertility, couples have choices galore of the treatments that best suit their needs and pockets.