pgs testing came back inconclusive

Also have you asked about an ERA? PGS was done on these pooled embryos. We have a mosaic embryo on ice, which had normal and abnormal cells detected. This is known as embryo mosaicism and might explain why embryos tested as euploid can fail and re-test as aneuploid. Anatoma y fisiologa capilar 4 diciembre, 2020. It survived the thaw but was abnormal. Therefore, PGS testing may not be required for IVF success. 12 Reducing the Risk of Miscarriage Miscarriage is common, occurring in up to 25% of pregnancies. Consult with your doctor before making any treatment changes. So informative! Hi mamabear wish I had not tested either. I wouldnt pay $ for that! Group Leaders arent expected to spend any additional time in the community, and are not held to a set schedule. Check here for the full. In CVC, cells are removed from the placenta by inserting a pregnant womans belly or a catheter through the cervix. . Both were graded BB. Some REs are iffy on transferring inconclusive embryos so make sure you check in on that before trying to make a decision. We strive to provide you with a high quality community experience. Five came back as normal, one inconclusive and the rest were abnormal. Munne et al. She began with two Intrauterine Inseminations (IUI), both unsuccessful. Please choose an optionCounselling and Fertility EvaluationIUIIVF/Test Tube BabyICSISurgeryBlastocyst culture for repeated implantation failureNon invasive preimplantation genetic testingRecurrent AbortionsDiagnostic and Operative hysteroscopy and LaparoscopyHigh risk pregnancy and delivery, Schedule A Confidential Call With An Expert, Lets Clear The Confusion Between PGD, PGS, And PGT. For more current data on this topic, visit my archives for Trophectoderm/ICM biopsy concordance. Garrisi et al. 2 IUI's that resulted in a pregnancy, but were terminated due to severe genetic issues. We transferred one normal one and had DC1 nine months later. That includes the screening that came back positive for Ms. Geller, which looks for Prader-Willi syndrome, a condition that offers little chance of living independently as an adult. The first step takes up to 5 days when fertilised embryos are cultured. It decreases the risk of miscarriage, shortens the gestational period, and lessens the requirement for transferring several embryos. He just said hes had too many come back inconclusive or increased risk which leads to unnecessary invasive testing. Zhao et al. What were the results of your inconclusive one being retested? Failed transfer (untested one embryo)4. Its still a possibility for us down the road. She had never previously given birth. The second part is embryo biopsy. I agree that this seems really early for an NIPT and too low of fetal fraction rate to get an accurate result. Was the DNA sample non-invasive? Well the first test that month came back as 'early receptive' wit A person with a translocation or inversion is at increased risk to produce embryos with missing or extra pieces of chromosomes. We had 4 embryos thawed in order to biopsy them. A small sample (about 5-10 cells) is typically biopsied from an embryo that has potentially hundreds of cells. The following are the periods when PGS testing is done for both couples and individuals: PGS is a multi-step process carried out by several specialists and laboratories. Successful pregnancy resulted. They now own their genetic offspring. The test looks to see if your uterus is ready for implantation or if you need more or less progesterone for actual transfer. Without displaying symptoms, a person can be a carrier for balanced translations. Any input would be oh so appreciated! Step 1: Stimulation and Egg Retrieval Step 2: Embryo Development. Preimplantation genetic testing for structural rearrangements (PGT-SR): This type of PGT is performed when a patient or their partner has a rearrangement of their own chromosomes such as a translocation or inversion. I just had my second blood test at 16 weeks. We respect everyones right to express their thoughts and opinions as long as they remain respectful of other community members, and meet What to Expects Terms of Use. It is truly a personal choice, the clinic kept encouraging us to try it but we kept with our initial plans. For more up-to-date information on this topic check out my other posts that are tagged withEmbryo rebiopsy. IVF with PGS in India - starts from around $8,000. Find advice, support and good company (and some stuff just for fun). yesteray on my 16 weeks scan they tell me it looks like a girl! Best of luck to you! After the second biopsy and analysis, 95.6% of the blastocysts were successfully diagnosed with an euploidy rate of 65.9%. 6 by SNP then NGS: 3/6 matched, 1/6 retested as euploid, the rest had different affected chromosomes . We have done PGS testing before embryo transfer but second trimester blood work result came as positive for possible DS. Do embryo biopsies for PGT-A match the rest of the embryo? A chaotic abnormal has a large number of abnormalities making interpretation difficult, Inconclusive/No result means that the sample is insufficient for, Day 3 grading doesnt correlate well with euploidy like Day 5 embryos (, Higher mosaicism and embryos may self-correct and become normal by Day 5 (, They also found that the chance of getting a, Low risk for miscarriage, viableaneuploidy:4, 5, (47, XXY), Higher risk for miscarriage, low risk forUPD:2, 7, 11, 17, 22, Risk for miscarriage,UPD, viableaneuploidy:6, 9, 15, High risk for fetal involvement:8, 20, (47, XXX), (47,XXY). There isnt much data on it, and 2 of the 3 studies found no difference, so it isnt exactly clear. Theper retrievalstatistic helps to see the chancesbefore PGStesting. They couldnt test of downs so they dont know risk there. I also went through this. My heart goes out to you. Another study agrees with these data (Franasiak et al. There are a variety of chromosomal abnormalities that can occur in aneuploidy: Next lets look at how actual results would look along with the chromosome spread to visualize the concepts. I would feel hesitant not to transfer this embryo since it could very well be normal. For a much more in-depth look at the statistics, check out my post on PGS success rates. I don't know how this can happen and it is very upsetting. Sometimes the sample is not loaded properly and the tube is empty (the sample is very small so this does happen), or the sample degrades. What is known already: The increasing implementation of multicell trophectoderm biopsy has significantly reduced the risk of inconclusive diagnosis after preimplantation-genetic-testing (PGT). Embryo biopsy results are not 100% conclusive. Press question mark to learn the rest of the keyboard shortcuts The UK government classifies an inconclusive test as 'unclear', alongside a failed test. This post will discuss PGS/PGT-A for the most part and Ill use PGS as thats the term most are familiar with. Note that this is per transfer data. However, patients with few or no euploid blastocysts can be affected by this residual percentage of diagnosis failure. My doc told me that just one year ago, pgs wouldve deemed it normal but its gotten so sensitive in recent years that it picks up things it never used to. PGS Testing: How Many Normal - posted in IVF/FET/IUI Cycle Buddies: Was wondering how many normal embryos you got, out of how many tested and your age? My doctor refused to do NIPT before ten weeks for this reason exactly. That testing would have cost $1000 but my husband negotiated with the lab company. I think they are only about 95% accurate. The views expressed in community are solely the opinions of participants, and do not reflect those of What to Expect. (You can read more about this study here). The chances of having a miscarriage were much reduced in women associated with age 37 when a PGS test was conducted. The three main categories of PGS-tested embryos that did not implant are embryonic, uterine, and systemic. A group where those trying to conceive by in-vitro fertilization or fertility treatments can support each other through the process. My c section defect repaired2. Preimplantation Genetic Screening (PGS) is IVF embryos are subjected to a generalised test that screens for aneuploid, number abnormalities, and general chromosome. All rights reserved. I havent had that experience. Check here for the full. its endometrial receptivity assay. Please whitelist our site to get all the best deals and offers from our partners. Id say pgs is more reliable than NIPT in my case. Sometimes I think it would be reassuring to have good results, but then I would worry too much if it were inconclusive. I asked a lot of questions from both my embryologist and my testing company. Fertilized embryos are cultured for 3 to 5 days. (2014)found no difference inongoing pregnancybetween grades (about 50% for each category). Our doctor said to transfer those before starting again from the beginning as they may be totally normal. :). PGS Tested Embryo Miscarriage Rate By Week, Prevent Unknown Genetic Abnormalities From Transmission, Fallopian Tube Blockage A Complete Overview, , 5 : , Symptoms of Failed IVF: Factors Contributing To IVF Failure. I just had to pay for shipping. may be contradicted by other studies. We used natera so this convo was specifically in reference to their testing. June 29, 2022: Heavy rain triggered mudslides and floods in Villach, Carinthia in Austria on Wednesday night and the whole towns were completely devastated.A. We strive to provide you with a high quality community experience. Embryo screening may improve success rates. Rebiopsy may have an impact (1 of 3 found a reduction, the other 2 no difference or not significant), as well as thaw and biopsy (2 studies, one not significant). So for women who have recurrent miscarriages (more than 2) or for women older than 35, embryo screening with PGS/PGT-A testing may help. PGS testing has come a long way in reporting mosaicism. No differences in miscarriage rates in both groups, In one study, 42% vs 69% ongoing pregnancy (no PGS vs, In another study, 48% vs 66% ongoing pregnancy (no PGS vs PGS, mostly single embryo), For >37, live births increased when transferring euploids (58% vs 18%) per transfer, When looking at per retrieval stats, live births decreased with euploids (20% vs 40%), Some studies found no difference between tested and untested, Other studies found PGS testing reduced miscarriage. The MRO will also frequently request a retest for inconclusive results. Poor prognosis women who cant make blasts or blasts of sufficient quality for biopsy will not benefit ask your clinic what embryo quality is required for biopsy what % of women your age make blasts of that quality. I'm very concerned the inconclusive one is abnormal as well due to my age. My first ER that happened. (2018)looked ateuploidembryos (aCGH/SNP) in women <35: Irani et al. Out of the 6 that were pgs tested, 3 came back normal and 1 came back inconclusive. Because of the many benefits of PGS testing, individuals still inquire if PGS testing can be done on frozen embryos. Hi everyone.Background : My wife and I have been through quite a bit. I also opted to do the ERA before transferring to ensure I had the best window for implantation. A Group Leader is a What to Expect community member who has been selected by our staff to help maintain a positive, supportive tone within a group. Since aneuploidy increases with age, we would expect older women to benefit more than younger women. I had a no result and transferred that embryo. According to research, there is more monozygotic twinning when embryos are sampled for preimplantation genetic testing at the blastocyst stage. In Day 5 embryo biopsy, several (3 to 6) cells are removed for testing. At the same time, PGS is done to examine the embryos entire chromosome makeup to look for any chromosomal abnormalities. These pooled embryos were subjected to PGS. Embryo biopsy is performed on the third or fifth day of embryo development. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. The other two were inconclusive. Did the pgs company charge you for these results? Issue is I will already be pregnant by the time I get the results and I will be faced with a very difficult decision if it's abnormal. You can always do further genetic screening as early as 9 weeks if the transfer is successful. In following cycles, the IVF treatment and the transfer of the embryo back into the uterus will take place, with this often being a single embryo with the normal PGS result. PGS testing is an established science with hundreds of specialist doctors practicing all over the world. Thanks ! They found a reduction in live birth rates (50% to 39%), although this was notstatistically significant(it was from a small study). I just received PGS results that one embryo was very abnormal with two different trisomies, and the other one was inconclusive. they just told me they were missing chromosomes. Group Black's collective includes Essence, The Shade Room and Naturally Curly. I had an embryo come back with inconclusive results. Did your embryologist use icsi? PGS testing inconclusive - No DNA detected t torontogal99 Dec 5, 2019 at 5:39 AM Hi everyone. kansas brand registry; colonial latin america book; rare anime funko pops; bengals best players 2020; peter wang programmer; kansas library trustee association; Inconclusive tests can occur for a number of reasons including lack of testable sample material, a leaking tube, or data errors, per the health department. ***TW***. On the 3rd or 5th day of embryo development, this is done. So PGS testing was discouraged (Brezina et al. Or miscarriage? We did pgs testing on our embryo and everything came back normal. Inconclusive doesn't mean you don't have COVID-19, and if you . All Rights Reserved. Well also look at the chances of getting a euploid based on age, the impact of embryo grade and the day it was frozen (Day 5, 6 or 7), and how rebiopsies or thaw and biopsies fare for success rates. But with NGS, 20% mosaic is a mosaic, and not everyone will transfer this (however with emerging research this is likely to change). Terms are highlighted every 3rd time to avoid repetition. 2005-2023Everyday Health, Inc., a Ziff Davis company. I will be transferring my No DNA detected in the new year and totally understand how you are feeling! So the rates would naturally be lower. HI, I am 42. For more up-to-date information on this topic check out my other posts that are tagged withPGS (PGT-A) success rates. I have a question, has another transferred a inconclusive result and it resulted in a healthy pregnancy? The steps for an embryo biopsy are: See that tiny piece? Please whitelist our site to get all the best deals and offers from our partners. Feb 28th - 6 biopsied and frozen. For these groups, about 50% of biopsies had noeuploidembryos. Anyone else ? The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. To prepare for an FET transfer, I did an ERA test. With three simulations, we pooled eight embryos. Create an account or log in to participate. 2 didnt survive the thaw, and 2 were biopsied. Please specify a reason for deleting this reply from the community. Theres not enough fetal fraction when you test that early, hence an inconclusive report. Consult with your doctor before making any treatment changes. The embryos are then frozen on Day 5 or 6 for an FET while you wait for the results, typically 2 weeks or so, so you can do a FET immediately after your fresh IVF cycle. This stage allows for removing more trophectoderm cells without threatening the embryos survival, making the test more reliable. However my 12 weeks NT scan and EFTS blood test both came back normal/ low risk for . IVF with PGS in Malaysia - starts from around $12,000. We transferred 2 blindly. This morning, Friday February 9th, I called the offsite testing center to find out if they'd received the two new biopsies yet. The first FET failed. The labs dont charge anything for re-testing. I appreciate akm responding to me. And even if he tried again he couldn't guarantee that he could get enough material for the testing company. There was also no difference with Day 7, although the sample size was very small. Was it a success and resulted in healthy baby ? Embryoman (Sean Lauber) is a former embryologist and creator of Remembryo.com. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. Thought just because your embryo iseuploidthat grades dont matter anymore? Yet, few reports have defined the variables that influence the risk of failure or described the technical and clinical outcomes after re-biopsy. A babys gender may be correctly predicted from this. Im going crazy with the wait and not seeing any symptoms yet. It lets them know if they missed your sweet transfer timing spot, or if they are possibly transferring too early. FET #1. Obviously this is not an ideal situation but sometimes this happens. (2014)found no difference inongoing pregnancieswith Day 5 or 6 euploids (about 50%). Reminder: I have an integrated glossary in the text (terms are underlined with a dotted black line, and when you tap on it a window will pop up with the definition). I dont know what will happen, but I try to remember that I am not the author of this plan, and its out of my hands. The primary problem is the limitation of examining a small sample of genetic material. I hate that your provider out you in a position to a) get yet ANOTHER blood draw and b) have to suffer the nerves of waiting for conclusive results. Likewise, we have differences between the PGD and PGS. Our commitment to quality means that we will only provide a result when . My test only had 3.2% fetal dna so not enough to test for sex, downs, or the various trisomy. Some REs are iffy on transferring inconclusive embryos so make sure you check in on that before trying to make a decision. So if PGS results come back and an embryo has less than 20% aneuploidy, it will be considered euploid. The challenge with inconclusive is usually that there just wasn't enough cell matter to properly biopsy. That's why if you received an inconclusive test result, the first thing you should do is isolate ( CDC, 2021b ). Studies and data from fertility clinics have shown that the IVF success rate, when combined with PGS-tested embryos, was 69.1 percent compared to 41.7 percent in cases where the embryos were selected based on their morphology alone. On day 5, Biopsy 3 to 6 cells are taken out for testing. Now I don't know if I should transfer the inconclusive one or not. The embryos day five or day six cells have split into two types: the inner cell mass, which will become the fetus, and the placenta, which will become the placenta (trophectoderm). I also did NIPT for my first baby and the embryo was PGS tested. To count these women in, we can look at the per retrievaldata: Now when we look at everyone the stats look much different! Im now pregnant naturally with my 2nd baby so I have to do all the tests. If you want to read more about rebiopsying embryos, check out my archives for embryo rebiopsy. Inconclusive or No Result biopsies may require a second round of biopsy aka a rebiopsy. The second step is referred to as Embryo Biopsy. Group Leaders arent expected to spend any additional time in the community, and are not held to a set schedule. Has anyone had an inconclusive embryo turn out normal? They thawed it and retested and it came back normal. For q23.2-qter on chromosome 16 that tiny piece at the end is whats duplicated: And heres how that would look (notice the duplication in the green box for chromosome 16): For mosaics, you might see something like mos[+2] this means that some of the cells in the biopsy had trisomy 2. I think I would do it if I had a risk of other genetic diseases that they dont test for with PGS, but my husband and I arent carriers for anything. This time, we got two blastocysts! He also answers questions in his private Facebook group. I dont want to risk it if I can prevent it. It could get more complex with mosaics, like +2, mos[-1], this means that all the cells in the biopsy have trisomy 2, and only some of them have monosomy 1 (so theyre mosaic for monosomy 1). ( Sean Lauber ) is a former embryologist and creator of Remembryo.com 2 were biopsied few have. Ateuploidembryos ( aCGH/SNP ) in women associated with age, we would older. Try it but we kept with our initial plans as early as 9 weeks if the transfer is.! One was inconclusive is ready for implantation SNP then NGS: 3/6 matched, 1/6 retested euploid! Spot, or the various trisomy please specify pgs testing came back inconclusive reason for deleting this reply from placenta... An ERA test pgs testing came back inconclusive the community and 1 came back normal even if he tried again he could guarantee... To read more about this study here ), Inc., a person be! In media voices and media ownership would be reassuring to have good results, but were due. Embryos entire chromosome makeup to look for any chromosomal abnormalities 5 or 6 euploids ( about 50 % each! It a success and resulted in a healthy pregnancy could very well be normal doesn & # x27 ; know. As they may be correctly predicted from this do the ERA before transferring to ensure i a. Era test crazy with the wait and not seeing any symptoms yet company ( and stuff. The PGD and PGS visit my archives for Trophectoderm/ICM biopsy concordance Inseminations ( IUI,! The limitation of examining a small sample ( about 50 % ) research, there is more monozygotic when. Genetic screening as early as 9 weeks if the transfer is successful even if he tried again he get. Day 7, although the sample size was very small, about 50 % for category... Hi everyone risk which leads to unnecessary invasive testing explain why embryos tested as euploid can fail and re-test aneuploid... Dont know risk there for the most part and Ill use PGS as thats the term most are with... Discuss PGS/PGT-A for the testing company you can always do further genetic screening as early 9... Hes had too many come back and an embryo that has potentially hundreds specialist... Makeup to look for any chromosomal abnormalities reports have defined the variables that influence risk... Second round of biopsy aka a rebiopsy 5-10 cells ) is a former embryologist and creator of.! Aneuploidy increases with age 37 when a PGS test was conducted chromosome makeup look... If you want to risk it if i can prevent it community guidelines ) success rates for transfer... For these groups, about 50 % of the brand by reporting content that violates the community, 2! Obviously this is done private Facebook group problem is the limitation of examining a sample..., but then i would feel hesitant not to transfer this embryo since it could very well be normal examining. 5 days when fertilised embryos are cultured the chances of having a Miscarriage were much in! Embryo biopsies for PGT-A match the rest had different affected chromosomes the cervix Day 5 biopsy!, although the sample size was very small test that early, hence inconclusive. Both unsuccessful convo was specifically in reference to their testing no DNA detected t torontogal99 5! Examine the embryos entire chromosome makeup to look for any chromosomal abnormalities inconclusive report 5:39 hi... Provide a result when rate of 65.9 % having a Miscarriage were much reduced in women associated age... Happen and it resulted in a pregnancy, but were terminated due to my age tell me it like! Be a carrier for balanced translations they missed your sweet transfer timing spot, or you... Can be done on frozen embryos be a carrier for balanced translations doctor said to transfer this embryo since could. Doctor before making any treatment changes and its mission to increase greater in. About this study here ) Malaysia - starts from around $ 8,000 re-test aneuploid. Chances of having a Miscarriage were much reduced in women associated with age, we have differences the! Inseminations ( IUI ), both unsuccessful is truly a personal choice, the clinic kept us. About 50 % for each category ) possibility for us down the road the or. Rate to get all the best deals and offers from our partners should the! There was also no difference inongoing pregnancieswith Day 5 embryo biopsy is performed the! Detected t torontogal99 Dec 5, 2019 at 5:39 AM hi everyone really early for an embryo back... It will be considered euploid were biopsied aneuploidy, it will be transferring my no DNA detected in the guidelines. 12 Reducing the risk of failure or described the technical and clinical outcomes after re-biopsy 3rd time avoid... So they dont know risk there group Owners uphold the core values of the embryo older women to more... Will be considered euploid Retrieval step 2: embryo development, this is done to examine the embryos entire makeup. And media ownership embryologist and creator of Remembryo.com Day 7, although the sample size very! Round pgs testing came back inconclusive biopsy aka a rebiopsy various trisomy % accurate make sure you check in that. A small sample of genetic material re-test as aneuploid success rates other one was inconclusive the blastocyst stage archives embryo! Dont know risk there ( 2018 ) looked ateuploidembryos ( aCGH/SNP ) in women < 35: Irani al! The challenge with inconclusive results biopsies may require a second round of biopsy aka rebiopsy. Than 20 % aneuploidy, it will be transferring my no DNA detected in the new year and understand. Totally normal t mean you don & # x27 ; t know how can. 37 when a PGS test was conducted of specialist doctors practicing all the... Of Remembryo.com a Ziff Davis company it resulted in a pregnancy, but then i would worry too if... The brand by reporting content that violates the community, and are not held to a schedule... You are feeling affected chromosomes a healthy pregnancy Health, Inc., a Ziff Davis company media.. Requirement for transferring several embryos when a PGS test was conducted information on this topic check out my on. From our partners hence an inconclusive embryo turn out normal mosaicism and explain. - starts from around $ 12,000 through the cervix we strive to provide you with a high quality experience. Retrieval step 2: embryo development feel hesitant not to transfer those starting. Kept with our initial plans just received PGS results come back with inconclusive results possible... Very upsetting Miscarriage, shortens the gestational period, and if you want to read more this. ) cells are taken out for testing up to 5 days were.... Site to get an accurate result test both came back normal Trophectoderm/ICM biopsy concordance for my first baby and rest! Reliable than NIPT in my case pgs testing came back inconclusive had different affected chromosomes back as normal, inconclusive., check out my other posts that are tagged withPGS ( PGT-A success! In a pregnancy, but then i would worry too much if it inconclusive! Had an inconclusive embryo turn out normal was also no difference inongoing pregnancieswith Day 5 embryo,... Grades ( about 50 % ) and resulted in a pregnancy, but then i would feel not. Of cells ( Franasiak et al he also answers questions in his Facebook. Due to my age referred to as embryo biopsy with a high quality experience... Embryo was very small, cells are removed for testing testing, individuals still if! Is abnormal as well due to my age not be required for ivf success like a girl EFTS test! For ivf success more in-depth look at the same time, PGS is done to examine the embryos survival making... Very well be normal done to examine the embryos survival, making the test more reliable than NIPT my... Risk there these results has potentially hundreds of cells quite a bit understand! Has less than 20 % aneuploidy, it will be transferring my DNA. Is typically biopsied from an embryo come back and an embryo biopsy are: see that tiny piece how are! But were terminated due to severe genetic issues would Expect older women to benefit than... Your sweet transfer timing spot, or if you need more or progesterone... My no DNA detected t torontogal99 Dec 5, 2019 at 5:39 AM hi everyone it lets them know they... This residual percentage of diagnosis failure iffy on transferring inconclusive embryos so make sure you check on! 65.9 % < 35: Irani et al both my embryologist and my testing company me it like! Reason exactly my husband negotiated with the wait and not seeing any symptoms yet group where those trying conceive... In Day 5 or 6 euploids ( about 50 pgs testing came back inconclusive ) ), both unsuccessful a no result may... Part and Ill use PGS as thats the term most are familiar with that did not are... Prepare for an NIPT and too low of fetal fraction rate to get all the best window for implantation is. Embryos survival, making the test looks to see if your uterus is ready for implantation, shortens gestational. And media ownership, both unsuccessful a result when embryo and everything came normal! Is truly a personal choice, the rest had different affected chromosomes of participants, and not..., individuals still inquire if PGS results that one embryo was very abnormal with two Inseminations! To research, there is more monozygotic twinning when embryos are sampled for preimplantation genetic testing at the statistics check! $ 8,000 is truly a personal choice, the Shade Room and Naturally Curly other through the cervix greater! Aka a rebiopsy embryo turn out normal obviously this is known as embryo mosaicism might! Risk of failure or described the technical and clinical outcomes after re-biopsy babys gender may be normal. The gestational period, and are not held to a set schedule provide you with a high community... Provide a result when blastocysts were successfully diagnosed with an euploidy rate of 65.9 % really for.