Do you know that there are natural therapies that can help you prepare for your IVF fertility journey? In this guide I will share with you suggestions to help you best prepare for your IVF.
A note before we begin: Any of the supplements or herbs talked about in this guide should not be taken while you are on any IVF medications. This program should be completed before you begin your medications. Ideally, give yourself 90 days (3 months) to prepare with these supplements and the fertility diet before beginning your IVF medications or treatments.
Why Prepare for Your IVF?
Think of this time as “preparing of the soil”. When your IVF procedure is successful, you will be pregnant, so this is the best time to prepare your body and give your baby the best possible start. By preparing for your IVF, you are able to support your hormonal and reproductive system, nourish your body, have nutrients available during the crucial early stages of fetal development, and have the tools to handle any stress that may come your way during this journey. This is similar to when you are starting a garden… you begin by preparing the soil before the seeds are planted. You do this by removing any debris or rocks, then you add nutrients, various types of minerals and other amendments to the soil, making sure everything has been done to help the seed grow into a healthy plant. Think of your body and uterus as that soil; you want a nutrient-rich, hydrated soil that has everything that little seed will need to grow. This guide will share with you some steps you can take to prepare for your IVF in the healthiest and supportive way possible. So, let’s get started…
How to Increase IVF Success Rates
IVF success rates vary depending on many different factors including age, cause of infertility and the clinic where you are having the procedure done. In 2015, the IVF success rate for live birth was on average around 40%, with numbers going up to almost 54% for women under 35, according to the Society for Assisted Reproductive Technology.
There are many different options you can explore to help you increase your IVF success rates. Some therapies have results supported by studies while others are based on nutritional/anatomical knowledge and help by supporting the general health of the body and reproductive system. Some natural therapies like acupuncture and mind/body therapies have been shown to increase IVF success rates greatly. Below I have included the top natural options for increasing your IVF success rate naturally and how to get started.
Create a Plan Ahead of Time
In order to prepare for your IVF procedure, you will need to plan and prepare ahead of time. A general IVF cycle takes around 6 weeks from the time you begin medications and ultrasounds to the transfer of the embryo(s), so plan accordingly. If you choose to use any herbs or supplements in preparation, it is ideal to use them for at least 3 months prior to beginning any part of your IVF cycle, including the medications at the beginning. Herbs and most supplements should not be used while you are on your IVF cycle as we do not know how they will interact with the medications. Please talk with your doctor if you have any questions about this.
Another reason we suggest to take at least 3 months to prepare beforehand is because the cycle of the egg (ovum) is 90 days. This is the period of time during the egg’s journey when what you eat, drink, ingest, and breathe, your stress levels, and the health of your blood flow will all have an effect on the health of that egg. So what you eat today is impacting the egg you will ovulate or have “harvested” three months from now. So for best results prepare at least 90 days out.
Three steps to consider when preparing your plan…
Cleansing
Cleansing is an important component of preparing for pregnancy. Fertility cleansing consists of supporting the liver’s natural ability to cleanse itself as well as supporting uterine health and circulation. This in turn supports hormonal health and encourages a healthy uterine environment.
Nourishing
The second part of the program focuses on supporting egg health, eating nutritious food, taking supplements and preparing your body for pregnancy.
Nurturing
The final part of the program contains therapies specific for helping you through IVF and the stress that may be experienced once you begin medications and procedures.
All of these steps can be started at the same time and be done together.
Step 1: Fertility Cleansing & Massage For Healthy Hormone Balance and Circulation
Fertility Cleansing
Fertility cleansing is one of the best ways to “prepare the soil” before becoming pregnant. Fertility cleansing supports liver health for proper hormone balance, healthy liver function and aids in cleansing the body of environmental toxins and pollutants. Fertility cleansing also helps to support uterine health by increasing circulation, aiding the uterus in its natural ability to clear out old menstrual blood and tonifying the uterine muscles. Fertility cleansing is based on your monthly cycle and generally lasts from 25-30 days.
Fertility Massage
Massage is a natural therapy that can help you to prepare for your IVF procedure and pregnancy. While traditional massage is beneficial to reduce stress and increase circulation, Fertility Massage specifically helps to increase circulation to the reproductive system and supports a healthy ovarian-uterine environment.
There are three options when it comes to fertility massage. You can book a massage with a general massage therapist, you could find a massage therapist who specializes in Fertility Massage or abdominal massage (such as a Mayan Abdominal Practitioner) or you can learn how to massage yourself with Self Fertility Massage techniques at home.
Self Fertility Massageβ’ is a series of massage techniques that are used to help support reproductive health, the menstrual cycle, and your fertility. I created this natural fertility therapy to help women apply the fertility massage techniques for themselves.
Fertility Massage helps you to prepare for your IVF by:
- Increasing circulation to the ovaries and uterus*
- Helping to reduce stress*
- Bringing fresh oxygenated blood to the uterus and ovaries*
- Supporting hormone balance*
- Promoting egg health*
Note: Massage should only be done before beginning your IVF medications, not during. As you begin your IVF cycle with medications, you should discontinue massage because you most likely will be very sensitive in the ovarian area as your follicles/eggs mature and ovaries become larger. Also, do not do massage after transfer of the embryos or during pregnancy.
Step 2: Nourish Your Body for Optimal Nutrition With Diet, Supplements and Superfoods
The second part of this program focuses on nutrition and the nutrients you are adding to your diet. We just covered cleansing and increasing circulation to the reproductive system; this is one aspect of “preparing the soil”. Now is the time to add good things to the soil that will help the seed to thrive and grow. You can do this for yourself through diet, supplements and superfoods.
Eating a Fertility Diet
Nutrition is the foundation of healthy fertility and a healthy pregnancy. Nutrition can have a direct impact on the future development and health of your child. This is a big deal and such a great opportunity for you to prepare ahead of time.
So, what exactly is a fertility diet? A natural fertility diet is a way of eating that is supporting your body in its reproductive efforts. It includes foods which are dense in specific nutrients needed for hormonal function, production and balance, fetal development, egg health, sperm health, blood health, and much more. It is a diet that is designed to help your body to balance and support your fertility, building up nutrients stores and providing all the building blocks for a healthy child. It is also a diet that is focused on giving you and your future child the best start in life.
Benefits of eating a natural fertility diet
- Provides antioxidants, vitamins, and minerals, which help to protect egg and sperm health from damage caused by free-radicals.
- Supports the body towards normal hormonal balance by providing the fats needed for hormone production and function.
- Provides the body with an abundance of vitamins, minerals, antioxidants, and other nutrients needed for optimal health.
- Helps to provide important nutrients for early pregnancy.
Make sure you are eating a fertility diet for at least 2-3 months before your IVF as well as talking with your doctor about any preconception nutrients they would like you to take, such as folic acid or a prenatal vitamin.
Use Supporting Supplements
Prepare for Pregnancy with a Prenatal Multivitamin
Making sure your body has all of the nutrients necessary for early pregnancy is much easier when you are taking a multivitamin. My favorite is the 100% whole food Baby and Me from Mega Food. Synthetic multivitamins won’t have the same effect or absorption by the body. There are certain nutrients such as Folate that are needed by the fetus even before pregnancy is detectable. The first weeks of pregnancy are a critical time of development. Prepare for your pregnancy by taking a prenatal multivitamin.
Antioxidants
Antioxidants are one of the most important components to having healthy fertility that every woman and man needs to focus on. Antioxidants help to protect the egg and sperm from free radical damage. Free radicals are able to damage cellular health and the DNA within the cell. The ovum (egg) is one of the longest living cells in your body; as the years pass, your eggs become exposed and vulnerable to free radicals on a daily basis. This adds up!
I’ve formulated FertilicaTM Choice Antioxidants to contain the complete network of important antioxidants needed to support healthy fertility in women.This blend is great for both men and women and should be a part of everyoneβs health program, especially to help improve egg health prior to IVF.
Studies in the journal Fertility and Sterility have shown that CoQ10 Ubiquinol supplementation improves egg health and fertilization rates, especially in women over 35. A promising randomized, placebo-controlled in-vivo tudy of mice out of Samuel Lunenfeld Research Institute, Canada, showed that CoQ10 supplementation on mid-aged female mice resulted in more pregnancies and more babies per litter; “…their eggs appeared to rejuvenate. There were significantly more egg follicles in the old mice treated with the CoQ10β¦β
Researchers think that CoQ10 supplementation may help cells function more normally and divide more normally by restoring energy to the mitochondria in each cell. This is very important when considering conception and how the first stages of life are dependent on proper cell division. With IVF, doctors rely on healthy cell divisions to rate embryo quality, so they know which embryo to transfer.
There are two forms of CoQ10, ubiquinone and Ubiquinol. CoQ10 starts off as ubiquinone and then is converted within the cell to the more powerful ubiquinol. As a woman ages, her bodyβs ability to convert ubiquinone to ubiquinol declines. Almost all CoQ10 supplements available are in the form of ubiquinone. Ubiquinol is different in that it is the most biologically active form of coenzyme Q10 and does not need to be converted by the body. Ubiquinol is eight times more potent than ubiquinone. For women over the age of 35, CoQ10 Ubiquinol supplementation alongside an antioxidant blend may greatly help to improve egg health over a few months’ time.
L-Arginine
Researchers found that L-arginine, which is an amino acid can increase ovarian response, endometrial receptivity, and pregnancy rates in IVF patients who were previously poor responders. In the study, patients were given large doses (16 grams) of L-arginine daily leading up to and throughout the IVF cycle. (Published in Human Reproduction 1999).
In the L-arginine/IVF study, 34 women about to begin IVF were split into two groups. Both groups used the same flare protocol, while one of those groups received 16 grams a day of L-arginine in addition to the medications. The group that received L-arginine had a lower cancellation rate, an increased number of oocytes and an increased number of embryo transfers were observed. The L-arginine group had 3 pregnancies compared to no pregnancies in the other group. The study concluded that:
“…oral L-arginine supplementation in poor responder patients may improve ovarian response, endometrial receptivity and pregnancy rate.”
This is one study that shows promise for the use of L-arginine to help support IVF, but it is currently the only study. Discuss with your RE if this is a good option for you.
Note: L-arginine should not be taken if you have herpes as it can trigger an outbreak.
Uterine Calming Herbs for Implantation Support
One aspect of IVF that weighs heavy on a womanβs mind is implantation. Soon you will have a healthy embryo (or more) for transfer, now all that needs to take place for pregnancy to occur is implantation. A calm uterus is going to be more receptive to implantation.
The time leading up to transfer is a great time to focus on your uterus and nervous system. The herbal blend UteriCalm is an excellent way to help calm and prepare the uterus for implantation. This liquid blend contains herbs that not only calm, relax, and prepare the uterus for implantation, they work to support the nervous system, so your body will better handle the potential stress, anxiety, and worry of the outcome of this procedure. The herbs in this blend have been shown to be supportive of early pregnancy through the first trimester. In addition, none of these herbs has an action on the hormonal system, so they are considered safe in most cases* to use at the same time you are on medications for IVF.
Click here to learn more about the herbs in UteriCalmβ¦
Add Fertility Superfoods to Your Diet
Fertility superfoods are rich in nutrients and can be taken daily as food. One of my favorite ways to take fertility superfoods is to put them all in a fertility smoothie. Two of the most popular fertility superfoods are maca and royal jelly.
Maca
Maca is an incredible fertility superfood. It helps to support hormone balance yet it does not contain any hormones itself. Maca is able to do this by nourishing and balancing the endocrine system. This is essential in preparing for IVF because healthy hormonal balance contributes to healthier eggs. You will want to use maca for a couple of months before you begin your IVF medications and discontinue as soon as your medication cycles begin.
Royal Jelly and Bee Propolis
Royal jelly and bee propolis are both super foods which may help to support egg quality. Royal jelly is the food that only the queen bee eats. The only difference between a queen bee and a regular worker bee is that the queen is eating royal jelly exclusively. She was an ordinary bee and then she was chosen and fed royal jelly and became the queen bee who lays up to 2000 eggs a day. It should be taken for at least two months before IVF procedures begin and discontinued once your medication is started.
Caution: If you are allergic or think you are allergic to bees or bee products, do not take royal jelly or bee propolis.
To purchase a kit with these ingredients, click hereβ¦
Step 3: Nurture Your Body, Mind, and Spirit
I am sure I don’t have to tell you that preparing and going through IVF may be a stressful experience at times, but it does not have to be a roller coaster ride. It is important to nurture and take care of yourself when preparing and going through your IVF journey. This can be done by creating a stress support system for yourself by using tools such as visualization, acupuncture, meditation or hypnosis. Not only will it help your experience be a more enjoyable one, it may also help to increase your chances for IVF success as some of the therapies mentioned below have been shown in studies to increase the success rates of IVF.
Can stress decrease my IVF success?
Data taken from 14 studies on IVF and stress involving 3,583 infertile women showed that there was no difference in IVF success rates of those who considered themselves stressed than those who stated they did not feel a high level of stress. This may seem surprising but it does make some sense since IVF cycles use very controlled hormonal levels for their success. The strong hormonal medications used for IVF may render stress hormones less potent on fertility since the entire hormonal cycle is being controlled. While this is reassuring (no one wants to experience additional stress from being stressed) you should still consider creating a stress support system for yourself so your experience is a supported one. Studies have also shown Mind/Body therapies to increase IVF success rates greatly!
Mind Body Therapies and IVF
Mind/Body therapies use the power of thoughts and emotions to influence physical health. A study in Fertility and Sterility found a dramatic increase in IVF success rates for those who participated in a Mind Body program prior and during their IVF procedure. The study consisted of 143 women under 40 years of age undergoing IVF. Subjects were randomly put into either a mind/body program, which consisted of 10 sessions, or into a control group for two IVF cycles. First cycle success results for all subjects was 43%. Those that had finished at least half of their mind body session prior to their 2nd IVF cycle had a 52% success rate of pregnancy while the control group had 20% success rate of pregnancy. (Fertility & Sterility June 1, 2011)
This study shows a dramatic increase in IVF success for those who completed only 50% or more of their mind/body program. Imagine the success rate if they completed the entire program.
There are many different programs that can help you tap into the mind/body connection while preparing and during your IVF cycle. Below I have mentioned the ones I have found to be the best.
Circle+Bloom IVF/IUI Mind-Body Program
The Circle+Bloom IVF program consists of visualizations tailored to reduce stress and potentially increase IVF success. The program consists of 18 sessions (12-20 minutes long) which correspond to the special requirements of the medicated cycle and include special attention to the synthetic hormones, timing and procedures done during an IVF cycle.
The Fertile Mind Assisted Conception Program
The Fertile Mind program uses mind/body hypnosis techniques to help lead the body and mind to a relaxed and prepared state for IVF. This program consists of 4 hypnosis tracks that help your mind and body through each step of the IVF process – from preparation, egg harvesting, embryo transfer and the two-week wait. It also helps you to let go of any limiting beliefs, leaving you feeling more relaxed and in control of life.
Meditation
Meditation is a wonderful way to help calm the mind and balance the body. There are many types of meditation one can practice, all of them being beneficial. Meditation can be used alone or in conjunction with any of the mentioned therapies. Meditation helps to clear the mind of excess thoughts and chatter. Once you have a clear mind, you feel peace and surrender to lifeβs current circumstances, helping to make your IVF journey enjoyable and peaceful.
EFT
The theory behind EFT (Emotional Freedom Technique) is that all negative emotions are caused by a disruption in the bodyβs energy system. Therefore, by balancing the energy via the same system as used in acupuncture (the meridians), negative emotions are resolved which, in turn, can mean a change is brought about in the physiological condition of a person. The release of emotions such as fear, worry and sadness, gives way to rational and logical thinking. It can also generate feelings of great relief and lightness.
One of the reasons I really like EFT is that it can be used anywhere at any time. All that you need is your hands and knowledge of where the points are located for tapping.
IVF Counseling
Generally, when you begin your IVF journey you will be put in touch with a counselor who specializes in counseling prior and during IVF. Take advantage of this opportunity and go for it. Speaking to a counselor could help fill that gap of support that sometimes friends and family are not able to fill or understand.
Acupuncture and IVF
Acupuncture is an effective therapy that you can use in preparation, during, and after your IVF cycle. Acupuncture uses tiny, solid needles to stimulate different points in your body that help to support various systems. For fertility, acupuncture can be used to not only help with stress, but it can help support the body to overcome underlying imbalances that may keep a couple from conceiving. Acupuncture also supports and encourages egg health, healthy reproductive circulation, a healthy uterine lining, hormonal balance, and much more.
When to begin acupuncture…
When using acupuncture in conjunction with IVF, you will want to begin seeing your acupuncturist well before your IVF cycle begins, ideally 3 months before. Find an acupuncturist that specializes in infertility since they will have a deep understanding of what IVF is, can read your hormone blood tests for an understanding of your situation and can support you during critical times of your IVF such as egg retrieval, embryo transfer, and directly post transfer.
In one study 114 women with similar fertility profiles undergoing IVF were divided into two groups. 53 received acupuncture and 61 did not. The acupuncture group experienced no ectopic pregnancy (non-acupuncture group had 9%), fewer miscarriages (acupuncture group had 8%, non-acupuncture group 20%), and 51% pregnancy rate for the acupuncture group versus 36% pregnancy rate in the non-acupuncture group.
Get Acupuncture Before and After Embryo Transfer
Two studies have shown an increase of IVF success when done around the time of embryo transfer. The first study published in Fertility and Sterility showed that live birth rates doubled for those who used electro-acupuncture (also known as TEAS – transcutaneous electrical acupoint stimulation). The non-acupuncture group had 21% live birth rate and the acupuncture groups live birth rate was 42%.
In this study, 309 women between the ages of 21 and 44 undergoing IVF were randomly placed into three groups:
1. Mock/placebo group,
2. Single electro-acuupuncture treatment group – treatment was done 30 minutes after embryo transfer
3. Double electro-acupuncture treatment group – received the treatment 24 hours before embryo transfer as well as 30 minutes after transferFollowing are the clinical live birth rates:
Group 1 (mock/placebo group): 21.2%
Group 2 (single TEAS treatment): 37.3%
Group 3 (double TEAS treatment): 42%
Study 2
This 2006 study involving 273 IVF patients receiving acupuncture during embryo transfer in Fertility and Sterility showed…
Group 1: Acupuncture on day of the embryo transfer (immediately before and after transfer)
Group 2: Acupuncture on embryo transfer day(immediately before and after transfer) and again 2 days later (closer to implantation day)
Group 3: Control group, not receiving any acupuncture.Results:
Group 1: 39%
Group 2: 36%
Group 3: 26%
This study suggests that…
Acupuncture on the day of embryo transfer significantly improves the reproductive outcome of IVF compared with no acupuncture. Repeating acupuncture two days past transfer provided no additional beneficial effect.
To increase your chances even more, make sure to seek out your acupuncturist well before your procedure so they are “on call” for after the procedure; timing is crucial for this one.
Summary
I hope you have some ideas to help you create your own IVF preparation plan. Just remember that this time is such a great opportunity for you to prepare for your coming pregnancy.
Here is a quick summary of how to increase your IVF success rate naturally:
1. Make a 90-day (3 month) preparation plan – this would be for the 3 months prior to beginning medications for your IVF.
2. Prepare through cleansing and increase circulation with massage.
3. Eat a healthy fertility diet.
4. Use supplements such as a multivitamin, antioxidants, EFA & superfoods to help support egg health.
5. Create a stress support system with a mind/body program.
6. Get acupuncture in preparation and around the time of embryo transfer.
IVF is a profound procedure that is a blessing to have available as an option. Move forward feeling encouraged, empowered, and nourished on your journey.
* As always, it is best to check with your doctor before beginning any new herbal supplement.
- Levitas E, Parmet A, Lunenfeld E, Bentov Y, Burstein E, Friger M. and Potashnik G. (2006) Impact of hypnosis during embryo transfer on the outcome of in vitro fertilization embryo transfer: a caseΒ control study. Fertility and Sterility, 85(5): 1404Β8. Retrieved from: https://www.fertstert.org/article/S0015-0282(06)00077-X/fulltext
- Paulus, W.E.., Zhang, M., Strehler, E., ElΒDanasouri and E., Sterzik, K. (2002) Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility and Sterility. Vol 77, No 4. doi:10.1016/S0015Β0282(01)03273Β3 Retrieved from: https://www.fertstert.org/article/S0015-0282(01)03273-3/fulltext
- Powell, A. (2005) Harvard, MGH researchers track egg cell production to marrow. Researchers restore egg production in sterile mice. Harvard University Gazette. Retrieved from: https://news.harvard.edu/gazette/story/2005/07/harvard-mgh-researchers-track-egg-cell-production-to-marrow/
- Burstein, E., Perumalsamy, A., Bentov, Y., Esfandiari, N., Jurisicova, A., & Casper, R. (2009). Co-enzyme Q10 supplementation improves ovarian response and mitochondrial function in aged mice. Fertility and Sterility, 92(3). doi:10.1016/j.fertnstert.2009.07.121 Retrieved from: https://www.fertstert.org/article/S0015-0282(09)01557-X/fulltext
- Gougeon, A. (1986). Dynamics of follicular growth in the human: a model from preliminary results. Human Reproduction. 1(2):81Β7. Retrieved from: https://academic.oup.com/humrep/article-abstract/1/2/81/917818
- Meissner, H.O., Kapczyski, W., Mcisz, A. and Lutomski, J. (2003). Use of Gelatinized Maca (Lepidium peruvianum) in Early Postmenopausal Women. International Journal of Biomedical Science. 1(1): 33β45. Retreived from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3614576/
- Muller V. (1997) Maca in Hormone Replacement Therapy. Whole World Botanicals Report. 1Β7.
- Muller V. (2002). South American Herb Maca as Alternative to Hormone Replacement Therapy. βWhole World Botanicals Report. Retrieved from: http://kokming.com/smsmaca/MacaasAlternativetoHormoneReplacementTherapy.htm
- Walker M. (1998) Effect of Peruvian Maca on Hormonal Functions. Townsend Letter for Doctors and Patients; 11:18.
- Scibona M, Meschini P, Capparelli S, Pecori C, Rossi P, Menchini Fabris GF. (1994) LΒ arginine and male infertility. Minerva Urol Nefrol. Dec; 46(4):251Β3. Retrieved from: http://www.altmedrev.com/archive/publications/5/1/28.pdf
- Westphal LM, Polan ML, Trant AS and Mooney SB. (2004) A Nutritional Supplement for Improving Fertility In Women. J Reprod Med. Apr; 49(4):289Β93. Retrieved from: https://pdfs.semanticscholar.org/0431/59300feb0bb91ff7ba3a208b5b2da5c7e73f.pdf
- Packer, L., & Colman, C. (2001). The antioxidant miracle: Your complete plan for total health and healing. New York: Wiley.
- Bowden, J. (2017). The 150 healthiest foods on earth: The surprising, unbiased truth about what you should eat and why. Beverly, MA: Fair Winds Press.
- Battaglia, C., Salvatori, M., Maxia, N., Petraglia, F., Facchinetti, F., and Volpe, A. (1999) Adjuvant LΒ arginine treatment for inΒ vitro fertilization in poor responder patients. Hum. Reprod. 14 (7): 1690Β1697. doi:10.1093/humrep/14.7.1690 Retrieved from: http://humrep.oxfordjournals.org/content/14/7/1690
- Domar, A. Ph.D., Rooney, K., B.A., et el., (2011). Impact of a group mind/body intervention on pregnancy rates in IVF patients. Fertility and Sterility. Volume 95, Issue 7, Pages 2269β2273. doi:10.1016/j.fertnstert.2011.03.046 Retrieved from: https://www.fertstert.org/article/S0015-0282(11)00476-6/fulltext
- Zhang, R., Feng X.J., Guan, Q., Cui, W., Zheng, Y., Sun, W. and Han, J. (2011) Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placeboΒ controlled study. Fertility and Sterility. Volume 96, Issue 4, Pages 912Β916. doi:10.1016/j.fertnstert.2011.07.1093 Retrieved from: https://www.fertstert.org/article/S0015-0282(11)02190-X/fulltext
- Westergaard L.G., Mao Q., Krogslund M., Sandrini S., Lenz S., Grinsted J. (2006). Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and Sterility. May;85(5):1341Β6. doi:10.1016/j.fertnstert.2005.08.07017. Retrieved from: https://www.fertstert.org/article/S0015-0282(06)00212-3/fulltext
- SART CORS. (2015). Clinic Summary Report: All SART Member Clinics. Retrieved from: https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
