The anniversary of 3/8/09.

It’s a date that won’t ever go by without me remembering the events of that day.

It was the turning point of my journey through infertility.

It was the day that separated infertility treatments and adoption.

It was a devastating day for me.

It was the platform God used to perform a miracle …

The Miracle of Little Bug.

On that day, March 8, 2009, I didn’t know how I was going to make it past that day, but now, two years later, I look back on that day with thanksgiving in my heart.

If God had allowed that IVF cycle to produce more than just The Lone Ranger, or if God had prompted us to give IVF another try instead of turning in adoption paperwork a month and day later, I wouldn’t be the mother of this precious little girl.

God knows what He is doing! I will be the first to admit that I questioned God on that day. Nothing made sense on March 8, 2009. Nothing.

There were tons of people praying during that IVF cycle. We had already gone through three failed IUIs. Four months prior, I had undergone surgery to remove endometriosis. My doctor had given me high hopes of finally achieving a pregnancy with this IVF cycle.

And then everything that could possibly have gone wrong, went wrong! I left the doctor’s office a total mess, totally clueless what God was doing and with my head filled with a million and one Why? questions.

And then, just when things couldn’t get any worse God was asking me to lay my desire for pregnancy at His feet and pursue adoption immediately.

What? Are you crazy, God? Don’t you know this has been my desire since I was a little girl? Surely, you are not serious about this?!?!

Oh, He was serious alright. I knew there was not going to be another try at IVF.

I praise God that He didn’t make me wait long to find out just what He was up too.

Twelve weeks later, instead of staring at a tiny, flickering heartbeat on an ultrasound screen, I was staring at this:

Many are the plans in a man’s heart, but it is the Lord’s purpose that prevails. Proverbs 19:21

Staring at Little Bug’s tiny little face almost two years ago allowed me to see why I had to live 3/8/09.

Oh, God’s love for us is deeper and wider than our human minds will ever be able to fully comprehend!

I praise Him for this journey!

Four and a half years of trying to have a baby while battling infertility. Four cycles of IVF. Three beautiful embryos were placed in her womb during her fourth, and final, chance at IVF. They were the best embryos they had ever had and they were so hoping this would be their miracle.

But today her beta came back as negative.

Man, why do people have to go through this?!?!

And then an even weirder, odder question is this:

Why didn’t I have the chance to go through that?

I know that calls for a little explanation.

You remember March 8th, 2009, I was told IVF wouldn’t even help me conceive. Truth be told, I’ve always been a little leery of that “diagnosis” because it wasn’t my RE who told me that – it was the other RE in the practice because my RE wasn’t on call that fateful day. Logic tells me that obviously the other RE knows what he’s talking about because he’s been doing this since before I was born. But my heart wants to cling to the hope that maybe, just maybe, he was wrong and my RE could figure out something that just might work to finagle around the obstacles the other RE says make conceiving through IVF very unlikely because he’s the best RE in the entire Universe.

And so, as the time approaches for us to start thinking (yes, thinking, not necessarily wanting…yet ) a second child, I can’t help but let my mind wander.

There are so many stories out there of women who had a poor response many times but, finally, after three, four, five tries, they got their miracle.

T’s blog is private, but her story is amazing. After many tries at IVF her last try was filled with miracle after miracle! It was her last try. She went it to it knowing if this failed, they had done everything possible to try to conceive. They prayed for a miracle as they had done with their previous cycles. She was a poor responder, but this final cycle, they had beautiful embryos transferred. More beautiful than they ever imagined. Beta day came and her beta was negative, however, against all odds, the clinic called her back several days later and told her there had been a mistake in her first beta and they needed to recheck her. Trying not to get her hopes up, she went in for another beta draw. And lo and behold, that beta came back indicating she was pregnant! Her numbers were extremely low, but with every beta draw after her second one, the numbers kept doubling and tripling. Around 5-6 weeks into the pregnancy she saw the most miraculous thing on the ultrasound screen: the tiny, healthy heartbeat of her precious baby!

So how does all this tie into me?

I honestly don’t know at this time.

I’m trying to figure it out myself as I seek the Lord about why He has me wondering about all this.

I guess, if I could have things my way (which I know full well may not be God’s way AND I know full well that I ultimately desire God’s Will because I know full well HIS WILL is best and perfect and better than anything I could ever wonder or dream about) I wish I could have a second try at IVF.

We didn’t give IVF another thought after our first cycle where I responded very poorly and we ended up converting to an IUI mid-cycle. The reason we didn’t give IVF another thought is so obvious now.

At the time, getting up from that examination table and walking away from it all just like that was nerve-wracking and it felt like I was just giving up prematurely.

But I knew I had to say no to another try because of one reason:

God was telling us to move to adoption because he wanted to give us Little Bug!

Obviously, what I am saying here is I do not, for a second, wish we had given IVF another try back in the Spring of 2009 because I would not ever trade my Little Bug for 10 biological children!

What I am saying is this: When I think of adding to our family, excitement pours into my soul because now, more than ever, I know God has another miraculous plan ahead for us in building our family and I am so excited to see where He takes us on our journey to #2. I am not naive to think the journey will be filled with only joy and no heartache and pain. Unfortunately, when you mix infertility and trying to add to your family, there is bound to be some pain and heartache along the way. But now, more than ever, I know God has a plan bigger and better than all the pain and heartache I will ever experience in my lifetime. I know that what is required of me on my journey to #2 is trusting God and patiently waiting for Him to reveal HIS PLAN. The waiting is bound to get hard (waiting is never easy!) but every day I will have a blue-eyed, blonde haired little reminder that His ways are perfect and His timing is impeccable.

So I guess, right now, my heart is just open. Open to whatever way God would choose to add to our family. I wouldn’t say any of this stems from a desire to experience pregnancy but it stems from a curiosity and wondering if what I was told on March 8th, 2009, is really what would have happened had we pursued another IVF cycle.

Which means all this will probably be just what it is today: my wonderings. Because I can’t see giving IVF another try simply because I am curious to see what the outcome would be. That is how I know this is not a “pregnancy desire” speaking. Sure, if I was told I could do an IVF cycle free of charge, I don’t think I’d have to think twice about jumping on that offer! But, we all know IVF isn’t free.

And so, I guess I will always just wonder. But I can live with that because I do believe if God wants to build our family by a biological child, He most certainly does not need IVF to do it.

My God (our God!) is just awesome like that.

I did that last night and came across something I wrote back in February of this year. I was days away from starting my March 2009 IVF cycle.

Here is a piece of what I wrote:

I feel so weak right now. Honestly, I feel like I want to run to the side line and quit. I’m scared and nervous. I want everything to go perfectly and at the end of the month I want to finally see two pink lines and one word: PREGNANT. But I may run this race at full speed and not end up with that result.

It’s all about focus and keeping my eyes on the Lord. I can’t take my eyes off for a moment or I will stumble.

I can do all things through Christ who gives me strength. I can do whatever is coming my way in God’s strength. Whatever God is going to ask of me next I know He will equip me with the strength and power – HIS STRENGTH AND POWER – to do it.

God, I want a baby at the end of this marathon!! But not my will, Lord. Not my will. May Your will be done.

On this very night I surrender this cycle to you, God. When something “doesn’t go right” I can know I’m not the one in control. You are.

God, give me strength to run this race in a way that only serves to point people to You. I pray this IVF cycle will be used for your glory.

The time has come. It is time to do IVF. I’m at the starting line just about to take off.

This sentence stuck out to me: When something “doesn’t go right” I can know I’m not the one in control. You are.

Every single aspect of my IVF cycle went wrong! Nothing went my way at all!

But, I wasn’t the one in control and neither was my doctor.

Through that situation I have learned that when life seems to be falling apart (and that is certainly how I felt as I learned IVF wouldn’t even work for us), God still has a plan. Sometimes God has to take us to rock bottom before revealing that marvelous plan.

We can find rest in that we don’t have to be in control of anything! God hung the moon, rotates the earth and keeps the universe in order. He has a plan for our lives even when it seems nothing is going right.

God had a plan for me that went beyond a successful IVF cycle.

And now, six months later, I wouldn’t take a successful IVF cycle over what God gave me for anything!

I’ve spent a lot of time lately going back and reading previous posts in the blog and the personal journals I have kept throughout this time.

Here is the unedited version of what God laid on my heart and spoke to me on March 6th…

It is quiet. The girls are in bed, the dishes are washed and put away, the toys are cleaned up. All is quiet. So peaceful and quiet. I can feel God calling saying, “Just be still and know that I am God.”

Know that I (God) love you and created your very life for a purpose. And in order for your life’s purpose to be played out in the way I have planned since time even began, you must trust me and follow my leading. Know that I (God) have a plan for you concerning infertility and motherhood that is far greater than anything you, or anyone else on this earth, could plan for you.

Know that I (God) have placed this strong desire in your heart to be a mother to many children. I created and molded you that very way so that I (God) could take your deepest desire to be a mother, give you infertility and use your infertility to mold and shape your character and your dependency on me. I know once you are dependant on me and trust me with all your heart, it is then that I can bring about the fruition of the marvelous plan I have for your life.

Know that I (God) am with you wherever you go – even as you walk and climb the mountain of IVF. I am here. I travel with you. You are not alone, so do not be afraid. Take my Word and bind it to your heart so that when Satan tries to attack, you will have weapons against him.

And don’t forget for one moment … this battle is already won and you are the winner! Keep your eyes on Me and I will bring you through this valley so you will one day stand upon the mountaintop with Me.

I think it should be noted that it was exactly a week later (March 13) that Satan attacked me like he’s never attacked before.

I believe the message here is that God is at work, even when at the time we see no evidence of that.

Today it measured 15mm.

I am waiting for a nurse to call and let me know when I am to have the hCG injection (to induce ovulation) and when the IUIs will be.

For now, I leave you with a post I actually wrote on Saturday. I think this post will help you understand the biggest factor for us in deciding if we should try another IVF ovarian stimulation and hope and pray for more follicles.

*****

Some people call IVF “playing God”.

I, however, see IVF as a genius medical intervention that allows a woman to essentially combine a number of menstrual cycles into one, thus allowing the medical field to sift through the harvested eggs and then embryos and find the ones that have the most potential to produce a viable pregnancy.

In order to understand why I do not believe doing IVF “plays God” in any way, you need to first understand what naturally occurs in a fertile couple trying to conceive.

I’ve mentioned that I am reading the book In-Vitro Fertilization: The ART of Making Babies by Geoffrey Sher, M.D. in a previous post. (Excellent book!) When I read the part of the book about natural conception, it blew my mind away and helped me realize that IVF adapts the principals of human reproduction to achieve pregnancy in a faulty reproductive system!

Only about one out of every three embryos implants in the uterus long enough to delay the menstrual period. This means, in two out of every three pregnancies, a woman is not even aware conception has taken place! (Sher, 2005, page 29)

The actual fertilization process is such a complex process that many times egg and sperm do meet but something goes wrong in the fertilization process and the embryo is just not capable of producing a viable pregnancy. In other words, the woman has conceived, but she will never know it! In other cases, a woman may miss her period, but will have a very early miscarriage because the embryo isn’t capable of producing a viable pregnancy (among other reasons also mentioned in the book).

One reason IVF gets a bad reputation from some people is because people have a problem with embryos being discarded. (Please understand I am not referring to discarding frozen viable embryos.) Maybe people would have a different point of view if they understand the high rate of embryo wastage and early miscarriages that occurs even in natural conceptions!

These facts should only encourage someone standing on the brink of an IVF cycle.

While a woman’s natural menstrual cycle produces on average one mature follicle, a woman (under the age of 40) undergoing IVF produces an average of 10-15 follicles. (Sher, 2005, page 63) The way I see it, IVF essentially takes approximately a year’s worth of monthly menstrual cycles and combines them into ONE cycle.

For example, let’s say a woman undergoes IVF and at retrieval, twelve follicles are aspirated from her ovaries. Of those 12, maybe only 10 follicles actually contain a mature egg. Of those 10 eggs, let’s say 8 fertilize normally after being left overnight with sperm in a petri-dish.

Of those eight fertilized eggs, more than likely, a number of them will not continue to grow and divide properly and will not be able to produce a viable pregnancy. These embryos would be the ones in a “natural conception” that would float around in the woman’s reproductive tract but would not implant for one reason or another.

In an IVF lab, embryos are carefully monitored. When the embryologist finds embryos that are not growing after several days, the embryos are discarded just like non-viable embryos are discarded in nature without the woman ever even knowing she has conceived. In the example, let’s say of the eight fertilized eggs, three of the embryos stop growing by day three after retrieval. We are now left with five embryos.

The remaining five embryos continue to grow in the IVF lab and are carefully monitored for proper growth and cell division. On day five after retrieval, the embryos are now at the blastocyst stage and embryologists look for the healthiest embryos to transfer to the woman’s uterus.

If this example was me, most likely at my age of 27, the two most viable embryos would be selected for transfer. The remaining three embryos would stay in the IVF lab and would continue to be monitored. Let’s say of the three remaining embryos, one stops growing and there are two viable embryos left. Those two embryos would be frozen for a future IVF cycle and considered an added “bonus” to the overall IVF cycle.

Do you see how IVF weeds out the follicles with no eggs, the eggs not capable of normal fertilization and the embryos not capable of producing a viable pregnancy (most likely because of a chromosomal defect that occurred during the very complex fertilization process) in the time span of one month compared to the many more months it would take for a woman’s natural menstrual cycles to do the same?

Playing God? No.

In my own personal infertility case, we believe our ability to do IVF is a gift from God. It is a well-known fact that the largest playing factor in ANY woman’s fertility is her AGE. Throw endometriosis into that mix and that woman’s biological clock is ticking louder than Big Ben because it is also believed that egg quality in a woman who has (or has had) endometriosis declines sooner than a woman who has never had endometriosis. At the age of 27, I am standing in my “window of opportunity” to conceive and give birth to a biological child. That God would put together every necessary detail to proceed with IVF at this particular time in my life is nothing short of a miracle, in and of itself.

We see this IVF cycle as a blessing from God in that IVF will allow me to harvest a number of eggs, and hopefully, at the end of this month end up with at least one viable embryo capable of implanting in my uterus and producing a viable pregnancy.

There is something else that must be taken into consideration when doing IVF. At the end, when it comes to transfer time, it is not so much the number of embryos that you have available to you, but your embryo quality, that is extremely important.

In other words, while I am praying earnestly for “lots of follicles to be retrieved”, in the end our goal is not “lots of embryos in the IVF lab” but “several GOOD QUALITY embryos available for transfer”. I would rather only have two perfect, good quality embryos at transfer time than TEN not-so-good or even poor quality embryos.

The simple fact here is that we need “lots of follicles” to start with in order to increase the odds of weeding out the “bad eggs” and continuing the IVF process with the “good eggs”.

It is not the number of embryos you have at the end of an IVF cycle that matters – it is their viability that makes all the difference in whether the IVF cycle ends in a pregnancy or not.

That and, of course, if God wills to bring another life into the world. Even taking all the meds required for an IVF cycle, harvesting many eggs and paying the big bucks to do the cycle does not guarantee a pregnancy.

In an IVF cycle, God is still the creator and sustainer of life and He will never hand that role over to any medical professional.

*****

Side Note:

Knowing what we know now, apart from a miracle of God, my ovaries are never going to produce enough eggs for my IVF cycle to mirror that of the example I gave above. Dr. L predicts, if we choose to go through IVF ovarian stimulation again, we can expect no more than three follicles to mature.

If even one, two or three follicles mature, are retrieved, fertilized and even produce one viable embryo, we have good odds of a pregnancy.

The thing is, we won’t know the quality of the eggs in the follicles until the follicles are retrieved. Retrieval is one of the most expensive aspects of IVF, which is why we cancelled before retrieval this time. At this point, I can’t justify going to retrieval for one follicle that may or may not have an egg in it!

I know God has placed this deep desire in my heart to be a mother. There is no experience that can possibly compare to pregnancy and childbirth. I was the little girl growing up with pillows constantly shoved up my shirt playing “pregnant” and dreaming of the day I would actually “have a baby in my tummy”.

I think it is pretty obvious that I am willing to fight and do whatever it takes to make this dream become a reality. However, I am surrendered to the fact that my dream may not be God’s marvelous plan and ultimately, I desire His plan, not mine.

Until He says “stop”, I will persevere and claim the promise found in Psalm 37:4.

Delight yourself in the Lord and he will give you the desires of your heart.

It’s no joke that the road of infertility is full of ups and downs. While yesterday was probably the lowest of the lows for us in our journey so far, I still found myself watching the clock and waiting for the day to end so a new one could begin.

I know a new day signifies a fresh outlook and while we never assumed the outcome of our first attempt at IVF would be this bad, we can only move forward from here and deal with the new set of circumstances that have been given to us.

I decided long ago that I am going to choose to set my mind on God and not my circumstances that seem to grow dimmer and dimmer with each passing treatment.

However, this blow knocked me down hard. Yesterday put me that much closer to the reality of having to accept that I may actually never be pregnant and give birth to a baby.

But yesterday also made me realize once again that I am not in control here and neither is my doctor. God is in control and yesterday did not take Him by surprise at all.

Now, more than ever, I must trust that God has a perfect plan that somehow involves the bleak circumstances of yesterday. If I don’t believe that simple truth, I literally have nothing.

As for now, we are converting this IVF cycle to an IUI. I will go in tomorrow at 8am for another ultrasound to monitor what this solo follicle hanging out in my left ovary is doing. I’m predicting (based on how the three IUIs before surgery went) that we will be ready for insemination towards the end of this week. Assuming, of course, that this one follicle doesn’t decide to take a leave of absence as well.

Honestly, I’m not allowing myself to think too much about this IUI and the possibilities that lie within. I just can’t allow my mind to think that this could be it.

As far as our next step beyond an IUI goes … we are once again at a crossroad of decision-making and need your prayers as we make (another) big decision.

When not-so-great odds, a huge sum of money and a deep desire to be a mother are all thrown into making one decision, it makes for a very complex decision to be made.

I know without a shadow of doubt that the prayers of many faithful prayer warriors is what pulled me through yesterday. Thank you, from the bottom of my broken heart, for all the prayers, comments, emails, Facebook messages and phone calls.

I could never convey to you in words how much it means to me to know that I have an army of prayer warriors lifting me up to the Father on a consistent basis – especially on a day like yesterday when I literally just didn’t know what to pray.

We will probably never fully understand this side of heaven the complete impact your prayers have made.

But I am completely confident that one day we will all be able to look back on this entire journey and see a beautiful outcome that is far better and far greater than anything we can even imagine today.

I, for one, am looking forward to that glorious day!

There is still just ONE follicle in the left ovary … only. When Dr. F was doing the ultrasound and found the one follicle only, I told myself I needed to remain calm so I could clearly think and ask questions.

I was thinking, This is not the results we were expecting but we can try again and hope for a better response next time.

And then Dr. F began to explain something called a hypothalamic component and the world began to unravel all around me.

When someone (like me) is underweight the part of the brain responsible for FSH and LH production shuts down. FSH and LH are the hormones that are responsible for stimulating follicles to grow and mature. This is something that has been around since the prehistoric ages to prevent a “starving” species from being able to procreate.

Dr. F said that with my particular circumstances the normal range of number of eggs retrieved during an IVF cycle is anywhere from 0 to 6. I definitely fall into that range with only one follicle maturing.

I immediately told Dr. F that I wanted to cancel this IVF cycle. There is no way I am paying these big bucks for one egg. Dr. F told me they have gone through with an IVF cycle before with low egg numbers and have still been able to achieve a pregnancy.

Let me just say that I was prepared to go in there and have only 1 or 2 or 3 eggs. My gut feeling was that my ovaries were not producing what they should for an IVF cycle and we would just adjust my protocol and try again later.

However, I was not prepared to hear that because of this hypothalamic component, the best we can hope for at this point is 2 eggs, possibly 3 even with all the IVF ovarian stimulation meds.

The tears won’t stop because for the first time it is looking like I just may have to give up on this dream I’ve had since childhood to conceive, be pregnant and give birth to a baby who is half me and half my husband, yet uniquely an individual person.

I can’t explain how I feel other than to say that it feels like a death has occurred in the family.

I know it’s not all over yet. However, things are growing more and more grim by the day that I will ever actually have life growing inside of me.

The plan for now is to convert this IVF cycle into an IUI cycle. I would like to discuss my options with Dr. L on Monday as he was not on call today. I am grateful for Dr. F’s input and am anxious to know what Dr. L’s opinion is. It never hurts to hear the opinions of two excellent doctors.

This is one of those very dark days. However, I can still see a glimmer of hope found in God’s Promise in Jeremiah 29:11.

“For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.”

I still firmly believe that with all my heart and know one day I will look back on this day and see once again the faithfulness of God iron out all the wrinkles of a very ugly day.

I think it can go without saying that I need prayers, but I’ll say it anyway. I need your prayers.

Please pray for wisdom to know if we should shoot for another IVF cycle in June and hope for at least a few more eggs or if we should throw in the towel and seek other options that are equally overwhelming to think about.

I never imagined on March 7, 2008 that this blog would …

• become an integral part of my infertility journey.
• be a place for me to sort through the many thoughts and feelings that accompany something like going through infertility.
• be a place for me to be a witness to anyone who reads that God IS faithful through even the darkest trials life has to offer.
• connect me to many incredible other women walking this road.
• be the “Command Center” for initiating masses of people to pray me through this season of my life.

Honestly, I started the blog because I wanted a place for family and friends to come to receive updates so I wouldn’t have to spend hours on the phone giving updates after doctor appointments!

And, as always, God’s plan for this blog has turned out to be way better and way bigger than anything I could have planned one year ago today.

*****

After injecting ALL OF THIS into my stomach twice daily for the past week, there have GOT to be follicles growing in there somewhere.

Don’t forget to pray the game of hide-n-seek ends tomorrow as I go in for another ultrasound.

*****

To anyone reading this and facing self-inflicted IVF injections in the near future, after a week of them, I can still say it really isn’t bad at all!

The injection sites do become tender after a couple of days and your stomach will begin to look like a pin cushion but other than that, it’s really no big deal.

Amazing, even if I do say so myself!

*****

I haven’t really allowed myself to do much thinking in the department of “If this works …”

But, if this works in one month from now I will actually be pregnant.

If this works, I will celebrate my 28th birthday 3-months-pregnant.

If this works, this Christmas will be spent with a newborn in the house.

It’s nice to think this way, but I can’t leave my mind there. For now, I must focus on one day at a time and I’m not quite there yet.

But it is, however, nice to allow myself to think about that if only for the few minutes it has taken me to write these sentences.

It’s like a spring flower shooting up after a long cold winter.

My time will come. All this is but for a season. This I do believe with all my heart … I will be a mother, one day.

*****

What would I do without my IVF Verses Scrapbook?

Flounder around aimlessly and drown in a sea of worry, I suppose.

Now right ovary needs to kick into gear!

Thanks for praying.

I am at peace with whatever the outcome of Sunday’s ultrasound is.

Just keep up the prayers and pray there will be enough follicles playing the game to continue past Sunday.

Again, I cannot say it enough …

Thank you so much for your prayers and support.

Estrogen level = 40

In the words of my nurse, “That’s on the low side, but it’s okay because it means you definitely don’t have a dominate follicle in there.”

At that point I am thinking, Well I’d just like to know that there is a follicle in there and having, you know, maybe TEN would be fine and dandy considering I AM DOING IVF!

Of course I didn’t say that, though!

So here’s the deal: Dr. L increased my menopur dosage to 375ui every night. Follistim is still the same dosage (100ui every morning). I will go in on Sunday at 9am for another ultrasound.

PLEASE PRAY MANY FOLLICLES ARE FOUND AND GROWING ON SUNDAY!

So tonight was Freak Out Session One for IVF. I basically second guessed my protocol because of things I’ve researched and from what someone else told me. The Freak Out Session eventually brought me to this conclusion:

I need to stop thinking, stop researching and just trust that Dr. L knows what he’s doing. I know he knows what he’s doing. That’s why I chose him as my RE! After all, he is a doctor that went through the schooling to learn what he knows and is even now involved in many research projects. This doc knows his stuff. I have to trust that 100ui of Follistim and 5 vials of Menopur are just what my ovaries need to produce some follicles.

End of discussion. End of Freak Out Session.

The comments received today were the icing on the cake and just what I needed to hear tonight to help get my mind refocused. So, THANK YOU to everyone who commented in one way or another. Thank you to everyone who prayed. God is still at work. God is ALWAYS at work – even when it seems your follicles will never grow!

I finished my “IVF Verses Scrapbook” today. Just in time to look over it and read God’s Word and allow it to soak in and put my mind at ease! If only I could resort to doing this before resorting to a Freak Out Session! I don’t know if that will ever be possible this side of heaven.

Keep the prayers coming. IVF is definitely an uphill battle all the way but I WILL persevere.