Intracytoplasmic sperm injection - Medicow
About us  |  Why use us?  |  Press  |  Contact us

 

Topic: Intracytoplasmic sperm injection


  
 ART Fertility Treatment: GIFT, ZIFT, IVF, ICSI
Sperm can also be aspirated from the testicles in a surgical procedure called testicular sperm aspiration, or TESA.
One procedure called microsurgical epididymal sperm aspiration, or MESA, is used when sperm are unable to move through the genital tract due to uncorrectable blockage, congenital absence of the vas deferens or seminal vesicles.
When there is an absence of sperm in the ejaculate, surgical extraction procedures are performed.
http://www.fertilitext.org/p2_doctor/art.html   (1715 words)

  
 Intracytoplasmic Sperm Injection (ICSI)
One sperm is then gently inserted into the egg using a very small needle.
The one group of patients that professionals are somewhat concerned about, however, are the men whose sperm are low in number, have poor motility, and have poor morphology, for no obvious reason.
Our experience in the lab has also shown us that sometimes even though sperm parameters are within our subfertile range, fertilization may occur, contrary to our predictions.
http://www.vmmc.org/dbFertility/sec419.htm   (938 words)

  
 ICSI IVF for Male Infertility
The sperm is injected in to the cytoplasm and the needle carefully removed.
This needle is then carefully inserted through the zona (shell of egg) and in to the cytoplasm of the egg.
There is no "standard of care" in this field of medicine regarding which cases should have the ICSI procedure and which should not.
http://www.advancedfertility.com/icsi.htm   (732 words)

  
 Male Infertility Program at GIVF
A tiny needle is used to extract sperm directly from the testis.
For many men, non-surgical sperm aspiration eliminates the need for vas reversal surgery.
The technique will be immensely helpful to men who have had vasectomies and later decide that they want to have children.
http://www.givf.com/male_inf1v.cfm   (1025 words)

  
 Fertility Centre: ICSI (Intracytoplasmic Sperm Injection)
Sperm microinjection, better known as ICSI, is a technique that allows infertile couples with male factor infertility to have genetically-related offspring.
The technique was researched for many years, but it was only in late 1993 that a group of Belgian scientists demonstrated ICSI’s safety and effectiveness even in previously hopeless cases of severe sperm problems.
In fact, only the microinjection aspect of this technique, done in the laboratory, differs from conventional in vitro fertilization.
http://www.conceive.org/eng/programs_ivf_icsi.htm   (303 words)

  
 ICSI Intracytoplasmic Sperm Injection IVF
In ICSI, PESA procedure, a small needle is placed into the epididymis using local anesthesia and sperm are withdrawn.
No treatment of the female should begin until her partner has had a thorough semen analysis.
These techniques are relatively simple, the equipment required is minimal and the procedures are much less invasive than the previous microsurgical approaches.
http://www.havingbabies.com/icsi.html   (574 words)

  
 Intracytoplasmic Sperm Injection ICSI
In any field of medical research, success is often measured in minute degrees, the impact of which may only be known to those whose careers are spent in the laboratories.
ICSI is performed by the embryologist, who surgically inserts one sperm into each egg.
This procedure has revolutionized the treatment of male infertility since it allows couples to achieve fertilization, even when only a few sperm are available.
http://www.reproductivegenetics.com/icsi.html   (367 words)

  
 American Pregnancy Association: Infertility: Intracytoplasmic Sperm Injection
A tiny needle is used to extract sperm directly from the testis.
Azoospermia is a condition where there is no sperm in the male’s ejaculation.
The sperm is injected into the cytoplasm and the needle is carefully removed
http://www.americanpregnancy.org/infertility/icsi.html   (675 words)

  
 Intra Cytoplasmic Sperm Injection
The sperm is deposited deep inside the egg and the empty needle is withdrawn.
Your sperm sample is processed to recover the strongest and best swimming sperm to be used to inseminate the eggs.
All couples having IVF treatment will have their sperm sample analyzed by the laboratory staff.
http://www.embryo-adoption.org/articles/pages/icsi.php   (996 words)

  
 The Risk of Major Birth Defects After Intracytoplasmic Sperm Injection and In Vitro Fertilization New England Journal ...
Such defects were diagnosed by one year of age in I infant in the intracytoplasmic sperm-injection group (0.3 percent), 7 infants in the in-vitro-fertilization group (0.8 percent), and 25 infants in the natural-conception group (0.6 percent).
When the nine infants with known inherited conditions and the seven with metabolic disorders were excluded from the analysis, the overall prevalence of birth defects was 8.0 percent in the intracytoplasmic sperm-injection group, 8.5 percent in the in-vitro fertilization group, and 4.0 percent in the natural conception group.
When infants with these conditions were excluded from the analysis, the odds ratio for a major birth defect was 2.5 (95 percent confidence interval, 1.6 to 4.0) in the intracytoplasmic-sperm-injection group and 2.2 (95 percent confidence interval, 1.6 to 3.0) in the in-vitro fertilization group.
http://www.mindfully.org/Health/2002/Birth-Defects-ISI-IVF7mar02.htm   (4387 words)

  
 Fertility treatment: Intracytoplasmic sperm injection (ICSI)
If there isn't enough sperm in your ejaculate, your doctor will remove some from your testicle with a needle.
Though the technique is still new and many clinics don't yet offer it, about 7,000 ICSI babies are born each year in the United States.
Your doctor will give your partner an anesthetic and remove her eggs from her ovaries by inserting a needle through her vaginal wall.
http://www.babycenter.com/refcap/preconception/fertilityproblems/4097.html   (1135 words)

  
 Johns Hopkins Reproductive Endocrinology and Infertility - ART Technology
You can bring someone with you who will be giving you the injections, if so desired.If, at any time, you have concerns or second thoughts about being an egg donor, please contact someone in our office.
Viable embryos not utilized during an IVF procedure may be frozen for future transfer into the uterus.
Therefore, any babies that may result from this treatment would carry the genetic material of the father but not of the recipient mother.
http://womenshealth.jhmi.edu/rei/conditions/art_techology.html   (1917 words)

  
 Information on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) at Yale Fertility Center.
Orientation sessions are offered to provide couples an opportunity to meet our team members, have a session with nursing staff with a demonstration on techniques for injection administration, tour our egg retrieval and embryo transfer areas, and participate in an educational seminar lead by one of our physicians.
We realize the process of resolving infertility can be difficult, therefore, our program makes every effort to minimize any confusion or frustration couples may be experiencing by thoroughly discussing all procedures and aspects of care.
Due to the high sucess of IVF and intrauterine embryo transfer, GIFT (Gamete Intra Fallopian Transfer) and ZIFT (Zygote Intrafallopian Transfer) techniques are rarely used in current practice.
http://www.yalefertilitycenter.org/patient/ivf.html   (703 words)

  
 BabyCentre Intracytoplasmic Sperm Injection (ICSI)
The doctor gave him a treatment with pils, which, as he said, has a 30% chance to work and create some motile sperm.
The doctor has told us some of what to expect medically but emotionally we have no idea what to expect.
We are doing ours in Bristol (priory road) We are just waiting for a date for him to have the surgical sperm recovery now.
http://www.babycentre.co.uk/tips/4097.html   (11428 words)

  
 BabyCentre Intracytoplasmic sperm injection (ICSI)
The doctor retrieves sperm from the man, in most cases from a testicle with a needle under anaesthetic (the procedure is called percutaneous epididymal sperm aspiration).
Because ICSI bypasses this process, critics worry about long-term health and development problems for children conceived using whatever sperm are available.
After giving the woman a local anaesthetic, the doctor will remove her eggs using a fine, hollow needle.
http://www.babycentre.co.uk/refcap/4097.html   (720 words)

  
 MSFI Services: Intracytoplasmic Sperm Injection (ICSI)
Human reproduction is a natural, but highly complicated process, and difficulties for successful conception may occur at any stage in either the male or the female.
Based on the results of the tests on each couple, the physicians can recommend the techniques that are most suitable to the couple’s particular needs.
the morphology of the sperm (an assessment of their shape and structure)
http://www.abacusarts.com/midsouthfertility/icsi.htm   (588 words)

  
 Steven Mavros, Licensed Acupuncturist. Acupuncture in Center City Philadelphia, PA and Society Hill.
Siterman et al5 showed improvement in sperm quality among subfertile men treated with acupuncture.
Infertility is an area of women's health that has sparked much consumer interest in acupuncture.
The mechanisms responsible for the systemic actions of acupuncture have been debated but not yet clearly defined.
http://www.tcmstrategies.com/infarticle4.html   (1663 words)

  
 Fact Sheet: Intracytoplasmic Sperm Injection (ICSI)
ICSI involves the insertion of a single sperm directly into the cytoplasm of a mature egg (oocyte) using a microinjection pipette (glass needle).
Furthermore, approximately 1 in 20 individuals in the general population will have some birth defect and this risk is likely to be similar in babies born as a result of the ICSI procedure.
Frozen sperm collected prior to cancer treatment that may be limited in number and quality.
http://fertilethoughts.net/faq/asrm/icsi.html   (512 words)

  
 Dr. Silber's Bibliography
Asch, RH, Silber, SJ: Microsurgical Epididymal Sperm Aspiration and Assisted Reproductive Techniques.
Silber, SJ, Rodriguez-Rigau, LJ: Quantitative analysis of testicle biopsy: determination of partial obstruction and prediction of sperm count after surgery for obstruction.
Silber, SJ: Microsurgical technique of sperm retrieval under local anesthesia.
http://www.infertile.com/closlook/bibliogr.htm   (5392 words)

  
 Cytoskeleton and Chromatin Reorganization in Horse Oocytes Following Intracytoplasmic Sperm Injection: Patterns ...
During the development of pronuclei, the sperm aster
were associated with aberrant sperm integration and failure
Gynotec) with the polar body positioned at 6 or 12 o'clock.
http://www.biolreprod.org/cgi/content/full/69/1/186   (7084 words)

  
 TCART - Intracytoplasmic Sperm Injection
A conventional semen analysis is performed and the sperm is prepared for injection using the various techniques available.
This micromanipultion procedure was developed and refined by a group in Belgium under the direction of Dr. Andre VanSteirteghem at the Centre for Reproductive Medicine.
Approximately 16 to 18 hours after injection, the oocytes are assessed for fertilization and subsequent transfer at approximately 72 hours post oocyte retrieval.
http://www.tcartonline.com/fertility_clinics/intracytoplasmic_sperm_injection.htm   (312 words)

  
 Center of Reproductive Medicine / ART Lab - ISIC Intracytoplasmic Sperm Injection
The impact of these techniques has been a major benefit to our patients by allowing us to treat couples successfully in situations where standard IVF would not.
The Center of Reproductive Medicine has offered micromanipulation as a standard of care in the ART laboratory since 1996.
Intracytoplasmic Sperm Injection (ICSI) offers patients with severe male factor infertility the opportunity to achieve a successful pregnancy when standard therapies have failed.
http://www.infertilitytexas.com/artlab.shtml   (443 words)

  
 Intracytoplasmic sperm injection ICSI
Men whose sperm are unable to achieve adequate fertilisation rates in IVF now have the opportunity to father their own children with the use of ICSI, which would not have been possible any other way.
About 13% of these men have untreatable sterility many having no sperm at all.
Eventually it is expected that with fertilisation rates less than 40% ICSI will be the treatment of choice.
http://www.conceptfert.com.au/facts/icsi.htm   (872 words)

  
 Science commentary: What is involved in intracytoplasmic sperm injection? -- Berger 318 (7185): 705 -- BMJ
Intracytoplasmic sperm injection involves injecting a single sperm into the centre of an ovum using a fine glass needle (one
techniques of intracytoplasmic sperm injection to obtain their
Sperm injection can also be used to treat
http://www.bmj.com/cgi/content/full/318/7185/705   (515 words)

  
 Sexual Reproduction
In contrast to the male, however, such responses are not a prerequisite for copulation and fertilization to occur.
Movement of the penis back and forth within the vagina causes sexual tension to increase to the point of ejaculation.
Harvesting is usually no problem, but often the sperm are defective in their ability to fertilize (so setting the stage for ICSI);
http://users.rcn.com/jkimball.ma.ultranet/BiologyPages/S/Sexual_Reproduction.html   (3465 words)

  
 Intracytoplasmic Sperm Injection (ICSI) - Monash IVF Australia
In addition, men previously considered untreatable seem to have similar success, including those with very abnormally-shaped sperm or those where sperm must be obtained from the testicle at surgery.
The technique was developed by Professor Van Steirteghem's group in Belgium and made possible by the production of extremely fine glass needles.
The SUZI technique has been superseded by intracytoplasmic sperm injection (ICSI), which is not only more effective, but is also more useful in male factor couples previously regarded as untreatable.
http://www.monashivf.edu.au/library/factsheets/icsi.html   (1067 words)

  
 Intracytoplasmic Sperm Injection (ICSI)
In recent years a very successful technique called intracytoplasmic sperm injection or ICSI has been developed to address this problem.
(Fig.3) The needle is pushed through the egg membrane and the sperm is released.
Our experience with micromanipulation indicates that the success rate with sperm microinjection (ICSI) is not related to the severity of the male factor and most cases of male infertility can now be treated with ICSI.
http://www.acu-uch.demon.co.uk/icsi.html   (577 words)

  
 INTRACYTOPLASMIC SPERM INJECTION (ICSI). Center for Applied Reproductive Science. Dr. Samuel Thatcher.
ICSI is one of a group of assisted reproductive laboratory procedures referred to as micromanipulation.
These techniques have been abandoned in favor of ICSI.
The sperm membrane must fuse with the oocyte membrane and the sperm head along with associated parts must be drawn into the the egg.
http://www.ivf-et.com/tlc/fact_icsi.html   (1690 words)

  
 SIRM: Intracytoplasmic Sperm Injection (ICSI)
Before ICSI there was no effective treatment for poor sperm other than to use a donor.
We are pleased to introduce Clear Passage Therapies (CPT) for fertility enhancement
Intracytoplasmic sperm injection (ICSI) is a procedure developed in Belgium in 1993 that has revolutionized the treatment of male factor infertility.
http://www.haveababy.com/infert/icsi.asp   (142 words)

  
 Intracytoplasmic Sperm Injection (ICSI).
There is a need for ongoing developmental follow up to see if increased risk of learning difficulties or intellectual impairment occurs at school age in these ICSI children
However, no studies have been done to determine whether this hypothetical concern is realistic or not
These genes appear to be related only to sperm production and not to any other physical or mental characteristic.
http://www.tcartonline.com/intracytoplasmic_sperm_injection.htm   (1833 words)

  
 Effectiveness of in vitro fertilization with intracytoplasmic sperm injection for severe male infertility -- Pinheiro ...
WHO laboratory manual for the examination of human sperm and sperm-cervical mucus interaction.
the scrotal skin directly into the epididymis, and sperm were
treatment): couples in group 2 (treated by intracytoplasmic
http://www.cmaj.ca/cgi/content/full/161/11/1397   (2516 words)

  
 Children born after intracytoplasmic sperm injection: population control study -- Sutcliffe et al. 318 (7185): 704 -- ...
Chronological age and mean scores on Griffiths scales of mental development for infants conceived by intracytoplasmic sperm injection (study) and infants conceived naturally (control)
International Collaborative Study of Intracytoplasmic Sperm Injection-Conceived, In Vitro Fertilization-Conceived, and Naturally Conceived 5-Year-Old Child Outcomes: Cognitive and Motor Assessments
Intracytoplasmic sperm injection is often successful for treatment of male infertility; over 20 000 children have been born
http://www.bmj.com/cgi/content/full/318/7185/704   (1289 words)

  
 Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection (Cochrane ...
Authors' conclusions: Although an increase in clinical pregnancy rate with day three embryo transfer was demonstrated, at present there is not sufficient good quality evidence to suggest an improvement in live birth when embryo transfer is delayed from day two to day three.
Delaying transfer from day two to day three would allow for further development of the embryo and might have a positive effect on pregnancy outcomes.
Objectives: To determine if there is any difference in live birth and pregnancy rates when ET is performed on day three, compared with day two, in infertile couples undergoing treatment with in vitro fertilization (IVF), including intracytoplasmic sperm injection (ICSI).
http://www.cochrane.org/cochrane/revabstr/AB004378.htm   (451 words)

  
 Assisted conception. II--In vitro fertilisation and intracytoplasmic sperm injection -- Braude and Rowell 327 (7419): ...
In azoospermic men sperm can be retrieved surgically from the
Pregnancy outcome or success rates of IVF may be presented per
sperm quality is extremely poor, each sperm can be examined
http://bmj.bmjjournals.com/cgi/content/full/327/7419/852   (1486 words)

  
 Intracytoplasmic Sperm Injection ICSI North Carolina
Sometimes there is no sperm in the ejaculate due to conditions such as anatomical blockage.
If you have a medical problem or a health-related question, consult your physician or call Health On-Call at 336-716-2255 or 1-800-446-2255.
However, if the sperm are inadequate, egg penetration and fertilization may not occur and ICSI becomes necessary.
http://www1.wfubmc.edu/ivf/Treatments   (367 words)

  
 Intracytoplasmic Sperm Injection
However, strict vigilance is still required since many biological, psychological and ethical issues can be subjects of future concern.
Today, it is well known that this anatomical condition is a mild form of cystic fibrosis.
A classical example of potential for transmitting a genetic disease is the use of epididymal sperm from men with congenital absence of the vas deferens.
http://www.obgyn.upenn.edu/IVF/Intracytoplasmic.html   (564 words)

  
 IngentaConnect Intracytoplasmic sperm injection using surgically retrieved epidi...
IngentaConnect Intracytoplasmic sperm injection using surgically retrieved epidi...
Intracytoplasmic sperm injection using surgically retrieved epididymal and testicular spermatozoa in cases of obstructive and non-obstructive azoospermia
You will be able to remove this item from your shopping cart at any time before you have completed check-out.
http://www.ingentaconnect.com/content/bsc/ija/1997/00000020/00000001/art00103   (321 words)

  
 Intracytoplasmic Sperm Injection (ICSI) in Fish Eggs
Although our results have demonstrated the feasibility of intracytoplasmic sperm injection (ICSI) in fishes, the diversity of physiological and morphological characteristics among fish gametes suggests that techniques will need to be modified for various taxa.
This can be overcome by the use of lubricants (e.g.
Preliminary results in our laboratory show that direct injection of sperm into the cytoplasm of oocytes is possible in fish.
http://www.cfr.msstate.edu/msafs/Poleo,German.html   (439 words)

  
 West Coast Infertility Medical Clinic, Inc., Dr. Kamrava - Embryo Implantation
ICSI stands for intracytoplasmic sperm injection, a technique perfected by Dr. Andre Van Steirteghem and colleagues at the Center for Reproductive Medicine at University Hospital, Brussels Free University in Belgium.
Their successes using ICSI approach results obtained from regular IVF.
In theory it takes just one sperm for each egg to be fertilized.
http://www.westcoastinfertility.com/icsi.html   (409 words)

  
 Intracytoplasmic Sperm Injection
If no sperm are available naturally, your physician may schedule a sperm retrieval procedure such as testicular biopsy, microdissection, testicular sperm extraction (TESA) or percutaneous sperm aspirations(PESA) around the time of egg retrieval.
Intracytoplasmic sperm injection, commonly referred to as ICSI, is an infertility treatment performed as part of the IVF procedure in which a single sperm is injected directly into an egg.
ICSI is most commonly recommended as part of the IVF procedure when there is a problem with the sperm, including low motility, low sperm count or abnormally shaped sperm.
http://www.ivf.com/ivf_icsi.html   (225 words)

  
 Intracytoplasmic Sperm Injection (ICSI)- Tampa, Florida Infertility and IVF Clinic
Even in men with no sperm seen at the time of semen analysis, there may be sperm within the testes.
There is no difference between the offspring produced by ICSI and those conceived by other methods.
Intracytoplasmic Sperm Injection (ICSI)- Tampa, Florida Infertility and IVF Clinic
http://www.floridafertility.com/IVF/ICSI.aspx   (219 words)

  
 Effect on Clinical Outcome of the Interval Between Collection of Epididymal and Testicular Spermatozoa and ...
men undergoing surgical sperm retrieval for obstructive azoospermia.
Effect on Clinical Outcome of the Interval Between Collection of Epididymal and Testicular Spermatozoa and Intracytoplasmic Sperm Injection in Obstructive Azoospermia
The results of 154 ICSI cycles using surgically retrieved sperm from azoospermic men
http://www.andrologyjournal.org/cgi/content/abstract/24/1/67   (360 words)

  
 Intracytoplasmic Sperm Injection ICSI IVF
While at the Jones Institute, Dr. Muasher participated in the original research to develop the ICSI technique and establish its clinical value.
ICSI also makes it possible for men with little or no sperm in their ejaculates to father children.
ICSI is a procedure used in conjunction with IVF to help couples with moderate to severe male factor infertility, unexplained infertility, failed fertilization, and other conditions.
http://www.mcfivf.com/icsi.html   (393 words)

  
 Intracytoplasmic Sperm Injection-AIOF
The needle (containing the sperm at its tip) has been advanced into the oocyte.
The ICSI technique is performed under powerful magnification using hydraulic robotic arms to maneuver the minute glass needles and microtools necessary to perform precise microsurgery on the sperm and egg cells.
It is the most advanced and logical approacyh to achieve fertilization for patients who have severe oligo and/or asthenospermia (severely reduced sperm volume and/or motility); may have performed poorly on Hamster Egg Penetration Assay (HEPA); and/or may have had failed fertilization in previous IVF attempts.
http://www.aiof.com/html/icsi.htm   (224 words)

  
 Science: Intracytoplasmic Sperm Injection@ HighBeam Research
53), which includes an excerpt from his stage play An Immaculate Misconception, identifies a number of important broad ethical and social issues relating to the use of intracytoplasmic sperm injection (ICSI) that need wider appreciation and discussion.
One hopes that his play may help expedite this process.
The imaginative essay "Sex in an age of mechanical reproduction" by Carl Djerassi (Essays on Science and Society, Science's Compass, 2 July, p.
http://www.highbeam.com/library/doc0.asp?DOCID=1P1:29465625&refid=ip_almanac_hf   (161 words)

  
 Screening for cystic fibrosis transmembrane conductance regulator gene mutations in men included in an intracytoplasmic ...
In conclusion, we do not bring any evidence suggesting a role
(1994) Conventional in-vitro fertilization versus intracytoplasmic sperm injection for patients requiring microsurgical sperm aspiration.
In contrast, CFTR gene mutations did not seem to affect sperm
http://molehr.oupjournals.org/cgi/content/full/5/6/587   (3516 words)

  
 Intracytoplasmic sperm injection - Wikipedia, the free encyclopedia
Intracytoplasmic sperm injection (ICSI) is an in vitro fertilization procedure in which a single sperm is injected directly into an egg; this procedure is most commonly used to overcome male infertility problems.
There is some suggestion that birth defects are increased with the use of IVF in general, and ICSI specifically.
Concern has been raised that in ICSI this sperm selection process is bypassed and the sperm is selected by the embryologist without undergoing any specific testing.
http://www.wikipedia.org/wiki/Intracytoplasmic_sperm_injection   (233 words)

  
 INTRACYTOPLASMIC SPERM INJECTION (ICSI)
Because of impaired sperm function and poor fertilization rates after electroejaculation in anejaculatory patients (e.g., spinal cord injury) using intrauterine insemination or standard IVF, ICSI may have a prominent role in this group of patients.
When high quantities of antisperm antibodies are present in the male, treatment with corticosteroid therapy, sperm washing, and routine IVF has been frustrating and often unsuccessful.
Although the indications for ICSI with teratospermia are not fully defined, ICSI should be the treatment of choice after failed IVF, despite using high sperm concentrations.
http://www.infertility-male.com/treatment/icsi.htm   (1538 words)

  
 Genesis Fertility Centre - Intracytoplasmic sperm injection (ICSI)
ICSI has revolutionized the treatment for male infertility.
Intracytoplasmic sperm injection (ICSI) is a specialized form of IVF that is used for the treatment of severe cases of male factor infertility.
Individuals that may be helped by ICSI include couples who have had poor or no fertilization during standard IVF, as well as men who have:
http://www.genesis-fertility.com/services/services2.htm   (148 words)

  
 OHSU Infertility Lab - ICSI, Extended Embryo Culture
Intracytoplasmic sperm injection is now an established technique for the treatment of male based infertility in the context of assisted reproduction.
The glass needle is gently inserted into the egg and the sperm deposited.
The technique is based on depositing or "injecting" a single sperm into the egg, thereby bypassing many steps in the fertilization process.
http://www.fertilityoregon.com/lab/extended.htm   (241 words)

 About us   |  Why use us?   |  Press   |  Contact us

 Copyright © 2006 Medicow.com Usage implies agreement with terms.