PGD can prevent transmission of these this disorder ie, monogenic diseases due to the function of gene is altered by change in the specific sequence, called mutations. This is known as embryo mosaicism and might explain why embryos tested as euploid can fail and re-test as aneuploid. These include the following: If you would like PGS testing alongside IVF, you will need to allow an additional 7-10 days for the embryos to be screened prior to implantation. All Rights Reserved. Upgraded but still having issues? In women 35-40, ongoing pregnancies for were 51% for euploids vs 37% for untested in an RCT using NGS (Munne et al. For years, Malaysian fertility clinics have been popular with some Singaporean residents who want children. Sunfert has shipped two unscreened embryos to Singapore since the borders closed. It has been another agonising wait to see if we got any blasts. All 19 Fertility Test Clinics in Malaysia ServiceScore Very Good from 339 users 7.5 Featured DR WEE CLINIC (HORIZON HILLS) 03-9212 1174 ext: 65000 87 Jalan Harimau Tarum Taman Century 80250 Johor Bahru Johor, Malaysia, HORIZON HILLS, ISKANDAR PUTERI, 79100 See more details. Prices for COVID-19 tests conducted by private providers can range from RM100-600. By transferring only one, healthy embryo, doctors can remove the risks of multiple pregnancies in IVF. So in these studies, PGS testing did improve rates! If you want our Health + Ancestry Service plus access to new premium reports and features throughout the year. By Day 5 of development (that is, five days after fertilisation), an embryo has divided into multiple cells - and PGS works by removing some of these cells for testing. PGS is a highly advance technology in modern medical science and accuracy is up to 97% as per the latest report but everyone should know that everything has a limitation and PGS has its own limitations too. So how sure can we be that the results are representative of the whole embryo? With so many clinics for IVF in The basic idea behind PGS is that embryos that have the right number of chromosomes (euploid) have better success than embryos with the wrong number of chromosomes (aneuploid). They were there to answer all my questions, the costs were outlined very clearly and simply, the staff were very friendly and made the experience as comfortable as possible given the nature. I was just transfered to my OB/GYN who recommended I do NT scan. These days theyre considered inferior to Day 5 (trophectoderm) biopsies for several reasons: One perk is that embryos can be biopsied on Day 3 and the results can come back in time for a fresh Day 5 transfer. These are some of the highest success rates, not just in Asia but in the world. PGS decreases risk to couples or individuals with serious inherited disorders of having children affected with same problem. Sep 26, 2019 at 7:04 AM. 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). Thailand offers the best prices Worldwide Price: $ 497 Search by Region Delhi, India This and the fact that I live in Singapore, and the issues with logistics that came with this proved challenging at time - they were very helpful. It does not include the preliminary investigations and consultations with the fertility specialist prior to the start of IVF. By determining which embryos are euploid, we should have a better chance at choosing the right embryo to transfer. It also considers whether the relevant processes and standards of the overseas centres, as well as the local centres receiving the imported embryos, meet Singapores regulatory requirements. Therefore, choosing healthy embryos with PGS also reduces the risk of miscarriage. We only work with a select few doctors/clinics in Asia and have constantly received excellent feedback from our clients. The average costs of PGS for up to five embryos are given below: IVF with PGS in the USA starts from around $20,000, IVF with PGS in Thailand starts from around $12,500, IVF with PGS in Malaysia starts from around $12,000, IVF with PGS in India starts from around $8,000, IVF with PGS in the UK starts from around 9,000, IVF with PGS in Spain starts from around 8,000. This trip will be about a week. Share; The follicle growth will be monitored throughout this period though you will NOT be required to visit the clinic every day. Since March last year, Sunfert has had five patients, aged 38 to 45, who would like to ship their PGS-tested embryos to Singapore. Although the numbers and statistics are everywhere on the internet, we have compiled and organised the information accordingly (by centre) in one place for your convenience. Introduction. Your Location: South Australia . They now have a few embryos here, but they want to ship their embryos from Malaysia as a backup. pasifika festival townsville; Your IP: The failure to ovulate regularly leads to problems with . Higher quality embryos performed better than lower quality embryos. (2016) compared NGS test results to miscarriage POC (as an indication of the ICM) and found that 14 of 20 matched. Tests on soil for sub-grade: LOI , LL and PL Compaction CBR. And the abnormal embryos that are actually 60-80% mosaic by aCGH? This is a much more specific test, which looks to identify the presence of gene mutations which are linked to certain genetic disorders. Three of them Alpha IVF, IVF Bridge and TMC Fertility declined to comment. So PGS testing was discouraged (Brezina et al. The MOH said it understands the challenges faced by couples under the current situation, and will facilitate the appeals where possible. Some of our doctors have recorded average success rate of 82.9% with IVF-PGT. PGS can reduce the amount of IVF cycles required to achieve a successful pregnancy. Viral markers to test for HIV, Hepatitis B and C, Syphilis, etc. CNA Insider spoke to four individuals with PGS-tested embryos in Malaysia. After suffering another miscarriage, the couple opted to go through IVF again in Singapore. Available at Sunway Fertility Centre, next generation sequencing (NGS) is the latest, most advanced PGT technology which allows for comprehensive chromosome testing of embryos. But their fertility treatments since late last year have cost more than S$30,000, as they have maxed out their government subsidies. GeneSure Genetic screening of embryos (PGS) (test dependent) Starting from $900 per embryo tested. PGT-A typically costs the patient around $5,000 per IVF cycle and equates to 20%-30% of the overall costs of treatment. A mosaic is a mix. A basic IVF package normally includes the following: Daycare ward admission and anaestheticrequirements. Others {{#results}} . These samples are analyzed for chromosomal or genetic disorders in the fetus. If you have recent test reports (within 6 months) you may not need to repeat the tests. Sperm freezing. (2) The rate of currency conversion shall be the rate in force at the time when duty is payable. These may provide additional information regarding potential genetic problems during the pregnancy. Two of them, including Kloor, have done so and are waiting to hear from the authorities. When carried out by a highly experienced doctor, the risks of this procedure are minimal. So either youre clear to transfer, or youre not, even though the embryo is actually neither. She does not know the gender of her embryos and will definitely make an appeal to ship them from Malaysia. PGT-A is a comprehensive chromosome screening of an embryo that determines if the embryo has a normal chromosome count. pgs testing cost in malaysia. Waiting times may also be shorter. Border closures have landed a small group of couples in a uniquely difficult situation. This occurs when embryos contain both normal and abnormal cells. PGT-A enables the checking of all 23 sets of chromosomes including X and Y in each embryo so that only normal embryos are selected for transfer into the womb. A small sample of each embryo is sent to a genetic testing lab, but your embryos will safely be stored at your IVF . porterville unified school district human resources; Tags . (2018) argue that this may not be an accurate cell number for the TE, which could invalidate their findings. Having a healthy baby is the expectation of each parent. to this rather demanding procedure. While cost in an important factor, you must not ignore that treatment quality, success rates, the doctors knowledge and capability, and overall clinic standards are more important factors if you want the greatest bang for your buck. Local fertility centres must ensure that the embryos are packaged and transported in a way that minimises the risk of contamination, among other requirements, the MOH added. 24.2k sold. For the next 20 years or so FISH was the primary method of testing. Im doing (PGS) for medical reasons, said the analyst. We see a lot of patients delaying their The PGS testing lab may or may not give the % of mosaicism. PGS differs from another procedure called pre-implantation genetic diagnosis (PGD), which caters for those who may pass certain inheritable diseases to their children. Sperm collection: Your partners sperm is collected on the same day and the gametes are fertilized together under controlled conditions in the laboratory. PGD is indeed a boon for couples faced with risk of genetic diseases in their offspring. Because my PGS embryos are stuck in Malaysia, Im forced to go through a few more rounds (of IVF) in Singapore.. Many patients, when looking for IVF, base their decision solely on the treatment cost, which could be detrimental to your parenthood dreams. We offer the test at 11 locations across the country - Kuala Lumpur, Subang Jaya, Penang, Petaling Jaya, Tawau, Cyberjaya , Ipoh, Johor Bahru, Melaka, Kuching and Kota Kinabalu. pgs testing cost in malaysia. The steps for an embryo biopsy are: See that tiny piece? Tests conducted by the Ministry of Health are free of charge. I am on my fourth cycle, without ever having seen those two lines. The cost of PGD can vary depending on your individual circumstances. Heres how a single biopsy of a mosaic embryo can have 3 different results from the same embryo: Only the first result is accurate. It is important to go into IVF feeling Results in more than 99% of cases. Especially if you are a women over 35 as the incidence of aneuploidy (abnormal number of chromosomes) increases significantly with advancing maternal age. PGT-SR = PGT for structural rearragements, A tiny hole is lasered into the zona of the embryo on Day 3 (assisted hatching), By Day 5-7 (it varies), the cells of the embryo poke out of this hole, The cells that are poking out are suctioned and separated using a laser, This biopsied piece is stored in the freezer then sent to another lab for, The biopsied embryo is frozen until results are received and an embryo transfer set up, A monosomy is a deletion of a whole chromosome, A segmental deletion/addition affects only a segment of a chromosome, dup(16) means theres a duplication on chromosome 16, (q23.2-qter) means that this duplication is for the q23.2-qter region. Although there are preimplantation genetic screening pros and cons, this method of genetic testing is a precious one as it: requires to transfer only the healthiest embryo which means a diminished amount of multiple pregnancies; lowers the number of abortions and . Alternatively, you can plan two trips of shorter duration (mostly for people from Singapore).Have your assessment and counselling done on the first trip and collect the medications that you can take back home. Editor's note: The main photo for this story has been changed. (iii) Claiming that PGS (PGT-A) can improve the IVF success rates with donor eggs. ALLtest saliva antigen test kit 1s Covid 19 Home Test Kit - Pls add bubble wrap, bubble wrap is NOT free & NOT included. PGT-M is a genetic test of the embryo for a specific gene defect. 6 by SNP then NGS: 3/6 matched, 1/6 retested as euploid, the rest had different affected chromosomes . 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). Check here for the full. Owing to his chromosomal condition, only the PGD testing has been available to the analyst and his wife. The Ministry of Health (MOH) disclosed in March that it may on an exceptional basis allow importation of the embryos, subject to conditions. Some of our top Malaysian IVF doctors have established that the transfer of a single good graded euploid blastocyst brings about the highest success ratesupto 82.9%. For a much more in-depth look at the statistics, check out my post on PGS success rates. I also wanted to save time because after every unsuccessful IVF (cycle), you have to rest for one or two months.. (2017) did the math and found that you would need 27 cells to confidently determine the embryos status (from a 300 cell trophectoderm). In the 1990s there was FISH fluorescent in situ hybridization but this was only able to screen a few of the 23 chromosomes and was mainly done using cleavage stage embryos. The correct number of chromosomes (46) is necessary for the embryo to become a normal child. They learnt that their PGS treatment had yielded some normal embryos. PGS testing can test to see if there are any extra or missing copies of chromosomes in each embryo. PDPA Statement | Anti-Bribery and Corruption Policy | Terms and Conditions, EMMA Endometrial Microbiome Metagenomic Analysis, ALICE Analysis Of Infectious Chronic Endometritis, PGT-A Preimplantation Genetic Testing For Aneuploidies, PGT-M Preimplantation Genetic Testing for Monogenic Diseases, PGT-SR Preimplantation Genetic Testing For Chromosomal Structural Rearrangement, PGT HLA TYPING Preimplantation Genetic Testing For Human Leukocyte Antigen, Artificial Intelligence-Enhanced Embryo Selection, Ion Torrent Next Generation Sequencing (NGS) For PGT, EMBRYOSCOPE+ Embryo Culture and Monitoring System, PGT-HLA TYPING Preimplantation Genetic Testing For Human Leukocyte Antigen, XXY (abnormal boy Klinefelters) compared to. But there is now hope. we may calculate the displayed price on daily updated exchange rates. The selection of normal embryos for transfer, Avoids amniocentesis and its associated risks, Increase the change of having a healthy baby. Embryos that test chromosomally normal (euploid) are then considered for embryo transfer into uterus. PGD for specific genetic abnormalities requires the development of a "probe". Gleicher et al. kit + plus. PGS is done on the chromosomal level - they look to see if there is a correct number, if any of the chromosomes are missing chunks or have extra bits. Repromed Fertility Specialists SA Since 1950. PRIVACY NOTICE However the negatives outweigh this positive and Day 5 (trophectoderm) biopsy is now the norm. Number of eggs retrieved. Mosaic embryos were detected using more sensitive PGS testing technology. PGT-M is carried out to reduce the risk of your child inheriting a genetic disease or medical condition. The benefits of including PGS testing within your IVF cycle include: By only transferring healthy embryos into the uterus, fertility doctors can improve the chances of a successful clinical pregnancy. Consult with your doctor before making any treatment changes. IVF in Malaysia Cost & Procedure details, Have been tried in Hong Kong, but bad service , costs is not equal to service and not professional , no communication , only charged high, Consult with the leading IVF doctors in Kuala Lumpur, Complete hormone profile (usually done between day 2 to day 4 of menstrual cycle), Ultrasound to assess your uterus and ovaries, Complete Semen analysis to check sperm numbers, motility and quality. Highly recommend. Globally Recognised Software Testing Foundation Certification Courses. 2016). Contact us 1300 30 4227 We know it's a hassle to switch browsers but we want your experience with CNA to be fast, secure and the best it can possibly be. gold-standard for couples facing fertility problems and it could be your way to This is an all-inclusive, one low fee package with no hidden charges that allows you to plan your budget. 15th International Conference on Preimplantation Genetic Diagnosis (PGDIS), 8-11th May 2016, Bologna, Italy. Meanwhile, in private hospitals, the test is priced between RM350 and RM500. Noting the benefits of PGS testing, many fertility doctors offer it as a routine procedure to improve success rates for IVF patients. You may experience mild discomfort and bloating, but there are no major side-effects. Sheen Clinic. This is because the embryos have undergone a genetic screening that is restricted in Singapore. They moved here in 2016. This is an additional process that can determine the health of the embryo and this also helps to increase your chances of conceiving and it can only be done via IVF. Ted's Bio; Fact Sheet; Hoja Informativa Del Ted Fund; Ted Fund Board 2021-22; 2021 Ted Fund Donors; Ted Fund Donors Over the Years. Maxwell et al. The first step is to get cells from the embryo for testing. Varies depending on number of embryos tested. Accu-Chek Instant S Glucose Monitoring Kit & Strips (10 Test Strips + 10 Lancets + Extra 25'S Test Strips) Limited Offer. Quick Heal From Surgery. 13. course is accredited by BCS. You and/or your partner carry a balanced structural chromosome rearrangement eg. (File photo: Reuters). one year prepaid membership. Ever wondered how much does it cost to have an IVF procedure in Malaysia? Selangor DE, Malaysia. Lower miscarriage rates (through selecting competent embryos). PGT-A is a reproductive technology used with an in vitro fertilisation (IVF) cycle. These samples are also analyzed for chromosomal or genetic disorders in the fetus. The sole advantage of PGT-M is that it will provide information about the possible presence of a hereditary gene mutation in the embryo. Kang et al. PJU 5/22, Kota Damansara, It is used to analyse the chromosomes of the embryos before their transfer into the womb. Find new cars for sale, car prices, car reviews, auto news & more at Carlist.my - Malaysia's No.1 Car Site. Fertility medications: $4,000-$8,000. The Ministry of Higher Education Malaysia has endorsed the implementation of the Malay Language Proficiency Test for Non-Malaysians. In fact some studies flat out showed that testing had worse outcomes vs untested. The success rate of conventional IVF is about 20 to 30 per cent. We look for the following three essential qualities whileselecting an IVF clinicand recommend that you also check for: The quality of eggs is one of the most commonreasons for IVF failure, and it declines steeply as a woman ages. (2018) present data that shows PGS/PGT-A testing reduces miscarriages, as well as data that shows it doesnt. 2021 Sunway Fertility Centre | All Rights Reserved, Intracytoplasmic Morphologically Selected Sperm Injection (IMSI), IVF Treatment | Award Winning Fertility Clinic Malaysia, Pre-Implantation Genetic Testing for Aneuploides (PGT-A), Pre-Implantation Genetic Testing for Monogenic Diseases (PGT-M), Increases pregnancy rates, even for high-risk patients, Minimises the risk of chromosomal abnormalities in your child, Able to identify the chromosomally healthy embryos to be frozen for future use, Couples who have undergone multiple unexplained miscarriages, Couples who want to increase the success rate of their IVF treatment, Couples with a family history of chromosomal conditions/abnormalities, Couples with serious genetic conditions who want to avoid it from being passed on to the next generation. Im appreciative of the MOH looking into it and listening to us, she said. Cloudflare Ray ID: 7a29b72a3a1b520e Preimplantation Genetic Screening, or PGS, is a genetic test which allows doctors to screen IVF embryos for abnormalities in chromosome number. $29. These werent transferred or possibly discarded because they were labelled aneuploid due to the limitations of the technology at the time. It is a noninvasive medical test that is often used to find out why you are having difficulty conceiving. 2.75 % As of 19 Jan 2023 BNM International Reserves. However, other factors are also considered and the cost will be provided along with the profiles. Check here for the full glossary (please excuse the repeated terms!). As this procedure involves removing a sample of cells, you may question whether it can cause any lasting damage to the embryo. I go to FCI in illinois. It is a race against time if a pregnancy does not result from all the viable embryos, noted the fertility specialist. The following tests are required and you may get them done locally before traveling for IVF in Malaysia. (2016) found that (out of 19) embryos that were aneuploid for the TE, the ICM was also aneuploid. A small sample (about 5-10 cells) is typically biopsied from an embryo that has potentially hundreds of cells. Will there be a day where there are no euploid or abnormal embryos, but only shades of mosaic? and we will connect you with the donor bank to provide closely matching profiles. Sunway Fertility Centre IVF Cost and packages, Fertility Screening for couples > RM 550 per couple, All medications from the start of treatment until pregnancy test, All laboratory charges, including ICSI, Laser-Assisted Hatching and Blastocyst Culture if required, All nursing fees, daycare operative room and recovery room charges, Enfamil vs Enfalac Malaysia : Price and Reviews 2022, Hospital Baby Delivery Rates and Maternity Packages in Malaysia 2022, 10 Best Confinement Centres in KL & Selangor 2022, Top Recommended Gynaecologists in Malaysia 2023, 12 Best Formula Milk for Baby 0-6 months for 2023: Price and Reviews, Difference between Step 1 vs Step 2 vs Step 3 Formula Milk in Malaysia 2022, 7 Best Prenatal Vitamins for Pregnancy in Malaysia 2022, 7 Best Chlorine Free Diapers Malaysia 2022, 12 Best Baby Diapers of 2023 - Prices and Reviews. So how many cells do you need to biopsy for accurate results? How well this matches the rest of the embryo is controversial. Success rates in IVF can be misleading and PGS is a genetic test designed to increase the success rates of IVF. In Singapore, PGS is allowed only in a pilot programme involving nearly 400 patients at three public hospitals. The high attrition rate is because some patients changed their minds and transferred embryos to their wombs without doing PGS, or froze their embryos instead. I feel like someone else posted a question similar to this the other day but can't find the post. As at . After 10-12 days you can travel back for egg collection and the rest of the IVF process. (2015) reviewed several studies: Penzias et al. It is important to discuss the risks and limitations of such procedures. It screens embryos for the correct number of chromosomes before they are transferred to. So based on this data, its controversial whether or not PGS reduces miscarriages. IVFkasih package > from RM 8,800 nett. Garrisi et al. No Siri Kelulusan: KKLIU 0194/2023 Maternal age does not affect clinical outcomes of vitrified-warmed euploid blastocysts: an Asian Study. conception problems later in life, even with IVF. Here is how PGS works. Results are very obvious and I am very satisfied with their service Chui, Malaysia, 16 05 22. We routinely ask patients at the beginning of the treatment whether they want the gender to be revealed.. This post will discuss PGS/PGT-A for the most part and Ill use PGS as thats the term most are familiar with. RM9.90. You may be eligible for PGD/PGS if you have any of the following: PGD/PGS testing is also offered to females close to or over 35 years of age to check the genetic content of the embryos before transferring them to the uterus, so as to improve their chances of a successful pregnancy. The cost of PGS/PGT-A testing (and the cost of potentially more cycles in order to get euploid embryos) needs to be weighed against no testing and potentially more transfers/miscarriages by using untested embryos. Infertility Aide is dedicated to connecting you with the most trusted doctors and honest practices for IVF treatments. 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). However, there are different technologies for testing embryos, and not all of them work the same. This involves a small sample of cells being taken from the amniotic fluid, between weeks 16-18 of the pregnancy. This way, when it combines with an egg cell with the normal 23 chromosomes, it makes an embryo with 22+23 = 45 chromosomes and this is aneuploid. RTAC certification in compliance with the standards of RTAC International Code of Practice. Selangor. The two tests conducted on embryos are Preimplantation genetic diagnosis (PGD) and Preimplantation Genetic Screening (PGS). Side effects: Some women complain of side effects from the hormones such as nausea, vomiting, dizziness, and if that is your case, the doctor might advise you to take rest. Since the ICM is what makes the fetus, and the biopsy is from the trophectoderm (TE), this is a great question! Business Registration No: 938460-K (2011 0101 0321) A complex abnormal is one that has 3 or more chromosomal abnormalities. A 40-year-old chief financial officer who wanted to be known only as Chen said she did PGS testing in Johor after having a failed IVF cycle in Singapore. To give you an idea of the cost per cycle at ORM, here's the breakdown: Pre-cycle screening fees: $2,500-$6,000. What is PGD? The wait time can be long, but as long as you are prepared to wait (I was coming from Singapore so had nothing else to do!) I'm a health specialist Complete embryo analysis of all 24 chromosomes. Hello,I'm 12 weeks pregnant after transfering a single PGS tested 5-day Blastocyst. You dont know how much money and emotional trauma you can save by giving timely attention to infertility. 2016) . Dates & Prices Enquire now. IVF with PGS in the UK - starts from around 9,000 If you have low ovarian reserve or have had multiple failed cycles of IVF with your own eggs, you might have to consider an egg donor for your IVF cycle. This helps to prevent the transfer of an abnormal embryo during IVF. It is good to take time to plan if you are 2017): With aCGH, a 20% mosaic was euploid and it would be transferred no problem. Another aspiring parent, a 34-year-old analyst who declined to be named, said he and his 32-year-old wife began fertility treatment in Singapore in 2018. SITEMAP Believe it or not, the success of PGS/PGT-A testing is controversial! Here the chief mission of PGS is to assure you give birth to a healthy child. . The MOH assesses each case based on the individuals medical need and particular circumstances, a spokesperson said. Almost every government hospital and clinics in Malaysia provide Covid-19 test. Nil. Google Map | Waze Contact Us Tel: +603 6141 6166 Fax: +603 6141 6066 Whatsapp : +6012 5686 290 Email us Operating Hours (2018) looked at about 650 euploid transfers: Note that this is per transfer data. What will the next phase of technology tell us? Chinese and Asian profiles are more easily available, while Caucasian profiles are relatively more expensive. pgs testing cost in malaysia fatal car accident in kentucky 2020. As time goes on we will only improve on the technology. The International English Language Testing System (IELTS) is the world's most popular high-stakes English language proficiency test for study, work and migration, with more than three million tests taken in the past year. IVF costs are affordable, the IVF clinics we work with have some of the highest success rates, and language is not a problemmost people speak multiple languages and English is widely spoken. Older technology like aCGH wasnt as sensitive as the current technology (NGS) and could only detect a mosaic between 40-60% (Maxwell et al. A small sample of each embryo is sent to a genetic testing lab, but your embryos will safely be stored at your IVF . We encourage you to ask questions and settle all your concerns Prior to PGS, the standard IVF procedure will be carried out. in your 20s or early 30s, but research suggests that advanced age can cause While she qualifies for the local trial, she has been told that the earliest she can do PGS testing is in December.
Is Skillage An African Bum Disease, Naot Orthotic Sandals, Accident A426 Lutterworth, Mercer 2022 Salary Increase Projections, Henderson Silver Knights Salaries, Articles P