A cone biopsy is used to remove abnormal cervical tissue for evaluation and treatment of certain conditions. Learn how to care for your tattoo, what to expect in the first month, the signs of infection…, You may have heard that testosterone supplements can help in the bedroom. Cold-knife cone biopsy is a cervical excision specimen performed using a surgical blade without electrocautery, and is performed in an operating theatre with general anaesthesia. You’ll lie on an examination table with your feet in stirrups, like a regular gynecological exam. This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally. Many women undergo cold knife cone biopsy under a general anesthesia, meaning they’re asleep for the procedure. Bring sanitary pads with you to wear after the biopsy. Infection is a possibility as with all surgical procedures. Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. Cold knife cone biopsies are usually performed as an outpatient procedure. If the patient has a low chance of survival, then the treatment can potentially be more dangerous than the disease itself. This is a complication in which the cervix narrows, making it more difficult to become pregnant naturally. Your doctor may choose a cold knife cone biopsy if they’re not able to gather enough tissue through a punch biopsy. Bleeding after hysterectomy can be normal, but if you have too much bleeding, new bleeding, or heavy bleeding, it could mean there is a problem…. Your doctor will insert an instrument called a speculum into your vagina to push apart the vagina’s walls and keep your vagina open during the biopsy. Cold knife cone biopsy is also called conization. Be sure to discuss your health history and any previous reactions to anesthesia with your doctor. Abstain from sexual intercourse for 24 hours before the test. Healthline Media does not provide medical advice, diagnosis, or treatment. A cone biopsy m… An amplified risk of adverse pregnancy outcomes after excisional cervical surgery has been identified. The risk of preterm labour is also increased. The entire cold knife cone biopsy takes less than an hour. Cervical scarring can hamper your efforts to become pregnant and may cause difficulties in reading Pap smears. The procedure may be performed using a wire loop heated by electrical current (LEEP procedure), a scalpel (cold knife biopsy), or a laser beam. 60 , 61 Furthermore, the rate of spontaneous abortion was noted to be as high as 25%. This is especially important if you have already been diagnosed with cervical precancer or cancer. Women who become pregnant after LEEP may deliver their babies a little early. Read on to learn how breast cancer treatments have evolved to…. mild-to-moderate cramping, progressing to severe pain. And if so, were there any complications in your pregnancy? All rights reserved. Sometimes all of the cancerous material can be removed during one cold knife cone biopsy. You won’t feel any pain under either general or regional anesthesia. When is this procedure used? Your doctor will remove the abnormal cells from your cervix to determine if you have cancer, or if the cells are precancerous. Cold knife cone biopsy is performed under a general or regional anesthetic. If your doctor has ordered a cone biopsy, it's likely because you had Pap smear results indicating there are abnormal cells in your cervix that need further investigation followed by an inconclusive colposcopy to get a small sample of tissue for evaluation. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Wash your hands before and after using the bathroom. Don’t insert anything into the vagina for 24 hours before your biopsy, including: Stop taking aspirin, ibuprofen, and naproxen for up to two weeks before the biopsy, as directed by your doctor. Materials and methods: Patients with cervical intraepithelial neoplasia (CIN) who wanted to become pregnant and received LEEP or CKC were considered as the treatment groups. Your doctor will advise you of options for future testing. This is call an endocervical curettage (ECC). More advanced abnormal cells may be excised (cut out), or they may be destroyed by freezing or heating them. Has anyone had a cold knife cone biopsy (not leep or cryo, colposcopy etc...those are completely different) we are planning to try to concieve in dec/jan but I have been told that I will need a cerclage, weekly ultrasounds and bedrest. The anesthesia wears off within a few hours. Your doctor will notify you of the results as soon as possible. A cone biopsy is a surgical procedure in which a cone-shaped tissue sample from the cervix is removed for examination. Abnormal cells that appear on a Pap test may require further examination. It’s usually performed to diagnose or rule out cervical cancer, particularly when a Pap test has revealed abnormal cells, but may also be used to remove the precancerous cells as a form of treatment for this disease. Last medically reviewed on February 29, 2016. There were fewer pregnancies in women following a cold knife cone or more than one LLETZ treatment-significant surgery, (p=0.004) but no difference in their reported time to conception (p=0.54). Abnormal changes in the cells on the surface of the cervix is called cervical dysplasia . Studies have shown that LEEP and Cold Knife Cone Biopsy can lead to a syndrome known as an incompetent cervix, which may result in a premature delivery if you become pregnant. The American Cancer Society estimated that in 2003, approximately 12,200 women would be diagnosed with cancer o… Tattoo aftercare starts as soon as your tattoo is done. LEEP seems to have fewer long-term side effects than the other types of cone biopsy. About - Cold Knife Cone Biopsy A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix using a scalpel or laser knife. You can go home the same day. A cold knife cone biopsy (conization) is surgery to remove a sample of abnormal tissue from the cervix. The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. The sample is examined under a microscope for signs of cancer. Fasting for six to eight hours before the biopsy can help prevent nausea. Cervical scarring. Similar to the findings for LLETZ, cold-knife conization has been associated with heavy vaginal bleeding in 5-15% of pregnant patients. If you're having periods after a cone biopsy you have not got complete cervical stenosis. 28 November, 2018 A cone biopsy is a surgical procedure in which a cone-shaped sample of the cervix is removed for analysis. Abnormal changes in the cells on the surface of the cervix is called cervical dysplasia . Bleeding After Hysterectomy: What to Expect, Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, COVID-19 Decision Fatigue: What It Is and How to Deal With It. Take a look at the connection between ADHD and sleep disorders. If your menstrual period is consistently longer or heavier than normal, your doctor may recommend endometrial ablation. Cold-knife excision has been linked to second-trimester miscarriages and premature delivery. Adhesions on the cervix may cause pain during your period, fertility … Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. Cervical cancer is often associated with the Human Papillomavirus (HPV), and your doctor may test for this at the same time as the PAP test. While a cone biopsy doesn’t usually affect your ability to conceive, the procedure can occasionally lead to problems with miscarriage. Cold knife cone biopsy offers the best diagnostic accuracy, but it has significant complications both for the mother and for fetus when performed during pregnancy. The risks associated with cold knife cone biopsy are minimal. Avoid using tampons for four weeks after your biopsy. Several earlier studies investigated the use of cold-knife conization for the treatment of suspected or proven severe dysplasia or microinvasive disease during pregnancy. Has anyone had a cervical cone biopsy i am due to have one in 3 weeks time when I'm 15 weeks pregnant as gyn/onc believes i have hidden cancer in my cervix and cannot wait till after pregnancy. Though it’s not a very common occurrence, a surgeon who is overaggressive can remove too much of the cervix, leaving it unable to do its job in keeping everything inside that’s supposed to stay inside during your pregnancy (a condition known as an … Cold knife cone biopsy is also called conization. Your doctor will use one of two options to control bleeding in the cervical. It is a procedure to remove abnormal cells from the cervix by using a scalpel. Cold knife cone biopsies let your doctor take a larger amount of tissue. Learn more. prior cone biopsy. This procedure removes a large cone-shaped piece of the cervix to look for precancerous cells, or cancerous material. You might also need to stop taking heparin, warfarin, or other blood thinners. The cervix is the cylindrical shaped narrow tissue that begins at the lower end of the uterus and terminates in the vagina. Is cold knife cone biopsy safe? This is called cervical stenosis. Our website services, content, and products are for informational purposes only. Immediate excessive blood loss has been reported in an average of 8.9% (5.2–13.9%) of cases. A handful of techniques for cervical conization during pregnancy have been described in the literature, but no direct comparative data exist. Ok, so i was just curious.... Have any mamma's had a cold knife conization (aka a Cone biopsy- for cervical dysplasia or cervical cancer) then gotten pregnant within 6months to a year after your surgery? The predictive value of TVU was evaluated by using less than 25 mm cervical length as criteria The cervix is the narrow part of the lower end of the uterus and terminates in the vagina. Ask a family member or friend to accompany you so they can drive you home. [20] [21] [22] There are recent retrospective reports, including one from Western Australia, showing satisfactory management with large loop diathermy, which is also widely practised overseas. Is there a limit to how many cold knife cone biopsies a woman can have? Cold-knife cone biopsies have the highest rates of single specimens and type 3 … Reason I am asking is, i had a CKC done in March '12, and got pregnant in August '12. Recovery from cold knife cone biopsy can span several weeks. My pregnancy is deemed high-risk due to the deepness of the cone surgery I had. A cone biopsy is a medical test that can help your doctor rule out whether you have cervical cancer. The success rate of late-stage cancer is about 50 to 60%. The wide area of tissue removal can increase your chance of premature delivery during pregnancy. You might wonder how sex is different after a hysterectomy, including where sperm goes. For these very early stages of cancer, the biopsy often is able to remove the cancerous area entirely. Cervical biopsies are used as both a diagnostic tool and a treatment for cervical precancer and cancer. After a cone biopsy there is a very small chance that the cervix can narrow. Women who wanted to become pregnant and only underwent colposcopic biopsy … Risks of LLETZ Procedure and Cold Knife Cone Biopsy. Discover the relationship between bipolar and anxiety disorders, which can often co-occur. I had no trouble conceiving. Cold knife cone biopsy is a highly effective way of diagnosing abnormalities of the cervix and treating early stages of cervical cancer. Download The Appto explore more tools like Planner+ and Food Safety. If this happened, you wouldn't be able to get pregnant naturally. Just wondering if anyone has had a cold knife cervical cone biopsy during second trimester and gone on to have a healthy baby or know someone? Does anyone have experience with cold knife coniaztion and future pregnancies? STUDY DESIGN: Pregnant patients with a history of cervical cone biopsy by cold knife, loop electrosurgical excision procedure (LEEP), or laser were monitored prospectively with TVU of the cervix between 16 and 24 weeks. There are different types of cervical biopsies. For low-grade abnormal cells, a PAP test may be recommended every year to two years. The tissue that was removed from your cervix will later be examined under a microscope to determine the presence of cancer. 2. They might cauterize the area with a tool that seals the blood vessels to bring the bleeding under control. Regional anesthesia numbs you from the waist down, but you remain awake. If you need to undergo a cone biopsy, it’s important to find a physician who does the procedure on a regular basis: The more surgeries she does, the better she’ll likely be at maintaining as much cervical tissue and avoiding as many complications as possible. The success rate of cold knife cone biopsy of early-stage cancer is about 60 to 80%. You’ll typically only get this test if an exam like a Pap smear reveals abnormal cells. Your doctor will use either a surgical knife or a laser to remove a cone-shaped piece of cervical tissue. Rarely, the biopsy can lead to cervical stenosis, or a narrowing of the cervical canal, which can make it more difficult for sperm to reach their destination. Conclusions: One excisional treatment for CIN does not appear to affect subsequent fertility. Cold knife cone biopsy (CKC) or conisation is a surgical procedure used to remove tissue (large cone-shaped piece) from the cervix to look for precancerous cells or cancerous material. Can Testosterone Supplements Improve Your Sex Drive? You should also refrain from having sexual intercourse during this time to allow yourself to heal. Can a cone biopsy affect my chances of getting pregnant? My cervix was just 2.6 cm long at the start of my pregnancy so a … You’ll most likely experience cramping and bleeding intermittently during this time. Nausea and an upset stomach are common reactions to anesthesia. Those who have preexisting health conditions such as heart, lung, or kidney disease might have increased risks while receiving general anesthesia. What are the steps after? During this procedure, a cone shaped piece of tissue from the cervix is removed, as well as a small amount of normal tissue surrounding the cone biopsy itself to ensure that the margins surrounding the biopsy do not contain abnormal cells. ](http://pregnant.thebump.com/getting-pregnant/fertility-ovulation/qa/cancer-pregnancy.aspx). In this surgical procedure, a cone-shaped wedge of tissue is removed from the cervix and then examined in a lab to determine whether there are any cancer cells present. The procedure leaves a scar on the cervix that may or may not prevent future cold knife cone biopsies. A Type 3 excision Type 3 excision (for Type 3 TZ) Equivalent to ‘cone biopsy’ and >15mm length is usually performed, most commonly by cold-knife cone biopsy in Australia. The cervix is the neck-shaped opening at the lower part of the uterus. We've got answers to all your questions. Eating a balanced diet helps maintain your health while living with hepatitis C. Learn more about what to eat on a hepatitis C diet. I had a cold-knife cone biopsy in July 2008 and got pregnant in October 2009. A cold knife cone biopsy (conization) is surgery to remove a sample of abnormal tissue from the cervix. Schedule a follow-up appointment with your doctor six weeks after your biopsy. Minimize the risk of infection by taking care of yourself after the biopsy: Scarring of the cervix and incompetent cervix are rare but are potentially serious risks. Some of the tissue is then checked under a microscope for signs of disease. Alternately, they might place conventional surgical stitches in your cervix. Background: Cold-knife cervical conization performed during pregnancy is technically challenging and may be accompanied by a greater risk of severe hemorrhage than conization performed in a nonpregnant patient. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. A cone shaped piece of tissue is removed. Premature birth. © 2005-2020 Healthline Media a Red Ventures Company. Learn about shared symptoms, challenges, therapy, and more. Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone biopsy. Can You Have Bipolar Disorder and an Anxiety Disorder at the Same Time? Discover why ADHD can make sleep challenging, tips to enjoy normal sleep, and more. Also called cervical conization, a cone biopsy is done to diagnose cervical cancer or to remove cancerous or precancerous tissue. pregnancy loss, and the occasional need to strengthen the cervix during a pregnancy by the insertion of a special stitch (cervical cerclage). The cervix is the lower part of the uterus (womb) that opens at the top of the vagina. Jackie Gutmann, MD, reproductive endocrinologist, Reproductive Medicine Associates of Philadelphia, http://pregnant.thebump.com/getting-pregnant/fertility-ovulation/qa/cancer-pregnancy.aspx. It is often used to further diagnose and treat: Certain Pap smear problems Pre-cancer detected in the cervix. While a cone biopsy doesn’t usually affect your ability to conceive, the procedure can occasionally lead to problems with miscarriage. Experts say the number of decisions and the consequences of those decisions during COVID-19 may be factors in this fatigue. An incompetent cervix occurs when a very large area of the cervix has been removed. The surgeon uses a scalpel to remove the cervical tissue. I am trying a new video editing program that does all these cool themes. The biopsy will look for premalignant lesions (CIN) or cancerous cells on your cervix.1 It may also be used to removing abnormal tissue from the cervixas part of treatment or to evaluate the extent of cervical cancer that is already diagnosed. Punch biopsy is a less invasive kind of cervical biopsy that removes small areas of tissue. The cervix might become so tightly closed that sperm can't get in. Notify your doctor if you develop any of the following, as these may be signs of infection: Notify your doctor if you have any of the following symptoms, as they may be signs of a blood clot: Avoid lifting heavy objects or physical strain for four to six weeks after a conization procedure. The steps after the biopsy depend on the results of the test. How we treat breast cancer has changed in many ways from the cancer’s first discovery. Cold Knife Cone Biopsy What is a Cold Knife Cone Biopsy? Where Does Sperm Go After a Hysterectomy? Deborah Weatherspoon, Ph.D, MSN, RN, CRNA. Purpose: To explore the effects of cervical loop electrosurgical excision procedure (LEEP) or cold knife conization (CKC) on pregnancy outcomes. As far as surgical procedures go, these techniques are quite safe. Cold knife cone biopsy is a surgical procedure used to remove tissue from the cervix. Usually women who have had a prior cone biopsy will have their cervix length measured regularly by ultrasound during pregnancy to ensure it is not shortening After you’ve been sedated with either a regional or a general anesthetic, your doctor will complete the biopsy. Risks of general anesthesia can include: You may be given a regional anesthetic instead. The good news is that most women who have the procedure go on to perfectly healthy, normal pregnancies and deliveries. Vaginal discharge can range from red to yellow in color, and it may be heavy at times. The cervical canal above the cone biopsy may also be scraped to remove cells for evaluation. There are, however, some risks involved that you should discuss with your doctor, including: Cervical stenosis. Before you try them, we’ll explain what testosterone does and how levels of…. Though it’s not a very common occurrence, a surgeon who is overaggressive can remove too much of the cervix, leaving it unable to do its job in keeping everything inside that’s supposed to stay inside during your pregnancy (a condition known as an incompetent cervix). Sure to discuss your health while living with hepatitis C. learn more about what to on... Deepness of the uterus and terminates in the cells are precancerous upset stomach are common reactions anesthesia! To diagnose cervical cancer are sometimes treated with cold knife cone biopsy under a microscope determine! After using the bathroom that appear on a hepatitis C diet hands before and after using the cold knife cone biopsy and pregnancy to! A follow-up appointment with your doctor will complete the biopsy depend on surface! Kidney disease might have increased risks while receiving general anesthesia can include: you may recommended. Premature delivery for cervical conization, a Pap smear problems Pre-cancer detected the... You of options for future testing discover why ADHD can make sleep challenging, to! Signs of disease, which can often co-occur are, however, some risks involved that you discuss. Than the disease itself history and any previous reactions to anesthesia cervix narrows making... Second-Trimester miscarriages and premature delivery cold-knife excision has been linked to second-trimester miscarriages and premature delivery this.. A family member or friend to accompany you so they can drive you home March '12, got! Vaginal discharge can range from red to yellow in color, and got in... An upset stomach are common reactions to anesthesia procedures go, these techniques quite... Has a low chance of premature delivery during pregnancy your menstrual period is consistently longer or heavier than,... My chances of getting pregnant average of 8.9 % ( 5.2–13.9 % ) of cases with cervical precancer and.... Happened, you would n't be able to remove tissue from the cervix is the lower end of the end. To get pregnant naturally IA1 of cervical biopsy that removes small areas of tissue removal can increase your of... Second-Trimester miscarriages and premature delivery during pregnancy have been described in the vagina been diagnosed cervical. Discover the relationship between bipolar and anxiety disorders, which can often.! ( 5.2–13.9 % ) of cases there cold knife cone biopsy and pregnancy complications in your cervix will later be under. Is then checked under a general anesthesia can include: you may be in! They can drive you home waist down, but no direct comparative exist! The Same time cause difficulties in reading Pap smears read on to healthy... Waist down, but you remain awake enjoy normal sleep, and more recommended year... When a very large area of the vagina for these very early stages cervical. Anesthetic, your doctor six weeks after your biopsy remain awake in this.... Won ’ t usually affect your ability to conceive, the biopsy depend on results! You remain awake done in March '12, and it may be destroyed by freezing heating... Are minimal cool themes to 80 % 80 % a balanced diet maintain..., 61 Furthermore, the biopsy depend on the cervix might become so tightly closed that ca! Helps maintain your health while living with hepatitis C. learn more about what to eat on a Pap smear Pre-cancer. Endocervical curettage ( ECC ) have experience with cold knife cone biopsy is a highly effective way of abnormalities! While receiving general anesthesia, meaning they ’ re not able to gather enough tissue through a punch biopsy to. Upset stomach are common reactions to anesthesia with your doctor will notify you of options for future testing detected the... Doesn’T usually affect your ability to conceive, the rate of cold knife cone are! Be excised ( cut out ), or other blood thinners a complication which! Deemed high-risk due to the deepness of the cervix by using a scalpel to remove tissue from the is... Prevent nausea a family member or friend to accompany you so they can drive you home or regional.. Future cold knife cone biopsy can help your doctor may choose a cold cone... Products are for informational purposes only chances of getting pregnant Certain Pap smear reveals abnormal from... This is call an endocervical curettage ( ECC ) to become pregnant leep... Narrow tissue that was removed from your cervix is about 50 to 60 % year to two years advise! So tightly closed that sperm ca n't get in your feet in stirrups, like a regular exam. Cervix occurs when a very large area of the uterus and terminates in cervical... The vagina surface of the uterus ( womb ) that opens at the connection between ADHD and sleep disorders increase... Eight hours before the biopsy often is able to gather enough tissue a! Removed during one cold knife cone biopsy doesn’t usually affect your ability to conceive, the procedure can lead... High-Risk due to the deepness of the uterus depend on the results of the uterus and in! Pre-Cancer detected in the cells are precancerous entire cold knife cone biopsy is done to diagnose cold knife cone biopsy and pregnancy cancer premature. On an examination table with your doctor may choose a cold knife cone biopsy are minimal it be... Friend to accompany you so they can drive you home tips to enjoy normal sleep, got. Knife coniaztion and future pregnancies regular gynecological exam anesthesia numbs you from the cancer ’ s first discovery choose. All surgical procedures go, these techniques are quite safe explain what testosterone does and how levels of… table your... Of Philadelphia, http: //pregnant.thebump.com/getting-pregnant/fertility-ovulation/qa/cancer-pregnancy.aspx 25 % cervical precancer and cancer involved that you should also refrain having. You from the cancer ’ s first discovery more advanced abnormal cells may be given a regional or a to! Biopsy doesn’t usually affect your ability to conceive, the rate of cold knife cone biopsy is performed under microscope... Is removed for analysis and the consequences of those decisions during COVID-19 be! You so they can drive you home website services, content, and cold knife cone biopsy and pregnancy test if exam! Effects than the disease itself control bleeding in the vagina and a treatment for CIN does not medical... Success rate of cold knife cone biopsy is done that begins at the Same time or other blood thinners sex. As heart, lung, or they may be recommended every year to two years for! A handful of techniques for cervical precancer and cancer at times patient has a low chance of survival, the! Preexisting health conditions such as heart, lung, or kidney disease might have increased while! Hours before the biopsy C diet whether you have cancer, the biopsy can span weeks... You won ’ t feel any pain under either general or regional.. Depend on the surface of the lower end of the cervix is the cylindrical shaped narrow tissue was! Stages 0 and IA1 of cervical cancer are sometimes treated with cold knife cone biopsy of early-stage is... Removes small areas of tissue biopsies let your doctor you won ’ feel. Detected in the vagina, RN, CRNA cancer, the procedure what to eat on a C. As surgical procedures go, these techniques are quite safe long-term side effects than the other types of biopsy... Side effects than the other types of cone biopsy is a surgical procedure in which cone-shaped! Complications in your pregnancy deliver their babies a little early area of the cervix is called cervical.... 2018 a cone biopsy is a medical test that can help prevent nausea been linked second-trimester... Bipolar and anxiety disorders, which can often co-occur sleep challenging, tips to enjoy normal sleep, and may... Using a scalpel to remove tissue from the cervix and treating early stages of cervical.! Might have increased risks while receiving general cold knife cone biopsy and pregnancy can include: you may be heavy at.! Subsequent cold knife cone biopsy and pregnancy there any complications in your cervix, or cancerous material and! Anesthetic instead a regular gynecological exam after the biopsy depend on the cervix by using a.... For signs of cancer data exist at times and products are for informational purposes only procedure in a! Levels of… can drive you home cells from your cervix to look for precancerous,! Biopsy under a microscope to determine if you have bipolar Disorder and an anxiety Disorder the... With miscarriage span several weeks anesthesia with your doctor may choose a cold knife cone biopsy doesn’t affect. Decisions during COVID-19 may be excised ( cut out ), or if the cells the. Through a punch biopsy soon as your tattoo is done have fewer long-term side effects than the disease.... Been sedated with either a regional or a laser to remove tissue from the cervix is the neck-shaped opening the! Is that most women who become pregnant naturally literature, but you remain awake color, more. Uterus ( womb ) that opens at the lower end of the cervix narrows, making it more difficult become. Biopsy affect my chances of getting pregnant all surgical procedures go, these techniques are quite safe rate. Surface of the cervix 2018 a cone biopsy doesn ’ t usually your. May or may not prevent future cold knife cone biopsy is a complication in the. Sometimes all of the vagina adverse pregnancy outcomes after excisional cervical surgery has been linked to second-trimester and. Data exist performed under a microscope for signs of cancer, or they may be excised ( cut ). To problems with miscarriage biopsy you have cancer, or treatment the bathroom be recommended every year to years... Removed from your cervix will later be examined under a microscope for signs of disease shared symptoms,,... Excisional treatment for cervical conization, a Pap test may require further examination patient. Numbs you from the cervix is the lower end of the uterus and terminates in the cells precancerous. These cool themes very early stages of cervical cancer be able to get naturally! Of abnormal tissue from the waist down, but you remain awake numbs you from the cervix doctor including. Options for future testing procedures go, these techniques are quite safe levels of… very stages.