Holistic Treatment to get rid of Polycystic Ovary Syndrome

The Natural Pcos Diet

The Natural Pcos Diet, By Jenny Blondel, A Leading Australian Naturopath In Response To Thousands Of Requests For Professional Information To Help Women Suffering From Pcos. Real Solutions To Naturally Overcome PCOS. Naturally balance your hormones Increase your chances of conceiving Help you lose weight and feel good Curb your cravings for sugary foods Turn your fatigue around Achieve clearer, glowing skin See improvements in your mood. Do You Feel PCOS Is. Ruling Your Life? At Last! The Natural PCOS Diet. A Naturopath’s Easy Step-by-Step Guide to Overcoming PCOS Is. Now Available! Read more here...

The Natural Pcos Diet Overview


4.6 stars out of 11 votes

Format: Ebook
Official Website: jennyblondel.com

Access Now

My The Natural Pcos Diet Review

Highly Recommended

The very first point I want to make certain that The Natural Pcos Diet definitely offers the greatest results.

All the testing and user reviews show that The Natural Pcos Diet is definitely legit and highly recommended.

The A-z Of Pcos Symptoms And How To Treat Them Naturally

This e-book is a .pdf file which uses Adobe Reader or can be open with your internet browser, and contains 48 pages and has an A-Z of Pcos Symptoms and information about one or more natural treatments for each symptom. Some treatments can be used to treat more than one symptom which makes it even easier to include in your lifestyle.

The Az Of Pcos Symptoms And How To Treat Them Naturally Overview

Contents: 48 Pages EBook
Author: Olivia May
Official Website: www.pcostreatments.net
Price: $19.00

Polycystic Ovarian Syndrome

PCOS is the most common cause of anovulatory infertility. This syndrome was first described by Stein and Leventhal in 1935. The PCOS Rotterdam Consensus Conference recently defined PCOS as a clinical syndrome comprising any two of the three features amenorrhea or oligomenorrhea clinical or biochemical hyperandrogenism, and bilateral polycystic ovaries on ultrasound (45). Although no single biochemical test is diagnostic of PCOS, most patients showed a characteristic ovarian ultrasonographic appearance, namely the presence of > 10 follicles between 2 and 10 mm in diameter. On the other hand, ultrasonographically identified polycystic ovaries are a common finding in apparently normal women, with a prevalence of 20-23 (46,47). On careful review, menstrual irregularities and evidence of hyperandrogenism are frequently associated with the presence of polycystic ovaries in these apparently healthy women (48). Infertile women with PCOS represent a difficult therapeutic problem for assisted...

Indications Pcos Patients

The use of GnRH-nts in large series of polycystic ovarian syndrome (PCOS) patients has not been published so far. One of the most important hormonal aspects of PCOS patients is the increased LH tone secretion. This group of patients is characterized by anovulation, and ovarian ovulation induction is usually performed using clomiphene citrate, FSH associated or not with GnRH agonists. The rationale for the use of GnRH-nt in PCOS patients is the fact that the LH FSH ratio will be decreased since LH secretion is more affected by the antagonist administration than FSH secretion (2). In IVF, another clear advantage is the reduced incidence of OHSS with the utilization of GnRH-nt. The use of GnRH-nt protocol allows also to induce the oocyte final maturation with GnRH agonist, to elicit an endogenous LH surge and, subsequently, decreasing the risk of OHSS (61). However, a large prospective trial is necessary to confirm these physiological hypotheses (see infra). Lubin et al. (62) described...

IVM of Oocytes from Women with PCOS

PCOS is a very heterogeneous syndrome, often first diagnosed when the patient presents complaining of infertility approximately 75 of these women suffer infertility due to anovulation. The majority of women with anovulation or oligo ovulation due to PCOS have menstrual irregularities, usually oligo- or amenorrhea, associated with clinical and or biochemical evidence of hyperandrogenism. In almost all these patients, ultrasonic scan of the ovaries typically reveals numerous antral follicles (28,29). Fertility treatments for women with PCOS include lifestyle management, administration of insulin-sensitizing agents, laparoscopic ovarian drilling, ovulation induction, ovarian stimulation, and IVF. As previously mentioned, this group of patients has an increased risk of severe OHSS from gonadotropin stimulation compared with women who have normal ovaries (5,30). The risk of multiple-follicle ovulation and subsequent multiple pregnancies is also of crucial importance (5,31). However, the...

The Nature Of Complications

Only recently have these ideas, developed so effectively by Dr. Reaven, become conventional wisdom. In fact, syndromes of insulin resistance are manifest by impaired responses to insulin in skeletal muscle, adipose tissue, and the liver, clusters of abnormality including dyslipidemia with high triglycerides, low HDL cholesterol, decreased LDL particle size, postprandial lipemia, increased susceptibility to oxidation of LDL, obesity, hypertension, impaired fibrinolysis, and perhaps of most importance to the patient at risk, accelerated coronary artery disease manifested by acute coronary syndromes. Some or all of these derangements are seen in patients with syndromes of insulin resistance even in the ab- -o sence of the derangements in intermediary metabolism typical of diabetes, including hyperglycemia. Thus, women with the polycystic ovarian syndrome who are insulin resistant have accelerated coronary disease as do normal subjects who are not diabetic but have elevated fasting...

Ovarian Stimulation And Ovarian Cancer

There are significant clinical differences between the prescription of clomiphene citrate to a U.S. population of women compared with the administration of clomiphene citrate in other parts of the world. In Australia, e.g., clomiphene citrate is only available on prescription from specialist gynecologists and obstetricians rather than from general practitioners as in the United States. Furthermore, clomiphene citrate can only be prescribed in Australia for patients with polycystic ovary syndrome or related disorders and not for women who are infertile but who are spontaneously ovulating. Moreover, our general advice is to use clomiphene citrate in order to achieve four to six ovulatory cycles but not more in the treatment of an infertile woman with polycystic ovary syndrome and chronic anovulation. The use of clomiphene citrate for more than 1 year in an infertile woman would be highly usual and not recommended in our experience.

Presentation and Diagnosis

The symptoms and signs of CAH depend on the degree of enzyme deficiency. For 21-hydroxylase deficiency, this results in a broad clinical picture complete 21-hydrox-ylase deficiency leads to cortisol and aldosterone absence and salt-wasting crisis in the newborn period. The androgen excess results in prenatal virilization of the external genitalia in women (classic salt-wasting form). Less severe 21-hydroxylase deficiency results in milder cortisol deficiency and milder prenatal androgen excess, with prenatal virilization in women, but no aldosterone deficiency (classic simple virilizing form). Patients with the mildest forms present with symptoms caused by androgen excess only pseudo precocious puberty, hirsutism, menstrual irregularities and infertility, all of which are most readily detected in women (nonclassic form) (1).

In Vitro Maturation Of Oocytes In Infertility Treatments

Were transferred to a woman with premature ovarian failure. The recipient subsequently delivered healthy triplet girls. Trounson et al. (25) further suggested that immature oocyte recovery could be developed as a new method for the treatment of women with infertility due to PCO because the oocytes of these patients retain their maturational and developmental competence. However, the initial reported IVM pregnancy rates were low. Our group demonstrated that priming with hCG 36 hours prior to immature oocyte collection significantly improved the maturation rate, and the pregnancy rate exceeded 30 (26,27). IVM was initially considered as a treatment for patients with PCOS, but the indications are now expanding to include various other fertility problems.

Causes Of Insulin Resistance

Insulin resistance may be caused by rare genetic defects that alter insulin binding to its cellular receptors or cause defects in receptor or postreceptor signal trans-duction (1). Recently, defects in the nuclear receptor, PPARy, have also been linked to syndromes of severe insulin resistance (2). In addition, some endocrine-metabolic syndromes, such as Cushing's syndrome, acromegaly, and polycystic ovary syndrome, are associated with insulin resistance because of the hormonal imbalances associated with these conditions. However, in the most common forms of insulin resistance, single gene defects have not been identified and the development of insulin resistance represents a complex interaction among a poorly understood array of predisposing genetic factors and acquired environmental factors that modify insulin sensitivity. Among the latter, the most prominent are obesity (particularly intra-abdominal obesity), physical inactivity, and increasing age. It is also now well documented...

Fertility Preservation

Oocytes could be harvested from ovaries of cancer patients after controlled ovarian hyperstimulation. However, there are two major drawbacks associated with conventional IVF first, the time interval needed for IVF ranges from 2 to 6 weeks beginning with the patient's next menstrual period, which may sometimes be too long due to the natural course of the malignant disease without therapy. Second, ovarian hyperstimulation is associated with high estradiol levels which may not be safe in some cases of estrogen-sensitive breast cancer. Ovarian stimulation for oocyte collection could be totally avoided by collecting immature oocytes (51). We recently reported the retrieval of immature oocytes from unstimulated ovaries before gonado-toxic therapy for oocyte vitrification purposes (52). This resulted in the successful preservation of fertility with no delay in chemotherapy, no surgery, and no necessity for hormonal stimulation. Since that report, 26 cancer patients have undergone immature...

Impaired Glucose Tolerance And Type 2 Diabetes

Obesity is a well-recognized risk-factor for development of type 2 diabetes, but alone is insufficient to cause glucose intolerance. Thus, while it is generally accepted that women with PCOS are predisposed to type 2 diabetes (13,14), the development of diabetes cannot be attributed solely to the obesity that typically accompanies PCOS. Initial studies placed the prevalence of diabetes in PCOS at approximately 20 (8). More recent data have established that the prevalence of impaired glucose tolerance and type 2 diabetes mellitus among women with PCOS is even higher, with consistency across populations of varied ethnic and racial backgrounds (14,15). In two recent, large prospective studies, the prevalence of IGT g was between 30 to 40 and that of type 2 diabetes between 5 to 10 (14,15). < j These prevalences approximate those in Pima Indians who have one of the highest Ji rates of diabetes in the world (16). Evidence for an enhanced rate of development J of diabetes is also evident...

Obstructive Sleep Apnea

Obese women with PCOS are at increased risk for obstructive sleep apnea (OSA) (56). Based on the increased prevalence of OSA in men, and recent evidence that androgens may play a role in the male predominance, overnight polysomnog-raphy was performed in obese women with PCOS and age weight-matched controls (56). Women with PCOS had a significantly higher apnea-hypopnea index (AHI), and were more likely to suffer from symptomatic OSA syndrome. The AHI correlated with waist-hip ratio, as well as total and free testosterone levels. g Vgontzas et al. (57) also reported that sleep-disordered breathing (SDB) and ex- < j cessive daytime sleepiness are more frequent in women with PCOS than in pre-menopausal controls. Insulin resistance appeared to be a risk factor for SDB in J women with PCOS. Q Whether there is a causal relationship between OSA and cardiovascular morbidity and mortality is uncertain. However, recent evidence suggests that OSA may indirectly increase the risk of...

Conclusions And Future Considerations

MacDougall MJ, Tan SL, Balen A, Jacobs HS. A controlled study comparing patients with and without polycystic ovaries undergoing in vitro fertilization. Hum Reprod 1993 8 233-237. 26. Chian RC, Gulekli B, Buckett WM, Tan SL. Priming with human chorionic gonadotropin before retrieval of immature oocytes in women with infertility due to the polycystic ovary syndrome. N Engl J Med 1999 341 1624-1626. 27. Chian RC, Buckett WM, Tulandi T, Tan SL. Prospective randomized study of human chorionic gonadotrophin priming before immature oocyte retrieval from unstimulated women with polycystic ovarian syndrome. Hum Reprod 2000 15 165-170. 28. Tan SL, Farhi J, Homburg R, Jacobs HS. Induction of ovulation in clomiphene resistant polycystic ovary syndrome with pulsatile GnRH. Obstet Gynecol 1996 88 221-226. 31. Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004 18 773-788. 32. Child TJ,...

Atherogenesis In The Prediabetic State

Particularly fertile ground for germination of vulnerable plaques. Thus, a focus on treatment in the prediabetic state is likely to be important in preventing cardiovascular events later in ultimately diabetic subjects. One example is women with the polycystic ovary syndrome. These subjects are insulin-resistant and often have postprandial hyperglycemia. They are also often hypertensive. They are at increased risk for coronary artery disease. Accordingly, therapy designed to ameliorate insulin resistance is under intense investigation.

Spermatogenesis Stimulation

Testosterone And Prenatal Development

Because the sperm concentration usually remains below the normal range, evaluation, and optimization of the female partner's reproductive functions is indispensable, because the fecundity of a couple is dependent on both male and female reproductive function (43). An evaluation of the female cycle quality should be performed, and if pregnancy is not achieved after 6 mo, tubal function should be checked. Furthermore, hormonal disturbances such as polycystic ovary syndrome (PCOs), endometriosis, and other gynecological or systemic diseases can lead to female infertility (44). It is also well-known that the time span within which a couple will conceive (time to preg-

Menstrual and obstetric history

The normal age of the menopause varies considerably within the age range 45-55. Secondary amenorrhoea is commonly due to pregnancy. If this is not the case, organic causes such as severe systemic illness, hyper-prolactinaemia, androgen excess or hypopituitarism should be excluded before attributing it to a psychological disorder. Useful questions in the menstrual history arc shown in Table 5.23.

Pathology Of Cortisol Metabolism

This syndrome has been reported in just four patients (92,93,147,148). All are female and presented with hirsutism and menstrual irregularity. Investigation reveals mild ACTH-dependent adrenal androgen excess. Urinary cortisol metabolites are strikingly abnormal, with markedly elevated cortisone metabolite excretion and elevated total cortisol metabolite excretion. Urinary free cortisol corti-sone ratio is normal. The conversion of cortisone, administered orally, into cortisol in peripheral plasma was markedly impaired in one affected patient, and unlike healthy volunteers a peak of cortisone was also detected in peripheral plasma (Figure 18.4).

Ovarian Hyperstimulation Syndrome

Low body mass index and PCOS are two clinical predictors and gonadotropin dosage should be reduced in such patients. When OHSS is suspected before hCG injection (as when serum E2 > 25,000 nmol L), hCG should be withheld. If, however, OHSS is diagnosed after oocyte retrieval, embryos should be frozen in order to avoid conception and replaced later in a natural cycle (64) or with estrogen progesterone therapy. This approach also allows GnRH agonist administration to be renewed immediately after oocyte retrieval and maintained until the onset of subsequent menstruation, further reducing the risk of significant OHSS (65). We use hCG at a dose of 5000 IU rather than 10,000 IU for final oocyte maturation before retrieval in all our IVF patients to help prevent OHSS.

Cushings Syndrome With Unusual Laboratory Behavior Periodic Cushings Syndrome

Plasma Cortisol has a circadian rhythm similar to that of normal subjects, albeit at elevated concentrations, and responds normally to stress tests such as insulin-induced hypoglycemia. The most frequent manifestation of glucocorticoid resistance is adrenal hyperandrogenism in women and children and mild hypertension in both genders.

Procoagulant Activity

Polycystic ovary syndrome (PCOS) is the most common endocrine abnormality in premenopausal women, and insulin resistance and compensatory hyperinsuli-nemia play a fundamental role in the etiology of this syndrome. This is another example of an organ, in this case the ovary, responding normally to hyperinsuli-nemia by increasing testosterone secretion in the face of muscle and adipose tissue insulin resistance. Indeed, in this instance, the ovary may be supersensitive to insulin stimulation. In any event, the primary clinical manifestations of PCOS (hirsutism, abnormal menstruation, and difficulty in conceiving) are secondary to increased insulin-stimulated testosterone secretion by the ovary. Women with PCOS are at increased risk to develop both type 2 diabetes and the dyslipidemia of syndrome X. Both of these changes suggest that insulin-resistant and hyperin-sulinemic women with PCOS will be at increased risk of CHD, and there is now evidence of enhanced atherogenesis in middle-aged...

And Hormone Mechanisms

Anthony P Weetman, 2007 When Puberty is Precocious Scientific and Clinical Aspects, edited by Ora H. Pescovitz and Emily C. Walvoord, 2007 Insulin Resistance and Polycystic Ovarian Syndrome Pathogenesis, Evaluation and Treatment, edited by John E. Nestler, Evanthia Diamanti-Kandarakis, Renato Pasquali, and D. Pandis, 2007 Hypertension and Hormone Mechanisms, edited by Kushnerand Daniel H. Bessesen, 2007 Androgen Excess Disorders in Women Polycystic Ovary Syndrome and Other Disorders, Second Edition, edited by Ricardo Azzis, JohnE. Nestler, and Didier Dewailly, 2006 Evidence-Based Endocrinology, edited by Victor

Testosterone Shbg And Insulin

The mechanism for the association between obesity and low testosterone and SHBG has received considerable attention. Many studies have shown that testosterone levels are inversely correlated with insulin and c-peptide concentrations (50,51). This association is partly through SHBG, because fasting insulin likewise correlates negatively with SHBG levels (52), and insulin infusion lowered circulating SHBG, albeit slighty (53). Moreover, lowering circulating insulin levels with diazoxide increased plasma SHBG in men (54) and in obese women with PCOS (55). The regulation of SHBG expression by insulin has been studied directly using cultures of HepG2 hepatoma cells that express the SHBG gene (56). In these cells, adding insulin reduced SHBG mRNA levels (13) and protein secretion (12). As noted in the section on the SHBG gene, this insulin effect may be mediated by the liver-enriched transcription factor HNF-4 (hepa-tocyte nuclear factor-4) that transactivates the SHBG promoter (57)....

IVM and Preimplantation Genetic Diagnosis

Preimplantation genetic diagnosis (PGD) is a procedure whereby embryos produced by couples who are at risk of having children with an inherited disease or genetic defect, or by patients who have had three or more unexplained miscarriages, can be tested prior to implantation. Couples can therefore choose to have only those embryos diagnosed as being unaffected implanted in the woman's uterus, thus improving the chances of a successful pregnancy. IVF is normally necessary for patients who elect to undergo this procedure in order to generate multiple embryos for genetic analysis. We have recently used IVM as an alternative for selected patients with PCO PCOS who require PGD so as to avoid the side effects of fertility-drug administration and avoid the risk of OHSS. We recently treated a 35-year-old patient with recurrent miscarriage who had been unsuccessfully treated with two IUI and two IVF cycles in Germany. We collected one MII and 14 GV oocytes and biopsied eight embryos generated....

Normal Sex Steps Amages

Hypogonadism Klinefelter Syndrome

Cardiovascular disease is more common in men than in menstruating women, and more common in women with elevated serum androgen levels, as in polycystic ovary syndrome (PCOS) (1) or type 2 diabetes (2) than in normal women. Interest in the relationship between androgens and cardiovascular disease has been stimulated further by the emerging use of testosterone replacement for older men because of concern that cardiovascular risk might increase as a side effect of therapy. The relationship between circulating androgens and the cardiovascular syndrome is intimately related to sex hormone-binding globulin (SHBG) and its downregulation in obesity and by insulin. In fact, SHBG is an indicator of the association between sex hormones and plasma lipids, and low levels of SHBG predict the development of type 2 diabetes. Thus, low testosterone and low SHBG are a part of the metabolic cardiovascular syndrome, and, therefore, testosterone replacement has been advocated in these men to reduce their...

Altered Cortisol Metabolism In Obesity

Previous studies using radioisotope tracers showed that metabolic clearance rate for cortisol is indeed enhanced in obesity (170). Very recent studies have identified which specific pathways of cortisol metabolism are involved. In a study of 68 men and women, we reported elevated ratios of cortisol cortisone metabolites in obese men and elevated excretion of 5a-reduced metabolites in obese men and women (Figure 18.10) (163). Our finding of enhanced 5a-reduced metabolites in obesity has been confirmed in a further independent study of nearly 500 men and women (164) and in our own unpublished observations in an additional 300 subjects. It is likely that the same change explains the observation of increased 5a-reduced cortisol metabolites in polycystic ovary syndrome (171). We have also observed increased hepatic 5a-reductase type 1 activity in liver of leptin-resistant, obese Zucker rats (72).

Suggested Reading

Ehrmann DA, Schneider DJ, Sobel BE, Cavaghan MK, Imperial J, Rosenfield RL, Polonsky KS. Troglitazone improves defects in insulin action, insulin secretion, ovarian steroidogenesis, and fibrinolysis in women with polycystic ovary syndrome. J Clin Endocrinol Metab 1997 82 2108-2116. 29. Velazquez EM, Mendoza SG, Wang P, Glueck CJ. Metformin therapy is associated with a decrease in plasma plasminogen activator inhibitor-1, lipoprotein(a), and im-munoreactive insulin levels in patients with the polycystic ovary syndrome. Metabolism 1997 46 454-457.

Recommended Regimens

As we saw in this paper we still have questions on the best protocol to be used with GnRH-nts. From available literature, we can suggest that GnRH-nt can be used in a single- or multiple-dose regimen. The flexible or fixed approach appears also to give similar results. Programming the cycle can be obtained with OC pill or luteal estrogen. The latter lacks a prospective study to confirm its interest as opposite to the OC pill which is already used in many IVF cycles. The supplementation with LH activity is not supported by available scientific data. The supplementation of the luteal phase is recommended. If GnRH-nt appears to give comparable results in good responders, it should be studied in poor responders, patients with PCOS or IUI deserve further study.


Most enzyme deficiencies that cause CAH are extremely rare, except for 21-hydrox-ylase deficiency and 11-hydroxylase deficiency. The prevalence of classic 21-hydroxy-lase deficiency worldwide is 1 10.000 to 1 18.000, as derived from results of neonatal screening. Nonclassic 21-hydroxylase deficiency is estimated to be more prevalent (1 600), but this diagnosis can easily be missed in men because signs of androgen excess may go unrecognized. The estimated prevalence of 11-hydroxylase deficiency is 1 100.000 (1).


Fertility in men with congenital adrenal hyperplasia can be impaired. Testicular tumors are the most frequent cause of impaired fertility. They arise from aberrant adrenal cells in the testes that are stimulated by ACTH. Their location adjacent to the mediastinum and their steroid-producing properties may interfere with spermatogen-esis and Leydig cell function. Secondary hypogonadotropism is a second cause of impaired fertility, resulting from suppression of the hypothalamic-pituitary-gonadal axis by adrenal androgen excess or by production of steroids by testicular tumors. Other testicular abnormalities and psychological factors may also contribute to impaired fertility.


Women with PCOS would appear to be highly predisposed to the development of hypertension by virtue of their characteristic obesity and insulin resistance. However, the presence of systolic and or diastolic elevations in blood pressure are not a uniform feature of PCOS during the reproductive years. In one study (33), women with PCOS and controls were compared using 24-h ambulatory blood pressure monitoring and echocardiography. Despite the fact that the PCOS women were significantly more insulin resistant than their matched controls, there was no difference in systolic or diastolic blood pressure levels or in left ventricular mass between groups. It is possible, however, that measurement of ambulatory blood pressures or left ventricular mass are not sufficiently sensitive to detect subtle effects, direct or indirect, of hyperinsulinemia upon the resistance vessels. -o women with PCOS compared to normal women (17,34). < j The pathogenesis of hypertension in PCOS and other...


Women with PCOS are frequently characterized as having hypertriglyceridemia, increased levels of VLDL and LDL, and a lower HDL cholesterol (47,48), a lipid pattern similar to that seen in patients with type 2 diabetes. Various lipid subfractions may possess a greater atherogenic potential due to alterations in their lipid and apolipoprotein composition. Rajkhowa et al. (49) have reported that the HDL composition in obese PCOS subjects is modified by the depletion of lipid relative to protein, with significant reductions in both the HDL cholesterol and phospholipids to apoA-1. This suggests a reduced capacity -o the pathogenesis of the lipid abnormalities in PCOS. Testosterone decreases lipo- g genesis of these lipid abnormalities includes the findings of Wild et al. (50), who noted that, among hyperandrogenic women, suppression of estradiol and testosterone levels with a GnRH agonist did not result in alteration of baseline lipid abnormalities. Rather, the lipid profiles remained...


The decline in ovarian function is associated with a decrease in estrogen secretion and a concomitant increase in LH and FSH, which is characteristic of menopausal women (Table 38.3). It is used as a diagnostic tool. The elevated LH stimulates ovarian stroma cells to continue producing androstenedione. Estrone, derived almost entirely from the peripheral conversion of adrenal and ovarian androstene-dione, becomes the dominant estrogen (see Fig. 37.9). Because the ratio of estrogens to androgens decreases, some women exhibit hirsutism, which results from androgen excess. The lack of estrogen causes atrophic changes in the breasts and reproductive tract, accompanied by vaginal dryness, which often causes pain and irritation. Similar changes in the urinary tract may give rise to urinary disturbances. The epidermal layer of the skin becomes thinner and less elastic.

The Natural Pcos Diet Official Download Link

There is no place where you can download The Natural Pcos Diet for free and also you should not channel your time and effort into something illegal.

Download Now