Dr. Paula Amato, United States
4.0
Consultations 90
Reproductive Medicine
Doctor Introduction
Dr. Paula Amato, United States
Dr. Paula Amato is a dual board-certified OB/GYN and reproductive endocrinologist dedicated to women's health. She is Professor of Obstetrics and Gynecology and Director of Reproductive Endocrinology and Infertility at Oregon Health & Science University. She served as President of the American Society for Reproductive Medicine from 2023 to 2024.
She will see patients part-time at Spring Fertility in Portland while continuing her research and teaching roles at Oregon Health & Science University (OHSU).
Dr. Amato specializes in caring for patients with infertility, polycystic ovary syndrome, and menopause-related concerns. Her research focuses on innovative assisted reproductive technologies to treat infertility and ovarian aging. Her passion for reproductive science and helping patients build families inspired her career in reproductive endocrinology and infertility.
Originally from Toronto, Canada, Dr. Amato loves the Pacific Northwest. Beyond exploring the outdoors and Portland's food and arts scene, she enjoys time with family, friends, and her Vizsla, and supports the Portland Trail Blazers and Portland Thorns.
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Location and Hours
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Monday
Open 24 hours
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Tuesday
Open 24 hours
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Wednesday
Open 24 hours
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Thursday
Open 24 hours
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Friday
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Saturday
Open 24 hours
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Sunday
Open 24 hours
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Jennifer VH
2 years ago
Jan 23, 2025
I could not access my child's MyChart because my child is now old enough to manage it independently, and we needed to message several medical professionals quickly. Sonia at the switchboard (Sonya? I am unsure of the spelling) was an angel! She gave me the MyChart Help Desk number, then helped me find the office number of the primary doctor we needed to contact immediately. We were accidentally disconnected, and Sonia called me back and left a message explaining what to do next. I reconnected with her, and she sent a message to the office for us. Sonia is sincere and empathetic. She is warm and attentive while efficiently resolving the issue so she can help the next caller. Thank you for taking the time to help us today, Sonia. You are wonderful. :)
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Karina Garcia-elias
1 year ago
Apr 4, 2025
This place needs to be shut down! They experiment on animals. Disgusting and cruel!
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3bq
1 year ago
Apr 2, 2025
Kudos to the ICU and Brain trauma team! They were phenomenal. Their exceptional surgical skills and dedication literally brought my grandson back to life. He was basically brain dead when he was admitted. The bedside manner of the entire staff was top notch. Jennifer and Ben were key in his continued recovery. Their initial care was paramount in him being able to speak again. I pray he’ll be walking soon, too. Kindness is never wasted. Peace and success to all. Thank you.
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Learning English Has Never Been Easier
1 year ago
Mar 14, 2025
Very kind and caring doctors and staff.
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Evan Salzwedel
1 year ago
Mar 10, 2025
This university has conducted animal testing for a long time. This is not the conscientious education you want.
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Ron Larson
1 year ago
May 19, 2025
I had gallbladder removal surgery here, and the doctors and nurses were excellent. My nurses, Matt Givik and Annica, were very professional and kind. It was reassuring to receive such high-quality care. My only concern was that the hospital was indescribably dirty, which was surprising. Two women at admissions were very rude to me and many other patients. I felt they belittled me, and other patients in the 9th-floor waiting room felt the same. One woman who checked me in and had me sign documents at her station was very kind and thoughtful. This was my first surgery at Oregon Health & Science University (OHSU), and based on the doctors and nurses, I would definitely return. The women at admissions could benefit from customer-service training, especially because they represent OHSU.
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ghost boi
1 year ago
Jun 15, 2025
Sign the petition to make OHSU stop using monkeys for animal testing and experiments!!!
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Becca Licious
1 year ago
May 30, 2025
My neurologist and the team are amazing.
I have a brain aneurysm, and they have taken excellent care of me.
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pm pdx
1 year ago
May 27, 2025
Avoid: OHSU Emergency Department.
Avoid: Knight Cancer Institute.
I have seen too much to ever come here if I had cancer or my life were in danger.
The emergency department is like traffic at 5 p.m.
Knight Cancer Institute = avoid.
BCBS insurance = avoid.
Oregon Health Plan = avoid.
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Amanda Lynne
11 months ago
Sep 30, 2025
The care was very good—or so I thought. Then I learned that sometime between my preoperative EKG and the day after surgery, I had a heart attack. No one said anything. For 11 months, I knew nothing and received no cardiac care, follow-up, or anything else. I saw specialists at Oregon Health & Science University, Adventist, and Providence, yet no one said a word. Follow-ups were scheduled but led nowhere. I only learned last weekend after an EKG in the emergency room. This is tragic and shows how poor American healthcare has become. I am tired of the irresponsibility of doctors, nurses, administrators, and insurance companies. You have started a war.
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Gina Stotts
11 months ago
Sep 29, 2025
I did not realize medical facilities allowed employees to make TikTok videos, dance, crochet, or use company computers for personal activities!
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Morgen Alex
10 months ago
Oct 28, 2025
Oregon Health & Science University (OHSU) offers first-rate medical care, innovative research, and expert teams. Patients benefit from advanced treatment options, compassionate clinicians, and a supportive, state-of-the-art environment.
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Sydnee Steele (Sydnee Steele)
8 months ago
Dec 24, 2025
I am extremely disappointed. We traveled here specifically for answers, and we have had enough.
We arrived excited to experience the "elite" service promised on the website, but instead encountered disorganization and waited months for an appointment. I prepared eight questions, and the doctor answered only four, vaguely and curtly. I then had to repeatedly press for an answer to the final question. His ultimate conclusion was that more testing was needed, as if asking why we had not already done it. If their medical care is as outdated as the staff profiles on their website, there is a serious problem. With poor privacy, disorganized scheduling, bad bedside manner, and concerning cleanliness, the only "elite" thing about this clinic is how much they exaggerate and fail to deliver. I traveled a long way for professional medical care, only to find a clinic that seemed to avoid doing an examination. The care felt less useful than interacting with a robot. Updates are needed.
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Jennifer Matthews
8 months ago
Jan 20, 2026
I spent months trying to gain admission to Oregon Health & Science University (OHSU), and the process was extremely frustrating. Several providers faxed referrals, but I was repeatedly told the information was 'incorrect,' even after two clinics updated them to OHSU's specifications. Sometimes OHSU claimed it never received the faxes.
For more than two months, I called weekly to check progress and confirm receipt. This took at least six hours of my time, plus my providers' time. I received different information on every call.
On the final call, they first said the materials had not arrived, then said they had and were correct, and finally said they were no longer accepting referrals.
If referrals were no longer accepted, they should have told me clearly before I spent months meeting changing requirements. This wasted my time and that of multiple providers and was honestly the worst administrative communication and customer service I have experienced.
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Wade McHargue
6 months ago
Feb 20, 2026
My husband was diagnosed with liver failure, and his doctors led him to believe he was an ideal liver transplant candidate. Oregon Health & Science University (OHSU) allowed his condition to deteriorate while continuing to tell him he would receive a donor liver. We were told it would take one week to determine his transplant eligibility, but it took three weeks. During that time, his kidneys also began showing signs of damage. He was eventually approved and placed on the transplant list. A few days later, a suitable liver became available and pre-transplant preparations began, but we were then told the liver had “expired” and was unsuitable. The next day, he was told he was still doing well and only needed to wait for a suitable donor liver. That same day, a catheter placed in his neck began leaking calcium solution at an alarming rate, but the doctors did not seem very concerned. He lost about 3 liters of fluid. They did nothing to stop the leak and let the fluid pour over him throughout the night. He lost too much blood, his blood pressure plummeted, and he had to be transferred to the ICU and treated with norepinephrine. On his second morning in the ICU, the hepatology team told him he was no longer eligible for transplant, that he would die, that nothing could be done, and that he should receive palliative care. The hepatology team abandoned him without hesitation and stopped communicating with us. Fortunately, my husband’s brother is a physician and used his resources to look for alternatives. An ICU nurse, a caseworker, his brother, and the palliative care team worked together to transfer him to another hospital. This took another three weeks because no one at OHSU seemed to know how to transfer a patient out of its health system.
He was transferred to Houston Methodist Hospital on January 31, 2026, received a liver transplant on February 16 and a kidney transplant on February 17. Today, February 19, he is recovering.
If you or a loved one needs a transplant and are considering OHSU, reconsider and go directly to Houston Methodist Hospital. I wish we had known sooner so we would not have wasted so much time and energy at OHSU.
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Deborah Garcia
7 months ago
Feb 17, 2026
The medical team and staff were wonderful. Thank you for their attentive care.
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Morgan R.
7 months ago
Feb 7, 2026
If you are seeking transgender healthcare, I strongly advise against coming here. Unfortunately, this is nearly the only institution in Oregon performing most of these procedures, and many doctors refer patients here. Surgical wait times are unbelievably long, and the referral process alone can take a long time. I began seeking a referral for sex reassignment surgery (SRS) in September and submitted about four requests through different doctors before it was finally approved in December. No one told me why the referrals kept failing, and I am very worried this will further delay my surgery.
The Transgender Health Program claims to integrate all departments so transgender people can access care here more easily, but that is not true. I personally do not even understand the program’s purpose. I had to contact each department separately and submit individual referrals, and no one notified me when problems arose. I truly did not know what to do. For example, urology has specific requirements for SRS, but no one told me in advance.
In October, I attempted suicide because of my experience with Oregon Health & Science University (OHSU). I was referred to OHSU for laser hair removal in April, but treatment did not begin until late September. My first appointment was supposed to be a consultation, but they confused me with another transgender person in the room because we shared the same former name. I received her laser treatment instead of a consultation and heard some of her personal information. At my October laser appointment, they told me my insurance had been canceled. I had no idea what they meant; it was completely unexpected, and they said it was due to a new dermatology policy. I asked how this would affect my surgeries at OHSU. At the time, I had a social-work assessment for facial feminization surgery scheduled for 2027—this was in 2025, by the way, haha. They said the surgery might now be impossible, but I could “wait a few months and maybe things will change.” They also told me that “OHSU as an institution” no longer accepted my insurance, making me feel completely hopeless. I contacted my insurer, and they were also confused because the doctors they covered worked only at OHSU.
I contacted the head of THP, who also knew nothing about the situation. Dermatology gave me no answers, calls elsewhere went unanswered, and I ultimately filed a complaint. In November, I received a “resolution,” but they had essentially been incompetent and left me stranded. I believe they introduced a policy saying patients with out-of-network insurance should first be counseled about possible costs, but they did not do that; they simply canceled my appointments. Moreover, despite being out of network, my insurance covered 12 appointments, and I paid nothing beyond the copay. I did not truly hear from them until November. On October 30, believing my surgery was completely lost, I nearly died by suicide.
Honestly, my surgery is still nearly impossible despite some progress with scheduling. The wait is so long that I cannot understand it. I am now 23, and my insurance will expire before my first gender-affirming surgery consultation in February 2028. I do not know when the surgery itself would happen; that date is only for a consultation. I must wait until February 2027 to see a social worker and qualify for facial feminization surgery, which is absurd because I saw a social worker three weeks after my referral was processed, while the consultation still is not until 2028. At this rate, facial surgery will probably not happen until at least 2029 or 2030. Since beginning care at OHSU, I have become increasingly discouraged about my transition, but I truly have no other option. I am seriously considering stopping my transition because I cannot address my severe gender dysphoria through surgery, so I do not understand why I should continue. I hate this place.
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Dave Baker
5 months ago
Apr 10, 2026
These people take caring for patients to another level. God has Blessed me 10 fold by leading me to this cancer hospital. God Bless every Dr, nurse and staff member for the great work that they do.
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Michel Mena 28
5 months ago
Apr 4, 2026
My experience calling to schedule an appointment at Oregon Health & Science University (OHSU) was disappointing. The staff member who answered was arrogant and unhelpful, making the interaction very uncomfortable.
I understand that medical facilities can be busy, but clear and respectful communication is essential, especially when patients are already dealing with health concerns.
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Leigha
4 months ago
May 3, 2026
From Georgia to Portland, this is the best children's hospital I have seen. The care, comfort, and understanding are truly on another level.
Thank you, Doernbecher Children's Hospital ❤️
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Christina Deleon Guerrero
1 year ago
Jul 30, 2025
I cannot thank Spring's Fertility enough. They brought hope to people like my husband and me, who never thought pregnancy was possible. The experience was an emotional roller coaster, and we could not have succeeded without the tremendous support of the Springs Fertility staff and care team.
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Abby
1 year ago
Jul 22, 2025
We loved the Spring Fertility team. Dr. Paula Amato and the entire staff made us feel deeply cared for throughout the IVF process. I highly recommend this clinic!
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Skylar Price
1 year ago
Jul 19, 2025
Dr. Amato is truly an angel! She is highly knowledgeable and compassionate. Her colleagues are equally professional and kind. Dr. Palmor, Dr. Kulkarni, and Dr. Bonus were all helpful and caring during our visits. Graduating from a clinic we love so much is bittersweet! If we plan another pregnancy, we will definitely return!
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Ti To
1 year ago
Jul 12, 2025
Communication and the financial department are poorly managed. They stretch a process that should take a few months with your physician into years, resulting in dozens of repeat appointments.
Spring has completely disappointed me. I was told they were the only clinic in the area covered by my insurance. At every visit, they assured me my insurance would cover everything. Yet bills arrived at my home every month with threats of collection, while my insurance company said it had received no response from Spring. I called Spring's financial department repeatedly and was told everything was resolved and I would receive no more bills. At my most recent appointment, I was still required to pay out of pocket because Spring had not handled the insurance paperwork properly.
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Katie Mellott
1 year ago
Jul 6, 2025
Extremely clean, pleasant atmosphere, strong team, and attentive service. The overall experience was wonderful and a million times better than our previous clinic. The only issue was that we could not get a clear explanation of which medications were excluded from the care package or their exact costs.
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Katherine
1 year ago
Aug 16, 2025
Infertility is an extremely stressful process. My husband and I decided to work with Spring in hopes of getting help and simplifying the process. Unfortunately, working with Spring felt like a nightmare. Communication was very poor and caused a great deal of unnecessary anxiety. During every cycle, it was difficult to reach my CD1 nursing team. It usually took 3-4 calls and portal messages to reach someone, or I would not hear back until the following afternoon—all on business days—and then had to rush to a last-minute appointment. Basic administrative tasks were completed only after repeated requests. At baseline and monitoring appointments, the doctor would tell us one thing, but when the nurse called later, we would be told something different and prescribed different medication, forcing us to seek clarification. I even had a doctor tell me one thing at one appointment and something completely different at the next, making me wonder whether she had reviewed the correct chart—or knew I was responding poorly to medication but wanted to continue anyway. Working with Spring was extremely frustrating and wasted a great deal of money. Based on the positive reviews, I do not know whether the problem was my care team or Spring overall, but I strongly recommend going elsewhere.
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Katherine Alegre
1 year ago
Aug 13, 2025
Thank you to the team at this clinic.
Thank you, Dr. Lee and Dr. Amato.
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Sivan Ben-David
1 year ago
Aug 6, 2025
I am still a patient at Spring, but I wanted to leave a review because I have been very impressed and pleased with my care.
Dr. Fisher is my doctor, and I am very glad I ultimately chose him for treatment. He creates a personalized treatment plan based on you and your goals and is very attentive and compassionate, which is especially important in a fertility doctor. I also appreciate that he presents information directly and involves you in decisions. His many years of experience and extensive knowledge are evident.
His nurse Sarina is excellent. She has undergone IVF herself and is very attentive.
The clinic is nice. Although others have complained about the app in reviews, I found that it does exactly what is needed and provides plenty of useful information, including a treatment calendar and medication reminders.
I would recommend this clinic for fertility care.
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Tiffany Wang
1 year ago
Aug 5, 2025
Dr. Fisher and his team, including Haley, Sarina, and Melanie, did an outstanding job. Communication was prompt and excellent from beginning to end. The team coordinated a complex schedule smoothly, ensuring that I understood the process well in advance and accommodating my personal and work commitments. When the pharmacy failed to send my injection pen, they arranged for me to pick one up from the clinic over the weekend. Dr. Fisher managed my IVF cycle and retrieved 28 eggs when I was 37, with no known preexisting issues. I ultimately had 4 grade-A, genetically euploid embryos. I am extremely pleased with the results and would wholeheartedly recommend Dr. Fisher and Spring to family and friends.
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Natalie LeMoss
1 year ago
Aug 2, 2025
Dr. Fisher was very kind, patiently explained everything at each appointment, and listened carefully to my questions. His nurse Sarina was warm and friendly, and with the Spring team's attentive guidance, my egg-freezing process was perfect.
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Angela Seaburn
10 months ago
Nov 8, 2025
I can’t say enough wonderful things about this clinic and the entire team! From the moment we walked in, we were treated with compassion, professionalism, and genuine care. Dr. Fisher was amazing. He took the time to explain every step of the IVF process, making sure we understood and felt comfortable throughout.
We did experience a few setbacks getting my husband’s vials sent over, but the staff handled everything with care and kept us updated until it was all resolved. Their communication and dedication made what could have been stressful feel manageable and supported.
I’m so grateful to have been referred to this clinic and this amazing team!
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Vina R
10 months ago
Nov 8, 2025
We visited many clinics during our fertility journey, and Dr. Wu and her team at Spring Fertility truly stood out. Their attention to detail, thoughtful planning, efficiency, and genuine care were unmatched. Dr. Wu is highly knowledgeable and meticulous. I always felt safe, well cared for, and confident in her hands.
I also want to thank my favorite nurse, Michaela, for her tremendous support, care, and encouragement throughout.
We are deeply grateful for their exceptional care and highly recommend Dr. Wu and the Spring Fertility team!
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J312
10 months ago
Nov 5, 2025
The staff are excellent, welcoming, attentive, and easy to communicate with. The doctors and nurses are knowledgeable. Highly recommended to family and friends!
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Devin VonderHaar
11 months ago
Oct 10, 2025
As many other reviews note, communication is terrible.
They handle everything through an app, which I found extremely frustrating.
My first appointment in May was in person. It cost $350, and with blood tests for both of us, the total was $630. I was billed incorrectly even though I firmly told the assistant that our insurance did not cover the blood tests. The assistant showed almost no emotional intelligence, and the interaction left me very upset.
We were persuaded to have blood work done for my transgender husband, though I knew it was unnecessary because he would not be carrying a pregnancy under any circumstances.
After the appointment, I told the very young, inexperienced coordinator that I preferred email to simplify communication. My feedback was ignored, and I received more app messages and phone calls.
Two steps were required before choosing a donor, after reviewing the blood test results.
We scheduled an HSG as requested by LO. Although it cost another $550, the experience was much better and was not at Spring.
The final step before choosing a sperm donor was mandatory counseling on how to discuss donor conception with our future child. I found it invasive and a money grab. Several others in our group were angry about this requirement and the lack of autonomy it imposed on a community that has already endured so much. The service cost $150 and wasted 2 hours. For heterosexual couples, the counseling costs $500.
The biggest headache was spending two weeks emailing the finance department after learning of the billing problem last week.
They said I had to pay $465 within 7 days or be sent to collections—5 months after the appointment!
They accepted no responsibility for their billing error and placed all blame on me.
The entire process felt cold, manipulative, and focused solely on money. We wasted $1,130 and made no progress toward having a child.
The staff are too young and inexperienced for this field. We are trying to have a child. The process should feel completely different.
Queer people and anyone seeking safety and support should stay away.
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Danielle
9 months ago
Dec 1, 2025
I highly recommend the Spring Fertility team.
We have had an excellent experience working with them over the past year and a half.
We are a same-sex couple and initially tried intrauterine insemination (IUI). After several unsuccessful attempts, we moved to in vitro fertilization (IVF).
All documents, results, and communication were handled through the Salve app, which made the entire process much easier to track.
The nurses, doctors, and counselors were extremely supportive throughout.
Thank you, Spring Fertility team!
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Samantha Gritton
10 months ago
Nov 12, 2025
Run! Do not start your fertility journey here. They drew a great deal of blood for testing, then somehow missed half of both my and my husband’s lab orders. They told us to repeat them at LabCorp but did not even contact LabCorp. Their own blood-draw room was filled with Starbucks cups and gym bags—I even questioned whether it met OSHA standards. Worst of all, I called several times and no one answered. What if my call had been urgent? Many IVF appointments are time-sensitive. Should the doctor not return calls proactively? We quickly left this clinic and are now having an excellent experience at another fertility clinic. I urge everyone to try somewhere else first!
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Tailor Johnson
8 months ago
Jan 15, 2026
We had our second transfer at Spring and are now holding our little baby. It was always clean, welcoming, and quiet ❤️, and everything moved very quickly and on time, which I truly appreciated. My favorite part was that there was always parking right outside. Thank you, Spring, and thank you, Dr. Krieg!
Tailor Johnson NextHome
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krissy girl
6 months ago
Mar 4, 2026
My experience at Spring Fertility was great. My husband and I have been trying to become pregnant for 4 years. After 2 years, I had fertility testing and learned that I had a blocked fallopian tube. I cried because I knew I could not become pregnant naturally. A year later, I sought a second opinion and received the same diagnosis. That was when I decided to undergo IVF. I was referred to Spring Fertility, and it was the best decision I made. At my consultation on December 16 last year, Dr. Fisher explained how IVF works and what was best for me. He is very knowledgeable and clearly knows what he is doing. Everyone, from the front desk and medical assistants to the nurses, especially Nurse Sarina, is friendly and treats you like family or a friend. The Salve app is also very helpful for medication and appointment reminders. You can contact the team through it, and they respond promptly. I am now waiting for my embryo transfer. I love Spring Fertility and will definitely recommend this clinic to anyone who needs IVF to have a baby because they cannot conceive naturally.
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Annie
6 months ago
Mar 14, 2026
We began our fertility journey at another clinic, then researched local options extensively, and we are very glad we chose Spring.
Dr. Fisher is thoughtful, knowledgeable, evidence-based, and highly attentive to detail and our individual needs. Infertility is an intensely personal and vulnerable subject, and I felt tremendous trust and reassurance placing our care in Dr. Fisher’s hands.
We also want to recognize our nurse Sarina, who called after every appointment to check on us and answered our many questions throughout the treatment cycle. Thank you, Sarina!
Graduating and saying goodbye to Spring was bittersweet because the clinic supported us so thoroughly through this challenging chapter of our lives.
Several reasons I chose and appreciate this clinic:
- It is open on weekends and holidays, unlike many clinics. Menstrual cycles and the body are unpredictable, so not having to worry about clinic hours for monitoring or retrievals is very important.
- Except on weekends, holidays, or when the doctor is away, the same doctor handles every appointment, including baseline testing, monitoring, and procedures. Almost all other clinics rotate doctors.
- The clinic has an on-site laboratory, so blood test results are available the same day.
- Embryologists are on site; some clinics bring embryologists in.
- Communication with nurses is easy through the Salve app.
- The clinic is conveniently located in downtown Portland, with ample free parking in the garage.
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Em Daugherty
5 months ago
Apr 15, 2026
I saw Dr. Wu to learn about my fertility and whether I still had time to consider having children. Every visit was excellent and very informative.
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Mariah Brooks
5 months ago
Apr 14, 2026
I had planned to wait the full nine months before sharing our experience, but with our due date approaching, I cannot help expressing my gratitude to Spring Fertility, especially Dr. Fisher.
I have never felt so heard, valued, and genuinely cared for by a doctor or clinic. Before beginning our IVF/ICSI journey, we researched several clinics both in and out of state. Everyone's situation is different, but for us, the most important thing was understanding the cause of our years of infertility rather than immediately starting treatment.
From the beginning, our concerns were taken seriously. At every step, we felt understood, supported, and guided. The team referred us to specialists so we could truly identify the cause, and we were ultimately diagnosed with male-factor infertility. This level of thoughtful care meant everything to us.
Throughout the process, we consistently felt seen, heard, and deeply cared for. Infertility is not easy, and accepting that assisted reproductive technology is needed to build a family can be emotionally difficult. But I can confidently say that our experience at Spring Fertility was incredible, almost magical, and deeply meaningful.
IVF is a major investment, both financially and emotionally, but the joy of parenthood is priceless. Every appointment, every conversation, and every step was worth it.
If I could, I would give Spring Fertility six stars. Thank you, Spring Fertility, for the gift that has made our lives better. As our due date approaches, our hearts are full of gratitude.
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Mallory Cotoe
3 months ago
Jun 5, 2026
**A note for LGBT+ clients**
This clinic lacks trauma-informed awareness, places additional burdens on LGBT+ people, and requires them to pay for group classes that heterosexual clients do not have to attend. The doctors were vague about the treatment process and went out of their way to avoid questions. We rarely received a response within a week, making our treatment take much longer than the clinic initially told us. They even lost my blood sample and made my wife return to provide another one, which was very concerning. My wife was treated terribly here, and choosing this clinic is our family's greatest regret. They also repeatedly used the wrong pronouns for me and ignored my objections when I raised the issue.
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3181 SW Sam Jackson Park Rd, Portland, OR 97239, United States
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