Fertility and Reproductive Health Terms

Acrosome

the packet of enzymes in a sperm's head that allows the sperm to dissolve a hole in the coating around the egg, which allows the sperm to penetrate and fertilize the egg

Acrosome reaction

a chemical change that enables a sperm to penetrate an egg

Adhesion

scarring as a result of tissue injury. It can be caused by infections such as gonorrhea or chlamydia or by previous surgeries such as removal of cysts or an appendectomy or because of endometriosis. Adhesions involving the tubes and/or the ovaries can cause infertility by preventing the normal pick-up of the egg from the surface of the ovary. If the adhesions are mild, they can be treated by laparoscopic surgery. If the adhesions are severe, surgery may not be successful and in most cases (IVF) is recommended

Amenorrhea

absence of menstruation

Amniocentesis

test performed between the 16th and 18th week of pregnancy in order to determine the presence of birth defects in the developing fetus. It involves the insertion of a small needle into the amniotic fluid that surrounds the developing baby. The fluid is then screened for genetic conditions such as Down Syndrome

Androgens

refers to male reproductive hormones, such as testosterone. These hormones may be produced in excess by the female in certain conditions such as PCOS

Anovulation

the absence of ovulation

Antibody

substances that are produced by specialized cells in the body, called B cells. These substances attack foreign material that enters the body in order to prevent or fight off infection. Sometimes these substances may mistakenly recognize the body's organs or sperm as being foreign and attack them

Antagon™

brand name GnRH antagonist (see GnRH antagonist). The generic name of this medication is ganirelix acetate

Anti-sperm antibodies

antibodies directed against sperm. If directed specifically against the head of the sperm, they can interfere with fertilization. These antibodies can be present in both men and women. There are different methods for testing for antibodies. A simple blood test can be done or a more sophisticated test called the immunobead sperm antibody assay. This test looks for antibodies directly attached to the sperm. The recommended treatment is IVF

Artificial Insemination (AI)

the process of depositing specially prepared sperm inside the woman's reproductive tract. Intrauterine insemination (IUI) is one type of artificial insemination that involves the placement of sperm inside the uterine cavity. The procedure involves the washing of sperm to obtain the best quality fraction and then injecting it (less than 0.5cc) into the uterus. A thin catheter is used, connected to a syringe that contains the washed sperm. The catheter is introduced through the cervix and deep inside the uterus. Cramping sometimes does occur but it is short-lived. Artificial insemination is commonly used with ovulation inducing medications, when there is abnormal cervical mucus, and always with donor sperm

Arcateuterus

a mild deformity of the uterus that involves the presence of a very small separation in the midline of the fundus (the upper part of the uterus) inside the uterine cavity. This condition is usually not associated with infertility or recurrent miscarriages and therefore it rarely needs any form of therapy

Assisted Hatching

the process of helping an embryo to hatch by making a surgical slit in the zona pellucida or "shell" or by digesting this "shell" with special enzymes. It is indicated in most women over 40 years of age undergoing IVF, and when the zona pellucida is thick

Assisted Reproductive Technology (ART)

a term used to describe medical procedures which enhance the opportunity for egg fertilization and pregnancy. Examples include ICSI, IVF, GIFT and ZIFT

Azoospermia

the complete absence of sperm. It can result from obstruction of the vas deferens (the duct that takes the sperm from the testicles to the urethra) or from failure of the testicles to produce sperm

 

Basal body temperature (BBT)

indirect evidence of ovulation can be obtained with a basal body temperature chart. The temperature is taken orally or rectally with a special thermometer immediately upon awakening and before any activity. It is then recorded on a special graph that enables visualization of different temperature shifts. The temperature will go down to its lowest point, 1-2 days prior to ovulation and then rises and remains elevated until a couple of days before impending menstruation

Bicornuate Uterus

a congenital abnormality of the uterus that involves a partial lack of fusion of the two parts of the uterus. A single cervix is present. In the majority of cases it does not cause infertility, but recurrent miscarriages and premature births have been reported in rare instances. If treatment is needed, it is through abdominal surgical repair

Blastocyst

an embryo made up of two groups of cells. One group will develop into the fetus and the other will become the placenta. Following IVF, blastocysts are typically allowed to mature for five days outside the body and then are transferred into the uterus

Bromocriptine (Parlodel®)

a medication that reduces levels of the pituitary hormone prolactin

Capacitation

the changes that a sperm goes through to be capable of penetrating the layers covering the egg. It involves the sequential time release of a series of enzymes, which allows sperm to digest a passage through loose layers

Cauterize

to destroy tissue with heat, cold, or caustic substances in order to seal off blood vessels or ducts

Cervical Cultures

the process of obtaining samples (of secretions) from the cervix and culturing them on special media to detect the presence of infectious organisms such as chlamydia , gonococcus and ureaplasma. These sexually transmitted diseases, if present, can cause infertility by damaging the fallopian tubes or interfering with implantation of the embryo by affecting the inside lining of the uterus. They are usually treated with antibiotic therapy

Cervical Mucus

a thick mucinous secretion that is present inside the cervical canal. It is produced by glandular cells that are present in the cervix. This mucus protects the uterus from invasion by bacteria present in the vagina. It also plays an important role in fertility. The cervical mucus, in response to the estrogen hormone, becomes thin and elastic at the time of ovulation. This allows the sperm to travel through the cervix and the uterus to reach the egg in the fallopian tube. It also helps the sperm stay alive in the crypts of the cervix for a longer period of time. A thick and dense mucus could prevent the passage of sperm through the cervix. The cervical mucus is checked by the postcoital test

Cervical Stenosis

narrowing or blockage of the cervical canal in such a way that menstrual flow can partially or completely be impeded. It is often the result of cervical injury due to surgery such as a cone biopsy done for an abnormal pap smear. It can cause infertility by hampering the normal passage of sperm through the cervix

Cervicitis

inflammation of the cervix

Cervix

the part of the uterus that opens into the vagina. It is the segment that is checked for abnormal cells by a pap smear. It is connected to the uterine cavity by a hollow canal called the cervical canal. The cervix secretes mucinous secretions (see cervical mucus) that play a major role in the transport of sperm in its journey towards the egg

Chlamydia

a type of bacteria that is frequently transmitted sexually between partners or from an infected mother to her newborn child; the most common sexually transmitted bacterial disease

Chromosome

the nuclear structure of every living cell. Chromosomes are made up of genes that govern all the body's functions, and are also responsible for all the physical characteristics of an individual. Abnormalities of chromosomes can result in miscarriages or congenital abnormalities. Age affects the quality of chromosomes in an egg and that is why infertility and miscarriages are more common in older women. For instance, the incidence of Downs Syndrome increases when a woman gets older. Every human cell normally has 46 chromosomes. Human gametes (i.e. eggs and sperm) contain only 23 chromosomes. When unified during fertilization, the total number of 46 chromosomes is restored

Clomiphene citrate (Clomid®, Serophene®)

medication also known by the trade names of "Clomid®" and "Serophene®". It is a synthetic nonsteroidal estrogen hormone that is commonly used for ovulation induction. It comes in 50 mg tablets that are taken by mouth once a day for 5 days in the early part of the menstrual cycle. It works by stimulating the release of gonadotropins (LH and FSH) from the pituitary gland. Due to its antiestrogenic actions, some of its effects include abnormal cervical mucus and endometrial lining. The former can interfere with normal passage of sperm through the cervix to reach the egg, and the latter with implantation. Some women may complain of hot flashes (10%), nausea and/or breast discomfort (2-5%). Visual symptoms (blurring) occur rarely (less than 1.5%) but are an indication to discontinue therapy

Colposcopy

examination of the cervix through magnifying telescope to detect abnormal cells

Conceptus/concepti

term given to an embryo which has already implanted in the uterus

Cone biopsy

a procedure where precancerous cells are removed from the cervix. Potential risks associated with this procedure include damage to the mucus membranes of the cervix and weakening the cervix so that it is unable to hold the fetus throughout the duration of a pregnancy

Conization

surgical removal of a cone-shaped portion of the cervix, usually as a treatment for a pre-cancerous condition

Corpus luteum

a follicle that releases an egg at the time of ovulation is subsequently called the corpus luteum. This is initially a partially cystic space that later can become a full-blown cyst, and is very active in hormone secretion. Its major product is progresterone, which is an essential hormone that prepares the endometrium for implantation. If pregnancy does not occur, the corpus luteum "dies" roughly 10 to 14 days after ovulation. The result is a sudden drop in progesterone levels, which leads to menstruation. If, on the other hand, if pregnancy occurs, the newly developing placenta secretes the HCG hormone (see HCG), which salvages the corpus luteum and stimulates it to continue producing progesterone. This placental support of the corpus luteum is indispensable for the first 7 weeks of pregnancy. From that point on, the placenta starts making its own progesterone and the corpus luteum is no longer needed. Therefore, it shrinks and becomes the "corpus albicans"

Culture Media

a specially formulated solution that enables growth and division of a fertilized egg outside of the body until embryo transfer takes place

Chorionic Villus Sampling (CVS)

a test that is done early during pregnancy to check for the presence of genetic disorders. It involves obtaining a biopsy of the placenta, usually between the 10th and 13th weeks of pregnancy. This biopsy is then tested to check for the presence of certain congenital defects, such as Down Syndrome

Cycle

refers to the menstrual cycle

Cyropreservation

the process of freezing sperm or embryos in extremely low temperatures (-196°C). This technique has been used for decades to freeze sperm. It allows the sperm to be quarantined while the donor is tested for transmittable infectious diseases (such as HIV). The sperm can then be thawed when necessary and used in artificial insemination. The quality of thawed sperm is not as good as a fresh sample, but is very acceptable and without negative effects in the resulting offspring. More recently we have been able to freeze and preserve human embryos, including those resulting from in vitro fertilization. These embryos can also later be thawed and transferred back to the uterus. Pregnancy rates with frozen/thawed embryos are not as high as fresh embryos and range in the 15-30% range

Danazol® (Danocrine)

a synthetic androgen frequently prescribed for endometriosis. It works by inhibiting the production of LH and FSH. This results in diminished levels of estrogen and progesterone, the hormones that support growth and activity of endometrial implants in endometriosis. Since this medication inhibits LH and FSH production, a woman will not ovulate while taking the drug. Common side effects include weight gain, acne abnormal hair growth, and oily skin

Deoxyribonucleic acid (DNA)

the combination of molecules in the cell's nucleus that make up the chromosomes, which transmit hereditary characteristics

Depot kit

an injectable medication (such as Lupron Depot™) which maintains its effect for an extended period of time. One injection with a "depot" medication may last a month or more, and therefore daily injections are not needed

DES

also known as diethylstilbestrol; This is a medication that was prescribed to pregnant women during the late 1940's to the early 70's to prevent miscarriage. Its use was banned in 1971 in pregnant women because it was found to cause abnormalities and deformities of the reproductive organs in the children of women who took this drug during pregnancy. During an infertility evaluation, you may be asked if your mother took this drug while she was pregnant with you

DHEAS

stands for dihydroepiandrosterone sulfate; This is a type of androgen that may be found in excessive amounts in women with PCOS, or other conditions of excessive androgen production. Its level may be checked as part of an infertility evaluation

Dilatation and curettage (D&C)

It is the process of gradually dilating the cervix to the point of being able to introduce a sharp instrument (curette) to scrape the surface of uterine cavity (endometrium). A suction cannula is also used if the amount of tissue being removed is large. This procedure is often used to treat abnormal bleeding, incomplete miscarriages, and abnormal uterine pathology such as polyps and small fibroids. It is during sedation and sometimes under general anesthesia. Complications include infection and uterine perforation. This latter involves the passage of one of the instruments through the wall of the uterus and inside the abdominal cavity. In the majority of instances, similar observation is enough, since this artificially made hole seals on its own

Donor insemination

artificial insemination with a donor's sperm

Ectopic pregnancy

a normal pregnancy results when the embryo implants inside the uterus. When implantation occurs outside the uterus, an ectopic pregnancy occurs. Such an abnormal pregnancy can be located in the tubes, the ovaries, the cervix or inside the abdomen. In 1987, roughly 2 of every 100 women who were known to conceive were hospitalized for ectopic pregnancy. This incidence is slightly higher with in vitro fertilization. The most common symptoms are abnormal bleeding and lower abdominal pain. Women who have tubule damage (such as scarring from infection) are at an increased risk for an ectopic pregnancy. The incidence is also higher in women who have had children, especially those who have been pregnant three or more times

Egg(ovum)

the female reproductive cell

Egg donation

the process that involves stimulation of a younger woman with fertility drugs, the retrieval of her eggs, fertilization of the eggs with the recipient's husband's sperm, and the transfer of the resultant embryos into the uterus of the recipient. Women who may need egg donation include the following:

women with no ovaries as a result of congenital absence or surgical removal
women with early (premature) menopause
older women, greater than 43 years of age
women who fail to produce adequate number of eggs after stimulation with fertility drugs
women with serious transmissible genetic traits or diseases
women who are about to undergo surgery for ovarian cancer, in which case they can freeze the resultant embryos for use at a later time. Egg donors should be less than 37 years old. Most egg donation is done anonymously, however known donors are also acceptable in many instances

Egg Retrieval

the process of introducing a long needle through the vagina and into the ovaries to aspirate the follicles that contain the eggs. It is done under ultrasound guidance. The ovaries are visualized on the ultrasound screen, and the needle, which is attached to the ultrasound probe, is directed into the follicles, which are aspirated with gentle suction. The aspirated fluid is sent to the embryologist who examines it and separates the egg. The procedure is done under heavy sedation and is therefore painless. It takes about 20-40 minutes to complete (depending on the number of follicles present) and the patient is discharged 2-3 hours later. The patient is not allowed to drive because of slight drowsiness for a few hours after the procedure. Complications are very rare and include bleeding from the site of the needle punctures or the ovaries, and infection. Bleeding almost always subsides on its own with light pressure, and infections are treated with antibiotics

Ejaculate

the semen and sperm-containing fluid released at orgasm

Ejaculatory ducts

the male ducts that contract the fluid released at orgasm

Electroejaculation

controlled electrical stimulation to induce ejaculation in a man with damage to the nerves that control ejaculation

Embryo

the developing baby from implantation to the second month of pregnancy or more scientifically, a fertilized egg that has begun the process of cell division

Embryologist

a specialist in embryo development

Embryo transfer

The process of depositing fertilized eggs (or embryos) inside the uterus. This often occurs 2 days following egg retrieval. A predetermined number of embryos are first placed inside a special catheter, which is then introduced inside the uterus through the cervix. The embryos are then gently injected and the catheter is removed. During this procedure, the woman is in a position similar to a pelvic examination for a pap smear. The patient will remain in that position for roughly an hour before being discharged. The number of embryos to be transferred depends mostly on the age of the woman and the quality of embryos. As a general rule, 4 embryos will be transferred in women less than 35 years of age to reduce the risk of high order (more than twins) multiple pregnancies. This number increases with age, and it is not unusual to transfer 8-10 embryos in women over 40. The couple will make the informed decision regarding the number of embryos to be transferred after conferring with her physician

Endometrial biopsy

a procedure that involves taking a small sample of tissue from the inside the lining of the uterus (called the endometrium). It is done in the office and takes only a few minutes. A small hollow catheter is introduced through the cervix inside the uterus and gently the endometrium is scraped, while a gentle suction is applied to the catheter. Small pieces of endometrial tissue are collected by this process and sent for microscopic examination. An endometrial biopsy is done for many reasons. In case of investigation for infertility, it is performed to evaluate the endometrium for its readiness to accept the embryo. An egg that is fertilized by a sperm in the fallopian tube travels to the uterus in about 3 days and then is ready to implant in about another 3 to 4 days. Therefore, roughly one week after ovulation and successful fertilization, that embryo will implant. During this crucial time, the endometrium should be "ready" for implantation. The biopsy will check for these specific changes in the cells and glands of the endometrium. A normal test is said to be "in-phase" with the menstrual date, since the biopsy is done on a specific day of the cycle (usually 7 to 12 days after ovulation). An abnormal test is said to be "out-of-phase" in relation to the date of the cycle. An abnormal test result usually signifies that there is a "luteal phase defect," which means that the second part of the cycle (called the luteal phase) is abnormal and can be the cause of infertility. Women who have very short luteal phases (less than 11 days) will often have an abnormal biopsy result. An endometrial biopsy is also performed for abnormal uterine bleeding, to diagnose hormonal imbalances or an anatomic cause for bleeding, such as polyps, hyperplasia (abnormal benign growth of the endometrium) or cancer

Endometrium

the inside lining of the uterus where implantation of the embryo occurs. It sheds every month in response to estrogen and progesterone stimulation. If pregnancy occurs, the endometrium will not shed

Endometrioma

a special type of ovarian cyst that is chocolate in color and contains endometrial cells that grow and bleed during menstruation; also known as a chocolate cyst

Endometriosis

inflammation of endometrium. The presence and growth of endometrial tissue (known as implants) in locations outside the uterus, such as over the fallopian tubes, ovaries, the lining of the pelvis, bowel or other unusual areas. The disease is benign but usually progressive. In advanced stages, it causes severe scarring of the ovaries and /or tubes which can result in infertility. Even milder forms of the disease, where only few implants are present, can be associated with infertility. The incidence of the disease is 30% to 45% in women with infertility. The cause of endometriosis is not known with certainty, but several mechanisms are involved. More recently immunological causes have been implicated in the mechanism of infertility in patients with endometriosis. The classic symptoms of endometriosis are cyclic pelvic pain and infertility. Medical or surgical therapy is successful only for the relief of pain. Studies have sown that medical therapy does not improve fertility. Surgery for endometriosis is also not successful in treating infertility except in instances where there are mild adhesions partially blocking the tubes

Epididymis

the tightly coiled, thin-walled tube where sperm maturation is completed. Sperm move from the testicles to the vas deferens through the epididymis

Epididymitis

inflammation of the epididymis

Estradiol

the principal estrogen produced by the ovary. This is the primary hormone monitored via blood test during stimulation with fertility drugs

Estrogen

the major female hormone secreted by the ovaries. A normally menstruating woman ovulates once a month about 14 days after the start of the menstrual cycle. The developing follicle (a balloon-like space in the ovary that contains the egg) secretes estrogen as it grows. The level of this hormone peaks at the time of ovulation; it then drops for several days and peaks again about a week after ovulation. Estrogen is responsible for the normal grown and differentiation of the follicle and the egg. It also plays an important role in preparing the endometrial lining for implantation. Estrogen also changes the quality and texture of the cervical mucus, making it thinner and more elastic. This allows the normal passage of sperm through the cervix towards the uterus and the fallopian tube where the sperm meets the egg. Estrogen also causes the vagina to be moist and healthy in addition to its beneficial effects on bone and the cardiovascular system. For these reasons, estrogen is recommended to most women after the cessation of menses at menopause. Estrogen can be measured on the second or third day of the cycle by a simple blood test. Its level reflects the functional status of the ovaries. Ideally, a level of less than 50ug/ml is desirable prior to the initiation of ovulation induction or IVF

Fallopian tubes

ducts that connect the ovaries to the uterus. Fertilization normally takes place in these tubes if sperm is present to meet the egg

Fecundability

the ability to become pregnant

Fertilization

union of the male gamete (sperm) with the female gamete (egg)

Fertinex™

brand name FSH medication (see FSH).

Fetus

the developing baby from the second month of pregnancy until birth

Fibroid

refers to a benign tumor located in the uterus. Although it is not cancerous, it may cause irregular bleeding, pain, and an enlarged uterus. Furthermore, it may cause difficulty in achieving a pregnancy because it can interfere with normal implantation of an embryo into the endometrium

Fimbria

the finger-like projections at the end of the fallopian tube nearest the ovary that capture the egg and deliver it into the tube

Fimbrioplasty

plastic surgery on the fimbria of a damaged or blocked fallopian tube

Fluoroscope

an imaging device that uses X-rays to view internal body structures on a screen

Follicle

small egg-containing sacks found in the female ovary. In fertile women, one follicle will become dominant and release a mature egg (ovulate) during every cycle. The other follicles will be reabsorbed into the body. In fertility treatments, medications may be used to stimulate the development of multiple follicles

Follicular phase

the pre-ovulatory phase of a women's cycle during which the follicle grows and high estrogen levels cause the uterine lining to proliferate (thicken) in preparation for implantation

Follistim®

brand name FSH fertility medication (see FSH)

Fructose

produced by the seminal vesicles, the sugar that sperm use for energy

FSH (Follicle Stimulating Hormone)

fertility medications in this class (Fertinex™, Follistim®, and Gonal-F®) are injectables which stimulate the growth and development of the follicles

Gamete

a reproductive cell; the sperm in men, the egg in women

Gardnerella

a bacteria that may cause a vaginal infection

Gene

the unit of heredity, composed of DNA; the building block of chromosomes

Gestation sac

the fluid-filled sac in which the fetus develops, visible by an ultrasound exam

GIFT (Gamete Intra Fallopian Transfer)

a procedure where eggs are retrieved from the woman, placed together with sperm in a catheter, and transferred back into the woman's fallopian tubes to allow fertilization inside the woman's body

GnRH (Gonadotropin releasing hormone)

the hormone produced and released in a pulsatile manner by the hypothalamus. GnRH controls the pituitary gland's production and release of gonadotropins

GnRH agonist

a medication that acts like gonadotropin releasing hormone (GnRH). Initially it causes a surge in the production of gonadotropins, but when given continuously, it suppresses pituitary and ovarian function. Examples include leuprolide or Lupron®, nafarelin or Synarel®

GnRH antagonist

this new class of fertility medications (soon to be available as Antagon™, ganirelix acetate and as cetrorelix acetate, pending FDA approval) which block the effect of GnRH, resulting in a rapid suppression of gonadotropin release by the pituitary gland

Gonadotropins

the hormones produced by the pituitary gland that control reproductive function follicle stimulating hormone (FSH) and luteinizing hormone (LH)

Gonads

organs that produce the sex cells and sex hormones; testicles in men and ovaries in women

Gonal-F

brand name FSH medication fertility medication (see FSH)

Gonorrhea

a sexually transmitted infection caused by bacteria Neisseria gonococcus that can lead to infertility

Granuloma

a ball of inflamed tissue, commonly formed after vasectomy due to sperm leaking from the vas deferens

Hamster test

a test of the ability of a man's sperm to penetrate a hamster egg stripped of its outer membrane, the zona pellucida. Also called the Sperm Penetration Assay

HCG (Human Chorionic Gonadotropin)

this hormone is produced naturally during early pregnancy, and is also available as an injectable medication (under the brand names Novarel™, Pregnyl® and Profasi®) to help mature eggs and trigger ovulation in fertility treatments. hCG causes the eggs in the developing follicles to mature and detach from the wall of the follicle. Therefore, when the ultrasound-guided egg retrieval takes place 35 hours after administration, the egg is floating in the fluid of the follicle and is easier to be aspirated by a needle

Hemizona assay

a laboratory test of the ability of sperm to penetrate into a human egg; first the egg is split in half, then one half is tested against the husband's sperm and the other half against sperm from a fertile man

Hirsutism

excessive hair growth. This condition may occur in women with polycystic ovarian syndrome (PCOS) or as a result of treatment with Danazol®

hMG (human Menopausal Gonadotropin)

these injectable medications consist of LH and FSH hormones recovered from the urine of postmenopausal women and are used to induce and development of multiple follicles in various fertility treatments. (Available under the brand names Humegon™, Pergonal®, and Repronex™.)

Hormone

a substance, produced by an endocrine gland, that travels through the bloodstream to a specific organ, where it exerts its effect

Hostile mucus

cervical mucus that impedes the natural progress of sperm through the cervical canal

Humegon™

brand name hMG fertility medication (see hMG).

Hydrotubation

injection of fluid, often into the fallopian tubes to determine if they are patent

Hyperandrogenism

excessive production of androgens in women, frequently a cause of hirsutism and also associated with polycystic ovarian disease (PCOD)

Hyperprolactinemia

excessive prolactin in the blood. This condition may interfere with the normal functioning of the menstrual cycle and result in anovulation

Hyperstimulation

excessive stimulation of the ovaries that can cause them to become enlarged

Hypogonadism

refers to a spectrum of disorders that result in reduced levels of male or female sex hormones. Hypogonadism is typically caused by a deficient production of hypothalamic or pituitary hormones

Hypothalamus

a gland in the brain that releases GnRH (see GnRH), which in turn stimulates the production of LH and FSH by the pituitary gland

Hypothyroidism

under activity of the thyroid gland, which results in low levels of thyroid hormone in the blood. Inadequate amounts of thyroid hormone can lead to hyperprolactinemia

Hysterectomy

surgical removal of the uterus

Hysterosalpingogram(HSG)

it involves the injection of a radio-opaque dye through the cervix and into the uterus and fallopian tubes. A series of x-rays are taken and the contour and patency of the uterus and tubes are assessed

Hysteroscopy

this is a procedures which involves the introduction of a telescope-like instrument through the cervix into the uterine cavity. It allows the physician to directly view the inner lining of the uterus. It is very helpful in the diagnosis of polyps and fibroids and other uterine abnormalities such as a uterine septum

ICSI (Intracytoplasmic Sperm Injection)

a micromanipulation technique sometimes performed during IVF or donor IVF. In the laboratory, the health care provider manipulates the male sperm, then places it in a needle and injects it directly into the female egg. This procedure may be useful in cases where the male has low sperm counts or decreased sperm motility

IM

abbreviation for Intramuscular, used to describe injections given into a muscle. Commonly recommended IM injection sites include the thigh and buttocks

Immune system

the body's defense against any injury or invasion by a foreign substance or organism

Immunoglobulins

a class of proteins endowed with antibody activity; antibodies

Immunosuppressive drug

a drug that interferes with the normal immune response

Immunotherapy

a medical treatment for an immune system disorder that involves transfusing donor white blood cells into a woman who has had recurrent miscarriages

Implantation

attachment of the fertilized egg to the uterine lining, usually occurring five to seven days after ovulation

Impotence

inability of a man to achieve an erection or ejaculation

Incompetent cervix

cervix with the inability to remain closed throughout an entire pregnancy; a frequent cause of premature birth

Infertility

inability of a couple to achieve a pregnancy or to carry a pregnancy to term after one year of unprotected intercourse in women 35 years of age and younger, and after six months of unprotected intercourse in women 36 years of age and older

Intrauterine Insemination (IUI)

artificial insemination of sperm, which have been washed free of seminal fluid, into the uterine cavity

In utero

while in the uterus during early development

In vitro fertilization (IVF)

(literally, "in glass") fertilization outside of the body in a laboratory.

Karyotype

an arrangement of all the chromosomes of a cell. A normal human cell has 46 chromosomes. Abnormalities of certain chromosomes, such as an extra chromosome, can be detected by doing a karyotype. This test is done in couples who suffer from recurrent miscarriages to look for a specific chromosomal abnormality called a "translocation," which can result in the loss of important genetic material and thus cause miscarriages

Klinefelter's syndrome

a chromosome abnormality that prevents normal male sexual development and causes irreversible infertility due to the presence of an extra X chromosome

Laparoscopy

the procedure involves the introduction of a thin telescope-like instrument through the belly button into the pelvis for direct visualization of the pelvic organs. At the same time, dye can be injected through the cervix and its flow can be traced into and through the fallopian tubes under direct vision. The procedure is conducted under anesthesia, but the patient does not have to stay overnight in the hospital. The patient might have mild abdominal discomfort for 1 or 2 days after the procedure, but can usually resume normal activities even as soon as the next day. The risks with laparoscopy are very small and include the following: infection, bleeding, damage to nearby organs, such as the bowel, and reaction to anesthesia. Very rarely, surgery by opening the abdomen is needed to take care of a complication. Indications for laparoscopy are many and include the following: diagnostic, to check for suspected problems such as infertility, blocked or damaged fallopian tubes, scarring, ovarian tumors and uterine anomalies such as fibroids, diagnosis and treatment of endometriosis, lysis (cutting) of adhesions (scarring), removal of fibroids, and removal of ovarian cysts or tumors, GIFT and other miscellaneous indications

Laparotomy

a surgical opening of the abdomen

Leiomyoma (fibroid)

a benign tumor of the uterus

Leydig cells

the cells in the testicles that make testosterone

LH kit

a kit used to detect a surge in luteinizing hormone (LH) which takes place 24 to 36 hours prior to ovulation. It is used to help time intercourse during some fertility treatments

LH surge

the sudden release of luteinizing hormone (LH) that causes the follicle to release a mature egg (ovulate)

Lupron

known medically as a GnRH-agonist. Lupron is a commonly used medication in IVF and in the treatment of severe endometriosis or large uterine fibroids. Lupron can be taken either by daily subcutaneous (under the skin) injections or monthly intramuscular depot injections. Lupron works by suppressing the function of the pituitary gland and ovaries. Simply stated, it will make the ovaries "go to sleep" and stop functioning. This stops the secretion of the ovarian hormones, estrogen and progesterone. Preventing the release of these hormones is important in IVF because we want to control the function of the ovaries and we do not want any interference from the pituitary gland. As far as endometriosis and uterine fibroids are concerned, both of these diseases require estrogen for growth. Since estrogen is secreted mainly by the ovaries, suppressing ovarian function lowers blood estrogen levels and therefore benefits both of these conditions

Luteal phase

post-ovulatory phase of a woman's cycle; the corpus luteum produces progesterone, which in turn causes the uterine lining to secrete substances to support the implantation and growth of the early embryo

Luteal phase defect (LPH)

inadequate function of the corpus luteum which results in insufficient levels of progesterone. This may prevent a fertilized egg from implanting in the uterus or may lead to early pregnancy loss

Luteinized Unruptured Follicle (LUF) syndrome

the failure of a follicle to release the egg even though a corpus luteum has formed

Luteinizing hormone (LH)

a hormone secreted by the pituitary gland. Along with FSH, it is one of the two most important hormones that regulate ovarian function. The role of LH is to trigger ovulation and help prepare the endometrial lining for implantation. The level of this hormone starts to rise roughly 24 hours prior to expected ovulation. The level of this hormone can be checked by a home urine ovulation prediction kit (such as OvuQuick, OvuKit or First Response). When the test color matches the control, this signifies the presence of elevated levels of LH in the blood. The individual then can plan intercourse within 24 hours of that positive test. LH is a hormone that is also found in the fertility medications Pergonal®, Humegon™, and Repronex™. These drugs contain LH and FSH in equal amounts. When given in the beginning of a menstrual cycle, (usually on day 2 to 5) they stimulate follicular development. The level of LH is also elevated (in relation to FSH) in some women with irregular cycles or with the condition known as Polycystic Ovarian Syndrome (PCOS)

Menarche

the time when a woman has her first menstrual period

Menopause

the time when a woman stops having menstrual periods

Menstrual cycle

this is the time between menstrual periods. A typical menstrual cycle is about 28 days, however this can be longer or shorter

Microsurgery

reconstructive surgery performed under magnification using delicate instruments and precise techniques

Miscarriage

spontaneous abortion

Morphology

the study of form, such as assessing the shape of sperm during semen analysis

Motility

motion, such as the forward swimming motion of healthy sperm

Mucus

secretion from a gland that can be watery, gel-like, stretchy, sticky or dry; fertile mucus is watery and stretchy

Myomectomy

surgical removal of a uterine fibroid tumor

Novarel

brand name hCG fertility medication (see hCG)

Obstetrician-gynecologist (ObGYN)

a physician who specializes in the treatment of female disorders and pregnancy

Oligomenorrhea

infrequent and irregular menstrual cycles

Oligospermia

a low sperm count

Ovarian cyst

a fluid-containig enlargement of the ovary

Ovarian Hyperstimulation Syndrome (OHSS)

enlargement of many ovarian follicles due to fertility drugs, causing gross enlargement of the ovaries. It is sometimes accompanied by accumulation of fluid in the abdomen and lungs and abnormal blood tests. It occurs less than 1% of the time in its severe form and requires hospitalization. Studies recently have shown that by using specific protocols, severe forms of this condition can be prevented

Ovarian wedge resection

surgical removal of a portion of a polycystic ovary to produce ovulation

Ovary

the female gonad; produces eggs and female hormones

Ovulation

release of an egg from the ovary

Ovulation Predictor Kit

this test is based upon the fact that ovulation is preceded by a sudden increase in the blood concentration of the hormone, LH, which spills over into the urine, and can be measured. Ovulation usually occurs 24 hours following the maximal color change in the urine test that reflects the presence of high concentrations of LH. The instructions on the insert of the particular kit should be read very carefully. The home ovulation test should be performed twice daily (in the morning and 12 hours later in the evening). Depending upon the test kit that is used (in our experience, OvuQuick is a good one) this could require the purchase of more than one kit per cycle of evaluation. The reason for performing the test on two occasions is to ensure the detection of the LH surge as early as possible. Research has demonstrated that when the home ovulation test is performed only once per day, you may (25% of the time) miss detection of the LH surge or only detect a subtle change in color because you are measuring the LH concentration in the urine after the surge has already taken place

Pap smear

removal of cells from the surface of the cervix to study microscopically

Parlodel®

see Bromocriptine

Patent

open; for example, fallopian tubes should be patent after a sterilization reversal operation

Pelvic cavity

the area surrounded by the pelvic bone that contains the uterus, fallopian tubes, and ovaries in women, and the prostate gland and seminal vesicles in men

Pelvic inflammatory disease (PID)

inflammation of any of the female pelvic organs, usually due to infection from a sexually transmitted disease

Penetrak

a test of how fast sperm can travel up through cow mucus

Penis

the male organ of sexual intercourse

Pergonal (hMG)

a brand name hMG fertility medication that contains luteinizing and follicle stimulating hormones recovered from the urine of postmenopausal women. It is used to induce the development of multiple follicles in various fertility treatments. (see hMG)

Pituitary gland

a small gland present at the base of the brain. It receives instructions from another gland in the brain known as the hypothalamus. The pituitary secretes many important hormones, such as FSH, LH, TSH, and prolactin. FSH and LH control the ovaries, TSH controls the thyroid gland, and prolactin controls milk production

Polycystic ovarian syndrome (PCOS)

a condition characterized by multiple ovarian cysts, increased androgen production, and anovulation

Polyp

a growth or tumor on an internal surface, usually benign

Post-coital test (PCT)

a test to check the quality of the cervical mucus and the sperm in it. It is performed up to 12 hours after intercourse. It is similar to a pap smear examination and involves no pain. The patient presents to the office within 12 hours after intercourse around the time of ovulation. A small sample of the cervical mucus is then taken and examined. We look for the amount and elasticity of the mucus. We also look at it under the microscope to evaluate the number and quality of sperm present in the sample, as well as the general cellularity of the mucus. A good test will show ample amount of mucus containing many moving sperm. An abnormal test may show normal mucus, but the sperm present in it will have an abnormal pattern of movement (moving in the same place instead of going forward). An abnormal test can also occur because of low levels of estrogen hormone, which is crucial in the formation of the cervical mucus. Treatment of abnormal cervical mucus can include intrauterine insemination, which bypasses the cervix. Another treatment of abnormal mucus is administration of estrogen hormone or stopping clomiphene therapy and switching to other fertility medications (such as Pergonal) that do not have this adverse effect on cervical mucus

Pre-embryo

a fertilized egg in the early stage of development prior to cell division

Pregnyl

brand name hCG fertility medication (see hCG)

Premature Ovarian Failure

cessation of menstruation due to depletion of ovarian follicles before the age of 40. It is one of the most common causes for infertility requiring egg donation. It can run in families and be associated with other disease processes such as thyroid disease or lupus

Profasi®

brand name hCG fertility medication (see hCG)

Progesterone

a naturally occurring hormone, also administered as a medication in injectable, oral and intravaginal formulations. Its role is to prepare the uterine lining for implantation of a fertilized egg. You may at times have bloodwork done to determine the level of progesterone in your body

Prolactin

a hormone secreted by the pituitary gland. Its major role is to control milk production, however it can interfere with normal ovulation if present in high amounts. Prolactin levels are therefore checked in every woman during the evaluation process for infertility. Certain women have elevated prolactin levels due to a tumor in the pituitary gland or the brain. These tumors are often called prolactinomas. They are usually easily treated by a medication called bromocriptine (Parlodel®). In rare instances, surgery may be required

Prostate gland

the male gland encircling the urethra that produces one third of the fluid in the ejaculate

Prostaglandins

a group of hormone-like chemicals that have various effects on reproductive organs; so named because they were first discovered in the prostate gland

Quantitative beta-HCG assay

a pregnancy test which measures the level of HCG present in the blood. This test can be used to detect an early pregnancy

Recipient

a women who receives the fertilized eggs (often by her husband's sperm) from an egg donor. These embryos are transferred to her uterus after a 2-3 week period of hormonal preparation to have the uterus ready to accept these embryos. The recipient is considered the biological mother since she will carry, nourish and deliver the infant

Reproductive endocrinologist

an OB-GYN who specializes in the treatment of hormonal disorders that affect reproductive function

Reproductive surgeon

an OB-GYN or Urologist who specializes in the surgical correction of anatomical disorders that impair reproductive function

Repronex™

brand name hMG medication (see hMG)

Retrograde ejaculation

ejaculation backwards into the bladder instead of forward through the urethra

Salpingectomy

surgical removal of the fallopian tubes

Salpingitis

inflamation of one or both fallopian tubes

Salpingitis isthmica nodosa

an abnormal condition of the fallopian tube where it attaches to the uterus, characterized by nodules

Salpingostomy

an incision in a fallopian tube, such as to remove an ectopic pregnancy

Salpingotomy

an operation to open a blocked fallopian tube

Scrotum

the sac containing the testicles, epididymis, and vas deferens

Semen

the fluid containing sperm and secretions from the testicles, prostate, and seminal vesicles that is expelled during ejaculation

Semen analysis

a test to check for sperm quantity and quality. A sperm sample collected by masturbation after 3 days of abstinence is used for the test. The test checks for sperm concentration (normal is greater than 20 million/ml), the sperm motility (normal is greater than 50% motility), sperm shape or morphology (normal is greater than 15% normal forms), volume of the sample (normal is greater than 2cc) and viscosity or thickness of the sample. The test is performed by computer analysis. A male factor (or some type of sperm abnormality) is responsible for up to 40-50% of infertility cases

Seminal vesicles

the paired glands at the base of the baldder that produce seminal fluid and fructose

Seminiferous tubules

in the testicles, the network of tubes where sperm are formed

Septate Uterus

the presence of a thick membrane that separates the uterine cavity either partially or completely into two separate cavities. This can interfere with normal implantation and cause recurrent miscarriages. The treatment is done by hysteroscopy and involves cutting the septum under direct vision

Septum

a wall that divides a cavity in half, such as a uterine septum

Sertoli cells

the cells in the testicles that provide nourshment to the early sperm cells

Sonogram

see Ultrasound Examination

Sexually transmitted disease (STD)

a disease caused by an infectious agent transmitted during sex

Sperm

male gamete or reproductive cell

Sperm bank

a place where sperm are kept frozen in lizuid nitrogen for later use in artificial insemination

Sperm count

the number of sperm in the ejaculate (when given as the number of sperm per millileter it is more accurately known as the sperm concentration or sperm density)

Sperm penetration assay (SPA)

see Hamster test

Spermicide

an agent that kills sperm

SQ

abbreviation for subcutaneous, used to describe injections given under the skin

Sterilization

a surgical procedure (such as tubal ligation or vasedtomy) designed to produce infertility

Sterilization reversal

a surgical procedure used to undo a previous sterilization operation and restore fertility

Superovulation

stimulation of multiple ovulation with fertility drugs; also known as controlled ovarian hyperstimulation (COH)

Surrogate

a women who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant. Women who need surrogates include those who do not have a uterus (for instance because of surgery), have an abnormal uterine cavity, have had several recurrent miscarriages, or have had recurrent failed IVF cycles

Testicle

the male gonad; produces sperm and male sex hormones

Testicular biopsy

the removal of a fragment of a testicle for examination under the microscope

Testosterone

the primary male sex hormone

TET

abbreviation for Tubal Embryo Transfer; this is typically a laparoscopic procedure where an embryo is placed directly into the fallopian tube several days following egg retrieval

Thyroid gland

the endocrine gland in the front of the neck that produces thyroid hormones, which regulate the body's metabolism

Thyroxine (T4)

along with T3, one of the main thyroid hormones; its level can be checked in blood by a simple blood test. It reflects the activity of the thyroid gland. It is important to measure this hormone especially in women with abnormal cycles, because thyroid diseases can interfere with normal ovulation

Tocolytic

a drug that relaxes smooth muscles and therefore interferes with uterine contractions; frequently used to stop premature labor

Total effective sperm count

an estimate of the number of sperm in an ejaculate capable of fertilization; total sperm count X percent motility X percent forward progressive motility X percent normal morphology

Toxin

a poison produced by a living organism, such as by some bacteria

TSH

a hormone secreted by the pituitary gland that controls the thyroid gland. Elevated levels imply abnormally low thyroid function. The level of this hormone in blood is checked in most women with infertility, because certain thyroid diseases are associated with infertility

Tubal ligation

surgical sterilization of a woman by obstructing or "tying" the fallopian tubes

Tubal pregnancy

see Ectopic pregnancy

Tuboplasty

plastic or reconstructive surgery on the fallopian tubes to correct abnormalities that cause infertility

Ultrasound (US) Examination

one of the most common imaging techniques a woman undergoes during infertility treatment. Almost all ultrasound examinations for this purpose are currently done through the vagina using a vaginal transducer. An ultrasound transducer emits acoustic sound waves that bounce back when they hit different types of tissues in the body along its path. These waves are then recaptured by the transducer and sent to the ultrasound computer. The ultrasound transforms these waves into gray scale pictures that are seen on a monitor screen. The texture of the particular tissue that the ultrasound wave traverses or hits determines the way it will look on the monitor. For instance, clear fluids such as water or urine will appear black, while bony structures will appear white. The vaginal transducer is about 15 inches long of which only about 5 inches will enter into the vagina. It is about 1 inch in diameter. The procedure is painless for the vast majority of women. It enables visualization of the pelvic organs including ovarian cysts, tumors, uterine fibroids and pregnancies. It is also used routinely to follow the growth and development of ovarian follicles (see follicle) during ovulation induction with fertility drugs, such as in patients who are undergoing IVF

Ureaplasma

a microorganism similar to mycoplasma, which may cause infection

Urethra

the tube through which urine from the bladder is expelled

Urologist

a physician who specializes in the surgical treatment of disorders of the urinary tract and male reproductive tract

Uterus

a hollow muscular organ (as big as a small pear) present in the pelvis. It is connected to the vagina by the cervix and to the abdominal cavity by the fallopian tubes. Its main function is to contain and nourish the fertilized egg as it develops into an embryo, a fetus and eventually an infant. Its inside is lined by a thick layer of specialized glandular cells called the endometrium (see endometrium)

Vagina

the female organ of sexual intercourse; the birth canal

Vaginituis

inflammation of the vagina, which is typically caused by bacterial or yeast infections

Varicocele

an abnormal dilation of the veins surrounding the testicles. They are present in 25% of infertile men. Because of this blood pooling, testicular temperature is raised which is detrimental to the sperm. Treatment is by minor surgery to ligate the dilated vessels or veins. The success of treatment is contraversial. Pregnancy rates after surgery are reported to be in the range of 30-50%

Vas deferens

- the tubes that conduct sperm and testicular fluid from the epididymis to the ejaculatory ducts

Vasectomy

surgical sterilization of a man by separating both vas deferens

Vasectomy reversal

surgical repair of a previous vasectomy for a man who wants to regain his fertility

Vasogram

an X-ray study of the vas deferens

Venereal disease

see Sexually Transmitted Diseases (STD)

Virus

a microscipic infectious organism that reproduces inside living cells

ZIFT (Zygote Intrafallopian Transfer)

fertilizing eggs and sperm outside of the body and immediately placing them in the fallopian tubes to enhance the chances of pregnancy

Zona pellucida

the translucent belt consisting of a noncellular layer that is deposited at the periphery of the egg while it is in the ovary and continues to surround the egg and the conceptus until the stage of implantation, during which time the embryo "hatches" outside the zona pellucida

Zygote

an egg that has been fertilized but not yet divided

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