Glossary

A

Adenomyosis

A benign disease that involves the abnormal growth of endometrial tissue (the lining of the uterus) into the uterine wall or myometrium. Can be associated with abnormal bleeding or periods and some data suggest lower pregnancy rates in women with adenomyosis. There is no medical or surgical remedy for adenomyosis.

Adhesions

Scarring is a result of tissue injury. The damage can be caused by infections such as Gonorrhea and Chlamydia, or by previous operations such as removal of cysts or an appendectomy. Endometriosis also causes adhesion formation. 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 adhesions are mild, they can be treated by laparoscopic surgery. If the disease is severe however, surgery will not restore normal fertility. Adhesions inside the uterine cavity are also known as Asherman’s syndrome and may result from prior surgeries of the uterine lining such as polyp or fibroid removal or dilation and curettage procedures. These adhesions can be diagnosed by saline ultrasonography or hysteroscopy and can be removed by hysteroscopy.

Alpha Fetal Protein

A protein secreted by fetal tissue that can be present in the mother's bloodstream. If present in high levels, it can be associated with congenital fetal anomalies such as neural tube defects.

Aneuploidy

An embryo is said to be aneuploidy if it contains an abnormal number of chromosomes. Down Syndrome, or Trisomy 21 is one form of aneuploidy, one of the few chromosome number abnormalities compatible with live birth. Most chromosome aneuploidies result in implantation failure or early miscarriage.

Anti-Mullerian Hormone (AMH)

AMH is a blood test that directly measures ovarian reserve. It is produced directly by early stage ovarian follicles. High levels (over 1.0) are favorable, while low levels (less than 1.0) indicate decreased ovarian reserve. AMH may be the best measure of the menopausal transition and ovarian age. It may also be useful in predicting ovarian hyperstimulation syndrome, the effects of chemotherapy, and in determining the treatment of PCOS. AMH seems a superior predictor of ovarian response compared to other markers, including age, and day 3 FSH and estradiol. It offers similar predictive value compared to AFC. AMH can be drawn at any time in the menstrual cycle, and is not affected by hormonal therapy, including oral contraceptives.

Antisperm Antibodies

Antibodies directed against sperm. If directed against the head of the sperm, they can interfere with normal fertilization.

Antral Follicle Count

An assessment of the number of small follicles present in the ovary at any point in the cycle. This count is ideally between 10-20 follicles and if much lower, can suggest diminished ovarian reserve. See also: Follicle, Diminished Ovarian Reserve.

Arcuate Uterus

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 rarely needs any form of therapy.

Asherman’s Syndrome

Adhesions inside the uterine cavity are also know as Asherman’s syndrome and may result from prior surgeries of the uterine lining such as polyp or fibroid removal or dilation and curettage procedures. These adhesions can be diagnosed by saline ultrasonography or hysteroscopy and can be removed by hysteroscopy.

Assisted Hatching

The process of helping an embryo to hatch by making a surgical slit using a specialized laser in the zona pellucida (see Zona pellucida) or "shell." Assisted hatching is performed on Day 3 embryos and frozen-thawed embryos routinely.

Assisted Reproductive Technologies (ART)

ART is a term for the collective high- technology Infertility treatment procedures such as In Vitro Fertilization, Intracytoplasmic Sperm Injection, Frozen Embryo Transfer, and Testicular Sperm retrieval, that require laboratory handling of sperm and /or eggs.

Azoospermia

The complete absence of sperm. It can result from obstruction of the vas deferens (the duct that carries the sperm from the testicles to the urethra) or from failure of the testes to produce sperm. MESA and TESE are two ART procedures to obtain sperm from azoospermic males.

B

Basal Body Temperature

Abbreviated BBT.Indirect evidence of ovulation can be obtained with the basal body temperature chart. The temperature can be taken orally with a digital thermometer immediately upon awakening and before any activity. This is recorded on a special graph that enables you to visualize the different temperature shifts. The temperature will drop to its lowest point, 1-2 days prior to ovulation, and then rises and remains elevated until a couple of days before impending menstruation. If the individual is pregnant the temperature will remain elevated. This elevation is not considered a fever because it will never exceed 38ºC (100ºF). This test is unfortunately not very reliable in every woman, and is therefore not used universally. Urine ovulation prediction testing is a better way to document ovulation and to determine prospectively when ovulation will occur.

Bicornuate Uterus

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

Blastocyst

An embryo that has undergone multiple cellular divisions with the formation of a cavity within it. A fertilized egg reaches the blastocyst stage usually 4 to 5 days after fertilization. Most embryo transfers at Pacific Fertility Center are done with blastocyst stage embryos.

C

Cervical Mucus

Cervical mucus is secreted 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 infertility. 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 to stay alive in the cervix for a longer period of time. A thick and dense mucus could prevent the passage of sperm through the cervix.

Cervical Stenosis

Narrowing 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 cone biopsy done for an abnormal Pap smear. It can cause infertility by hampering the normal passage of sperm through the cervix, and can often be treated by intrauterine insemination that bypasses the cervix altogether.

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 secrets mucinous secretions (see Cervical Mucus) which play a major role in the transport of sperm in its journey towards the egg.

Cetrotide

A GnRH Antagonist medication (see below) used in IVF to prevent ovulation prior to egg retrieval. Chemical Pregnancy A pregnancy in its earliest stages that was detected by blood hormone levels but a gestational sac never developed.

Chlamydia

A bacteria responsible for a sexually transmitted infection that can affect the tubes by causing permanent damage and thus infertility. Often occurs without significant symptoms.

Chromosome

The nuclear structure of every living cell. Every human cell has normally 46 chromosomes. These chromosomes are made up of genes that govern all of the body's functions, and are also responsible for all the physical characteristics of an individual. Human gametes (i.e. eggs and sperm) contain only 23 chromosomes. When unified during fertilization, the total number of 46 chromosomes is thus restored. 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 Down's Syndrome increases when a woman gets older.

Clinical Pregnancy

A pregnancy that has advanced to a stage where a gestational sac and/or a fetus can be seen by ultrasound.

Clomiphene Citrate

Also known by the trade names of "Clomid" and "Serophene," it is a synthetic 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. Due to its anti estrogenic actions, some of its side effects include thickening of the cervical mucus and thinning of the 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) rarely occur (<1.5%) but are an indication to discontinue therapy.

Corpus Luteum

A follicle that releases an egg at the time of ovulation is subsequently called the corpus luteum. This is initially a partially collapsed cystic space that later can become a true cyst, and is very active in hormone secretion. Its major product is progesterone. If pregnancy does not occur, the corpus luteum "dies" roughly 10 to 14 days after ovulation. This leads to a sudden drop in progesterone levels, which in turn leads to menstruation. If, on the other hand, pregnancy occurs, the newly developing placenta secretes the HCG hormone, which salvages the corpus luteum and stimulates it to continue making 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.”

Cryopreservation

The process of freezing sperm, eggs or embryos in extremely low temperatures (-196°C). This technique has been used for decades to freeze sperm. It allows us to quarantine the sperm while the donor is tested for transmittable infectious diseases. The sperm can then be thawed when necessary and used in artificial insemination. More recently, we have been able to freeze and preserve human embryos. This has enabled us to freeze and save embryos resulting from in vitro fertilization. These embryos can also be later thawed and transferred back to the uterus. This allows us to transfer fewer embryos at any one transfer, reducing the risks of high-order multiple births.

Cumulus Granulosa

A group of cells that surround the human egg. They are responsible for the nourishment of that egg. These cells secrete the hormone estrogen that causes the uterine lining to grow.

Cystic Fibrosis (CF)

The most common inherited single-gene mutation genetic disease in humans. Children with CF inherit a mutated copy of the gene CFTR from each parent. These children have serious lung and digestive problems that can lead to a shorter lifespan.

D

D and C

Dilation and curettage. It is the process of gradually dilating the cervix to the point of being able to introduce an instrument (curette) to scrape the surface of the uterine cavity (endometrium). A suction cannula is also often used if the amount of tissue removed is great. This procedure is often used to treat abnormal bleeding, incomplete miscarriages and abnormal uterine pathology such as polyps or small fibroids. It is done under sedation and sometimes under general anesthesia. Potential complications include infection and uterine perforation.

Diminished or Decreased Ovarian Reserve (DOR)

This is an infertility diagnosis for women that have elevated basal FSH levels, low AMH levels or low antral follicle counts and/or poor responses to fertility medications. Women with this diagnosis have a reduced potential for successful pregnancy with any particular cycle’s treatment but the overall odds of conception is better related to a woman’s age. Women with very severe DOR often will need egg donation to successfully conceive, especially if they are 39 and older.

Down Syndrome

Also known as Trisomy 21. An individual that has 3 copies of chromosome 21. Physical features include mild mental retardation, heart and thyroid defects. This is the major anomaly being tested for when pregnant women undergo Chorionic Villus Sampling (CVS) or amniocentesis in early pregnancy. The incidence of Down Syndrome and other aneuploidies is increased with increasing maternal age.

E

Ectopic Pregnancy

A normal pregnancy results when the embryo implants inside the uterus. When implantation occurs outside the uterus, an ectopic pregnancy ensues. Such an abnormal pregnancy can be located in the tubes, the ovaries, the cervix or inside the abdomen. The most common symptoms are abnormal bleeding and lower abdominal pain. Women who have tubal damage (such a scarring from infection) are at an increased risk for an ectopic pregnancy. About one out of four conceptions after an ectopic pregnancy is a repeat ectopic pregnancy. About 2-3% of all in vitro fertilization pregnancies turn out to be ectopic.

Egg

Lay term for oocyte. The largest cell in the human body. Unites with the sperm to make a zygote and eventually a baby. Carries 23 chromosomes.

Egg Donation

This process involves the stimulation of a woman's hormones with fertility drugs, the retrieval of her eggs, the subsequent fertilization with the sperm of the recipient's partner, and the transfer of the resultant embryos to the uterus of the recipient. Women who might or will need egg donation generally fall into the following categories: 1. Women with no ovaries, either because of their congenital absence or their surgical removal 2. Women with early (premature) menopause 3. Older women 4. Women who fail to produce adequate number of eggs after stimulation with fertility drugs 5. Women with serious transmittable genetic traits or diseases 6. Women who have decreased ovarian reserve Egg donors should be young women (ideally between 21 and 29 years of age). Most egg donations are 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 aspirates the follicles with gentle suction. The aspirated fluid is sent to the embryologist who examines it and isolates the egg. The procedure is done under sedation and is therefore painless. It takes about 20 minutes to complete and the patient is discharged one hour 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 and infection.

Embryo

A fertilized egg that has begun the cycle of cell division.

Embryo Transfer

The process of depositing fertilized eggs (or embryos) inside the uterus. This often occurs 3 to 5 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 removed. This procedure is done in a position similar to a pelvic examination for a Pap smear. The patient will remain in that position for roughly fifteen minutes before being discharged. The number of embryos to be transferred depends upon on the age of the woman and the quality of the embryos. The patient 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 lining of the uterus (called the endometrium). An endometrial biopsy is done for many reasons. In a case of investigation for infertility, it is performed to evaluate the endometrium for its readiness to accept the embryo. An abnormal test is said to be "out-of-phase" in relation to the date of the cycle. An endometrial biopsy is also performed for abnormal uterine bleeding to diagnose hormonal imbalances or an anatomic cause for the bleeding, such as polyps, hyperplasia (abnormal benign growth of the endometrium) or cancer.

Endometriosis

The presence and growth of tissue resembling the endometrium outside the uterus. Typical locations include over the tubes, the ovaries, the uterus, the peritoneal lining of the pelvis, the bowel and 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 whereby only few spots of endometriosis are present are associated 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 shown that medical therapy does not improve infertility. Surgery for endometriosis is similarly not successful to treat infertility except in instances where there are mild adhesions partially blocking the tubes.

Endometrium

The inside lining of the uterus where implantation of the embryo occurs.

Endoscopy

A surgical procedure to view the pelvic organs (laparoscopy) or the uterine cavity (hysteroscopy) via a small, fiber-optic telescope. Therapeutic surgery may also be performed during these procedures.

Epididymis

Sperm travels from the testicles through a tubular structure called the epididymis into the vas deferens and through the urethra and penis. Sperm undergoes advanced maturation during its stay in the epididymis.

Estradiol Valerate

An estrogen preparation for human supplementation to prepare the uterine lining for implantation. 

Estrogen (or Estradiol)

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 egg secretes estrogen as it grows. The level of this hormone peaks at the time of ovulation, it then drops and peaks again about a week after ovulation. Estrogen is responsible for the normal growth and differentiation of both the follicle and the egg. It also plays an important role in preparing the endometrial lining where implantation would occur in case of pregnancy. 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 tube where it meets the egg. The hormone estrogen is important in helping to maintain healthy vaginal tissue. It also has beneficial effects on bone and the cardiovascular system. For these reasons, estrogen replacement is recommended to most menopausal women. When estrogen is measured on the second or third day of the cycle, its level reflects the health of the eggs. Ideally, a level less than 80 ug/ml is desirable prior to the initiation of ovulation induction or IVF.

F

Fallopian Tubes

A hollow muscular tubular organ that is connected to the uterus at one end, and opens inside the abdomen close to the ovaries at the other. The latter part is made of finger-like projections, also called “fimbria," that pick up the ovulated egg from the surface of the ovary. The egg meets the sperm at the mid-junction of the tube where fertilization occurs. The fertilized egg then travels to the uterine cavity where implantation takes place. There are normally two fallopian tubes, one on each side of the uterus. Damage to these tubes is common with sexually transmitted diseases, such as Gonorrhea and Chlamydia. They can also be easily damaged during pelvic or abdominal surgeries or in patients with severe endometriosis. Reconstructive tubal surgery for infertility can be done in some women. The success rate depends on the state of the tubes prior to the surgery. If for instance, the tubes are blocked and swollen, the success rate is extremely small in achieving pregnancy. In such cases, IVF should be the treatment of choice. Recent data has also shown that swollen tubes lower IVF success rates; therefore, it is strongly recommended that swollen damaged tubes (hydrosalpinx) be surgically removed prior to IVF.

Fertility Preservation

Refers to undergoing IVF for the purposes of freezing eggs or embryos. Candidates for fertility preservation are women facing chemotherapy treatment that may harm their eggs or women who delay childbearing due to career commitments or other personal circumstances. This significant step forward in fertility treatment enables women to take advantage of their body’s fertility at a time when eggs are at their healthiest.

Fertilization

The unification of sperm and egg to form a zygote (the earliest stage of human life). The zygote would then become an embryo, and then a fetus. A sperm or an egg contains half of the genetic make-up of its species. A normal human cell contains 46 chromosomes, while an egg or sperm contains only 23 chromosomes. After successful and normal fertilization, the number of chromosomes becomes 46 (23 from the egg and 23 from the sperm). Fetus A fertilized egg is called a zygote. Further cellular division and differentiation yields an embryo. Once organic differentiation occurs, i.e., the embryo acquires human-like features, it is called a fetus.

Fibroid Tumors (or Myomas)

Benign tumors of the muscle of the uterus. Fibroids develop in one of every four women at some point during their lifetime. If present inside the uterine cavity, they can interfere with implantation. Fibroids can also cause problems if they become large in size and impinge or put pressure on the uterine lining. They are treated by surgical removal, either via laparoscopy, hysteroscopy, or a major abdominal surgery.

Fimbriae

The delicate finger-like projections at the end of the fallopian tubes that are responsible for picking up the egg from the surface of the ovary and transporting it to the inside of the tube.

Follicle

A fluid-filled space (like a balloon) present inside the ovary that contains and nourishes the egg. In a normal cycle, a woman will usually ovulate only one egg. Very early in the cycle, however (and actually before the cycle even begins), many small minute follicles containing immature eggs are recruited. During the first 5 to 7 days after the start of a period only one of these follicles will mature and grow. This leading follicle will increase and be ready for ovulation roughly 2 weeks after the start of the menstrual cycle. The follicle will then burst with ovulation and release the egg that is picked up by the finger-like projections (fimbria) of the fallopian tube. The collapsed follicle will become the corpus luteum.

Follicle Stimulating Hormone

Abbreviated as FSH. A hormone secreted by the pituitary gland; FSH stimulates the growth and development of ovarian follicles. It is the main hormone present in the gonadatropin medications Gonal-F, Follistim and Bravelle, and comprises half of the hormones in Menopur. A blood test for this hormone on the third day of the menstrual cycle is crucial in evaluating how the ovaries are functioning. A significantly elevated level (>10) implies possible decreased ovarian reserve. Women with higher basal FSH levels may not respond as well to fertility medications in terms of the numbers of follicles and eggs recruited but does not necessarily predict who will and who will not get pregnant. Age is a better predictor of successful pregnancy. The level of FSH also assists us in determining the ideal dosage and regimen of fertility agents necessary to initiate proper ovarian stimulation in a subsequent cycle of treatment.

Follistim

This fertility medication contains recombinant FSH. In other words, the medication is made up of cells that have been genetically engineered through recombinant DNA technology to produce large quantities of human FSH. It is self-administered by subcutaneous injection. Frozen Embryo Transfer The process of thawing and placing into the uterus embryos previously frozen from a preceding IVF cycle. Currently most embryos are frozen at the blastocyst stage (Day 5 embryos) and over 90% of embryos frozen by vitrification will survive the freeze-thaw process. See also “vitrification.”

G

Gamete

The female egg and the male sperm.

Ganirelix

A GnRH Antagonist (see definition below) used in IVF cycles to prevent ovulation prior to egg retrieval.

Gestational Carrier

A woman who accepts to bear (or be pregnant with) the child of another woman who is incapable of becoming pregnant using her own uterus. Women who need surrogates (an older term for what we now refer to as a "gestational carrier") include those who do not have a uterus, have an abnormal uterine cavity, have had several recurrent miscarriages or have had recurrent failed IVF cycles. Women that may have medical problems that would make a pregnancy risky for the mother or baby would also be a candidate to work with a gestational carrier.

Gestational Surrogacy

Also see Surrogate & Classic Surrogacy. In gestational surrogacy, the gestational carrier does not contribute any genetic materials since the egg and the sperm come from prospective parents or a separate donor.

GnRH

Gonadotropin releasing hormone is the single most important hormone controlling ovarian function. It is secreted by the hypothalamus and controls LH and FSH secretion by the pituitary gland, which in turn directly controls ovarian function. Absent or abnormal secretion of GnRH results in irregular cycles and lack of ovulation. GnRH is secreted in an episodic manner by the hypothalamus to be able to carry out its functions.

GnRH Antagonist

A synthetic hormone similar to GnRH agonists but without any initial “flare” effect on the pituitary as seen with GnRH agonists. Antagonists (Ganirelix or Cetrotide) are usually administered in IVF cycles during the last 3-4 days of stimulation to prevent an LH surge from occurring, thereby preventing the release of the eggs from the ovaries prior to egg retrieval.

GnRH-Agonist

A synthetic hormone similar to GnRH that is administered in a continuous fashion by daily subcutaneous injections (Lupron) or nasal spray (Synarel). This hormone will actually suppress pituitary and ovarian function. Given this fact, we are able to use the medication to suppress the hypothalamic-pituitary-ovarian axis in many women undergoing ovulation induction for IVF. The benefit of this suppression is that it allows us to control the ovaries ourselves without interference from the hypothalamus or the pituitary.

Gonadatropins

Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH) are pituitary hormones that stimulate egg production, ovulation, and estrogen and progesterone production. The gonadatropin FSH is the hormone that is the main ingredient in Gonal-f, Follistim, Pergonal, Repronex and Humegon. Injections of gonadatropin medications will cause the ovaries to make multiple eggs.

Gonal-f

This fertility medication is a gonadatropin hormone containing very pure human FSH. It is produced by cells that have been genetically engineered through recombinant DNA technology to produce large quantities of human FSH. It is self-administered by subcutaneous injection.

Gonorrhea

A sexually transmitted disease that can cause tubal disease and infertility. If caught early, it is completely curable and will not negatively influence your fertility potential. Common symptoms include pelvic pain, vaginal discharge and fever.

H

HCG

Human Chorionic Gonadotropin is the major hormone secreted by the placenta. In the early stages of pregnancy, continued survival of the corpus luteum (the follicle that releases the egg) is totally dependent on HCG and, in turn, the survival of the pregnancy is dependent upon hormones secreted by the corpus luteum during the 7th week of pregnancy. Thereafter, the corpus luteum is gradually replaced by placental hormone secretions. Studies have shown that after administering HCG intramuscularly, ovulation occurs 38 to 40 hours afterwards. This is why during an IVF cycle, egg retrieval is scheduled 30 to 40 hours after the HCG shot. Similarly, during simple ovulation induction with Clomiphene or Gonadatropins, HCG is sometimes given to trigger ovulation. HCG is chemically very similar to LH or luteinizing hormone, which signals the ovulation process to begin. Insemination or intercourse is then planned according to the time that HCG was administered.

Hydrosalpinx

A hydrosalpinx is a fallopian tube that is filled with fluid.

Hyperprolactinemia

A condition where there is elevated blood levels of the hormone Prolactin. This hormone is secreted by the pituitary gland. There are several diseases that can result in abnormally high Prolactin levels. Most commonly, this is due to a small and benign Prolactin secreting tumor in the pituitary gland called Prolactinoma. Often this can result from an abnormally slow functioning thyroid gland. The treatment is specific to the cause, but medical management with Bromocriptine (Parlodel) is the first line of therapy.

Hypothalamus

A small portion in the base of the brain that plays a major role in regulating the hormones involved in fertility and the menstrual cycle. (See GnRH).

Hysterosalpingography(HSG)

An HSG is an x-ray dye test used to visualize the uterus and tubes. It involves the injection of a radio-opaque dye through the cervix and into the uterus and tubes. A series of x-rays is taken and the contour and patency of the uterus and tubes are assessed. The procedure can be somewhat uncomfortable, and may result in some cramping which often lasts for a few hours after the procedure. The likelihood of this occurring can be diminished or lessened by taking Ibuprofen or other pain medications, one hour before the test. In a small percentage of cases an HSG can cause tubal infection. This is more common in women who have one or more blocked tubes. If this is the case, the individual should immediately contact her infertility specialist to be placed on antibiotics for a week.

Hysteroscopy

This is a procedure that involves the introduction of a thin telescope-like instrument through the cervix into the uterine cavity. It enables the direct visualization of the uterine cavity and its lining, thereby providing an opportunity to diagnose abnormalities such as polyps, fibroids or adhesions. It is best performed 2 to 7 days following the end of menstruation. Diagnostic hysteroscopy can be performed with general anesthesia in the doctor's office. The procedure is relatively risk free and is significantly less painful than a hysterosalpingogram. All patients suspected of having surface lesions involving the inner lining of the uterus should have a diagnostic hysteroscopy performed.

Hysterosonogram

As a diagnostic procedure, the hysterosonogram is equal to the hysteroscopy procedure in identifying polyps or fibroids in the uterine cavity. It is performed in the doctor's office or in a hospital radiology department and does not require anesthesia. Ibuprofen is sometimes taken prior to the procedure to decrease the incidence of cramping. A small tube with a tiny balloon is placed into the cervix. Under vaginal ultrasound visualization, a small amount of sterile saline solution is placed into the uterine cavity. If there are any polyps or fibroids in the cavity, they can be easily seen by a doctor, who can then perform a hysteroscopy to remove the lesion(s).

I

ICSI

Intra-Cytoplasmic Sperm Injection is a technique whereby a single sperm is injected into the cytoplasm of an egg by the embryologist in the laboratory. This technique, also called "Sperm Injection," is performed when a man has a very low sperm count or when his sperm show very poor motility. It is also recommended for individuals who have experienced poor fertilization of eggs in a previous IVF cycle. The procedure involves grasping a single sperm with a very fine needlepoint pipette and then gently inserting it inside the egg and releasing the sperm.

Implantation

The process by which an embryo burrows within the endometrial lining of the uterus. 

IUI

Intrauterine Insemination: The process of placing washed sperm into the uterine cavity. Using a thin plastic catheter, concentrated sperm is gently placed high in the cavity, moving the sperm sample past the potential barrier of the cervical mucus and getting a higher concentration of motile sperm much closer to the egg(s).

IVF

Literally "fertilization in glass," IVF comprises several basic steps: the woman is given fertility drugs that stimulate her ovaries to produce a number of mature eggs; at the proper time, the eggs are retrieved by suction through a needle that has been inserted into her ovaries; the eggs are fertilized in a glass Petri dish, or in a test tube, in the laboratory with her partner's or donor sperm; and subsequently the embryos are transferred back into the body. IVF with a Gestational Carrier (or "Surrogate") The prospective parents' eggs and sperm are used to create embryos, which are then transferred into the uterus of another woman—known as the carrier (or surrogate)—via in vitro fertilization. It is the job of the gestational carrier to "carry" the pregnancy to term.

K

Karyotype

The word karyotype can be used in two different ways. The karyotype of a cell is the presence, as well as the specific arrangement and form, of the cell's chromosomes. A normal human cell has 46 chromosomes. Abnormalities of certain chromosomes, such as an extra chromosome, can be detected by doing a test in which a photograph is taken of the chromosomes from a single cell. This test is also referred to as a karyotype because the shape, size and presence of chromosomes from the cell are analyzed. This test is done for couples who suffer from recurrent miscarriages, in order to look for a specific chromosomal abnormality called "translocation", which can result in the loss of important genetic material therefore causing miscarriages. In men with severe male factor infertility or azoospermia, there is an increased chance that they have a genetic abnormality. A karyotype of their blood is often recommended.

L

Laparoscopy

This is a procedure that involves the introduction of a thin telescope-like instrument through the belly button and into the pelvis for direct visualization of the pelvic organs. Dye is sometimes injected through the cervix, and its flow traced through the fallopian tubes. Physician use laparoscopy for a variety of reasons: to check for suspected problems such as infertility, blocked or damaged tubes, scarring, ovarian tumors and uterine anomalies such as fibroids; to diagnose and treat endometriosis; to lyse (cut) adhesions that result from scarring; to remove fibroids, ovarian cysts or tumors. Laparoscopy is conducted under general anesthesia. The majority of patients do not have to stay overnight in the hospital. Mild abdominal discomfort for 1 or 2 days after the procedure is common; however, most women resume their normal activities as early as the day following the procedure. There are risks associated with laparoscopy, but they are considered minimal and/or uncommon. These risks include the following: infection, bleeding, damage to nearby organs (such as the bowel), and reaction to anesthesia. Very rarely is abdominal surgery required post-procedure, in order to take care of a complication that developed as a result of the laparoscopy.

Laparotomy

A procedure in which the abdomen is opened with an incision to expose its contents.

Letrozole

A medication that lowers the levels of the enzyme that produces estrogen, thereby temporarily lowering estrogen levels. Can be useful for inducing ovulation in women that do not ovulate regularly.

LH

The luteinizing hormone (LH) is secreted by the pituitary gland involved in the control of ovulation. 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. We can check this by using a home ovulation predictor kit, such as Clear Blue Easy. 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 or IUI within 24 hours of that positive test.

Lupron

Known medically as a GnRH-agonist (see GnRH), Lupron is a commonly used medication in IVF, and also for the treatment of severe endometriosis or large uterine fibroids. Lupron taken continuously either by daily subcutaneous (under the skin) injections or monthly intramuscularly depot injections will suppress the pituitary-ovarian axis. Simply stated, it will make the ovaries "go to sleep" and stop functioning, therefore stopping the secretion of hormones such as estrogen and progesterone. Lupron is frequently used in IVF to prevent premature ovulation.

M

Meiosis

The cellular division that occurs in sexual gonads (ovaries and testicles) to reduce the number of chromosomes in the egg and the sperm by half (from 46 down to 23 chromosomes). After fertilization, when the egg and sperm unite, the normal complement of 46 chromosomes is re-established in the new embryo. Errors in the process of meiosis occur frequently in human eggs and may be one of the major causes of implantation failure and miscarriage in humans.

Menopause

The period in a woman's life when menstruation stops. The average age of menopause in the United States is 51. The few years prior to menopause, also called the climacteric or peri-menopause, menstrual cycles become irregular in many women.

MESA

Microsurgical Epididymal Sperm Aspiration (MESA) is a surgical procedure to remove sperm from the epididymis in men who have an obstruction of the vas deferens or epididymis (or congenital absence of the vas deferens). This procedure is also used for obtaining sperm from men who have had a prior vasectomy. Unlike the TESE procedure, millions of sperm can usually be obtained and excess sperm are frozen for subsequent IVF cycles if needed. The sperm are then injected into the female partner's eggs (see ICSI).

Metformin

An oral medication used to treat insulin-resistance associated with Polycystic Ovarian Syndrome.

Micromanipulation

Advanced techniques used to manipulate gametes, i.e. eggs and sperm, to enhance successful fertilization and implantation. Intracytoplasmic sperm injection is one form of micromanipulation.  Embryo biopsy for pre-implantation genetic diagnosis and assisted hatching are other micromanipulation techniques.

Mitosis

The replication of cells by equal division. Soon after fertilization, the zygote undergoes successive mitoses and thus yields an embryo. All organs in the body that regenerate do so by mitosis.

Morula

An early phase of a growing embryo that resembles a mulberry. This stage is the typical stage for a Day 4 embryo.

N

Nucleus

Structure in the cell that contains the chromosomes.

O 

Ovarian Hyperstimulation

Complication of taking fertility drugs resulting in gross enlargement of the ovaries. In other words, hyperstimulation occurs when the ovaries produce excess eggs in response to stimulation by fertility drugs. This complication can be accompanied by an accumulation of fluid in the abdomen and lungs, and abnormal blood tests. However, hyperstimulation occurs in this severe form, requiring medical intervention, less then 1% of the time. Additionally, we monitor the body's response to fertility drugs, which allows us to see which patients are at risk in order to take the proper steps to prevent any problems from occurring.

Ovarian Reserve

As a woman gets older, the number of viable, healthy eggs remaining in her ovaries diminishes. While a woman continues to ovulate monthly from her late 30s until menopause, the eggs she produces are increasingly at risk for genetic abnormalities such as Down syndrome. Ovarian reserve is a term used to refer to a woman's "reproductive potential"; i.e., the chances that a woman will have a successful pregnancy with her own eggs. In order to evaluate ovarian reserve, doctors use tests such as the FSH and Estradiol level on Cycle Day 2 or 3, AMH (Anti-Mullerian Hormone) level, and Antral Follicle Count.

Ovary

The small oval organs measuring 2 by 1.5 inches present in a woman's pelvis and responsible for making eggs.

Ovulation

The process by which a mature egg is released from the surface of an ovary.

Ovulation Induction

Stimulation of the ovaries by fertility drugs to produce and release one or more eggs. 

P

Pituitary Gland

A small gland present at the base of the brain. It receives instructions from a specialized area of the brain just above it called 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.

Placenta

The organ that is responsible in the nourishment of the developing embryo. Abnormalities in the placenta can result in abnormal fetal growth, pre-eclampsia and death.

Polycystic Ovarian Syndrome (PCOS)

A genetic condition that results in women with ovulation problems and menstrual irregularity. Can be associated with excess male hormones and insulin resistance. Women with PCOS often require Clomid or other ovulation-inducing medications to stimulate ovulation.

Polyp

Benign growth of the lining of the uterus or the endometrium. It looks like a small solid balloon and can interfere with normal implantation and cause infertility, abnormal bleeding and, theoretically, miscarriages. Polyps can be missed during a hysterosalpingogram, but usually are seen during a hysteroscopy or a mid-cycle endovaginal ultrasound.

Pre-Implantation Genetic Screening (PGS)

An advanced technique to evaluate cells from early human embryos for chromosome copy number. Current techniques use microarrays of human DNA and can determine if there is an abnormal number of chromosomes (for example Down Syndrome) and can determine the sex of the embryo. All 24 unique chromosomes can be tested as well as some other chromosome structural defects.

Preimplantation Genetic Diagnosis (PGD)

An advanced technique that involves checking the cells of a developing embryo for genetic abnormalities and thus helping to prevent serious transmissible genetic diseases. PGD is indicated when an individual or couple carries a genetic mutation that may put their offspring at risk for a serious genetic disease, for example, Cystic Fibrosis.

Premature Ovarian Failure(POF) 

POF is the cessation of menstruation due to depletion of ovarian follicles before the age of 40. This disorder can run in families and is occasionally associated with other diseases, such as thyroid dysfunction and/or lupus. Women who suffer from Premature Ovarian Failure may elect to use an egg donor as a means to become pregnant.

Progesterone

A hormone secreted by the ovaries that belongs to the steroid hormone family, like estrogen. Progesterone is secreted by the corpus luteum (see Corpus Luteum), the follicle that produces and releases the egg. The specialized cells of the corpus luteum, that surround the egg, produce high levels of progesterone just prior to ovulation. Progesterone also plays a major role in preparing the endometrium for implantation and supports a pregnancy through the first few weeks of gestation. However, the corpus luteum will stop secreting progesterone if pregnancy does not occur. The progesterone level in the blood will then drop, which induces menses within 24 to 48 hours. This is how a regular menstrual cycle takes place. On the other hand, if pregnancy does occur, the placenta will start secreting the HCG hormone, which will salvage the corpus luteum and cause it to continue secreting progesterone.

Prolactin

A hormone secreted by the pituitary gland. Its major role is to control milk production. Excess secretion can interfere with normal ovulation. This is why prolactin levels are checked in every woman during the infertility evaluation process. Certain women have elevated Prolactin levels due to a small benign tumor in the pituitary gland or the brain. These tumors are often called Prolactinomas. They are usually treated by a medication called Bromocriptine or Parlodel. In rare instances, surgery may be required.

Prometrium

Micronized progesterone in tablet form that is usually used intra-vaginally in the luteal phase of IUI or IVF treatment cycles to augment progesterone being secreted from the ovary.

R

Recipient

A woman who receives the fertilized eggs from an egg donor. The partner’s sperm are used to fertilize the eggs. In other cases, donor sperm are selected for fertilization. Once the embryos are ready, they are implanted via embryo transfer into the recipient's uterus. However, this only occurs after a 2 to 3 week period of hormonal preparation, in order to ready the uterus to accept embryos. Once the recipient is pregnant, she will carry, nourish, and deliver the infant.

S

Selective Reduction

Also known as "multiple pregnancy reduction.” A procedure that is performed to reduce a high order multiple pregnancies such as triplets, to twins or singleton. It is a relatively simple procedure with minimal risk of losing a whole pregnancy.

Semen Analysis

A test to check for sperm quantity and quality. A sperm sample collected by masturbation after three days of abstinence is used for the test.

Single Embryo Transfer, also known as “elective single embryo transfer”

The elective choice to transfer only a single embryo to the uterus at the time of IVF embryo transfer or a frozen embryo transfer. Ideal candidates for elective single embryo transfer are patients less than 35 years of age, patients using donor egg embryos or patients with known chromosomally normal embryos from pre-implantation genetic screening.

Spontaneous Abortion

A naturally occurring miscarriage caused by complications such as a genetically abnormal fetus, or an empty sac. Often a doctor will need to perform a minor procedure—called a dilation and curettage (D&C)—when this type of miscarriage occurs, in order to scrape clean the uterine cavity of remnant tissue and to stop the bleeding. 

T

TESE 

A Testicular Sperm Extraction (TESE) is a minor surgical procedure usually performed under local anesthesia, in which the doctor removes a piece of testicular tissue to collect sperm. This sperm can then be injected into the female partner's eggs (see ICSI). Usually only low numbers of sperm are obtained and are available only for IVF with ICSI on the same day as the TESE.

Testicles

Two oval glands present in the scrotum that are responsible for producing the male gametes (sperm). The testicles also secrete many of the male hormones, such as testosterone.

Testicular Mapping

A diagnostic procedure to identify "pockets" of isolated sperm production in the testicles of men who have very low sperm production. Once these areas are located a TESE procedure can be done to find the sperm for IVF and sperm injection (see "ICSI").

Testosterone

The main hormone secreted by the testicles. The effects of testosterone—such as beard growth, an increase in muscle mass, a deepening voice and sperm maturation—can be easily recognized in men.

Third Party Parenting

The involvement of a third person (a person outside of the couple) to create a baby. There are several ways to participate in third party parenting: egg donation, sperm donation, and/or IVF with a gestational carrier. 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 may be associated with infertility.

U

Ultrasonography

One of the most common imaging techniques used on women undergoing infertility treatment. Almost all ultrasound examinations performed for purposes of monitoring/diagnosing women with infertility issues are currently carried out by means of a vaginal transducer (a small probe inserted into the vagina). An ultrasound transducer emits acoustic sound waves that bounce back when they hit different types of tissues in the body. 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 urine will appear black while bony structures will appear white. The vaginal transducer is about 15 inches long and 1 inch in diameter. Only about 5 inches will enter the vagina. The procedure is painless for most women as well as harmless. It enables us to see the pelvic organs, including the ovaries and the uterus. It is commonly used to diagnose the presence of ovarian cysts, tumors, uterine fibroids, and pregnancies. It is also used routinely to follow the growth and development of ovarian follicles during ovulation induction with fertility drugs in patients who are undergoing treatment.

Ureaplasma

A microorganism that can infect the male and female genital organs. Some studies suggest an association with miscarriages or even infertility.

Uterine Septum

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

Uterus

A hollow muscular organ (the size of 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 through its stages of development from an embryo to a fetus. A layer of specialized glandular cells, called the endometrium, lines the uterus.

V

Varicocele

An abnormal dilatation of the veins surrounding the testes. A varicocele, present in 25% of infertile males, causes blood to pool in the veins of the testes. This pooling presents a problem for some men because the presence of excess blood raises testicular temperature, which can be detrimental to sperm. The surgical correction of a varicocele is minor, and performed in order to ligate the dilated vessels or veins. However, the success of treatment is controversial. Pregnancy rates after surgery are reported to be in the range of 30-50%.

Vas Deferens

The segment of the tube that connects the epididymis to the urethra in males.

Vasectomy

A surgery to ligate the vas deferens in males, thus blocking the transport of sperm to the urethra. It is a very effective form of contraception that can be reversed. However, the longer the wait from the time that you have a vasectomy to the reversal surgery, the less your chances are of a successful pregnancy, due to the presence of anti-sperm antibodies.

Vitrification

An ultra-rapid method of freezing eggs and embryos that has led to a significant leap forward in the success of freezing of these tissues. Vitrification has allowed for the successful freezing of human eggs prior to fertilization, a process that was very poor with older freezing methods. Vitrification has also allowed for the improved survival rates of frozen-thawed blastocysts.

Z

Zithromax

This is the antibiotic generally known as azithromycin. It is very similar to Erythromycin but can be given in a single dose instead of a ten day course. It is used to decrease the chances that the bacteria ureaplasma or mycoplasma may inhabit the uterine cavity, which could result in decreased chances of embryo implantation.

Zona Pellucida

A translucent noncellular layer, which surrounds the egg and embryo. Just prior to implantation the zona will be broken and the embryo released to implant in the endometrium. In some women, especially in women over the age of 37, the zona is thicker and therefore harder for the embryo to hatch. Assisted hatching is then employed to help the embryo in this process.

Zygote

A fertilized egg.