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Acrosome Reaction: The process by which the cap over the head of the sperm, the acrosome, is removed to expose the portion of the sperm head containing special enzymes that make it possible for the sperm to penetrate the cells and structures surrounding the egg.

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.

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.

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.

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

Artificial Uterine Insemination: The process of depositing washed sperm inside the uterine cavity. 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 is short-lived. Artificial insemination is commonly used with ovulation inducing medications when, for instance, there is abnormal cervical mucus.

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.

Assisted Hatching: The process of helping an embryo to hatch by making a surgical slit in the zona pellucida (see Zona pellucida) or "shell", or by digesting this "shell" with special enzymes.

Assisted Reproductive Technologies (ART) : Infertility treatment procedures such as IUI, GIFT, ZIFT, and TET, 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 procedures to obtain sperm from azoospermic males.

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 special 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.

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.
Capacitation: The changes that a sperm goes through to be capable of penetrating the layers covering the egg. It involves the sequentially timed release of a series of enzymes, which allows the sperm to digest a passage through those layers.

Cervical Cultures: The process of obtaining samples (of secretions) from the cervix and culturing them on special media for different types of infectious organisms such as Chlamydia, Gonococcus and Ureaplasma. These sexually transmitted diseases, if present, can cause infertility by damaging the fallopian tubes or can interfere with implantation of the embryo by infecting the lining of the uterus. They are easily treated with antibiotics.

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. The cervical mucus is checked by the Postcoital test.

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.

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.

Classic Surrogacy: The use of a third party to carry a baby to term. In classic surrogacy, the surrogate provides the egg and the male partner provides the sperm. This is not performed at Pacific Fertility Center.

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 non-steroidal 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 antiestrogenic 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. about 10% of women conceiving with clomiphene will have a multiple birth, usually twins.

Clomiphene Citrate Challenge Test (CCCT): The Clomiphene Challenge Test (CCCT) is a test for ovarian reserve or reproductive potential based on egg quality. a blood test on cycle day 2 or 3 for the hormones fsh and estradiol is performed first. then the woman takes two 50 mg tablets of clomiphene citrate from days 5-9 of the cycle. a second blood test for fsh only is performed on day 10. ideally, the fsh should be less than 10 miu />mL and the estradiol less than 80 pg/mL. If elevated, these tests may indicate poorer changes for successful conception.

Co-Culture: The process of helping embryos grow and develop in the presence of cells derived from the growth of other tissues such as tubal cells. The purpose is to enhance the growth of healthy embryos.

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 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.

Diethylstilbestrol (DES): A synthetic estrogen compound that was inappropriately prescribed in the 1960's to prevent threatened miscarriages. Many women exposed to this compound while their mothers were pregnant with them have subsequently developed a variety of genital tract anomalies. Some of these anomalies include an abnormally shaped and small uterus. DES exposed women have also been shown to be at an increased risk for infertility, miscarriages, ectopic pregnancy and certain vaginal tumors.

D & 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.

E2: See Estradiol.

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. In 1987, roughly 2 out of every 100 women who were known to conceive were hospitalized for an 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 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.

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 women'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 catagories:-

  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
  7. Women who are about to undergo surgery for ovarian cancer, in which case they can freeze the resultant embryos for use at a later date.
    Egg donors should be young women and should ideally have had at least one prior pregnancy. 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, the 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 heavy 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 mostly 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.

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 to peak 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.

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

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.

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 and Follistim, and comprises half of the hormones in Pergonal, Repronex, and Humegon. 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 impending ovarian failure or decreased ovarian reserve. These women will not respond adequately to ovulation inducing medications. 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.

FSH: See Follicle Stimulating Hormone.

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 administered by subcutaneous injection.

Gamete: The female egg and the male sperm.

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.

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.

GIFT: Gamete Intrafallopian Tubal Tranfer is a procedure that involves introducing sperm and egg (also called gametes) inside the fallopian tube. This is accomplished by laparoscopic surgery, whereby under direct visualization via a telescope inserted through the umbilicus, eggs and sperm are deposited by a catheter in the mid-section of the fallopian tube. It can only be performed when the individual has normal tubes. The success rate with GIFT depends on the Fertility centre and the expertise of the physician. In most good IVF centers, success rates with GIFT are lower than IVF. Since it is an invasive procedure (requiring laparoscopy) and is more costly, its indications are limited. It is a good alternative when a patient is undergoing laparoscopy to investigate long-standing infertility. If planned in advance GIFT can then be performed at the same time if a normal tube is present.

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-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 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.

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 lutenizing hormone,which signals the ovulation process to begin. Inseminations or intercourse is then planned according to the time that HCG was administered.

Hemi-zona Assay: A test that helps determine if sperm are able to attach and penetrate the covering of an egg or zona pellucida.

Human Chorionic Gonadotropin: See HCG.

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

Hyperprolactenemia: 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 Bromocryptine (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: 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 fibriods in the uterine cavity. It is performed in the doctor's office or in a hospital radiology department and does not require anethesia. 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 is then performed to remove the lesion(s).

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: See Artificial insemination.

Intracytoplasmic Sperm Injection: See ICSI.

Intrauterine Insemination: See Artificial insemination.

In Vitro Fertilization: See IVF.

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 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.

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 chormosomes. 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 choromosomes from a single cell. This test is also referred to as a karyotype because the shape, size and presence of 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.

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 utering anomalies such as fibroids; to diagnose and treat endometriosis; to lyse (cut) adhesions that result from scarring; to remove fibroids, ovarian cysts or tumors; and to perform GIFT, or other miscellaneous procedures. 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 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 abdominal surgery is required post-procedure, in order to take care of a complication that developed as a result of the laparascopy.

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

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 Plan Easy or OvuQuick One-Step. 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.

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 progestrone. Lupron is frequently used in IVF to prevent premature ovulation.

Luteinizing Hormone: See LH.

Macrophage: Specialized cells of the immune system that help fight infections. Macrophages also attack foreign bodies and are involved in inflammation.

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).

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 when they are united by fertilization.

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, menstrual cycles become irregular in many women.

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. (See ICSI)

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.

Nucleus: Structure in the cell that contains the chromosomes.

Oocyte: See Egg.

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.

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 hospitalization, 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 Cycle Day 2 or 3 FSH/estradiol test and the Clomiphene Citrate Challenge.

Ovulation Predictor Kit: See Ovulation.

Ovum Donation: See Egg Donation.

Pelvic Inflammatory Disease (PID): Infection of the pelvic organs that may result in scarring of the fallopian tubes and /or pelvic adhesions.

Percoll: A chemical that is used to wash the sperm by separating motile sperm from the dead ones. This is done in order to get a higher concentration of motile sperm which, in turn, therefore increases fertility potential.

Pergonal: See HMG, LH and FSH. This fertility medication is one of the oldest gonadatropin preparations on the market. It is made from the partial purification of FSH & LH from the urine of post-menopausal women. It is given by intramuscular injection. See also "gonadatropins".

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 and death.

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.

Postcoital Test: A test to check the quality of the cervical mucus and the sperm in it. It is performed up to 12 hours after intercourse. A small sample of the cervical mucus is taken (similar to a Pap smear in process) and is examined under the microscope. A good test will show ample mucus and contain many moving sperm. An abnormal test may be due to low levels of estrogen, as a side effect of Clomiphene therapy or as a result of antisperm antibodies.

Preimplantation Genetics: An advanced technique that involves checking the cells of a developing embryo for genetic and chromosomal abnormalities and thus helping to prevent serious transmissible genetic diseases. The sex of the offspring can also be determined through this method. Due to the expense and potential damage to embryos from this procedure, it is currently used only for couples at risk for having children with genetic diseases.

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

Progesterone: A hormone secreted by the ovaries that belongs to the steriod 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 Bromocryptine or Parlodel. In rare instances, surgery may be required.

Recipient: A woman who receives the fertilized eggs from an egg donor. In some cases, the husband'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 IVF (in vitro fertilization) 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 to accept embryos. Once the recipient is pregnant, she will carry, nourish, and deliver the infant.

Repronex: A gonadatropin fertility medication similar to Pergonal in that it comes from the partial purification of FSH and LH from human menopausal urine. Repronex has been approved by the FDA for subcutaneous administration. See also "Gonadatropins".

Saline Sonogram: See "Hysterosonogram".

Selective Reduction: Also known as "multiple pregnancy reduction". A procedure that is performed to reduce a high order multiple pregnancy such as quadruplets or 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.

Sperm Antibodies: Substances in either partner that may attach to sperm and interfere with fertilization.

Spontaneous Abortion: A naturally occuring 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.

Synarel: A nasal spray medication that can be used instead of Lupron to prevent premature ovulation during an IVF cycle (see also "GnRH agonist" and "Lupron".)

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.

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").

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.

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, IVF with a gestational carrier and classic surrogacy.

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.

Ultrasonography: One of the most common imaging techniques used on woman 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.

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.

ZIFT: The transfer of a zygote into the fallopian tube. Also see GIFT.

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.