Glossary

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A

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 suggests lower pregnancy rates in women with adenomyosis.

Adhesions
Scarring as a result of tissue injury. The damage can be caused by infections such as Gonorrhea and Chlamydia, or to previous operations such as removal of cysts or 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.

AIDS
Autoimmune Deficiency Syndrome. A disease of the immune system caused by the HIV virus that can be transmitted through sexual contact. The virus can remain in the blood stream for many years before causing AIDS. It weakens the immune system, and therefore simple infections can be deadly.

Alloimmunity
Antibody production against proteins of another individual, for example antibodies made by a woman against her husband’s sperm. (See Antibodies)

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.

Antagonist
GnRH Antagonist: Ganirelix/cetrotide. (See Ganirelix)

Antagon
(See Ganirelix)

Antibodies
Protein molecules that are secreted by specialized cells in the body, called B cells. These molecules are the “soldiers” of the immune system.

Antilymphocyte Antibodies
Antibodies that attack the male partner’s white blood cells, called lymphocytes. These antibodies can also attack fetal lymphocytes since these white cells will have similarities to the male partner’s white blood cells.

 

Antiphospholipid

Antibodies
Also known as APA. A group of antibodies that attach to a compound
called phospholipid. Phospholipids are present in the membrane of all cells. These antibodies, if present, can destroy the placental root system of the developing embryo, thereby causing infertility and early miscarriages. APAs can be checked by a blood test done any time during the cycle, and all women with infertility are encouraged to have this test.

Antisperm Antibodies
Antibodies directed against sperm. If directed against the head of the sperm, they can interfere with normal fertilization. These antibodies can be present in the woman’s or man’s blood or his semen.

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.

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.

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.

Autoantibodies
Antibodies that are directed against a person’s own tissues, such as antiphospholipid or antithyroid antibodies.

 

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.

Basal Body Temperature
Abbreviated BBT. Indirect evidence of ovulation can be obtained with the basal body temperature chart. The temperature can be taken orally or rectally 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 38˚C (100˚F). 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 6 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 of a fetus 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 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.

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.

Cumulus Granulosa
A group of cells that surround the human egg. They are responsible in the nourishment of that egg.

D & C
Dilation and curettage. It is the process of gradually dilating the cervix to the point of being able to introduce a sharp instrument, a 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. Complications include infection and uterine perforation.

Diethylstilbestrol (DES)
A synthetic estrogen compound that was inappropriately prescribed in the 1960s 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.

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 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
When a woman has no eggs or when the eggs are too few or abnormal, she may need to obtain eggs from an egg donor. Women who might need or will need egg donation include the following: (1) women with no ovaries, either because of their congenital absence or their surgical removal, (2) women with early (premature) menopause, (3) older woman, (4) women who fail to produce adequate number of eggs after stimulation with fertility drugs, or (5) women with serious transmittable genetic traits or diseases. Egg donors should be young women with no significant negative family history. 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 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 an hour 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.

Enbrel (Etanercept):

Humira (Adalimmab)
Enbrel/Humira is a Cox 2 anti-inflammatory medication)developed for
patients who have severe rheumatoid arthritis. They were approved by the Federal Drug Administration (FDA) for use in these patients in November of 1998. The Cox 2 inhibitors function is to bind with tumor necrosis factor (TNF) which is secreted by active natural killer cells. Patients with rheumatoid arthritis have been found to have elevated levels of TNF in their joints. They bind to the TNF, rendering it biologically inactive, resulting in significant reduction of inflammatory activity. These drugs are used with reproductive immunology patients where there is elevated natural killer activity, both peripherally and in the endometrial tissue. TNF produced by the natural killer cells in the uterus damages the DNA of blood vessels in the endometrium creating stromal hemorrhages which may decrease blood supply to the implanting embryo. The TNF also damages the DNA of the embryo and it may fail to grow, divide, and implant. Enbrel is administered by subcutaneous injection in the thigh, stomach, or back of the upper arm. It is given every 3 1/2 to 4 days and is packaged four doses in a box which provides a two-week supply. Each dose includes a syringe, one vial of Enbrel, one plunger and two alcohol swabs. The drug should be refrigerated and the manufacturer, Immunex Corporation, provides a toll free information service at 1-888-4Enbrel (1-888-436-2735) to answer any questions consumers may have. Humira is administered subcutaneously once every two weeks and comes in boxes of two syringes and is preloaded. The drug should also be refrigerated and the manufacturer, Abbott Laboratory, provides a toll free information service at 1-800-255-5162 to answer any questions consumers may have. The Cox 2 inhibitors are administered for at least 30 days and in some cases may be continued up until a heartbeat is seen on ultrasound at six weeks. Occasionally difficult cases may require more. The FDA classifies drugs into five categories in respect to pregnancy with Category A being deemed the safest. Enbrel/Humira have been classified as Category B and there have been studies in animals at doses 60-100 times higher than human doses that have revealed no evidence of harm to the fetus. At this time there are no formal studies with pregnant women. Current data suggest that the use of Enbrel/Humira does not reduce the body’s ability to fight cancer and also Enbrel should not increase a woman’s susceptibility to catch colds or viruses, but these medications should not be initiated in patients with an active infection or an active upper respiratory tract infection and also in patients who test positive for exposure to tuberculosis.

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 fertility. 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.

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.

Estrace (estradiol acetate):
Estrace is an estrogen medication used to relieve several conditions related to menopause, such as treating hot flashes and vaginal dryness, and preventing osteoporosis in postmenopausal women. Within IVF, Estrace is used to supply estrogen in a number of situations. It may be used to make the resting follicles more sensitive to the upcoming fertility medication. It may also be used to stimulate growth of the endometrial lining in patients who require a boost. Estrace comes in tablet form and can be used orally or vaginally.

Estradiol Valerate
The same estradiol, extracted from the Mexican yam or the soybean, is prepared for intramuscular injection and is usually given twice a week to patients who are recipients of embryos. This would include patients doing IVF with egg donation, patients doing frozen embryo transfer and gestational surrogates.

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 status of the ovaries. Ideally, a level less than 70 pg/ml is desirable prior to the initiation of ovulation induction of IVF.

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, thenumber 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 sometime 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 in picking-up the egg from the surface of the ovary and transporting it to the inside of the tube.

Folgard

(Folplex, Fabb)
This medication is high dose folic acid consisting of 2.2 mg per tablet
to which has been added Vitamin B6 and B12. This vitamin supplement is used in two specific situations, the first is for patients who carry one or two of the abnormal genes within Methyltetra-Hydrofolate Reductase (MTHFR) and also in patients with a history of neural tube defect in their family or their own obstetrical history.

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) on 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 medications, Gonal F, Follistim and Bravelle and comprises half of the hormones in Menopur and Repronex. A blood test for this hormone on the third day of the menstrual cycle is crucial in evaluation of the function of the ovaries. 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.

Gamete
The female egg and the male sperm.

Ganirelix

(formerly called Antagon)
Ganirelix acetate is a gonadotropin-releasing hormone (GnRH) antagonist. It acts by competively blocking the GnRH receptors on the pituitary gonadotroph cells. The suppression of pituitary LH secretion by Ganirelix is more pronounced than the suppression of FSH. There is no detectable initial release of endogenous gonadotropins (LH or FSH) and this is consistent with an antagonistic effect or a direct switch off. Upon discontinuing Ganirelix, the pituitary LH and FSH levels are fully recovered within 48 hours. Ganirelix is rapidly absorbed after subcutaneous injection with maximum serum concentrations reached approximately one hour after dosing. The half-life is 13 to 16 hours and steady state serum concentrations are reached after three days of treatment. Ganirelix is indicated for the inhibition of premature LH surges during ovarian hyperstimulation. Apart from known hypersensitivity to Ganirelix or GnRH analogs, and known suspected pregnancy, there are no known contraindications.

 

Gestational Surrogacy
In gestational surrogacy, the surrogate does not contribute any genetic materials since the egg and the sperm come from prospective parents. (See surrogate)

GIFT: Gamete Intrafallopian

TubalTransfer
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 midsection of the fallopian tube. It can only be performed when the individual has normal tubes. The success rate with GIFT depends on the Fertility Center 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.

Genetics
See Preimplantation Genetic Diagnosis (PGD)

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 its functions.

GnRH-Agonist
A synthetic hormone similar to GnRH. If given in a continuous fashion (such as by daily subcutaneous injections) it will actually suppress pituitary and ovarian function. GnRH is actually used to suppress the hypothalamic-pituitary-ovarian axis in many women undergoing ovulation induction for IVF. It allows us to control the ovaries ourselves without interference from the hypothalamus or the pituitary.

 

Gonal F/Bravelle/Follistim

Repronex/Menopur

(FSH/hMG)
This category of medication consists either of pure FSH or a mixture of
FSH and LH and this family of medications is responsible for stimulating
the ovary(ies) to make multiple follicles. Products like Gonal F and Bravelle contain almost pure FSH while products like Repronex and Menopur are collectively known as hMG and they contain equal parts of FSH and LH. The medications are given either by intramuscular or subcutaneous injection and they usually commence about 1 1/2 weeks after Lupron has been started. At Zouves Fertility Center we usually use a combination of a pure FSH product and an hMG product in proportions of approximately 80% and 20% respectively. The reason that we add a product containing LH is because some patients on Lupron may have very low levels of LH, where LH may be required for optimal follicular growth and development.

Gonorrhea
A sexually transmitted disease than can cause tubal disease and infertility. If caught early, it is totally curable without a bad sequel as far as fertility potential is concerned. Common symptoms include pelvic pain, vaginal discharge and fever..

Hamster-Egg

Penetration Test
A test that determines the ability of the human sperm to attach and penetrate a hamster egg. This test is used very infrequently since the advance of intracytoplasmic sperm injection (ICSI).

hCG: Human Chorionic

Gonadotropins
The major hormone secreted by the placenta. In the early stages of pregnancy continued survival of the corpus luteum (the follicle that released the egg) is totally dependent on hCG, and in turn, the survival of the pregnancy is dependent upon hormones secreted by the corpus luteum until the 7th week of pregnancy. Thereafter, the corpus luteum is gradually replaced by placental hormonal secretions. Studies have shown that after administering hCG intramuscularly or subcutaneously, 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, hCG is sometimes given to trigger ovulation. Inseminations or intercourse is then planned according to the time that hCG was administered.

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

Human Chorionic

Gonadotropin
See hCG.

Humira/Enbrel:
See Enbrel/Humira

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
Portions of the base of the brain that has a major role in regulating the hormones involved in fertility and the menstrual cycle. (See GnRH)

Hysterosalpingogram (HSG)
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. For this reason, antibiotics should be given prophylactically.

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 neurolept 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 before having a cycle at Zouves Fertility Center.

 

Hysteroultrasonogram

(HUS)
Hysteroultrasonogram is a diagnostic procedure performed to exclude pathology of the uterine cavity that could interfere with successful implantation of an embryo. HUS is usually performed in the office with the addition of some local anesthetic (paracervical blockade). HUS is usually performed on cycle day 6-12 of a normal menstrual cycle after bleeding has stopped but prior to expected ovulation. If you are on oral contraceptive pills or if you are post-menopausal the procedure can be performed at any time. In order to protect against any possible reproductive tract infection, you will be given prophylactic antibiotics in the form of either doxycycline or erythromycin. Ideally the antibiotics should be commenced the day before the scheduled HUS and will be continued for a total of three days. Doxycycline and erythromycin should be taken with food and do not interfere with most other medication.The most common side effect of an HUS is uterine cramping similar to menstrual cramps. You should take 600 mg of ibuprofen (Motrin) one or two hours before your scheduled HUS. Prior to performing the HUS several other minor procedures may be performed including measurement of uterine position and depth, and also a complete transvaginal pelvic ultrasound to evaluate the pelvic reproductive organs (uterus and ovaries).The HUS entails placing a speculum in the vagina and cleansing the vagina and cervix with antibacterial solution (Zephiran). Local anesthesia is administered in the form of paracervical blockade using Nesacaine. Following the transvaginal pelvic ultrasound evaluation, the cervix is again cleansed with iodine and a very narrow catheter is passed through the cervix into the cavity of the uterus and a small balloon is inflated holding this catheter in place. Sterile saline solution is then introduced to distend the uterine cavity and again using the transvaginal ultrasound probe a picture of an outline of the cavity of the uterus is obtained. Should there be any obvious polyps or abnormalities seen, you may need to have a formal procedure called a hysteroscopy to remove and correct the problem. It is not uncommon to experience some light vaginal bleeding or cramping for a few hours after the procedure. Patients experiencing bleeding more than just spotting, fever greater than 100˚F, foul smelling vaginal discharge, chills or abdominal pain are advised to call the office immediately.

ICSI: Intracytoplasmic

Sperm Injection
It is a technique whereby a single sperm is injected into an egg by the embryologist in the laboratory. It is performed when there is a very low sperm count or when the sperm show very poor motility. It is also indicated when there is 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.

Intracytoplasmic Sperm

Injection
See ICSI.

Intrauterine Insemination
See Artificial Insemination.

Intralipid (IL)
Evidence from both animal and human studies suggests that Intralipid, administered intravenously, may enhance implantation and maintenance of pregnancy when the patient has had an abnormal NK cell level or Function Intralipid is a 20% intravenous fat emulsion which is usually used as a source of fat and calories for patients requiring parenteral nutrition. Intralipid consists of soybean oil as well as egg yolk phospholipids, glycerine and water.

In vitro investigations have revealed the ability of Intralipid to suppress the natural killer (NK) cytotoxicity. Fifty patients with abnormal natural killer levels received Intralipid infusions and 78% showed suppression of the natural killer activity to the normal range one week after infusion, 22% showed suppression but not yet into the normal range in these patients received a second infusion 2 to 3 weeks after the first and all but one of these 11patients have normal natural killer levels the following week. Four patients required a third infusion and after the first, all showed normal natural killer activity. Forty seven of these 50 patients continue to have normalization of their NK levels for between six and nine weeks, two patients remained normal lives five weeks and in one patient the effect lasted for four weeks.

Conclusion of the study was that Intralipid was effective in suppressing in vivo abnormal NK cell function, suggesting that Intralipid can be used successfully as a therapeutic option to modulate abnormal NK activity in women with reproductive failure.

 

In Vitro Fertilization
See IVF.

IUI
Intrauterine Insemination. (See Artificial Insemination)

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.

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

Laparoscopy
The process involves the introduction of a thin telescope-like instrument through the belly button into the pelvis for direct visualization of the pelvic organ. At the same time, dye can be injected through the cervix, and its flow can be traced into and through the fallopian tubes under direct vision. The procedure is conducted under general anesthesia, but the patient does not have to stay overnight in the hospital. The patient might have mild abdominal discomfort for 1 or 2 days after the procedure, but can usually resume normal activities even as early as the next day. The risks with laparoscopy are very small and include the following: (1) infection, (2) bleeding, (3) damage to nearby organs, such as the bowel, (4) reaction to anesthesia. Very rarely abdominal surgery is needed to take care of a complication. Indications for laparoscopy are many and include the following: (1) diagnostic, to check for suspected problems such as infertility, blocked or damaged tubes, scarring, ovarian tumors and uterine anomalies such as fibroids, (2) diagnosis and treatment of endometriosis, (3) lysis (cutting) of adhesions (scarring), (4) removal of fibroids, (5) removal of ovarian cysts or tumors, (6) GIFT, and other miscellaneous indications.

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

LH
Luteinizing hormone. A hormone 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 at home using an ovulation predictor kit, such as OvuQuick. 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.

Lovenox (Enoxaparin):
This is a subcutaneous injection taken once a day. In high doses Lovenox is a blood thinner and is used to help prevent and remove blood clots. However, in low doses, as it is used in IVF, this medication promotes implantation and acts more like an anti-inflammatory medication and also decreases the viscosity of blood, thereby facilitating blood flow in the early developing placenta.

Lupron

(Leuprolide Acetate)

Lupron Down Regulation

Lupron Micro Dose
Leuprolide Acetate is an angonist meaning that it causes release of FSH
and LH from the pituitary gland. It is given daily or twice daily as a
subcutaneous injection and is used in IVF in two different strengths.
The first is the regular dose Lupron at 0.5 mg to 1 mg per day and this is usually started two weeks after the commencement of birth control pills and this dose of Lupron is used to down regulate and to suppress the pituitary gland to prevent a premature release of LH and therefore premature ovulation. The second dosage schedule of Lupron is called the micro dose Lupron and this microscopic dose of Lupron is given twice a day and is used to stimulate the release of a small amount of FSH and LH from the pituitary gland therefore being used as a stimulant rather than a suppressant. Because the micro dose is given twice a day it also works effectively to prevent the premature release of a surge of LH.

Lupron Down Regulation
See Lupron/Lupron Down Regulation/Lupron Micro Dose

Lupron Micro Dose
See Lupron/Lupron Down Regulation/Lupron Micro Dose

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.

Meiosis
The cellular division that occurs in sexual gonads (ovaries and testicles) to reduce the number of chromosomes in the egg and the sperm in half. When these latter unite with fertilization, the original 46 chromosomes are reduced.

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

(Glucophage)
This medication was originally developed to treat type II diabetesand it
prevents peaks and troughs of insulin thereby stabilizing insulin levels. When combined with a low carbohydrate diet Metformin is used in patients with polycystic ovarian syndrome (PCOS) and where all other fertility factors are equal it may result in a spontaneous pregnancy, but when continued through and up until 12 weeks of pregnancy, the Metformin has been shown to increase the success rate of in vitro fertilization (IVF) as well as decrease the risk of miscarriage especially in patients with PCOS.

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.

Ovarian Hyperstimulation
Complication of taking fertility drugs resulting in gross enlargement of the ovaries. It is sometimes accompanied by accumulation of fluid in the abdomen and lungs, and abnormal blood tests. It occurs in less than 1% of the time in its severe forms requiring hospitalization. Hyperstimulation occurs when the ovaries produce excess eggs in response to stimulation by fertility drugs. Monitoring the response allows us to see which patients are at risk and helps us take steps to prevent the problem from occurring.

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 when a mature egg is released from the surface of an ovary.

Ovulation Predictor Kit
See ovulation.

Ovum Donation
See egg donation.

Percoll
A chemical that is used to wash the sperm, thus separating motile from dead ones, therefore enhancing fertility potential.

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 when examined by a hysterosalpingogram, but usually are seen at a hysteroscopy or a hysteroultrasonogram (HUS).

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 Genetic

Testing (PGD/PGS)
Preimplantation Genetic Testing is a relatively new procedure in which eggs or embryos are tested for certain genetic conditions prior to being replaced in the womb.Children born in the United States have a 3% to 4% chance of a major birth defect. Some of these abnormalities occur because of a problem with a single gene which is inherited from one or both of the parents, which other abnormalities are related to an abnormal number of chromosomes (aneuploidy). Both of these problems can be tested before embryos are transferred to the uterus and this diagnostic procedure is called Preimplantation Genetic Testing. The majority of PGD procedures are performed for aneuploidy or abnormalities in the number of chromosomes and this problem increases with increasing maternal age. Studies have also shown that up to 85% of aneuploids are caused by the egg while the sperm may cause the remainder.With respects to single gene defects, these defects can be dominant and are transmitted by one parent alone with a risk of an affected child being 50% (e.g. Myotonic Dystrophy) or these defects can be recessive and both parents must have the gene with a risk of an affected child being 25% (e.g., Cystic Fibrosis, Sickle Cell Anemia or Tay-Sachs Disease). There are now more than 50 single gene diseases that can be diagnosed with PGD. Most of these genetic syndromes are relatively uncommon.In keeping with our goal of providing the latest technological advances to help our patients achieve a viable, healthy pregnancy, Zouves Fertility Center now offers PGD/PGS. Preimplantation Genetic Testing is an intricate procedure, which involves removing a single cell from a three-day old embryo and testing it for chromosomal disorders. This permits the selection of embryos, which are less likely to have chromosomal abnormalities and also embryos that may be free of a known single gene disorder, thereby increasing the likelihood of a healthy baby and decreasing the chances of having to terminate a pregnancy found to be abnormal through chorionic villus sampling or amniocentesis.

 

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

Progesterone
A hormone secreted by the ovaries. It belongs to the same family of hormones such as estrogen, called steroids. It is secreted by the corpus luteum (see corpus luteum), which is the follicle that has produced and released the egg. Progesterone is produced by specialized cells surrounding the egg and this starts just prior to ovulation. This hormone plays a major role in preparing the endometrium for implantation. It also supports the pregnancy through the first few weeks of gestation. The corpus luteum will stop secreting progesterone if pregnancy does not occur. The progesterone level in the blood will then drop and menses will start within 24 to 48 hours. This is how a regular menstrual cycle takes place. If pregnancy occurs on the other hand, the placenta will start secreting the hCG hormone, and this hormone in turn will salvage the corpus luteum and 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 evaluation process for infertility. 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.

Prolonged Coasting
The discontinuation of fertility drugs and postponing the hCG injection until the blood estrogen level drops below a certain level considered to be safe. Coasting is needed when severe hyper-stimulation has occurred. Its goal is to prevent some of the side effects of hyperstimulation.
Protease Digestion
Enzymatic digestion or thinning of the zona pellucida (“egg shell”) to enhance embryo hatching.

Recipient
A woman who receives the fertilized eggs (often by the husband’s sperm) from an egg donor. These embryos are transferred to her uterus after a 2 to 3 week period of hormonal preparation to have the uterus ready to accept these embryos. The recipient will carry, nourish and deliver the infant.

Selective 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 (1/300) of losing a whole pregnancy.

Semen Analysis
This test examines the number of sperm (concentration), the percentage of moving sperm (motility), and the percentage of normally shaped sperm (morphology). The semen analysis may also reveal infection in the male genital system. This degree of progressive movement indicates the actual vitality of the sperm, which in turn may relate to their ability to fertilize an egg. The third factor reported in a complete semen analysis is the morphology. The word, morphology, is derived from the Greek word for shape and structure. Sperm are examined microscopically to determine the percentage of normally shaped cells. We believe that normally appearing sperm are more likely to fertilize an egg, while those with obvious structural abnormalities are less likely to, or perhaps cannot, fertilize an egg. Fortunately, normal fertility is possible even when the percentage of normal sperm is low. The best predictor of the ability of sperm to fertilize is the percentage of perfectly normal forms as measured by the strict criteria of Kruger. If the percentage of normal forms is greater than 14% on the Kruger scale, unassisted fertilization is possible.

Sperm Penetration Assay

(SPA)
See hamster-egg penetration test.

Spontaneous Abortion
A miscarriage that is caused by nature. It can have several causes, such as a genetically abnormal fetus. Often a D & C is needed to help clean the uterine cavity from remnant tissue to stop bleeding.

Surrogate
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 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.

 

Testicles
Two oval glands present in the scrotum responsible in making the male gamete, the sperm. It also secretes many of the male hormones responsible for masculinity.

 

Testosterone
The main hormone secreted by the testicles and responsible for male characteristics, such as beard growth, deep voice, and sperm maturation.

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 the blood is checked in most women with infertility because certain thyroid diseases may be associated with infertility.

Ultrasonogram
One of the most common imaging techniques a woman undergoes during treatment of infertility. Almost all ultrasound examinations for this purpose are currently done with a vaginal transducer. An ultrasound transducer emits acoustic sound waves that bounce back when they hit different types of tissues in the body along its path. These waves are then recaptured by the transducer and sent to the ultrasound computer. The ultrasound transforms these waves into gray scale pictures that are seen on a monitor screen. The texture of the particular tissue that the ultrasound wave traverses or hits determines the way it will look on the monitor. For instance, clear fluids such as urine will appear black while bony structures will appear white. The vaginal transducer is about 15 inches long and 1 inch in diameter but only about 5 inches will enter the vagina. The procedure is painless and harmless for most women. 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 IVF.
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 separate cavities. A septum can interfere with normal implantation and cause recurrent miscarriages. The treatment 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 towards an embryo, a fetus, and eventually an infant. The uterus is lined by a layer of specialized glandular cells, called endometrium.