Medical Glossary

GLOSSARY OF MEDICAL TERMS RELEVANT TO
REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY

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ABORTION- Spontaneous: A pregnancy loss prior to twenty weeks gestation; Habitual: Three or more miscarriages; Incomplete: An abortion with some tissue remaining inside the uterus; Missed: The fetus dies in the uterus; Therapeutic: A procedure used to terminate a pregnancy prior to viability; Threatened: Spotting or bleeding early in pregnancy.

ACROSOME CAP- One of the most critical observations of sperm morphology is the acrosome cap. This portion of the sperm coats the outer surface of the sperm head and acts like velcro. It enables the sperm to attach to the egg. The acrosome cap then releases packets of enzymes that begin to soften and dissolve the egg's shell. This assists the sperm in penetrating the egg. Absence of acrosome caps on sperm is a critical problem. IVF with ICSI therapy may be the most effective remedy for this condition. See Sperm Morphology and Semen analysis, Complex.

ACTH- A pituitary hormone that stimulates the adrenal glands.  High levels can lead to fertility problems.

ADHESION- Scar tissue that attaches to the surfaces of organs, the abdominal cavity, fallopian tubes, or inside the uterus.  Adhesions may prevent egg pick up, transport of the egg, and implantation of the embryo in the uterus.

AMENORRHEA- The cessation of the menstrual period for six months or more at a time.  Primary Amenorrhea: when a woman has never menstruated; Secondary Amenorrhea: When a woman has menstruated at one time, but she has not had a period for six months or more.

ANDROGENS- Male sex hormones produced by the ovaries, testicles and adrenal glands.  (See DHEAS, Testosterone)  Excess androgens in the woman may lead to increased hair growth, acne and a deepened voice.  Elevated levels of androgens may be found with polycystic ovaries, or with a tumor in the pituitary gland, adrenal gland or ovary.

ANDROLOGIST- A technologist who performs laboratory evaluations of semen and sperm with regard to male fertility.

ANEUPLOIDY- Abnormal number of chromosomes in a cell.

ANOVULATION- Total absence of ovulation. Menses may still occur although there is a failure to ovulate—a failure of an ovary to release an egg.  See Ovulatory Failure.

ANTIBODIES- Chemicals the body makes to fight or attack foreign substances.  They are supposed to prevent infection. However, if they attach to sperm, then may impair the sperms ability to fertilize an egg leading to infertility. Antibodies may also induce blood clot formation in the placenta or fetal blood circulation during pregnancy leading to early or late pregnancy loss. This is called phospholipid antibody syndrome.  Antibodies may also be involved in the disease process of endometriosis yet this is poorly understood at this time. Antibodies may also be cause disease by interfering with normal functions of organs such as the thyroid, adrenal glands and ovary. 

ARTIFICIAL INSEMINATION- Placing sperm into the cervix of the uterus (intracervical insemination- ICI) or directly into the uterine cavity (intrauterine insemination- IUI).  The sperm is usually washed then injected through a catheter either into the cervical canal (ICI) or further into the uterine cavity (IUI).  This procedure is used for both donor (Therapeutic Donor Insemination-TDI) and male partner’s sperm.  This technique is used in the treatment of a wide variety of problems leading to infertility: sexual dysfunction, sperm-mucus interaction, problems, and female infertility factors with normal sperm and for poor semen quality. It is most effective when semen quality is good and the problem is delivery of sperm into the female reproductive system. It is least effective with major sperm/semen abnormalities in which case, intracytoplasmic sperm injection (ICSI) as a part of in-vitro fertilization (IVF) offers the best prognosis. Intrauterine insemination is more effective than intracervical insemination in helping couples become pregnant. See Intrauterine Insemination, Donor Insemination, Sperm Bank and Therapeutic Donor Insemination-TDI.

ASSISTED HATCHING- A micromanipulation technique as a part of IVF therapy that thins the zona pellucida (shell) of the embryo. The theory is that some embryos may have an abnormally hard or thick outer shell called the zona pellucida. This shell may trap the embryo not allowing it to hatch. Therefore, the embryo cannot implant and dies.  Thinning the shell may assist the embryo to hatch out and implant in the uterus. The problem is that there is no clear way to identify embryos that may have hardened or have thickened shells. Thus, it is difficult to know for whom to recommend this treatment. It is unclear if this procedure offers an improvement in the chance of becoming pregnant and having a baby. It may be considered for women who are age 38 and older, women who have a history of abnormally thick zona pellucida, and for couples who have not become pregnant with past IVF cycles.

ASHERMAN’S SYNDROME- The uterine walls are scarred to one another—usually a result of uterine inflammation, pelvic inflammatory disease (PID), or past surgery of the uterus. Past surgery may include a D&C, cesarean section, and removal of fibroid tumors.

ASSISTED REPRODUCTIVE TECHNOLOGY (ART)- A procedure that involves the surgical removal of eggs from the ovary to assist in fertilization of the egg and sperm.  In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), assisted hatching, microscopic epididymal sperm aspiration (MESA), testicular sperm aspiration (TESA) are the most common ART procedures.  An emerging technology to assist in genetic assessment of embryos is Preimplantation Genetic Diagnosis (PGD). Technologies still considered experimental or in early development including Oocyte Cryopreservation (egg freezing), nuclear transfer and cytoplasmic transfer. In 2002, the US Food &Drug Administration banned nuclear and cytoplasmic transfer from being provided in US IVF Clinics. Exceptions require strictly controlled preapproved research guidelines be followed as set forth by law similar to research of experimental drugs.

ASTHENOZOOSPERMIA- Low sperm motility defined as less than 50% of sperm are moving in a semen sample.  This condition is considered to be a major cause of infertility if motility is 40% or less.

AZOOSPERMIA -The absence of sperm in the seminal fluid.  This may be due to a blocked male reproductive tract or impairment of sperm production.

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BASAL BODY TEMPERATURE (BBT)- The body temperature of a person recorded immediately upon awakening, before any activity is undertaken. The temperature can be taken orally or rectally. The temperature is recorded daily on a graph, which can show some evidence of ovulation.  Biphasic: A BBT that shows a shift up of greater than 0.3-0.5 degrees near mid-cycle that stays up for at least 10 days.  Such a sustained upward shift in temperature suggests ovulation has occurred. The actual time of ovulation can only be estimated with 95% confidence within 3 days before to 3 days after the first temperature rise (6 day range). Monophasic: A BBT pattern where the temperature remains relatively constant or irregular throughout the cycle. This pattern suggests a woman is not ovulating. It is estimated that about 10% of women with a monophasic BBT pattern actually ovulated. Alternative assessment of ovulation includes use of commercially available urine LH kits, which are more accurate within a 3-day range of predicting ovulation.

BETA hCG TEST- (BhCG) - Blood test to detect pregnancy and evaluate embryo development. See Quantitative hCG.

BICORNUATE UTERUS- A congenital (present at birth) malformation of the uterus where the upper part of the uterus is divided into two parts. The outer appearance of the uterus is heart shaped. This is not a clear cause of infertility. In contrast, a septate uterus is a uterus divided into right and left halves by a wall of tissue (septum).  Women with a septate uterus have an increased chance of early pregnancy loss. The outer surface shape of the uterus is round and normal in appearance. Abnormal presentation of a fetus at delivery such as a breech position is more common in these conditions. See Septate Uterus.

BLASTOCYST- An embryo in its 5th to 6th days of development that has progressed from a sold ball of cells to a hollow sphere of cells with an inner cell mass that will become the baby and additional cells that will become the placenta. Blastocysts are graded differently than embryos within the first three days of conception. Observing embryonic growth to the blastocyst stage is encouraging, but our growing experience with preimplantation genetic screening raises caution that many blastocysts are not genetically normal. There is hope, but we must keep our feet solid on the ground!

BLASTOMERE- A single cell in an embryo, which can divide at its own rate.  See Preimplantation Genetic Diagnosis for information on how a blastomere can be studied during IVF.

BLIGHTED OVUM (Egg) - A general term used to mean a fertilized egg that fails to survive after implantation in the uterus. Our technologies enable us to detect a pregnancy loss before the first sign of miscarriage, vaginal bleeding. Pelvic ultrasound may show an empty gestational sac in the uterus. This means the embryo died earlier and is no longer present. However, the placenta and sac are still present in the uterus. . The placenta may survive longer than the fetus.  You may still feel pregnant during this time. You may have no symptoms of pregnancy loss either.

BRAVELLE- Brand name for urofollitropin, approved in May 2002 for the treatment of infertility, is a highly purified, human-derived follicle-stimulating hormone (hFSH) derived from the urine of postmenopausal women. It is indicated for ovulation induction and is available for both subcutaneous and intramuscular injection.

BROMOCRIPTINE (Parlodel brand name) - An oral medication used to reduce abnormally high prolactin hormone levels in the blood.   It can reduce the size of prolactin secreting pituitary tumors.  This medication may cause dizziness and upset stomach.   It may also be effective when the tablet is placed in the vagina. It should not be used after pregnancy to reduce and stop breast milk production. Use of Bromocriptine after pregnancy in the post partum time from of 6 weeks after delivery has been associated with blood clot formation and stroke. See hyperprolactinemia and galactorrhea. See Dostinex as an alternative medication with less side effects. Also see related topics of Hyperprolactinemia and Galactorrhea.

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CANDIDIASIS (Yeast Infection)- A vaginal infection that may cause burning or itching often associated with a white, thick vaginal discharge as in yeast vaginitis. It can also occur on the skin or in the mouth called oral thrush.

CAPACITATION - The change that sperm cells undergo as they travel through the woman's reproductive tract and that enables the sperm to penetrate the egg.CBC (Complete Blood Count) - This is a routine preoperative blood test. This test gives information regarding infection and anemia.

CERVICAL CERCLAGE- a suture surgically placed around the cervix at about 12 to 14 weeks of pregnancy to prevent its opening prior to term.  Sometimes the suture is placed at the lower part of the uterus within the abdomen to provide support (Abdominal Cerclage). Cerclage may be recommended if a woman has a history of incompetent cervix.

CERVICAL INCOMPETENCE – or Incompetent Cervix: A cervix that is weakened, possibly from previous surgery or trauma and opens prior to the term of pregnancy and can cause preterm delivery and the risk of losing the fetus.

CERVICAL MUCUS - Secretions produced by the cervix, which vary in viscosity according to the phase of the menstrual cycle; it becomes penetrable by sperm in the days preceding ovulation.  The mucous fills the opening of the cervix; most of the time, it is a thick plug preventing sperm and bacteria from entering the uterus.  At mid-cycle, estrogen causes the mucus to become thin, watery and stretchy—allowing sperm to enter uterus while filtering out bacteria and other components of seminal fluid. 

CERVICAL STENOSIS- A narrowing or blockage of the cervical canal.  This is usually from complications of cervical surgery or cervical trauma and rarely from congenital defects.  See Cervix.

CERVIX-The lower part of the uterus that sits at the top of the vagina similar in shape as the narrow neck portion of a light bulb.  The cervix is closed during pregnancy and dilates during labor and delivery to allow a baby to be born.  See Incompetent Cervix and Cervical Cerclage.

CETROTIDE- Brand name of Cetrorelix. A GnRH antagonist drug that blocks the release of gonadotropins (FSH- follicle stimulating hormone and LH- luteinizing hormone) from the pituitary gland. It is most commonly used to prevent premature LH surges in women undergoing controlled ovarian hyperstimulation for ovulation induction or in-vitro fertilization therapy. IVF cycles termed “short protocols” use GnRH antagonist medications such as Ganirelix or Cetrorelix. This is in contrast to IVF cycles termed “long protocol” using GnRH agonists such as Lupron.

CHEMICAL PREGNANCY- A positive hCG level in the blood that fails to continue to rise normally and does not lead to a clinical pregnancy. Pelvic ultrasound would not reveal a pregnancy at this early phase of pregnancy.

CHLAMYDIA - This is a microorganism that may be transmitted by sexual contact. This microorganism could exist in the reproductive tract without symptoms and cause infertility. If present, both partners must be treated. The test for chlamydia involves obtaining a swab sample of vaginal or cervical fluid from the woman or urethral swab of the male urethra at the end of the penis and culturing this in the laboratory under conditions suited to the chlamydia bacterium. Chlamydia causes infertility by damaging the fallopian tubes and creating shrink-wrap-like scarring around the ovaries in women. This damage can be in the form of scar (adhesions) with partial or complete blockage of the fallopian tubes. It can also cause infertility create scarring inside the pelvis, around both of the tubes, ovaries and intestines. Chlamydia can also cause scarring in the male reproductive tract leading to infertility. See PID.

CHOCOLATE CYST- An endometrioma. A cyst that is filled with old blood and contains endometriosis lining in its inner surface.  Endometriosis invades an ovary and causes the cyst with surrounding scarring called adhesions. Usually treatment can be carried out during laparoscopic surgery.  See Endometrioma.

CHROMOSOME- The cellular structures that carry the genetic material (genes).  The genetic messengers of inheritance.  The human has forty-six chromosomes—twenty-three coming from the egg and twenty-three coming from the sperm.  Two X-chromosomes are present in a female and an X and a Y are present in a male. CHROMOTUBATION- During surgery, the injection of a dye colored water into the uterus and observation of flow into and through the tubes in order to evaluate the status of the fallopian tubes.  If dye is not observed to flow through a tube, then the tube may be considered “blocked.”  A blocked tube may prevent an egg from being fertilized.  On occasion, the narrowest portion of the fallopian tube may have a temporary spasm or cramp due to the flow of fluid within it. The cramp could stop flow of fluid giving the appearance of blockage when it is not truly blocked.

CILIA- Tiny hair like projections on the cells lining the interior of the fallopian tubes.  The cilia move the egg inward and the sperm outward to the isthmic-ampullary junction of the tube where fertilization occurs.  Later, the cilia move the embryo to the uterus for implantation. The cilia can be damaged by infections; damage can cause infertility.

CLINICAL PREGNANCY- Pelvic ultrasound showing evidence of an intrauterine gestational sac. There have been differences of opinion as to whether an embryo or fetus with heart motion (cardiac activity) needs to be observed. The current definition recognized by the Society of Assisted Reproductive Technology (SART) is that of evidence of only an intrauterine sac. This does not exclude an ectopic pregnancy.

CLOMIPHENE CITRATE (Clomid, Serophene) CHALLENGE TEST- The clomiphene challenge test is a two-part test that helps the doctor to assess a patient’s ovarian reserve. The patient will have blood drawn to test for FSH and estradiol levels along with a transvaginal ultrasound on two different dates: when her period first starts (within cycle days 1-3) and then on cycle day 10 after taking a 5-day course of Clomiphene Citrate medication 100 mg/day dose cycle days 5-9. At our Center, FSH values of 10 or greater on either day of testing are strongly suggestive of the infertility condition of diminished ovarian reserve. The results of the two testing dates may be useful to determine the protocol and prognosis of infertility treatment.

CLOMIPHENE CITRATE (Clomid, Serophene) - A fertility drug for women and men that may stimulate ovulation by the ovaries and improve sperm production in men. It is actually an antiestrogen. See Tamoxifen for hormone action information. This drug causes an increased release of FSH (Follicle Stimulating Hormone) from the brain. The increased FSH into the bloodstream travels to the ovary and stimulates the follicles and egg(s) within the follicles to develop in at least one ovary.  Ovulation may follows. Clomiphene may be used in conjunction with other fertility medications such as Metformin, FSH and hCG as well as IUI.  It is most effective in treating ovulation abnormalities due to polycystic ovary syndrome, but is often used even when women already ovulated for a limited trial. Risks of ovarian overstimulation, multiple gestation, mood changing side effects, weight gain raise consideration for alternative medications of Letrozole (Femara) or FSH.

CONE BIOPSY- Surgical removal of pre-cancerous cells from the cervix by cutting a cone-shaped piece out.  This procedure may damage the cervix leading to scarring/narrowing and disrupt mucus production.  An alternative procedure is the LEEP.  Under microscopic control, an electrified loop is used to remove a more controlled amount of cervix, which decreases the risk of damage to the cervix. Women who have had these procedures performed may be at risk for cervical stenosis or incompetent cervix.

CONGENITAL ADRENAL HYPERPLASIA- An inborn condition characterized by elevated androgens.  The androgens suppress the pituitary gland and interfere with spermatogenesis or ovulation.  Females may have ambiguous or male-like genitalia from the excess androgen. Women may also experience excessive hair growth in areas of their bodies typical of men such as the face, back, chest and abdomen. Some women may also have virilizing signs such as deepening of their voice, increased muscle mass and enlargement of the clitoris. Women may also have infertility due to this condition. This condition is genetic in origin and can be passed on to a child. It is treatable. A portion of women with Polycystic Ovary Syndrome may have this condition.

CONTROLLED OVARIAN HYPERSTIMULATION (COH)- Stimulation of the ovaries to produce multiple follicles/oocytes by using fertility drugs. Monitoring ovarian response with blood tests such as estradiol and progesterone and pelvic ultrasounds (sonograms) is essential to assure optimal dose of fertility drug and ovary response while decreasing the risk of multiple gestation/birth and a complication called Ovarian Hyperstimulation Syndrome. 

CORPUS LUTEUM - The glandular structure that forms on the ovary at the site of the released egg and produces the hormone progesterone during the second half of the menstrual cycle. If pregnancy occurs, the pregnancy hormone hCG supports the corpus luteum to persist and produces the progesterone necessary to support pregnancy.  If the corpus luteum functions abnormally, the uterine lining may not support a pregnancy.  A deficiency in the progesterone produced or the length of function by the corpus luteum is called Luteal Phase Deficiency (LPD). There is still great debate as to whether luteal phase deficiency is a unique disorder or a sign of other hormonal imbalances such as Polycystic Ovary Syndrome (PCOS).

CRYOPRESERVATION- A technology for freezing sperm and embryos and oocytes (eggs) at very low temperatures of liquid nitrogen. These can be stored and thawed at a later time for use to overcome infertility.  Current technology does not provide reliable methods to cryopreserve oocytes (eggs) although much progress has been made in this endeavor, particularly with advances in a method called “vitrification”. Excess embryos of good quality from one IVF cycle are frozen in liquid nitrogen and preserved for future transfer.  A transfer using thawed cryopreserved embryos is called a frozen embryo transfer (FET).  Cryopreservation of embryos allows for additional attempts at pregnancy without going through the entire IVF treatment process.

CRYPTORCHIDISM- Undescended testis; the man’s scrotum does not contain a testicles. This can exist on one or both sides. See Undescended Testicles.

CUSHING’S SYNDROME- Overproduction of adrenal gland hormones such as cortisol.  The person usually has a very round face and may have a hump on the back at the base of the neck.  One may suffer from hypertension and water retention.  Elevation of adrenal gland androgens will suppress pituitary output of LH and FSH and decrease sperm production or cause a woman to be unable to ovulate.  The excess androgen hormones in a woman may cause male secondary sex characteristics to develop, including abnormal hair growth.  Cushing’s Syndrome describes a disease where the primary problem is within the adrenal gland that is out of control. Cushing’s Disease has the same symptoms, but those symptoms are the result of a primary problem in the brain such as a pituitary gland tumor or rarely gland tumors in the chest. These tumors release hormones that turn on the otherwise normal adrenal gland to release an excessive amount of its hormones.

CYTOPLASM- The contents (protoplasm) of a cell outside of the nucleus.

CYTOPLASMIC TRANSFER- An experimental procedure whereby the cytoplasm of an older woman’s egg is replaced with the cytoplasm of a younger woman’s egg while still keeping the nucleus of the older woman’s egg during the IVF process. This procedure is not available outside of specific experimental studies approved by the Food and Drug Administration (FDA). We accept that in nature, there are two sources of DNA-  the nucleus of the sperm from one man and the nucleus of the egg from one woman that  make a human being. A third source of DNA also resides outside the nucleus of the egg called mitochondria which are power plants of the cell contained within the cytoplasm of the egg. With cytoplasmic transfer, DNA are combined from three people: from the sperm, from the nucleus of the older woman’s egg and from the mitochondrial DNA within the cytoplasm donated from the younger woman’s egg. In short, three different people are contributing DNA to this conception. Such a phenomenon has yet to be observed in nature and the short and long term outcomes are not known. Assisting the creation of life in such a manner is a major ethical concern and the major pillar supporting the FDA’s current restrictions on both cytoplasmic transfer and nuclear transfer in the United States.

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DANAZOL- Brand name for Danacrine. An androgen-like hormone medication derived from testosterone used to treat endometriosis.  This androgen alters FSH production by the pituitary gland, which suppresses ovarian egg development.  This causes a decrease in estrogen that suppresses endometrial development.  The androgenic nature of this drug may also work directly on endometriosis by reducing the ability of endometriosis to respond to estrogen.  Side effects may include oily skin, acne, weight gain, abnormal hair growth, and muscle cramps with this medication.  Irreversible deepening of the voice may occur with prolonged use. These side effects have prompted use of alternative equally effective medications as first line treatments before considering use of Danazol.

DIETHYLSTILBESTROL (DES)- This synthetic estrogen was prescribed in the 1950s and 1960s for women to prevent miscarriage.  Some babies exposed to DES in-utero after the eighth week of pregnancy have developed deformities, including blockage of the vas deferens in men and uterine abnormalities of the cervix, uterus and fallopian tubes and a specific cancer of the cervix, uterus or vagina called clear cell carcinoma among women. It may be associated with miscarriages and unexplained infertility.  DES is no longer prescribed; however, people who were exposed to it in while a fetus in their mother’s womb are currently experiencing a variety of health issues.

DIHYDROEPIANDROSTERONE SULFATE (DHEAS) – An androgen-like hormone produced primarily by the adrenal gland in both sexes. If it is abnormally high, it can tell us the adrenal gland is overactive, producing too much androgen hormones that can cause hirsutism (excessive hair growth) and block ovulation (anovulation).   Elevated levels may be seen in patients with Congenital or Late onset Adrenal Hyperplasia, Stein-Leventhal or Polycystic Ovary syndrome (PCOS).  Test results showing elevated levels can lead to diagnosis and effective treatments for these conditions.

DILATION AND CURETTAGE (D&C)- Surgery that dilates the cervical canal and empties out the contents of the uterus.  A D&C is used to diagnose or treat the cause of abnormal bleeding, remove the products of a missed abortion, an incomplete miscarriage or to terminate an abnormal or unwanted pregnancy in the first trimester.

DIMINISHED OVARIAN RESERVE- Condition where the quantity and/or quality of oocytes (eggs) is abnormally low regardless of the age of the woman. Screening tests to assess a woman for this condition include a serum FSH test within the first three days after the start of a menstrual cycle or within the protocol of the clomiphene challenge test.  Pelvic ultrasound within the first three days after the start of a menstrual cycle can measure ovarian volumes and resting follicle counts. FSH values of 10 or greater and/or ovarian volumes less than 3 cc and less than 4 resting follicles per ovary are strong indicators of diminished ovarian reserve. Other observations of ovarian response and oocyte quality with IVF therapy may also indicate this condition is present. The prognosis for pregnancy is reduced by about half of what would be expected without evidence of this condition, even with IVF therapy. Women with this condition should consider more aggressive therapy including IVF therapy as the most effective therapy for infertility for having a mutually genetic biologic child. Although ovulation induction therapy with insemination can be done, prognosis with these treatments trend lower than with IVF. Other treatments such as donor egg IVF may need to be considered.

DONOR EGG (S) (Donor Oocyte(s)) - Eggs that are removed from the ovaries of one woman for use by another for in vitro fertilization.

DONOR INSEMINATION- Artificial insemination with donor sperm.  Also known as Therapeutic Donor Insemination (TDI). See Intrauterine Insemination, Sperm Bank and Therapeutic Donor Insemination-TDI.

DONOR SPERM - Sperm that are collected from a man who is not the woman's partner to be used to artificially inseminate her eggs, either by insemination or in vitro fertilization.  The source for anonymous donor sperm is a sperm bank or cryobank.  See Sperm Bank.

DOSTINEX- Brand name for Cabergoline. An oral medication used to reduce prolactin hormone levels.   It can reduce the size of prolactin secreting pituitary tumor. It is a pill taken twice a week, which is less frequent and with fewer side effects than bromocriptine.

"DOWN REGULATION"- A term which describes the way which Lupron is used to suppress a woman's pituitary hormone secretion of FSH and LH before injection of fertility medications containing Follicle Stimulating Hormone (FSH) to stimulate follicle and egg development. Clomiphene medication cannot be used with this treatment because clomiphene relies on increasing the FSH and LH hormone output of the pituitary gland which has been shut down (down regulated) by Lupron.

DOXYCYCLINE- -An antibiotic in the tetracycline family, which may be prescribed prophylactically (as a preventive measure against possible infection) in association with IVF egg retrieval surgery.  A broad-spectrum antibiotic that inhibits many of the bacteria of the reproductive tract.  It can also be used to treat ureaplasma or mycoplasma infections as well as sexually transmitted diseases such as chlamydia.  See Mycoplasma and Ureaplasma.

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ECTOPIC PREGNANCY- An embryo implanted and developing outside the uterus, usually in a fallopian tube, on an ovary or in the abdominal area.  Tubal pregnancies usually result from tubal damage, but in turn, they cause tubal damage sometimes leading to the loss of the tube.  Early evaluation measuring hormone levels and ultrasound can lead to early diagnosis, which allows for early intervention.  Early detection may allow for more conservative treatments with medication called methotrexate or by laparoscopy with less risk for loss of the affected fallopian tube. 

EGG RETRIEVAL SURGERY- Aspiration of eggs from ovarian follicles.  This may be done by ultrasound-guided aspiration with a needle placed through the wall of the vagina in order to locate the follicles and access the oocytes (eggs) in the ovaries.  The needle can be guided into each follicle and remove its contents.  The eggs are then transferred to a sterile container to await insemination.  Light anesthesia is used in order to provide the greatest level of comfort for the woman.

EJACULATE- The semen and sperm expelled during ejaculation.

EMBRYO – Fertilized egg from conception to eighth week of pregnancy.

EMBRYOLOGIST- A laboratory technician; a specialist in maintaining a laboratory environment and caring for the sperm, egg and embryo through early development. They are highly trained to perform assisted reproductive technologies including ICSI, assisted hatching, embryo assessment, embryo and sperm cryopreservation and thawing. Some have more specialized experience with performing embryo biopsy, removing a blastomere or polar body for preimplantation genetic testing.

EMBRYO TRANSFER - A procedure during which a fertilized egg is placed either into the uterus, as during IVF, or into the fallopian tube, as during tubal embryo transfer (TET), with the goal of implantation and pregnancy.  Embryo transfer is performed without anesthesia in the vast majority of instances. If TET is necessary due to a problem with the uterine cervix, then this requires general anesthesia and laparoscopy.

ENDOCRINE GLAND- Any of the ductless glands, such as the thyroid, pancreas, ovary, testicle, pituitary and adrenal gland, the secretions of which pass directly into the blood stream from the cells of the gland.  See Thyroid Gland.

ENDOMETRIAL BIOPSY- A small sample of tissue removed from the lining of the uterus for microscopic examination. It was introduced to infertility medicine testing in the 1949 gaining favor in the in 1950s to the late 1990s. The theory of benefit is that assessment of the tissue may help to determine hormone imbalances that may direct fertility therapy. The test can be painful and often done several times. Since the mid 1990s, very strong outcome based medical studies challenge the benefit of such testing for infertility care. Mainstream evidence-based studies now have settled this controversy recommending the endometrial biopsy no longer be performed as a part of the infertility battery of tests and should be resigned to historical medical care. The one exception is in the context of abnormal uterine bleeding that raises concern for precancerous changes or cancer of the uterus. Then endometrial biopsy can be a very important part of health care testing. Cancer and infertility intersect among women with polycystic ovary syndrome where menstrual periods may be rare leading to uncontrolled overgrowth of the uterine lining called the endometrium. If vaginal ultrasound testing reveals unusually thick endometrial lining to the uterus, then an endometrial biopsy should be done with the purpose of assessing for cancer.   Less invasive, painless testing for hormone imbalances are now available that do not involve endometrial biopsy.

ENDOMETRIOMA- A collection of endometriosis localized in one area—usually seen in the ovary.  See Chocolate Cyst. 

ENDOMETRIOSIS - The presence of endometrial tissue (the normal uterine lining) in abnormal locations, such as the fallopian tubes, ovaries, intestines and peritoneal cavity.  Each month, most women have some menstrual flow go out through the tubes and into the abdomen.  Some women will then have that endometrium implant and grow leading to pain and infertility.   These endometrial implants continue to grow, sometimes causing adhesions in the abdominal cavity encasing the ovaries and/or the fallopian tubes like shrink-wrap.  Endometriosis may interfere with ovulation, egg pick-up and fertilization of the oocyte. It has also been related to diminished ovarian reserve, but the manner in which this connection occurs has yet to be found. Endometriosis can also cause pain and abnormal uterine bleeding, which may become so severe as to require medical or surgical treatment. There is no known cure. Medications and surgery reduce the disease and control the symptoms. The diagnosis can only be confirmed by surgery with direct view of the disease.  The condition of pregnancy often reduces the amount of this disease and diminished the symptoms. Endometriosis is classified into 4 stages from stage 1 minimal disease to stage 4 severe disease. Staging is determined by the amount and location of lesions and adhesion formation. Stages 3 and 4 can be major causes of infertility.

ENDOMETRIUM- The lining of the uterus, which grows and sheds in response to estrogen and progesterone stimulation. This is the tissue in which implantation of an embryo occurs.

ENDORPHINS- Natural painkilling chemicals manufactured in the brain to reduce sensitivity to pain and stress.  May be associated with PMS. Excessive production of endorphins with physical activity such as gymnastics, ballet or long distance running may lead to shutting down the control center in the brain that directs normal ovary function. Ovulation may be blocked, menstrual periods may become infrequent, irregular or stop, infertility can occur and loss of bone density may occur somewhat offset by the strenuous exercise.

EPIDIDYMIS- A coiled, tubular organ attached to and lying on the testicle within the scrotum.  Sperm complete their maturation and develop their powerful swimming capabilities within the epididymis.  The matured sperm exit the epididymis through the vas deferens.

ESTROGEN - The primary steroid hormone produced by the ovaries from puberty to menopause, which causes the uterine lining to thicken in preparation for pregnancy; the female sex hormone.  See Ovary.

ESTRADIOL LEVEL (E2 Level) - The most potent form of estrogen. It is measured to determine follicular maturation prior to ovulation.  The main estrogen produced by the ovary, which is responsible for formation and development of breasts and other female secondary sex characteristics.  It is produced by the growing follicle and induces the development of the uterine lining.  At mid-cycle, a rapid rise in estrogen levels triggers the release of the LH surge from the pituitary gland.  The LH surge triggers ovulation: the release of the ovum (egg) from the follicle. Women on fertility medications have routine E2 level monitoring.

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FALLOPIAN TUBE - Either of a pair of tubes that conduct eggs from the ovary to the uterus.  Normal fertilization takes place within this structure.  The tube is attached to the uterus through which eggs travel after the tube’s trumpet-shaped end (fimbriated end) catches the egg as it is released from the follicle.  Sperm meet the egg in the fallopian tube where it narrows down (isthmic-ampullary junction), the site at which fertilization usually occurs. The fallopian tube then moves the fertilized egg (embryo) through the tube into the uterus over a 4-day period of time.

FEMALE KALLMAN’S SYNDROME- Infantile sexual development, very low FSH and LH levels and an inability to smell.  Since the pituitary produces inadequate LH and FSH to turn on her otherwise normal reproductive organs, the woman is treated with hormone supplementation in order to develop and maintain normal breasts, have menstrual cycles and later, with gonadotropins (FSH) or GnRH, to achieve fertility.

FERNING- A fern-shaped pattern of dried cervical mucus viewed on a slide.   When the fern pattern appears, the mucus is usually thin and stretchy for estrogen’s effect.  This creates tubular fluid filled passages in the mucus enhancing the passage of sperm.  Mucus, which does not fern, suggests the woman is not at a fertile time of her menstrual cycle. That she is not near the time of ovulation.

FERTILIZATION - Union of egg and sperm, which forms a zygote. Once the sperm and egg fuse and the first cell division has occurred the zygote has become an embryo.  This occurs within the fallopian tube (in vivo) naturally, but may also occur in a petri dish (in vitro- Greek for “under glass”) during assisted reproductive technology (ART) procedures.  See also In Vitro Fertilization.

FERTINEX- Brand name for Urofollitropin. Highly purified Follicle Stimulating Hormone (FSH) manufactured from the urine of postmenopausal women. It is a fertility drug administered as a subcutaneous injection. It is no longer manufactured.

FETUS - The developing human organism after the embryo state—from the beginning of the ninth week of pregnancy (day 56 from last menstrual period) to the moment of birth.

FIBROID - A non-cancerous (benign) tumor of the uterine muscle and connective tissue usually located in the uterus.   Also known as a myoma or leiomyoma.  Fibroids can interfere with the implantation or growth of a fetus.  Fibroids can increase in size during pregnancy and in certain instances result in miscarriage.  This condition can usually be corrected with surgery. Not all women who have fibroids require surgery.

FIMBRIA- Finger-like projections that fan out at the end of the fallopian tube like a trumpet nearest the ovary.  During ovulation, prostaglandins are released that cause contraction of portions of the fimbria, which connect to the ovary called the fimbria ovarica, drawing the finger-like end of the tube toward the ovary and catching the egg when it is extruded and drawing it into the tube.

FIMBRIOPLASTY- Surgical repair of the fimbriated end of the fallopian tube.  This is performed by means of a surgical procedure called laparoscopy. See Fimbria.

"FLARE"PROTOCOL- This stimulation of the ovary takes advantage of the initial rise or "flare" of gonadotropins (LH & FSH) in response to Lupron administration starting on the second day of the menstrual cycle. Giving FSH 1 day after the start of Lupron for continued follicular development then augments this “flare” response. This fertility treatment protocol is one of many protocols considered during IVF for women with diminished ovary. Outcome-based studies have not demonstrated a clear advantage of this protocol over others.

FOLLICLE - Fluid-filled cyst on the ovary that contains the ripening egg and from which the egg is released at ovulation or retrieved during the treatment cycle. The dominant follicle is approximately 1 inch in diameter when it is ready to ovulate.

FOLLICLE STIMULATING HORMONE (FSH) - A hormone produced in the pituitary gland that stimulates the ovary to develop a follicle for ovulation and also stimulates sperm production in the testicle. It can be used as a fertility medication to stimulate the ovaries or testicles. It can be measured in the blood to assess fertility. See Clomiphene Challenge Test, Diminished Ovarian Reserve and Menopause. 

FOLLICULAR FLUID- The fluid inside the follicle.

FOLLICULAR PHASE- The portion of the woman’s cycle prior to ovulation during which a follicle grows.  Estrogen that is produced by the follicle causes the lining of the uterus to grow thicker.

FOLLISTIM- Brand name for Follitropin beta. Follicle stimulating hormone medication produced through recombinant DNA technology, which functions in the role of naturally occurring FSH to stimulate the growth of follicles and the maturation of eggs.

FORTAMET- See METFORMIN.

FROZEN EMBRYO TRANSFER- See Cryopreservation.

FSH- see Follicle Stimulating Hormone.

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GALACTORRHEA- A clear or milky discharge from the breasts, which may be associated with elevated blood levels of prolactin caused by medications or pituitary gland tumors both small and large. Infrequent, irregular or lack of menstrual periods is often associated with this condition.  See Hyperprolactinemia.

GAMETE - A sperm or an egg; a reproductive cell.

GAMETE INTRAFALLOPIAN TUBE TRANSFER (GIFT) –A procedure similar to IVF except that the sperm and eggs are placed inside a catheter, separated by an air bubble, and then transferred inside a woman's fallopian tube, where fertilization takes place naturally (in vivo). This can be done only in women with at least one normal tube. Fertilization is not known to have occurred unless the woman becomes pregnant. General anesthesia and laparoscopy are required to perform this procedure. This procedure was introduced in 1984 at a time in vitro fertilization success was low. Now in vitro fertilization success rates exceed the outcomes with GIFT. 99% of all assisted reproductive technologies performed in the United States are now with IVF therapy. GIFT has become a more historical procedure although some physician still offer this and related procedures. GIFT, ZIFT and TET procedures may still be considered to have advantage in rare conditions where transfer of embryos through the uterine cervix is not possible and the fallopian tube is the only route of access to the uterine cavity.

GANIRELIX- Brand name of Ganirelix acetate.A GnRH antagonist drug that blocks the release of gonadotropins (FSH- follicle stimulating hormone and LH- luteinizing hormone) from the pituitary gland. It is most commonly used to prevent premature LH surges in women undergoing controlled ovarian hyperstimulation for ovulation induction or in-vitro fertilization therapy. IVF cycles termed “short protocols” use GnRH antagonist medications such as Ganirelix or Cetrorelix. This is in contrast to IVF cycles termed “long protocol” using GnRH agonists such as Lupron.

GENE- A unit of DNA found in a chromosome.

GENITOURINARY- Pertaining to the reproductive organs (genito-) and urinary tract.

GERM CELL (STEM CELL)- The cell in the testicle that divides to produce the immature sperm cells.  In a woman, they are the root cells that produce the eggs (oocytes).  The male germ cell reproduces throughout the man’s reproductive life.  Women stop growing new eggs halfway through their development as a fetus in their mother’s womb.  These are the most eggs they will have in their lifetime. Eggs are present from birth.  Eggs are used up at the rate from hundreds up to one thousand per menstrual cycle.  In most women, there is great attrition among these many eggs for only one egg matures per cycle.

GERM CELL APLASIA (Sertoli Cell Only)- A condition in which germ cells are absent from the testicles.  With this condition, there are Leydig cells and hormones, so the man has secondary sex characteristics.  May be inherited or caused by large and/or prolonged exposure to toxins or radiation.  See Leydig Cell, Sertoli Cell and LH. This condition may also be present in a woman. She has no eggs that have formed.

GLUCOPHAGE- See METFORMIN.

GONAL-F- Brand name for Follitropin alpha. Follicle-stimulating hormone medication produced through recombinant DNA technology, which functions in the role of naturally occurring FSH to stimulate the growth of follicles and the maturation of eggs.

GONAD- The gland that makes reproductive cells and “sex” hormones (testicles and ovaries).

GONADOTROPIN - A hormone capable of stimulating the testicles or the ovaries to produce sperm or an egg respectively.  FSH and LH; these hormones control reproductive function.

GONADOTROPIN RELEASING HORMONE (GnRH) - A hormone secreted by the hypothalamus in the brain. This hormone is released in pulses 60 up to 120 minutes apart.  If the pulses are not timed correctly, this could be a cause for infertility.  GnRH triggers the pituitary gland in the brain to release LH and FSH, which stimulate the ovaries or testes.  See FSH, LH.

GONORRHEA- This is a microorganism that may be transmitted by sexual contact. This microorganism could exist in the reproductive tract without symptoms and cause infertility. If present, both partners must be treated. The test for gonorrhea involves obtaining a sample of vaginal or cervical fluid from a woman or a swab of the urethra inside the end of the penis in the man and culturing this in the laboratory under conditions suited to the Gonococcal bacterium causes infertility by damaging the fallopian tubes and creating shrink-wrap-like scarring around the ovaries in women. This damage can be in the form of scar (adhesions) with partial or complete blockage of the fallopian tubes. It can also cause infertility create scarring inside the pelvis, around both of the tubes, ovaries and intestines. Chlamydia can also cause scarring in the male reproductive tract leading to infertility. See PID.

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HIRSUTISM- Women experience excessive hair growth in areas of their bodies typical of men such as the face, back, chest and abdomen. This condition is seen in women with excess androgens or familial hypersensitivity to androgens.  See Adrenal Androgens.

HORMONE- A substance produced by an endocrine gland that travels through the bloodstream to a different organ, where it has a specific effect.

HORMONAL ASSAY- Also known as hormone tests. These include: E2 (Estradiol), P4 (Progesterone), FSH (follicle stimulating hormone), LH (luteinizing hormone), hCG(Human Chorionic Gonadotropin) DHEAS (dehydroepiandrosterone), Prolactin and (TSH) Thyroid Stimulating hormone.

HOST UTERUS- A woman who carries a fetus that is not genetically hers in her uterus for another woman.  The egg and sperm from a couple are fertilized in vitro and the resultant embryo is placed in the host uterus by embryo transfer.  The baby is returned to the genetic parents immediately after birth.  Also known as gestational carrier.

HOSTILE MUCUS- Thick cervical mucus that prevents the sperm from penetrating the cervical canal. This may be a sign that a woman is not ovulating. It can also be caused by certain fertility medications such as clomiphene citrate. See Cervical Mucus.

HUMAN CHORIONIC GONADOTROPIN (hCG) - Hormone secreted by the placenta that prolongs the life of the corpus luteum beyond its usual fourteen-day life span, resulting in the production of sufficient progesterone to support a pregnancy. hCG is chemically similar to LH and may be injected to start ovulation and ensure adequate luteal function. hCG is the hormone measured in pregnancy test. Medications containing hCG for use in fertility therapy for women and men are Novarel, Profasi, Pregnyl and Ovidrel.

HUMAN IMMUNODEFICIENCY VIRUS (HIV) ANTIBODIES - Test done on the blood of both the male and female partner to screen for previous exposure to the AIDS virus. A positive test means that the individual has been exposed to the AIDS virus but does not necessarily that he/she will get AIDS.  A positive test may mean that the antibody to the virus is present in the blood.

HUMAN MENOPAUSAL GONADOTROPIN (hMG) - A natural product containing both human FSH and LH. Distributed under the brand names Menopur, Humegon, Repronex or Pergonal, the hormones are extracted from the urine of post-menopausal women. The drug is used to treat both male and female infertility and to stimulate the development of multiple oocytes. Pergonal is no longer manufactured.

HYDROCELE - A swelling in the scrotum that contains fluid. This condition may be present, but is not a clear cause of infertility.

HYDROSALPINX- A fallopian tube that is enlarged, filled with fluid and blocked at the end farthest from the uterus and closest to the ovary.  The inside lining of the tube (endosalpinx) is usually damaged. The wall of the tube is thinned and dilated. The normal cilia that line the inside of the tube are replaced by scar. The appearance would be similar to that of a person with severe burns of the skin. The skin is stiff, no longer soft and supple with loss of hair and movement of the underlying joints. So too is the function of the fallopian tube diminished. The fimbriae are usually fused and may be gone. The tube is filled with fluid that may contain substances that impairs fertilization of an egg or development of an embryo. This means that even if a couple undergoes IVF therapy and the fallopian tube is bypassed completely, the tubal fluid may harm the embryos that are placed in the nearby uterine cavity. This may be the cause for lower pregnancy rates among women undergoing IVF therapy with at least one hydrosalpinx present. There have been many studies around the world since the mid 1990’s demonstrating improved pregnancy rates if the hydrosalpinx fallopian tube(s) are removed in advance of IVF therapy.Formation of a hydrosalpinx is the direct result of PID in most cases. Other causes can be infections due to intestinal disease such as a ruptured appendix from appendicitis. Hydrosalpinx may also be associated with severe endometriosis. In some patients, surgical repair of a hydrosalpinx may substantially improve the chance of pregnancy, but it may also increase the chance of ectopic tubal pregnancy. The tube may still not assist a fertilized egg in passing all the way into the uterus. In the final analysis, consultation with a reproductive endocrinologist will assist you in your choice of either surgical repair of the tube(s) or proceeding directly to IVF either with the hydrosalpinx removed before IVF or only to consider removal of the hydrosalpinx if IVF therapy was unsuccessful.

HYPERPROLACTINEMIA- Elevated blood levels of prolactin.  This may be due to a benign tumor of the pituitary gland, but can be due to the use of certain medications, e.g., anti-hypertensive drugs or anti-depressants.  Prolactin can suppress LH and FSH production, reducing male sex drive.  Prolactin directly suppresses ovarian function in women and can block egg release, and stop a women from having periods (amenorrhea) Suppressing the ovary may decrease blood estrogen levels placing women at risk of osteoporosis (thinning of the bones). This condition is treatable with medications such as bromocriptine or Dostinex.  It can be related to an underactive thyroid. See Hypothyroidism.

HYPERSTIMULATION- See Ovarian Hyperstimulation Syndrome (OHSS).

HYPERTHYROIDISM- Excess thyroid hormone, which may impair ovulation and cause menstrual disorders. In the past decade, less emphasis has been made on it being a cause of miscarriages.  A severe form called thyroid storm can be life threatening demanding immediate emergent care.  Thyroid disorders often run in families and have its root cause in a problem with your immune system. This can be related to other diseases caused by immune disorders. See Thyroid Gland.

HYPOESTROGENIC- Lower than normal blood levels of estrogen.  It may reflect an inactivity of the ovary.  Tests should be done to discover the cause.

HYPOGONADOTROPIC HYPOGONADISM- Low pituitary gland output of LH and FSH.  Men will have low sperm counts and may lose their sex drive.  Women do not ovulate. Both conditions are treatable.

HYPOSPERMATOGENESIS- Low sperm production.

HYPOTHALAMUS- A part of the brain that regulates hormones. It is located above the pituitary gland.  This tissue secretes GnRH in pulses 60 to 120 minutes apart.  The pulsatile GnRH stimulates the pituitary gland to secrete LH and FSH.  See also FSH and LH.

HYPOTHYROIDISM- The thyroid gland produces an insufficient amount of thyroid hormone.  This causes lower metabolism and lethargy.  The low thyroid hormone causes thyroid-stimulating hormone to go up which can cause elevation of prolactin.  See Hyperprolactinemia.

HYSTEROSALPINGOGRAM (HSG)- An x-ray screening test during which liquid dye that blocks x-rays is introduced into the uterus through the cervix and passed into the uterine cavity showing its shape and then passes through the fallopian tubes to determine if they are open. If the uterine cavity has an abnormal shape, there may be an abnormal development from birth, or a new growth such as a polyp or fibroid tumor. Some of these conditions can affect fertility. If the dye is not observed to flow through a tube, then the tube may be considered “blocked”. See Hydrosalpinx. A blocked tube may prevent an egg from being fertilized.  On occasion, the narrowest portion of the fallopian tube may have a temporary spasm or cramp due to the flow of fluid within it. The cramp could stop flow of fluid giving the appearance of blockage when it is not truly blocked. It has limitations in that it cannot detect endometriosis nor verify scarring in the pelvis that does not involve the fallopian tubes.

HYSTEROSCOPY- Fiberoptic visualization of the inside of the uterus through the cervix with a telescope-like device.   Many surgical repairs can be done during a hysteroscopy.  This procedure is sometimes performed in conjunction with a laparoscopy.  Diagnostic hysteroscopy can be done in the office with a 3-mm fiberoptic flexible telescope. Patients tolerate this procedure well without anesthesia. Should an abnormality be found by hysteroscopy in the office, an operative hysteroscopy can then be scheduled in the operating room. A larger rod-shaped telescope is used. This requires anesthesia to relieve pain that would be caused by the need to dilate the cervical opening to the uterus. Conditions treated include fibroid tumors of the uterus, polyps, uterine septum, intrauterine scarring (Asherman’s Syndrome), among others. This procedure does not test for problems with the fallopian tubes. See Laparoscopy.

HYSTERSONOGRAM- A screening test in which special water solution is introduced by way of a tube being placed inside of the uterus through the cervix. Vaginal ultrasound probe is also placed allowing the physician to watch the flow of fluid into the uterine cavity and into the fallopian tubes. This allows view the outline of the uterine cavity like a silhouette looking for abnormalities in the formation of the endometrial cavity such as those described in the above section of hysterosalpingogram. The fallopian tubes may also be tested to see if they are open or blocked. As with the hysterosalpingogram, there are limitations in that it cannot detect endometriosis nor verify scarring in the pelvis, nor exclude spasms involving the fallopian tubes. No x-rays are used.

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IDIOPATHIC INFERTILITY (Unexplained Infertility)- The term used when no reason can be found to explain the cause of a couple's infertility.

IMPLANTATION- The embedding of the fertilized egg into tissue; the appropriate place is in the lining of the uterus. There, the embryo establishes an interface with the mother’s blood supply for nutrition. If implantation takes place any place other than the uterine cavity, it is considered an ectopic pregnancy. Implantation outside of the uterus can occur in the wall of the uterus (cornual ectopic), in the fallopian tube, or rarely on the ovary, in the abdominal cavity and in the uterine cervix.

IMPOTENCE- The inability of the man to establish and maintain an erection and to ejaculate.

INFERTILITY- The inability to conceive and/or carry a pregnancy to term after one year of unprotected intercourse for women less than 35 years old or after 6 months for women 35 years old or greater; also known as sub-fertility

INHIBIN-A-  hormone made in the gonads to regulate FSH production by the pituitary gland for men and women.

INTRACYTOPLASMIC SPERM INJECTION (ICSI)- An advanced reproductive technology where a single sperm is injected into an egg.  This micromanipulation technique helps enable fertilization with very low sperm counts or with non-motile sperm.  See Micromanipulation.

INTRAUTERINE DEVICE (IUD)- A birth control (contraceptive) device placed within the uterus by a trained physician that is made from a variety of substances such as plastic or copper and may also contain progesterone hormone.  Alternative forms of contraceptive devices include hormonal therapies by pill, skin patch, vaginal ring and injections under the skin; barrier contraceptives such as condoms, vaginal diaphragms and cervical caps. The IUD may also be used to treat a woman who has had scarring in her uterine cavity (Asherman’s Syndrome).  The relationship between IUD use and pelvic infection observed in the 1970’s and 1980’s was misunderstood leading to IUDs falling out of favor. The problem was not with the IUD, it was with the string attachment used to remove the IUD. A change in this string making it more slippery did not permit bacteria to follow the string like a wick into the uterine cavity. Very good IUD safety from infection has been consistently observed with the currently available devices.

INTRAUTERINE INSEMINATION (IUI)- The introduction of specially prepared sperm directly into the uterus through the cervix. This results in a higher concentration of sperm in the fallopian tubes at any given time and may enhance fertilization and fertility. Outcomes with ovulation induction therapy are improved with the addition of IUI therapy in many cases.  This technique bypasses the cervical mucus.  See Artificial Insemination.

IN VITRO FERTILIZATION (IVF)-  “Fertilization under glass.”  The procedure during which an egg is removed from a follicle in the ovary and fertilized by a sperm outside the human body in a small clear dish (petri dish).   IVF was originally developed to treat infertility caused by blocked or damaged fallopian tubes.  It is now used to treat a variety of infertility problems.

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KALLMAN’S SYNDROME- A congenital dysfunction of the hypothalamus, which includes the failure to complete puberty and lack the sense of smell.  See Female Kallman’s.

KARYOTYPING- A test to evaluate the number and make up of chromosomes for the presence of genetic defects.

KLINEFELTER’S SYNDROME- A genetic abnormality of aneuploidy in a man with one Y and two X chromosomes.  Although the gender is male, abnormalities resulting from abnormal testicle development with little to no sperm production and infertility are common. If more than one cell line is present called a mosaic aneuploidy, there may be a greater chance for sperm to be present with successful pregnancy by means of surgical removal of sperm and IVF/ICSI therapy. Although the cause is of a genetic origin, overall mental function capacity and life span are usually not impaired.  Testosterone hormone replacement is often needed.

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LAPAROSCOPY- A surgical procedure where a telescope-like device and two smaller tubes are inserted through three small incision: one within the navel and two on above the pubic bone on either side in order to visualize the pelvic cavity, the ovaries, fallopian tubes and uterus.  Used for diagnosis and treatment of infertility, pelvic pain, pelvic abnormalities including endometriosis, abdominal and pelvic adhesions, damaged fallopian tubes, fibroid tumors of the uterus and removal of cysts from the ovaries.  This is considered minimally invasive or minimal access surgery.  This procedure does not assess the uterine cavity- see hysteroscopy, hysterosonogram and hysterosalpingogram.

LAPAROTOMY- Major access and invasive abdominal surgery. For fertility needs, a laparotomy should only need to be done for removal of fibroid tumors or other masses that cannot be removed by laparoscopy.

LETROZOLE (FEMARA) – This is another fertility medication that was discovered while it treated breast cancer. The formal drug classification is aromatase inhibitor. Aromatase is a special compound called an enzyme that converts hormones to estrogen. Letrozole differs from Clomiphene and Tamoxifen in that it does not attach and coat estrogen receptors to block estrogen from growing tumors. Instead, Letrozole just stops estrogen production at its source. This results in no estrogen to turn on the receptors that are sitting on the tumors. Therefore, the tumors shrink. We discovered a side effect among women with breast cancer treated with Letrozole during their fertile years – they developed many ovarian cysts- specifically follicles with eggs. Often the ovaries became very large and painful. Such side effects limited Letrozole’s use among premenopausal women with breast cancer. However, the observation presented an opportunity for treating infertile women suffering from ovulation disorders particularly caused by polycystic ovary syndrome. Letrozole also has less side effects than clomiphene- less effect on mood, no association with thinning of the uterine lining. The worldwide experience with clomiphene extends over at least 40 years. Letrozole is gaining a following, but for less than a decade.  We also care for young women in their reproductive years diagnosed with breast cancer that are facing surgery, chemotherapy and radiation therapy to treat their cancer. In an effort to preserve future fertility on short notice, Letrozole has been used with FSH for IVF therapy to harvest eggs while keeping blood estrogen levels low in advance of therapy for breast cancer. There is little organized clinical registry information that would assist in estimating the effectiveness of this strategy.

LEYDIG CELL- The testicular cell that produces testosterone.  LH stimulates the Leydig cell.

LUPRON- Brand name for leuprolide acetate.  A drug within the classification of gonadotropin releasing hormone agonists (GnRHa). It was originally used to treat men with prostate cancer in the 1970s-1980s. It worked by turning off the pituitary glands ability to release FSH and LH hormones, which turns off the activity of the gonads. Any body functions depending on the gonad hormones are slowed down. For men, this resulted in shrinkage of prostate tumors. In 1984, it was introduced and prescribed for women undergoing IVF therapy to block a premature LH surge that was occurring in 25% of women going through IVF therapy leading to failure of IVF therapy. With a quarter of couples overcoming the problem of premature LH surge, they made it to egg retrieval surgery and some became pregnant thus increasing the overall success of pregnancy with IVF therapy. In the last decade, the US Food and Drug Administration has approved this drug for use in the treatment of endometriosis and fibroid tumors of the uterus.  A longer acting prolonged release form called Lupron Depot in once per month and once per three months injections is available for treatment of these two conditions. In 2001, a new class of medications called GnRH antagonists was introduced serving a similar role to suppress the premature LH surge with IVF therapy. The GnRH antagonists brand named Ganirelix and Cetrotide provide effective treatment with far fewer (usually 3 to 5) injections during IVF. With few injections, the GnRH antagonists are often used in a “short “ protocol and GnRH agonist Lupron is used in a “long” protocol for about 26 days of daily injections or a single dose of 1 month duration depot formulation of Lupron.

LUTEAL PHASE - The days of a menstrual cycle following ovulation and ending with menses, during which progesterone is produced.  Progesterone causes uterine lining to make final preparations for implantation and growth of the embryo.

LUTEAL PHASE DEFICIENCY (LPD)- Variant form of polycystic ovary syndrome. Inadequate progesterone or a failure of the corpus luteum to produce progesterone long enough to allow implantation—or the inability of the uterine lining to respond to progesterone stimulation.  This may contribute to the risk of miscarriage, but the risk of miscarriage may be more directly related to the condition of polycystic ovary syndrome with androgen hormone excess, high blood insulin levels and impaired egg quality. Endometrial biopsies and serum blood progesterone levels have been the cornerstone tests used to identify LPD, but these tests are very unreliable.

LUTEINIZED UNRUPTURED FOLLICLE (LUF) SYNDROME- The follicle develops and becomes a corpus luteum without releasing the egg. This may occur in about 5-10% of infertile women. If this condition is persistent with clomiphene or FSH medications, then IVF therapy may be needed.

LUTEINIZING HORMONE(LH)- A hormone secreted by the pituitary gland, which causes the egg to mature and be released by the ovary (ovulation).  LH is necessary for spermatogenesis (Sertoli cell function) and for production of testosterone (Leydig cell function).  In the female, LH is necessary for normal function of FSH, normal follicle development and egg development and for triggering ovulation. An excess of LH hormone release is common with Polycystic Ovary Syndrome causing elevated testosterone production in the ovary, impairing follicle and egg development, impairing ovulation and fertility as well as contributing to an increased risk of miscarriage likely related to testosterone induced genetic abnormalities within the egg.

LUTEINIZING HORMONE (LH) SURGE- A spontaneous release of large amounts of Luteinizing Hormone (LH). This normally results in the release of a mature egg (ovulation).  Ovulation test kits detect the increase of LH, signaling that ovulation is to occur—usually within 24-36 hours.

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MATURATION ARREST- A testicular condition in which sperm development halts throughout all testicular tubules.  May result in oligozoospermia or azoospermia. This may also be observe among a woman’s oocytes during IVF therapy and may be due to a lack of certain hormone receptors or other genetic abnormalities.

MEIOSIS- The cell division peculiar to reproductive cells, which divides genetic material in half.  New cells contain twenty-three chromosomes.  The spermatids (immature sperm) and ova (eggs) each contain twenty-three chromosomes.  Fertilization brings them together in the baby, which will have a normal complement of 23 paired chromosomes, forty-six chromosomes total.

MENOMETRORRHAGIA- Heavy bleeding at an unexpected time for menstruation to occur in a menstrual cycle.

MENOPAUSE- Permanent cessation of the menses; termination of the menstrual life due to hormonal changes.

MENOPUR- Brand name for purified urofollitropin. A natural product containing both human FSH and LH-like hormone activity in the form of hCG. The hormones are extracted from the urine of post-menopausal women. The drug is used to treat both male and female infertility and to stimulate the development of multiple oocytes. It is administered by subcutaneous injection.

MENORRHAGIA- Heavy or prolonged menstrual flow.

MENSTRUATION- The shedding of the lining of the uterus that occurs approximately every four weeks in non-pregnant women.

MESA- Microscopic epididymal sperm aspiration.  A surgical procedure to collect sperm from the epididymis, the final storage tank for mature sperm in the scrotum next to the testicle in order to use the sperm for in vitro fertilization.  This is a treatment for male factor infertility, when no sperm is present in the ejaculate due to some blockage of the ejaculatory duct.

METFORMIN (GLUCOPHAGE or FORTAMET)- This medication is in a family of oral hypoglycemic drugs called sulfonureas. In the context of women’s reproductive health, it is considered first-line therapy prescribed to women with Polycystic Ovary Syndrome. Metformin acts in four ways: 1) reduces insulin resistance in the cells of the body; 2) directly reduces testosterone production in the ovaries; 3) reduces total cholesterol and LDL levels in the bloodstream; 4) reduces absorption of carbohydrates by the intestines thus limiting sugar absorption into the body. People taking Metformin should follow a low carbohydrate composition diet to reduce the excess unabsorbed sugar intake that can cause diarrhea and gastrointestinal upset often experienced with use of this medication. Metformin is used in the treatment of type 2 diabetes mellitus. It was first observed to assist obese women with both type 2 diabetes and polycystic ovary syndrome to ovulate and have more regular menstrual periods. Among women with polycystic ovary syndrome, Metformin has been associated with improved pregnancy rates, decreased risk of miscarriage, decreased risk of diabetes during pregnancy and may be preventive against the development of diabetes later in life. Although it was initially thought to be helpful only for obese women with polycystic ovary syndrome, it has been found to be even more beneficial to non-obese women with polycystic ovary syndrome. Unlike another family of oral hypoglycemics called Thiazolidinediones such as Avandia (Rosiglitazone), Metformin is not metabolized by the liver therefore does not pose a risk of liver damage. Thus, it is not necessary to have liver function tests while taking Metformin. Metformin is cleared by your kidneys unchanged and passes in your urine. A simple creatinine blood test is required to assure normal kidney function and safe use of this medication. If kidney disease is present, then Metformin should not be taken as it could lead to a rare serious medical illness of lactic acidosis. Metformin does not cause hypoglycemia. It is a class B medication and can be used throughout pregnancy with recent studies showing no impaired effect to children followed up to 18 months of life. Dr. Mersol-Barg usually limits Metformin therapy to the end of the first trimester of pregnancy among women with PCOS as the first trimester is the highest risk time frame for miscarriage. Use of this medication beyond the first trimester of pregnancy should be discussed with your obstetrician.

METRODIN- Brand name for purified urofollitropin. No longer commercially available. Purified Follicle Stimulating Hormone (FSH) manufactured from the urine of postmenopausal women. It is a fertility drug administered as a subcutaneous injection.

METRORRHAGIA- Spotting or light bleeding at an unexpected time for menstruation to occur in a menstrual cycle.

MICROMANIPULATION- Procedure by which a single sperm is injected under the outer layer of the egg to induce fertilization.  This procedure can be useful for successful treatment of male infertility.  See Intracytoplasmic Sperm Injection (ICSI).

MISCARRIAGE- Pregnancy loss.  Spontaneous loss of pregnancy.  See Abortion.

MITOSIS- The cell division leading to two identical cells with forty-six chromosomes.

MULTIPLE BIRTH- Birth of two or more children from a single term of pregnancy.

MYOMA- A common benign tumor of the muscle of the uterus. This is sometimes called a fibroid or leiomyoma.

MITTLESCHMERZ- Painful ovulation. During ovulation, the follicle ruptures. Small blood vessels on the surface of the follicle may tear and bleeding occurs. Any time there is blood in the abdomen, a chemical irritation occurs that leads to the sensing of pain.

MYCOPLASMA- A bacteria that has been implicated in the cause of miscarriage. A clear cause effect relationship with miscarriage has not been scientifically proven. About 40% of all women have mycoplasma as part of the natural bacteria that resides in the vagina. Since these women who carry the bacteria are not necessarily the women that experience miscarriage or even have fertility problems, the role of this bacteria in infertility is not clear.  See Ureaplasma.

MYOMECTOMY- The surgical removal of fibroid tumors from the wall of the uterus. This surgery may be done either by hysteroscopy, laparoscopy or laparotomy. The surgical approach depends on the nature of the fibroid and the condition of the patient as well as the experience of the surgeon.

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NECROSPERMIA- Condition in which sperm are produced and found in the semen, but they are dead.  These sperm cannot fertilize eggs.  Sperm that are not moving are not always dead; special stains are used to make this diagnosis.

NOVAREL- (Chorionic Gonadotropin for Injection)A fertility medication of human chorionic gonadotropin (hCG) used to prompt ovulation. It is a preparation of hCG administered by injection.

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OLIGOMENORRHEA- Infrequent menstrual cycles of more than 35 days duration.

OLIGOZOOSPERMIA- A condition in which the number of sperm in a sample is abnormally low, less than 20 million sperm per milliliter of seminal fluid.

OLIGO-OVULATION- Irregular or infrequent ovulation. Menstrual cycles 35 days or longer from the start of one period to the start of the next period.

OOCYTE- The egg cell produced in the ovaries. Also called the ovum or gamete.

OVARIAN CYST- A fluid-filled cavity lined by cells in the ovary.  An ovarian cyst forms each cycle with follicular development.  That is, a follicle is a specialized cyst that has an egg inside of it.  Cysts may also be found with ovulation disorders, neoplasms of the ovary, and endometriosis.  See Chocolate Cyst and Endometrioma.  They can form after ovulation from the site of the ruptured follicle refilling with fluid.

OVARIAN DRILLING- Newer generation of surgical procedure replacing ovarian wedge resection.  It can be considered in the treatment of women with polycystic ovary syndrome who desire fertility, but are resistant to medical therapy.  Laser or cautery may be used to vaporize small follicles and surrounding tissue on the ovarian surface in an effort to decrease testosterone levels within the ovary and create a window of opportunity for reduced resistance of the ovaries to ovulation induction therapy using clomiphene or FSH medications combined with Metformin and a low carbohydrate diet. This treatment is quite effective on the short term. The opportunity for pregnancy is greater for women within a limited timetable. However, it is temporary and the condition of testosterone excess and increased ovarian resistance will return. There is also a risk of periovarian adhesion formation after surgery that could create an adhesive barrier impairing fertility.

OVARIAN FAILURE- Failure of the ovary to respond to FSH stimulation by not developing follicles.  Diagnosed by elevated FSH in the blood, usually of a level greater than 20.  May be due to exhaustion of the egg supply or an autoimmune problem.  Exhaustion of eggs means menopause.  Autoimmune problem means that a woman’s immune (defense) system is interfering with the ovaries’ ability to respond and develop follicles. Therefore the eggs that are present are neither developing nor being released (ovulating).

OVARIAN HYPERSTIMULATION- Administration of hormones to promote egg development in the ovaries.

OVARIAN HYPERSTIMULATION SYNDROME (OHSS)- When a woman is undergoing controlled ovulation hyperstimulation (COH), it is possible that this may result in a dramatic increase in the size of the ovaries, causing a cluster of symptoms referred to as "ovarian hyperstimulation syndrome" (OHSS). This is a serious condition and can be life-threatening if not detected and treated. It may occur more use of gonadotropins (FSH) more so than of Clomiphene Citrate during the treatment of IVF or ovulation induction.  The ovaries become enlarged and produce numerous eggs.  Hormone levels rise, and fluid can collect in the abdominal cavity or lungs.  The numerous ovarian cysts can rupture causing internal bleeding or the ovary may twist (See Torsion, Ovary).  Symptoms include weight gain and abdominal pain.  Cycles stimulated with these drugs require careful monitoring with ultrasound scans and hormone level tests. Women with polycystic ovary syndrome and younger women in their 20s and early 30s are at greater risk for this disorder. It is more likely to occur among women with 20 or more follicles developing and in which multiple gestations is the outcome of fertility treatment. I can require hospitalization and intensive therapy and care. OHSS may be prevented by lowering the dose of FSH medication prescribed; withholding the hCG injection if ultrasound indicates that too many follicles have developed; retrieving all the oocytes possible, inseminating them, freezing all embyros that form and not performing an embryo transfer that cycle, and by limiting the number of embryos transferred thereby lowering the risk of multiple gestation which invariably is associated with OHSS. The risk of OHSS in Dr. Mersol-Barg’s practice is less than 1 in 500 for women undergoing controlled ovarian hyperstimulation as part of ovulation induction and less than 1% for women undergoing IVF therapy. See Controlled Ovarian Hyperstimulation.

OVARY- The female gonad containing the eggs.  The ovary releases hormones (estrogens, androgens and progesterone among many others) that cause development of secondary sex characteristics and reproductive organs in women. 

OVIDREL- Brand name for Choriogonadotropin alfa. A fertility medication of human chorionic gonadotropin (hCG) used to prompt ovulation. It is the first preparation of hCG to be available of subcutaneous injection. It became available for use in the United States at the beginning of the year 2001.  Other hCG preparations (Profasi, Novarel, or Pregnyl) require the deeper intra-muscular injection.

OVULATION - Release of an egg from the ovarian follicle.

OVULATION INDUCTION - The use of female hormone therapy (clomiphene citrate, FSH, Letrozole, hCG) to stimulate oocyte development and release.  See Controlled Ovarian Hyperstimulation, Clomiphene Citrate, Human Menopausal Gonadotropin, Human Chorionic Gonadotropin, Fertinex, Follistim, Gonal-F, Letrozole, Pregnyl, and Profasi.

OVULATORY FAILURE- The failure to ovulate.  Treatment may be ovulation induction therapy. See Anovulation.OVUM- The mature egg. 

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PANHYPOPITUITARISM- Complete failure of the pituitary gland.  See Pituitary Gland, Sheehan’s syndrome.

PAPANICOLAOU SMEAR (Pap Smear)- Also known as Pap test. This is a screening test for precancerous cells to evaluate the cells of the cervix and vagina to determine if the cells are normal.

PARLODEL- See Bromocriptine.

PATENT- Open.

PELVIC INFLAMMATORY DISEASE (PID)- An infection of the pelvic organs.  Chlamydia and gonorrhea infections can cause PID.  PID can result in severe illness, high fever, and extreme pain.  PID can also cause tubal blockage and pelvic adhesions.  In severe cases, tubovarian abscesses can form. A tubovarian abscess is a pocket of infection and pus that forms involving the ovaries and fallopian tubes. This can cause severe pain. Hospitalization with intravenous antibiotics may be required. Should a woman not improve with antibiotic therapy, surgical removal of one or both tubes and sometimes the one or both ovaries is done as a lifesaving measure. Constant pelvic pain and recurrent pelvic infections can develop after the initial infection. This condition is a very common cause of infertility and is also a common cause of future ectopic pregnancy.  Contrary to the above description, some women have no history of symptoms such as pain, but they have clear evidence of PID in viewing the uterus, fallopian tubes and ovaries by hysterosalpingogram or at the time of laparoscopic surgery. This can be very disheartening when family planning is a couple’s major goal. Surgical treatment may improve fertility. Often, IVF therapy is needed. See Adhesions, Chlamydia, Gonorrhea, hydrosalpinx.

PHOSPHOLIPID ANTIBODY SYNDROME- An immunologic factor associated with recurrent pregnancy loss. The most significant antibodies are specifically targeted against phospholipids, which are most often detected through measures of anticardiolipin antibody (ACA) and lupus anticoagulant (LAC) tests. These antibodies interfere with the normal balance of blood clotting and promote direct injury to the placental tissue, blood clots to form in the placenta, and/or fetal blood circulation that can cause pregnancy loss at any time in pregnancy: early miscarriage to fetal death in later trimesters. Once this condition if diagnosed, the most effective treatment is with low molecular weight heparin in the form of Lovenox or Innohep along with low dose aspirin of 81 mg/day starting prior to conception through the entire pregnancy. It is unclear if there is an increased risk of blood clots to the woman during pregnancy or at any other time in her life due to the presence of these antibodies.

PITUITARY GLAND- The master gland.  This gland is controlled by the hypothalamus and controls most hormonal functions.  It is located at the base of the brain just below the hypothalamus.  It controls the function of the thyroid, adrenal gland, ovary or testicle, and growth and development.

PLACENTA- The tissue part of the embryo that invades the uterine wall and provides an exchange of the baby’s waste products for the mother’s nutrients and oxygen.  The baby is connected to the placenta by the umbilical cord.

POLAR BODY- The discarded extra genetic material resulting from female germ cell division. It contains the entire chromosome compliment. The first polar body forms at the time of ovulation when the egg undergoes its first cell division. The two resulting cells are uneven in size much in relation to that of the earth and the moon (polar body). The second polar body is formed at the time of fertilization when the oocyte undergoes a second uneven cell division.  Polar bodies can be removed and analyzed for specific gene disorders through a process called preimplantation genetic diagnosis (PGD). Genetic testing of polar bodies is less reliable than other methods of PGD.  See PGD & Meiosis.

POLYCYSTIC OVARY SYNDROME (PCOS or Stein-Leventhal Syndrome)- The presence of multiple (12-100) small cysts in the ovary commonly due to an abnormal release of LH and FSH hormones.  There is often an abnormality in blood sugar metabolism called insulin resistance leading to abnormally high levels of insulin in the blood stream. Higher levels of LH and insulin in the blood circulate to the ovary and increase the amount of testosterone produced in the ovary. This can block follicle and egg development, disrupt chromosomes in eggs, block ovulation and result in infertility by lack of conception or greater risk of miscarriage. The higher testosterone levels from excess LH and insulin release can also lead to increased hair growth, hirsutism, in areas of the body typically seen in men and acne on the face, back and chest. Obesity is often, but not necessarily, associated with this syndrome. It is treatable first-line with medications such as Metformin (Glucophage) and a low carbohydrate diet/exercise program and the addition of ovulation induction medications such as clomiphene citrate, Letrozole and FSH in conjunction with ultrasound and endocrine blood test monitoring. Health risks to women with PCOS include infertility, gestational diabetes and pre-eclampsia with related obstetrical complications to mother and baby. Lifetime increased risk for diabetes, cardiovascular disease and endometrial cancer as well as other disorders arising from these issues include Syndrome X or Metabolic Syndrome. See Stein-Leventhal Syndrome.

POST COITAL TEST- A microscopic evaluation of cervical mucus and mixed sperm performed two to eight hours after intercourse to determine compatibility between the woman’s mucus and the man’s sperm Initially introduced in the 1860’s by Dr. Sims and rediscovered in 1911 by Dr. Huner, a growing body of evidence-based medical studies accruing since the mid-1990’s provides strong evidence that this test offers no clinical value in a couple’s infertility evaluation. Although often prescribed, Dr. Mersol-Barg does not be recommended this test be part of your infertility evaluation.

POST EJACULATE URINE- A laboratory test where a man’s urine is examined for the presence of sperm after he has ejaculated.  This test is performed on men who have had a very low sperm count or no sperm seen in past semen analyses. These men may have retrograde ejaculation. That is, the sperm takes a wrong turn during orgasm and enters the bladder instead of exiting through the penis. This condition is more common among men with diabetes or nervous system disorders due to spinal cord injuries. Treatment of adjusting the pH of the urine to be less harsh on sperm, collecting the sperm in the post ejaculate urine, washing and concentrating the sperm and performing intrauterine insemination therapy (IUI) is very effective fertility therapy for couples having this problem.

PREIMPLANTATION GENETIC DIAGNOSIS (PGD)- A process whereby a single blastomere (cell) from a 6 to 8 cell embryo (three days after egg collection during the IVF process) is removed, prepared, and subjected to one of two types of genetic tests. The results are determined by day 5 and embryos that do not have an abnormal test result can be chosen for transfer into the uterus. One test is Fluorescent In-site Hybridization (FISH). This test can assess up to about 9 of the 23 chromosomes checking for the correct number (which should be 2) and overall structure of these chromosomes. The second type of test is Polymerase Chain Reaction (PCR) in which we can look for a specific gene defect if a known gene defect is present in one of the parents. Examples include Cystic Fibrosis, Tay Sachs Disease and a growing hundreds of others.  With PCR, the parents are first tested to identify the variety of genetic mutation. The probe for this mutation is then applied to the cell from the embryo checking for the presence of a normal or mutant gene. These tests can assist in screening for genetic abnormalities in an embryo but does not help to fix the problem. In some cases it may improve our ability to select an embryo without the problems we look for, but other problems may be present that we cannot see that lead to failure of embryo survival. The FISH testing is a tool similar to the Hubble telescope. We can see further into the universe of life, but it doesn’t seem to assist in controlling the outcome.

Bottom line points regarding PGD:

1. Worldwide observations are that FISH is not improving the chance of successful pregnancy.
2. FISH may help infertile couple’s better understand why pregnancy failures have occurred offering an avenue for them to consider alternatives such as donor egg IVF therapy.
3. FISH is a screening test and not a diagnostic test. What about the other 14 pairs of chromosomes that are not tested or the other 6-7 cells in the embryo that are not tested? We are missing much information.
4. PCR as a truly diagnostic tool used to identify single gene mutations is likely going to be the mainstay of PGD in the future.
5. The future of PGD is headed towards a complex system called genetic microarray. It involves simultaneously testing for thousands of genes through PCR on a small color coded dotted grid with each dot per gene tested that we think are critical to normal survival of an embryo. The grid composed of thousands of color dots (one dot per gene tested) is similar to a Georges Seurat painting: close up you only see dots, but step back and the portrait comes into clear view.

PREMATURE OVARIAN FAILURE- Ovarian failure before the age of 40. See Ovarian Failure.

PREGNYL- See Human Chorionic Gonadotropin.

PRIMARY INFERTILITY - Infertility in couples where the woman has never conceived. See Infertility.

PROFASI- See Human Chorionic Gonadotropin.

PROGESTERONE (P4) - A hormone produced and released by the corpus luteum of the ovary during the second half of an ovulatory cycle and is the major source of progesterone until about 10 weeks of pregnancy. It is necessary for the preparation of the lining of the uterus for the implantation of the fertilized egg. It is dependent both on LH hormone release from the brain and egg quality influence on the cells in the follicle before ovulation that will be making progesterone after ovulation. During pregnancy beyond 10 weeks, the placenta is the major producer of progesterone.  Injection or suppository will provide supplemental support when indicated. Progesterone therapy is often used with recurrent or threatened miscarriages. However, studies are not showing it to be effective except in special cases where the ovary from which the egg was released is surgically removed before 8-10 weeks of pregnancy or a woman has been on medications such as Lupron or Ganirelix with IVF therapy that decrease LH production from the brain, thus reducing the signal that would direct the ovary to make enough progesterone. Blood tests to monitor progesterone levels will help determine the progress of a cycle, but adding progesterone may not change the outcome of the pregnancy. The root problem of the vast majority of pregnancy losses is an abnormal embryo, not an abnormally low progesterone. Remember, pregnancy hormone from the placenta also stimulates progesterone production from the ovary early in pregnancy. If the embryo is abnormal and the placenta does not produce adequate HCG, then progesterone will be abnormally low.  We also monitor progesterone blood levels during ovulation induction or ovulation enhancement therapy. If progesterone levels rise too early in a treatment cycle, this may signal a premature LH surge, the result of which harms the egg development that cycle. This is treatable in future cycles. If progesterone levels are greater than 2.0 after hCG medication is taken with ovulation induction therapy, then this suggests ovulation has occurred. If progesterone is low, less than 15 during early pregnancy, this may be a sign of impending miscarriage. These are the most common ways to interpret blood tests measuring progesterone and the most common reasons to give progesterone hormone as a medication.

PROGESTERONE WITHDRAW- Some women have infrequent or no periods due to hormone imbalances or problems with structures in the female reproductive system. Of course, this is assuming she is not pregnant! If the time between menstrual periods is less than 6 months, it is called oligo-menorrhea; 6 months or greater is called amenorrhea. Both estrogen and progesterone need to be produced in your body in this sequence to induce a menstrual period. Some women make enough estrogen, but if they do not ovulate, then will not make enough progesterone resulting in a very late or even absence of a menstrual period. I she takes progesterone medicine for 5 to 10 days to replace the progesterone she is not making, then stops it (withdraw of progesterone) she may begin a menstrual period. Don’t be fooled. Such a medically induced menstrual period does not mean you released an egg (ovulated). Progesterone withdraw can be used as a treatment or a diagnostic test.  Progesterone withdraw has many advantages: 1) it can start a period permitting fertility medications to be started; 2) it can be used to clear the uterine lining from abnormal tissue overgrowth that would otherwise place a women at increased risk for developing cancer of the lining of her uterus; 3) it can regulate a woman’s menstrual cycle giving her a sense of regularity and feeling normal and healthy; 4) it can be used as a test to make sure no other hormone imbalances are taking place that may cause a  women not  to have a period such as menopause, pituitary gland disorders, thyroid disorders or intrauterine scarring (Asherman’s Syndrome). In these cases, a period will not start with progesterone withdraw. Progesterone withdraw is most commonly used for women with Polycystic Ovary Syndrome or as hormone replacement along with estrogen for women in menopause.

PROLACTIN - A hormone produced by the pituitary involved in so many normal body functions from eating food, to sexual function to preparing the breasts of women for infant mealtimes after delivery! If a man or woman is making too much prolactin, it could result in infertility, decreased libido (sex drive), thinning of the bones called osteoporosis. The root problem can be due to a thyroid disorder or the root problem can be due to a microscopic overgrowth of cells in the pituitary gland easily treated with medications such as Dostinex or Parlodel. More rare is a larger tumor of the pituitary gland seen by CT scan or MRI of the head that again is most often treated with medication, but may need to be treated with surgery. See Hyperprolactinemia, Galactorrhea, Bromocriptine and Dostinex.

PROSTAGLANDINS- Compounds that are present in semen, in the follicle of the ovary at the site of ovulation, produced by endometriosis, and are produced by the breakdown of the lining of the uterus and other tissue.  Prostaglandins help to regulate a wide range of body functions. When it comes to pain during your menstrual period, it can be the culprit for cramps and intestinal diarrhea.

PROSTATE GLAND- The gland in the pelvis of a man that produces a portion of the semen, including the chemical that liquefies the coagulated semen after entering vagina. Problems with the prostate gland can lead to problems with sexual function, pain, and infertility.  A urologist medical specialist is the likely physician to examine the prostate gland. Further testing can be done by ultrasound or other radiology imaging technologies.

PROXEED- Proxeed which is heavily marketed male infertility “dietary supplement” to physicians and patients underneath the radar of the FDA and is unproven to improve your chance of having a baby. The marketing data addresses sperm movement as one would describe widgets, but the manufacturer stops short of assuring improved pregnancy rates for the female partner. Such a claim would raise challenge by the FDA as a clear medicinal benefit rather than a dietary supplement. Bottom line: Proxeed is a waste of time and money.

PYOSPERMIA- Condition in which the presence of white cells in the sperm indicated possible infection and/or inflammation.  See Semen Leukocytes.

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QUANTITATIVE hCG-Testing the exact value of the serum beta hCG level to assess the progress and reassurance of good progress during early pregnancy. The hCG levels may also assist in determining the timing of further testing and interventions during early pregnancy.  It is also used during prenatal testing for genetic abnormalities such as Down Syndrome in the second trimester at about 16-18 weeks. See Human Chorionic Gonadotropin.

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REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY (REI) SPECIALIST- A subspecialist physician who has received residency training in Ob/Gyn and advanced training  (fellowship) in the treatment of hormonal disorders related to the reproductive system or the function of reproduction we term fertility.  Reproductive Endocrine & Infertility fellows are trained in advanced procedures used through a minimally invasive technique of operative laparoscopy and operative hysteroscopy. Such procedures are more advanced infertility surgeries treating endometriosis, pelvic scarring that causes damage to the fallopian tubes and ovaries leading to infertility and pelvic pain, abnormal formation of the uterus. We have also been trained to reverse tubal ligations (past elective tubal sterilization procedures). However, some of our most high-tech training is in the area of In Vitro Fertilization therapy which has become so successful as to make major tubal reversal surgery far less attractive as a treatment choice for a patient. Almost all the topics in this glossary come under the expertise of the REI specialist.

REPRONEX - Brand name for purified urofollitropin. A natural product containing both human FSH and LH. The hormones are extracted from the urine of post-menopausal women. The drug is used to treat both male and female infertility and to stimulate the development of multiple oocytes. It is administered by either subcutaneous or intramuscular injection.

RESISTANT OVARY SYNDROME- An ovary unresponsive to follicle-stimulating hormone (FSH).  Germ cells will be present in the ovary, but they will not respond to FSH.

RETROGRADE EJACULATION- At the time of ejaculation, the sperm enters the bladder instead of exiting the penis. See Post Ejaculate urine.

RUBELLA TITER - A blood test that determines if the patient is immune to rubella (German measles). If immunity isn’t present, the patient may be advised to have a rubella vaccination, wait 1 month before attempting pregnancy. Such immunization creates a firewall against this nasty virus that can otherwise cross the placenta, infect the fetus leading to deafness, blindness and reduced mental capacity and brain function. Bottom line: get checked and if you’re not immune already,  get immunized!

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SALPINGECTOMY- Removal of the fallopian tube.

SALPINGOLYSIS- Surgical removal of adhesions that restrict the movement and function of the tubes.

SALPINGOSTOMY- Cutting open the fallopian tube that was completely blocked before surgery. It may also refer to cutting open the fallopian tube in the process of removing a tubal ectopic pregnancy.

SCROTUM- The bag of skin and thin muscle surrounding the man’s testicles.

SECONDARY INFERTILITY- The inability to conceive or carry a pregnancy after having conceived in the past irrespective of whether the past pregnancy led to the birth of a child.

SECONDARY SEX CHARACTERISTICS- Beard, hair pattern, genital development, increased muscle mass and deep voice in men.  Breast, genital development and female body hair pattern in women.  Characteristics stimulated by sex hormones (testosterone and estrogen).  These characteristics begin to appear at puberty (onset to sexual maturity).

SEMEN ANALYSIS, COMPLETE - Freshly ejaculated semen is evaluated under microscope to count the number of sperm, the percentage of moving sperm (motility), assess the size and shape of the sperm (morphology).  Also measured are semen (fluid) volume and presence of white blood cells, which might indicate an infection.

SEMEN ANALYSIS, COMPLEX - Semen analysis with addition of extraction of sperm out of the seminal fluids by a one of several methods of washing the sperm. This test provides critical additional information about the amount and quality of sperm recovered. This may determine the next step in fertility treatment. Choices of treatment based on sperm quality and recovery include intrauterine insemination (IUI) and IVF/ICSI. The seminal fluids must be washed away from the sperm prior to intrauterine insemination. If the seminal fluids were placed directly into the uterus during IUI, severe pain and possible severe allergic reaction called anaphylaxis could occur and is life threatening. A complex semen analysis is done while preparing sperm for IUI therapy, which takes about one and a half to two hours to complete. At our Center, a complex semen analysis report is provided for each IUI treatment.

SEMEN LEUCOCYTES- White blood cells in the semen.  Increased numbers have been associated with deficiencies in sperm function and motility, genitourinary infection and/or inflammation.

SEMEN VISCOSITY- Consistency/thickness of semen.

SEMINAL VESICLES- Glands that produce much of the semen volume, plus fructose (sugar) to nourish the sperm.

SEMINIFEROUS TUBULES- The testicular canals where sperm grow to maturity, then move toward the epididymis. The seminiferous tubules are to sperm as shipyards are to boats. At times when men cannot emit sperm through ejaculation, surgery may be necessary to find sperm in these seminiferous tubules, then placed into an egg with IVF therapy leading to having a baby. See MESA and TESA.

SEPTATE UTERUS- A uterus divided into right and left halves by a wall of tissue (septum).  Women with a septate uterus may have an increased chance of early pregnancy loss and more likely of preterm delivery. The outer surface shape of the uterus is round and normal in appearance. This is in contrast to a bicornuate uterus where the outer wall is heart shaped following the shape if the inner cavity of the uterus. Abnormal presentation of a fetus at delivery (e.g. breech position) is more common. Pelvic ultrasound, hysterosonogram and MRI testing may all assist in confirming this diagnosis. Keep in mind not to panic. This condition is often found in women during delivery at term (9 months). We only see the women experiencing a problem with this condition.

SERTOLI (Nurse) CELL- A testicular cell that nurtures the spermatids (immature sperm), which secretes inhibin, a feedback hormone that regulates FSH.  When stimulated by FSH, the Sertoli cell starts spermatogenesis (sperm production).

SHEEHAN’S SYNDROME- A condition caused by low blood pressure or shock at the time of obstetrical delivery. Poor blood circulation and poor delivery of oxygen and nutrients the pituitary gland in the brain, the hormonal airport’s control tower of the body, leads to damage of the pituitary gland. Tissue within the pituitary gland dies and becomes non-functional.  See Pituitary Gland, Panhypopituitarism. Such a condition is critically urgent requiring fast recognition and replenishment of hormones by means of receiving medications.

SONOGRAM  (Ultrasound)- Use of ultra high-frequency low energy sound waves (like sonar) to create an image of internal body parts.  Used to evaluate the size and number of ovarian follicles.  Also used to detect and monitor pregnancy, identify uterine fibroids, pelvic masses such as endometriomas, ovarian cysts and uterine malformations such as a septate or bicornuate uterus. To perform pelvic ultrasound, the ultrasound probe may be applied on the lower abdomen with a full bladder for improved view or it can be placed inside the vaginal with an empty bladder.

SPERM- The male reproductive cell; the microscopic cell that carries the male’s genetic information.  Male gamete.

SPERM AGGLUTINATION- Clumping of sperm caused by antibody reactions or by infection.  This may occur when either the man or woman develops immunity to the sperm.  Can only be seen with a microscope.

SPERM ANTIBODIES (Immunological Response) - Antibodies against sperm cells, which may attack and disable them. These antibodies can be produced either by men against their own sperm particularly after past vasectomies or testicular trauma or by women through their own serum with main exposure by oral ingestion of sperm into the intestinal tract where sperm are then absorbed, processed by intestinal lymph nodes which stimulate antibody production. Sperm antibodies attach themselves to parts of the sperm and inhibit movement and fertilization.   Intrauterine insemination (IUI) is first line therapy followed by IVF/ICSI as second line therapy. Not all sperm antibodies cause infertility. Immunobead Sperm Antibody Testing can be done to see if sperm antibodies directed to critical parts of the sperm are present and are present in high levels to indicate the need for therapy.

SPERM ANTIBODY TESTING- Test that is done to determine if a man's sperm or a woman's blood harbors substances that cause his sperm to clump together, lose motility, or lose the ability to fertilize an egg. The direct immunobead test “directly” tests for the presence of antibodies in the man’s sperm. The indirect immunobead test tests for sperm antibodies in the woman’s blood serum. The direct immunobead test appears to be most predictive of a sperm antibody problem that may cause infertility. The indirect immunobead test for the women poorly predicts infertility. This may be the case because the presence of antibodies in her blood stream does not mean those antibodies will ever come into contact with a sperm during intercourse. In contrast, antibodies found in the man’s semen (direct immunobead) are detecting antibodies that are already attached to the sperm. This is the reason only direct immunobead testing is usually done. There is no method to wash antibodies off of sperm that doesn’t destroy the sperm in the process. The emergence of ICSI with IVF has raised great debate as to whether sperm antibody testing should even be done. If IUI doesn’t work, move to IVF/ICSI and get around the problem.

SPERMATOGENESIS- Sperm production in the testicles.

SPERM BANK-(See Therapeutic Donor Sperm Insemination –TDI) A place where men can choose short or long term storage of their sperm for their own future use or to donate to infertile women. More than one day of semen collection is common. Portions of sperm are placed in a special fluid that reduces freeze-thaw damage to the sperm called a cryoprotectant. The sperm are stored at a very cold temperature with the containers submerged in liquid nitrogen (temperature of liquid nitrogen = -196 °C or = -321 °F). There is some sperm loss in the freeze thaw process, but if the sperm were of good quality going into the freezer, they usually do well coming out of the freezer. There is a very detailed, thorough battery of health screening tests not only for men who wish to store their own sperm, but also for men who wish to serve as anonymous sperm donors. These tests include detailed medical/family/social history, serum and urine testing for communicable diseases such as HIV, hepatitis, etc and drug screening. For intended sperm donors, they of course have to have a normal semen analysis. If they pass the first set of tests, their sperm is stored in quarantine for 6 months, then they give additional blood and urine for testing of the diseases again. Only if all tests continue to be normal is their semen available for purchase and use. They can only be selected for a maximum of about 12 infant delivery successes, then they are retired.  About 10% of men who wish to serve as donors are actually accepted in most sperm bank donor programs. This reflects the rigorous screening process first introduced in 1986 with the recognition of AIDS and delineated by the Food and Drug Administration (FDA) Guidelines and carried forth through the American Association of Bioanalysts (AAB) with processes for quality assurance and quality control that are followed by reputable tissue banks in the United States.
Men may bank sperm for many reasons:

1. A man has a serious disease and will be exposed to radiation or chemotherapy that will destroy his sperm producing cells;
2. Sperm may need to be surgically extracted from the testicle due to a irreparable blockage of the ejaculatory duct or a genetic problem;
3. Male partner may not be available at a critical time of ovulation for his female partner, therefore recent semen can be collected, stored and later thawed for intrauterine; a man chooses to have vasectomy, but wishes to store sperm for future family planning should that be his choice. This will permit him to avoid having surgery to reconnect is vas deferens for future fertility.
4. Men may wish to serve as sperm donors to assist other women desiring family planning goal best served by this approach.

SPERM COUNT- The number of sperm in the ejaculate, and is reported as concentration in millions per ml.  Normal sperm count/concentration is 20 million/ml of seminal fluid as per WHO convention. See Ejaculate.

SPERM MATURATION- The sperm grow and gain their ability to swim.  Sperm take about 72 days to reach maturity.

SPERM MORPHOLOGY- The shape and physical characteristics of normally formed sperm.  Assessment of the acrosome cap, the sperm head, the midpiece and the tail. Abnormal morphology includes sperm with kinked heads, diminished or absent acrosome caps, doubled tails, or coiled tails.  The greater the percentage of abnormally shaped sperm, the less likely fertilization will occur. This semen analysis measure is the most subjective. That is why the normal range is so great at 30% or more normal sperm being a normal test results. One of the most critical observations of morphology is the acrosome cap. This portion of the sperm coats the outer surface of the sperm head and acts like Velcro. It enables the sperm to attach to the egg. The acrosome cap then releases packets of enzymes that begin to soften and dissolve the egg's shell. This assists the sperm in penetrating the egg. Absence of acrosome caps on sperm is a critical problem. Abnormal appearing sperm does not lead to abnormal babies. Assessment of sperm morphology can be done through two conventions: 1) World Health Organization (WHO) criteria: normal is 30% or greater normal forms; 2) Krueger’s strict criteria: normal is 4% or greater. Either convention is acceptable. As consumers of healthcare, please be cautious of having confidence in laboratories and results not following one of these two conventions.

SPERM MOTILITY- The ability of sperm to swim. Normal sperm motility should be 50% or greater as per WHO convention. Motility at 40% or less is a likely contributing cause of infertility.

SPERM PENETRATION- The ability of the sperm to penetrate an egg.

SPERM PENETRATION ASSAY (HAMSTER EGG TEST)- This test is performed in the following way: The outer shell of a hamster egg is removed exposing the inner hamster egg surface. The patient has collected sperm, which is placed in the same container as the hamster egg. If 20% or more of the male partner’s sperm attach to the hamster egg, the test is normal.  Some physicians and scientists believe this test can predict the success of human sperm fertilizing a human egg.  The benefits of performing this test are uncertain and controversial at this time. This test was used most frequently in the 1980s and early 1990s. Few centers around the world perform this test any more. With the introduction of ICSI for IVF therapy in 1992, the need for this test or any test that mixes different species’ cells in an attempt to arrive at a conclusion applied to the human condition has become much less compelling.

SPERM WASH - Technique for separating sperm from seminal fluid.  Sperm washing concentrates the more active, normally formed sperm into a small volume of fluid that can be contained within the uterine cavity. The sperm are analyzed to determine sperm quality recovered. It is a method used in fertility therapy with intrauterine insemination and IVF. See Complex Semen Analysis.

SPINNBARKEIT- The stretchiness of cervical mucus that occurs at mid-cycle under the influence of estrogen.  See Post Coital Test and Cervical Mucus. The greater the length of stretch, the more fertile the time of the female partner.

SPLIT EJACULATE - A method of collecting a semen specimen so that the first portion of the ejaculate is caught in one container and the rest is captured in a second container. In most men, the first specimen will contain the vast majority of the sperm. The first portion can then be used to inseminate the eggs.  It is a method of separating the best sperm for insemination.

STEIN-LEVENTHAL SYNDROME- Polycystic ovaries with androgen-excess symptoms.  See Polycystic Ovary Syndrome (PCOS).

STERILITY- The total inability to reproduce. Not to be confused with infertility.

STILLBIRTH- The death of a fetus after the twentieth week of gestation.

STIMULATION- Administration of hormones, which induce development of multiple ovarian follicles.

SUPEROVULATION- Stimulation of multiple follicles with fertility drugs; see Controlled Ovarian Hyperstimulation.

SURROGATE MOTHER- A woman who is artificially inseminated and carries a baby conceived with her own egg and who at childbirth will be give the baby up raised by its genetic father and his partner.

SWIM-UP TEST- This technique is a method of sperm washing that separates motile sperm form non-motile sperm and cellular debris in a semen sample. The most motile sperm will "swim-up" in a small volume of media so they can be more easily separated for insemination.

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TAMOXIFEN- A fertility drug that stimulates ovulation by the ovaries and may improve sperm production in the testicle. This drug is a cousin to clomiphene. It is a synthetic compound designed to attach to estrogen receptors, thus not permitting estrogen to attach to these receptors and blocking estrogen’s work. This drug was first used to treat breast cancer that grows due to the cancer containing estrogen receptors. Block the receptors, estrogen can’t stimulate tumor growth and the tumors shrink. At the level of the brain though, Tamoxifen fools the brain into perceiving low estrogen. The brain then increases release of FSH (Follicle Stimulating Hormone) from the brain. The increased FSH into the bloodstream travels to the ovary or testicles and stimulates the follicles and egg(s) within the follicles to develop in at least one ovary.  Ovulation usually follows. Likewise, sperm production may be promoted.

TESTICLE- The two male sexual glands contained in the scrotum. They produce the male hormone, testosterone, and produce the male reproductive cells, sperm.  See Testosterone.

TESTICULAR BIOPSY- A small surgical excision of testicular tissue to determine ability to produce normal sperm.

TESA- Testicular sperm aspiration.  Biopsy sample of tissue containing sperm.  The sperm are used for in vitro fertilization.  This is a male factor infertility treatment for men who do not produce sperm in their ejaculate and if no sperm can be found in the epididymis (through MESA surgical procedure). The testicle tissue containing the sperm can be cryopreserved (frozen) and stored for future use at a time his female partner will undergo egg collection for in vitro fertilization (IVF). Intracytoplasmic sperm injection (ICSI) is required due to the low number of sperm. Intrauterine insemination is not possible with this type of sperm collection.

TESTICULAR FAILURE- Primary: A congenital, developmental or genetic error resulting in a testicular malformation that prevents sperm production.  Secondary: Acquired testicular damage, for example, from drugs, prolonged exposure to toxic substances, or a varicocele.  See Varicocele.

TESTICULAR STRESS PATTERN- A semen analysis result showing decreased sperm count, poor sperm motility and morphology.   See Semen Analysis.

TESTOSTERONE- The male hormone responsible for the formation of secondary sex characteristics and for supporting the sex drive.  Testosterone is also necessary for spermatogenesis.

THERAPEUTIC DONOR SPERM INSEMINATION (TDI)- We support family planning care to our patients requesting anonymous and known donor sperm insemination therapy irrespective of sexual orientation or presence of a life partner. Specifically:

1. Heterosexual couples;
2. Lesbian couples;
3. Single women.

See Intrauterine Insemination, Donor Insemination, Sperm Bank.

THYROID GLAND- The endocrine gland in the front of the neck that produces thyroid hormones to regulate the body’s metabolism.  See Hypothyroidism, Hyperthyroidism.

TORSION- Torsion means “twist.”  The twisting of the testis inside the scrotum will cause extreme pain and swelling.  The rotation twists off the blood supply and causes severe damage to the testicle.  Torsion of the ovary may occur in a woman experiencing hyperstimulation—a complication of ovulation induction treatment. A man and a woman with torsion of their gonad are at risk of losing the gonad. This is a surgical emergency.

TSH- Thyroid Stimulating Hormone is released by the pituitary gland to increase thyroid hormone production.  TSH results can reveal whether thyroid function is normal, which is necessary for normal ovulation.

TUBAL EMBRYO TRANSFER (TET) - The ovum is fertilized in vitro, allowed to grow in culture for 2-3 days and transferred to the fallopian tube. This can be done only in women with at least one normal tube. General anesthesia and laparoscopy are required to perform this procedure. This procedure was introduced in the late-1980s and had advantages for about a decade. With the improvement of IVF laboratory technology, this procedure along with ZIFT and GIFT provide no advantage over IVF therapy. The only exception is if a woman has an abnormal uterine cervix not allowing an embryo to be transferred through the cervix into the uterus. Then the only access for the embryo is through the fallopian tube. Some women are born without a cervix or have scarring of the cervix making TET a consideration. This procedure is currently preformed in less than   1% of IVF cases worldwide. See GIFT, ZIFT.

TUBOCORNUAL ANASTOMOSIS- Surgery performed to remove a blocked portion of the fallopian tube and to reconnect the tube to the uterus.  Tubouterine implantation may also be performed to remove fallopian tube blockage near the uterus and reimplant the tube in the uterus. This procedure is performed far less often because of the ready minimal invasiveness, availability and high success of IVF treatment. IVF therapy offers excellent success without requiring the women to undergo general anesthesia and major abdominal surgery for anastomosis.

TUBOTUBAL ANASTOMOSIS- Surgery performed to remove a diseased portion of fallopian tube and reconnect the two ends.  Can also be done for sterilization reversal for those who have had their “tubes tied.” This procedure is performed far less often because of the ready availability of IVF treatment. IVF therapy offers excellent success without requiring the women to undergo general anesthesia and major abdominal surgery for this tubal surgery.

TUBOVARIAN ABSCESS- is a pocket of infection and puss that forms involving the ovaries and fallopian tubes. This can cause severe pain. Hospitalization with intravenous antibiotics may be required. Should a woman not improve with antibiotic therapy, surgical removal of one or both tubes and sometimes the one or both ovaries is done as a lifesaving measure. See PID.

TURNER’S SYNDROME- The most common genetic defect contributing to female fertility problems.  The ovaries fail to form and appear as slender threads of atrophic ovarian tissue, referred to as “streak ovaries.”  Karyotyping will reveal that this woman has only one female (X) chromosome instead of two. (46, XO Karyotype)

TWO PRONUCLEAR STAGE EMBRYO- Normally, when fertilization occurs, a sperm penetrates an egg resulting in a two-pronuclear stage (2PN-one cell) embryo also known as a zygote. Each pronucleus represents a nucleus from the egg and the other from the sperm. Shortly after this stage, the nuclei combine, the genes fuse and an embryo is formed.

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ULTRASOUND- See Sonogram or Vaginal Ultrasound.

UNDESCENDED TESTICLES (Cryptorchidism)- The failure of the testicles to descend from the abdominal cavity into the scrotum by one year of age.  If not repaired by age six, it may result in permanent infertility because the testicles are kept too warm within the abdominal cavity; sperm require 1 degree below core body temperature, which is why the testicles need to be within the scrotum. If an undescended testicle is left in place and not surgically removed before puberty, a man has a 25% risk of testicular cancer forming in that testicle. Therefore, such testicles are removed if they cannot be surgically brought into the scrotal sac during infancy.

UNICORNUATE UTERUS- An abnormality in the formation of the uterus from birth. Normally during fetal development, the uterus forms by the connection or fusion of two tubes resting side by side- left and right. The common wall of the two tubes is then resorbed leaving a hollow cavity between the outer walls of both tubes. In the case of a unicornuate uterus, one of the tubes never formed. Therefore the uterus is made up of only one tube. The cavity of the uterus tends to be slightly smaller than the normal uterine cavity and there is only one fallopian tube. The woman still has two ovaries.  The condition of a unicornuate uterus has not been a clear cause of infertility. There is a risk of preterm labor. A woman’s urinary tract from the kidney to the bladder forms in close connection to the reproductive tract: the fallopian tubes, uterus, cervix and vagina. This close relationship in development of the urinary tract and the genital tract is important. If a woman is missing one side of her reproductive tract, as is the case with a unicornuate uterus, then there is a 15% risk of major urinary tract abnormalities such as a missing kidney on the same side as the missing uterine tube and a 40% risk of minor urinary tract abnormalities. Therefore if a woman is diagnosed with a unicornuate uterus, she should undergo testing of her urinary tract. The same holds for the reverse situation. If a major abnormality of the urinary tract is first found, a woman’s internal genital tract should be evaluated.

UREAPLASMA- A bacteria that has been implicated in the cause of miscarriage. A clear cause effect relationship with miscarriage has not been scientifically proven. About 40% of all women have ureaplasma as part of the natural bacteria that resides in the vagina. Since these women who carry the bacteria are not necessarily the women that experience miscarriage or even have fertility problems, the role of this bacteria in infertility is not clear. See Mycoplasma.

URETHRA- The tube that allows urine to pass from the bladder to the outside of the body.  In the man, this tube also carries semen from the area of the prostate to the head of the penis.

UROLOGIST- A physician specializing in the genitourinary tract.  This specialist is often needed for physical evaluation and treatment of male infertility issues.

UTERINE ARTERY EMBOLIZATION (UAE) -  also called Uterine Fibroid Embolization (UFE), is an experimental surgery currently being promoted as an alternative to hysterectomy or myomectomy as a treatment for uterine fibroids. This surgery uses a technique called embolization: a mass of microspheres (tris-acryl gelatin) or polyvinyl alcohol (PVA) material (an embolus) is injected into the uterine arteries in order to block the flow of blood through those vessels. The microsphere gelatin or PVA remains permanently in the uterine arteries. UAE attempts to shrink fibroids by cutting off their blood supply.For women desiring future fertility, the risks to the strength, elasticity and ability for the uterus to support a pregnancy to term with labor and delivery is unknown. Bottom line: If you have a fibroid uterus and fertility is in your future, this procedure should not be done.

UTERINE LINING- See endometrium.

UTERUS- Female reproductive organ in which a fertilized egg is implanted and develops during the course of a pregnancy; also known as a womb.

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VAGINA- The canal leading from the external genital orifice of the uterus.  It admits the penis during sexual intercourse, and is the birth canal down, which the fetus passes during delivery.

VAGINAL ULTRASOUND - Visualization of soft tissue by projecting sound waves through a probe, which is inserted into the vagina. A baseline ultrasound shows the ovaries and uterus within the first three days after the start of her menstrual cycle.  A follicular ultrasound shows ovary follicle maturation and is used for ovulation induction monitoring. A pregnancy ultrasound shows if a pregnancy is intrauterine or tubal and measures growth of the embryo or fetus.

VAGINISMUS- Spasmodic contraction of the entrance to the vagina during attempted intercourse, thus preventing the entrance of the penis.  It is usually of psychological origin, although it may be due to inflammation of the vagina (vestibulitis), causing a reflex contraction.  Treatment can be done with psychotherapy directed relaxation routines and use of vaginal dilators in advance of infertility treatments. Vestibulitis may be treated surgically.

VAGINITIS- Yeast, bacterial vaginosis, or trichomonas infections of the vagina.  Frequent vaginitis may indicate the presence of pelvic adhesions and tubal blockage from other infections, such as chlamydia.  Vaginitis may interfere with sperm penetration of the cervical mucus, and the symptoms may even interfere with the ability and desire for the woman to have intercourse.

VARICOCELE - A collection of varicose veins in the scrotum.

Here is the theory:

1. Blood flows in a sluggish, slow manner through these veins in leaving the testicles.  The resulting enlarged vessels surrounding the testicles create a pool of stagnant blood, which elevates scrotal temperature. Similar to poor coolant circulation through a car’s radiator. The elevated temperature may reduce sperm production and sperm quality.
2. The backpressure of blood into the testicle tissue may also compress the stem cells reducing sperm production. Similar to a bedridden person develop skin sores due to pressure from the bed. This can progress to cause permanent damage of the testicles. This may be a cause of male infertility.

Here is the reality:

1. Left sided varicoceles are very common because the veins have their longest return to the right side of the body. A varicocele without an enlarged, boggy testicle is unlikely to be hurting sperm production. A varicocele with very small, hard testicles means the destruction to the testicle is too far advanced to rely on surgical removal of a varicose vein to deal with irreversible damage and loss off sperm producing cells. The loss of these cells accounts for the shrinking in size/volume of the testicles.
2. Most medical studies examine the results of varicocele surgery with the end measure being sperm count or movement rather than the most important measure: did his partner become pregnant? The studies require waiting several years to see if a difference can be seen. How long do we wait for the female partner’s biologic clock to tick before alternative action is taken?
3. In this day and age with the advent of IVF/ICSI as a major boon for male factor infertility, this is the treatment of choice. I only recommend varicocele surgery for scrotal pain, really soft/boggy testes with large varicoceles. Varicocele surgery is not without risks and complications either.
4. Bottom Line: Choose IVF/ICSI and bypass varicocele surgery or hormone therapy for male factor infertility unless a clear male hormone deficit can be replaced returning the testicle to normal sperm production form. If hormone levels for men are normal, then hormone therapy and dietary supplements such as Proxeed which is heavily marketed to physicians and patients underneath the radar of the FDA  are unproven to improve your chance of having a baby any different than random chance (that’s not a coin toss).

VARICOCELECTOMY- Repair of a varicocele is termed either a varicocelectomy or ligation of internal spermatic veins. See varicocele.

VAS DEFERENS- One of the tubes through which the sperm move from the testicles (epididymis) toward the seminal vesicles and prostate gland.  These tubes are severed during a vasectomy performed for birth control. Congenital absence of the vas deference has been strongly associated with carrying the cystic fibrosis gene.

VENEREAL DISEASE- Any infection that can be sexually transmitted, such as chlamydia, gonorrhea, ureaplasma and syphilis.  Many of these diseases will interfere with fertility and some will cause severe disease.  See Pelvic Inflammatory Disease (PID).

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X CHROMOSOME- The genetic material that transmits the information necessary to make a female.  Women’s chromosomes are all X; therefore, all eggs contain one X chromosome. Half of all sperm also carry an X chromosome.  When two X-chromosomes combine, the baby will be a girl.

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Y CHROMOSOME- The genetic material that transmits the information necessary to make a male, exclusively found in men. Men’s chromosomes are half Y and half X. When an X and a Y chromosome combine, the baby will be a boy.

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ZONA PELLUCIDA- The outer covering of the egg/embryo.

ZYGOTE- An embryo in the early stages of development.  A fertilized egg that has not yet divided.

ZYGOTE INTRAFALLOPIAN TRANSFER (ZIFT) - The ovum is fertilized in vitro and transferred to the fallopian tube before it divides. This can be done only in women with at least one normal tube. Embryo formation and development is not known to have occurred unless the woman becomes pregnant. General anesthesia and laparoscopy are required to perform this procedure. This procedure was introduced in the mid-1980s and had advantages for about a decade. With the improvement of IVF laboratory technology, this procedure along with GIFT provide no advantage over IVF therapy. This procedure is currently preformed in less than   1% of IVF cases worldwide. See GIFT.