Pregnancy loss before 20 weeks of gestation.
Scar tissue that abnormally attaches to internal organs, such as the fallopian tubes, ovaries, bladder and uterus. Adhesions can wrap up or distort these organs, limiting their movement or function and cause infertility and pain.
A procedure done from 16 weeks of gestation onwards that can detect many fetal abnormalities. It is performed by sampling a small quantity of the amniotic fluid that surrounds the fetus with a needle under ultrasound guidance.
The removal of fluid and cells by suction through a needle. This technique applies to some procedures in reproductive medicine.
ASSISTED HATCHING (AH)
A procedure that creates a small opening in the “shell” that surrounds every embryo. This assists the embryo in breaking out of this shell and extruding itself to implant in the uterine lining. This is done my embryologists in the laboratory prior to embryo transfer in IVF cycles.
BASAL BODY TEMPERATURE (BBT)
The body temperature at rest taken orally in the morning before arising from bed. Successive BBT’s can be measured each morning and recorded on a calendar chart. These charts can be studied to help identify the time of ovulation (or even if a woman is ovulating at all). Menstrual calendar information is also an important part of a BBT chart. An ovulation predictor kit can be used instead of daily temperature readings.
see Human Chrorionic Gonadotropin (hCG)
The process that sperm must undergo in order to fertilize an oocyte (egg).
CERVICAL FACTOR INFERTILITY
Infertility due to a structural or hormonal abnormality of the cervix. This can be induced by previous surgery on the cervix (such as a LETTZ or cone procedures) that leaves the cervical canal scarred or closed, termed stenosis. Also applied when there are factors associated with the cervix which inhibit sperm function such as thickened mucus which prevents the sperm from traveling through the cervix into the female reproductive tract. Cervical factor infertility can usually be overcome using inseminations of sperm past the cervix in to the uterus.
Normal secretions of the cervix which change in volume and consistency throughout the menstrual cycle.
The lower section of the uterus which protrudes into the vagina and serves as a reservoir for sperm. Its anatomical functions include being a natural barrier to the inner uterus, and also keeping pregnancies from delivering prematurely.
CHEMICAL (OR BIOCHEMICAL) PREGNANCY
A pregnancy where there is a positive pregnancy test, but the levels of βhCG are too low for ultrasound documentation of a pregnancy. Typically this definition refers to pregnancies that have low βhCG levels that spontaneously decline and end up as abortions.
The division of one cell into 2, 2 into 4, 4 into 8, etc. This is observed in the embryology laboratory during IVF cycles.
A pregnancy in which there is ultrasound documentation of a pregnancy in the form of a beating fetal heart.
CLOMIPHENE CITRATE (e.g. Clomid)
An oral medication used to stimulate the ovaries and/or synchronize follicle development.
A non-hereditary characteristic or defect developed before birth. This can be a very minor irregularity, such as curvature of the second toe so it overlaps the third toe or it can be a more major anomaly such as a heart defect.
It forms from the ovulated follicle in the ovary and it produces progesterone during the second half of the menstrual cycle, which is necessary to prepare the uterine lining for implantation. It also supports early pregnancies by secreting the necessary hormones until the placenta becomes fully functional between 8-10 weeks of gestation.
Controlled freezing and storage. This may be employed for sperm, embryos and oocytes (eggs).
A fluid filled structure. Cysts may be found anywhere in the body, but in reproductive medicine we primarily refer to them in the ovaries. Ovarian cysts may be normal or abnormal depending on the circumstances. Often they are just follicles that have not been fully reabsorbed from previous menstrual or treatment cycles. They are very common in both natural and stimulated cycles.
DUCTUS DEFERENS (VAS)
A thick-walled tubular structure running from each testis into the ejaculatory duct. These structures carry sperm from the testicles to the epididymis to the penis for ejaculation. The vas deferens can be scarred or damaged by surgery, trauma or infection to the point where it does not allow sperm to pass through.
A pregnancy implanted outside the cavity of the womb; most often in the fallopian tube. This is also termed a tubal pregnancy. This can usually be diagnosed in its early stages by following the pregnancy hormone, βHCG, very closely during the early part of pregnancy. Left undiagnosed and untreated, an ectopic pregnancy can have serious medical consequences.
The procedure during an IVF cycle where the oocytes (eggs) are harvested through a minimally-invasive surgical procedure. This is done under light anesthesia so that the women are sleeping during the entire process. Typically takes about 30 minutes total.
The term used to describe the early stages of fetal growth. Strictly defined from the second to the ninth week of pregnancy, but often used to designate any time after conception.
The procedure of transferring embryos back into the endometrial cavity (womb) of a woman during an IVF cycle. It occurs on the third or fifth day after an egg retrieval or on the appropriate day of a ‘frozen’ cycle.
The extraction of a small piece of tissue from the endometrium (lining of the womb) for microscopic examination.
The space inside the womb that is created by its inner lining.
The presence of endometrial tissue (tissue that normally lines the womb) in abnormal locations such as the ovaries, fallopian tubes and abdominal cavity. These lesions lead to local irritation and inflammation that can cause scarring to occur which can bind-up pelvic organs to the point of dysfunction and pain.
The inner lining of the womb that responds to female hormones during the menstrual cycle and treatment cycles. This lining, when properly prepared, forms the area of attachment and implantation of the embryo. A portion of this lining is shed each month with menstruation.
The portion of the male genital tract next to the testis where sperm maturation is partially accomplished. Receives sperm from the testis and continues as the ductus (vas) deferens.
ESTRADIOL (OR OESTRADIOL)
The principal hormone produced by the growing ovarian follicle. It is frequently measured in the blood to gauge the strength and development of the follicles during treatment cycles.
The anatomic and physiologic connection between the uterus and the ovary which serves to transport the oocyte (egg) and sperm. It is also the site of fertilization and supports and transports the early-stage-embryo towards the endometrial cavity.
Union of a sperm with an oocyte (egg) to facilitate creation of a genetically unique embryo.
Benign overgrowth of the muscular tissue of the uterus. Fibroids are typically knotty masses of benign muscle tissue that can distort the shape and function of the uterus. They are typically classified into three categories: sub-mucosal, intramural and serosal. Sub-mucosal fibroids are found in the uterine cavity and impair implantation. They need to be removed in order to conceive. Intramural fibroids are problematic when they become severely enlarged or impinge on the uterine cavity. Sub-serosal fibroids generally are left alone during fertility treatments.
The soft and supple finger-like extensions of the fallopian tube that aid in gathering in the oocyte (egg) at ovulation.
A fluid-filled pocket in the ovary that houses the microscopic egg. Each ovary has many follicles within it. Follicles start out extremely small and then grow larger under the influence of hormones (and the medications that mimic these hormones). Follicles are lined with granulosa cells which produce estrogen and nourish the oocyte (egg). Each follicle contains a single oocyte.
FOLLICLE STIMULATING HORMONE (FSH)
A hormone produced by the pituitary gland in the brain that stimulates the ovarian follicles to grow and develop. FSH is measured in the blood at specialized times during the menstrual cycle to help assess ovarian reserve.
The menstrual cycle is divided up into two main parts- the follicular phase and the luteal phase. The follicular phase refers to the first half of the cycle, from onset of menses to ovulation and lasts approximately 14 days. It is associated with developing follicles that produce estradiol.
GAMETE INTRA-FALLOPIAN TUBE TRANSFER (GIFT)
An older method of assisted conception that involves surgically removing an egg from the ovary, combining it with sperm, and immediately surgically placing the egg and sperm into the fallopian tube. Fertilization then takes place inside the tube.
Hormones that stimulate the ovary.
GONADOTROPIN RELEASING HORMONE (GnRH)
A hormone produced by the hypothalamus in the brain that stimulates the pituitary gland to secrete gonadotropins.
HUMAN CHORIONIC GONADOTROPIN (hCG)
A hormone of early pregnancy that is monitored to determine viability of the gestation. This hormone is also used as an injection to induce ovulation and maturation of the oocyte (egg) in ovarian stimulation protocols.
HUMAN MENOPAUSAL GONADOTROPIN (hMG)
A purified extract of LH and FSH, the hormones secreted by the pituitary gland to stimulate the ovary. It is administered by injection to facilitate development of multiple follicles in treatment cycles.
A portion of the brain that stimulates the pituitary gland to secrete LH and FSH in order to stimulate ovarian follicle development. The hypothalamus acts as the “pacemaker” for many important hormone-driven processes, controlling the production and periodic release of hormones from the pituitary gland.
An x-ray procedure to examine whether the fallopian tubes are patent (open) or not. This test helps determine if the tubes are blocking sperm from reaching the ovulated eggs waiting inside the fallopian tubes. Special x-ray dye is gently injected through the uterus and then x-ray pictures are taken to see where the dye travels uninterrupted.
Minimally invasive surgery in which a small telescopic camera, much like a laparoscope, is placed through the cervical canal into the uterine cavity. This allows direct visualization of the endometrium where an embryo implants. This surgical technique is minimally-invasive, well-tolerated and can be performed in a day-surgery center. It allows removal of any impediments to implantation such as polyps or fibroids in the uterine cavity.
The attachment and embedding of the conceptus (embryo) into the lining of the uterus.
IN VITRO FERTILIZATION (IVF)
A powerful procedure to help women conceive. IVF entails stimulating the ovaries to develop multiple follicles -this is achieved most commonly with injectable medications. The goal of IVF is to produce a large number of growing follicles, then harvest the eggs inside the follicles through a short surgical procedure named egg retrieval. The eggs are then inseminated with sperm in the laboratory, sometimes using ICSI, in order to create embryos that can then be transferred back to the endometrial cavity (the womb) of the woman. The name in vitro fertilization refers to the fact that the oocyte (egg) is fertilized by the sperm in the laboratory, rather than inside the female reproductive tract.
INTRA-UTERINE INSEMINATION (IUI)
A technique that transfers sperm directly into the uterus. It bypasses the vaginal and cervical defense mechanisms of the female reproductive tract and allows better sperm delivery to the fallopian tubes. This allows the sperm and egg to interact in close proximity. It is a very common treatment for mild and moderate deficits in the semen analysis. IUI is typically used in conjunction with medications that increase the number of eggs per cycle and triggering of ovulation. The goal is to have more ‘targets’ (eggs) for the sperm, perfect timing and better sperm delivery.
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
The placement of a single sperm inside a single oocyte (egg) by penetrating the outer coatings of the egg. This technique is used in cases where sperm concentration/motility/morphology is significantly affected. ICSI is also used for patients who have had previous IVF cycles with failed fertilization.
A thin, lighted viewing instrument with a telescopic lens through which a surgeon views the exterior surfaces of a female’s reproductive organs and abdominal cavity. In this minimally invasive procedure, the laparoscope is placed through the belly-button in order to view and operate inside the abdominal cavity on the reproductive organs. This surgical technique is minimally-invasive, well-tolerated and it allows your physician to diagnose and remove endometriosis, amongst many other indications.
The menstrual cycle is divided up into two main parts- the follicular phase and the luteal phase. This refers to the second half of the cycle, usually the last fourteen days. It begins from the time of ovulation to the onset of menses. It is associated with progesterone production from the corpus luteum that facilitates implantation of embryos
LUTEAL PHASE DEFICIENCY (LPD)
Also called luteal phase defect. A deficiency of progesterone in the second half of the menstrual cycle when a pregnancy begins. Treatment involves supplementation with progesterone and other measures.
LUTEINIZING HORMONE (LH)
A hormone produced and released by the pituitary gland. In the female it is responsible for ovulation and the maintenance of the corpus luteum. In the male it stimulates testosterone production and is important in the production of sperm cells.
A “period”. Cyclic (monthly) flow of blood (menstruation) signifying ovulation, but failure to achieve pregnancy. Onset of bleeding is considered cycle day 1. The purpose of a natural menstrual cycle is to produce one follicle available for fertilization each month.
The female germ cell often called an egg.
The female sex gland with both a reproductive function (release of eggs) and a hormonal function (production of estrogen and progesterone).
The release of a mature egg from the surface of the ovary.
OVUM (or egg)
The mature oocyte.
A small organ at the base of the brain that secretes many hormones, including LH and FSH, in response to signals from the hypothalamus.
POLYCYSTIC OVARIAN SYNDROME (PCOS)
A common endocrinologic condition that causes hormonal imbalances in women of reproductive age. It can lead to dysfunctional ovulation and infertility, weight gain, pre-diabetes and an increase in the male hormone, testosterone.
An overgrowth of the glandular surface of the endometrium. Polyps are often resected by hysteroscopic surgery to remove any impediments to implantation.
POST-COITAL TEST (PCT)
The microscopic analysis of a sample of vaginal and cervical secretions that has been collected after sexual intercourse. This test allows your physician to see if sperm survive in your reproductive tract. It has largely been replaced by the semen analysis.
PRE-IMPLANTATION GENETIC TESTING (PGT)
A technique for identifying genetic or chromosomal information about embryos before transferring them back to a patient’s endometrial cavity (the womb). It entails taking a biopsy of the embryo on day three or on day 5 after egg retrieval. PGD can be employed to identify embryos that carry a genetic disease that may be asymptomatically carried by the parents or it may be used to improve pregnancy outcomes in selected women.
A hormone produced by the ovary which prepares the uterus for implantation and supports the early pregnancy.
The examination of the male ejaculate under the microscope to determine -amongst others- the number of sperm, their ability to move forward (motility) and their shape (morphology). The semen analysis is one of the cornerstones of the evaluation of couples experiencing infertility. The sperm counts, motility and morphology all provide important information about how the sperm will perform in treatment cycles.
Single Embryo Transfer (SET) or Elective Single Embryos Transfer (eSET)
A specific definition of only transferring a single embryo at the culmination of an IVF cycle. This is appropriate only for some women and it is different from the conventional practice of transferring more than one embryo. Traditional embryo transfer strategies include the idea of transferring as many embryos as is deemed safe for each individual woman. Traditional strategies expose women to the possibility of having more than one baby, such as twins or more.
TESTICULAR/EPIDIDYMAL SPERM ASPIRATION (TESA)
The surgical removal of sperm directly from the testis or the epididymis using a needle for aspiration. This procedure is used for men who have no sperm in their ejaculates or have had vasectomies in the past. Sperm obtained through TESE requires ICSI to ensure fertilization of the oocyte (egg).
Through the vagina.
The lack of obstruction of the fallopian tubes.
High frequency sound waves that can be used painlessly, safely and without radiation, to view the internal portions of the body. Ultrasound is especially useful for visualizing the female reproductive organs and pregnancies.
The inability to identify the cause of infertility despite a complete evaluation of semen, ovarian reserve, ovulation, endocrinologic disorders and pelvic anatomy. It can occur in up to 15% of cases.
The womb. The reproductive organ that houses, protects and nourishes the developing embryo and fetus. It consists of the cervix, the endometrium and the muscular layer that comprises the body of this reproductive organ.
A varicose vein around the ductus (vas) deferens and the testis. This may be a cause of low sperm counts, motility and morphology and may lead to male subfertility.
The first cell of the fetus after the egg and sperm have united.