Glossary of Terms
Adhesion: Scar tissue that abnormally attaches to internal organs, such as the fallopian tubes, ovaries, bladder, uterus or other internal organs. Adhesions can wrap up or distort these organs, limiting their movement, function and cause infertility and pain.
American Society of Reproductive Medicine(ASRM): (formerly the American Fertility Society or AFS) Large multidisciplinary patient and physician organization serving as a platform for new ideas, education and advocacy in fertility and reproductive medicine issues. ASRM is a leading advocate for patient care, research and education.
Amniocentesis: A procedure done in the second trimester of pregnancy 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.
Aspiration: Removal of fluid and cells by suction through a needle. This technique applies to many procedures in reproductive medicine.
Assisted Hatching (AH): Placing 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 endometrium. This is done my embryologists in the laboratory prior to embryo transfer in IVF cycles.
Assisted Reproductive Technologies(ART): A group of fertility therapies that employ manipulations of the oocyte (egg) and sperm in the laboratory in order to establish a pregnancy. These include IVF, ICSI, donor egg cycles, assisted hatching, preimplantation genetic diagnosis (PGD) and others.
Basal Body Temperature (BBT): The body temperature at rest taken in the morning before arising from bed. Successive BBT’s can be measured orally each morning and recorded on a calendar chart. These charts can be studied to help identify the time of ovulation, or even if a patient is ovulating at all. Menstrual calendar information is also an important part of a BBT chart. An ovulation predictor kit (OPK) can be used instead of daily temperature readings.
beta HCG: see Human Chrorionic Gonadotropin (hCG).
Capacitation: The process that sperm must undergo in order to fertilize an oocyte (egg).
Cervical Factor: Infertility due to a structural or hormonal abnormality of the cervix. This can be induced by previous surgery on the cervix (such as a LEEP 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.
Cervical Mucus: Normal secretions of the cervix which change in volume and consistency throughout the menstrual cycle. Its quality is a reflection of hormonal stimulation.
Cervix: 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 Pregnancy: A positive pregnancy test, but with levels of pregnancy hormone (beta hCG) too low for ultrasound documentation of a pregnancy. Typically this definition includes pregnancies that have low beta hCG levels that spontaneously decline without any further development.
Cleavage: Division of one cell into 2, 2 into 4, 4 into 8, etc. This is measured in the embryology laboratory during IVF cycles.
Clinical Pregnancy: A pregnancy in which the beating fetal heart has been identified by ultrasound.
Clomiphene Citrate (Clomid TM or Serophene TM): An oral medication used to stimulate the ovaries and/or synchronize follicle development.
Congenital Anomaly: A non-hereditary characteristic, or defect, developed before birth. These can include very minor irregularities, such as curvature of the second toe so it overlaps the third toe, or can be a more major anomaly such as a heart defect.
Corpus Luteum: A special gland that forms from the ovulated follicle in the ovary. 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.
Cumulus: The cloud-like collection of supportive follicle cells that surround the oocyte (egg).
Cryopreservation: Controlled freezing and storage. This may be employed for sperm, embryos and oocytes (eggs).
Cyst: 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.
Donor Egg Cycle: The use of donated eggs from an anonymous or known donor. These eggs are harvested via an IVF cycle performed on the donor. The resultant eggs are inseminated with sperm and then form embryos which are transferred into the womb of the intended parent.
Donor Embryo Transfer: The transfer of embryos resulting from the oocyte (egg) and sperm of another patient, who may be anonymous or known, to an otherwise infertile recipient
Donor Insemination: The introduction of sperm from an anonymous volunteer donor into the vagina, cervix, or uterine cavity in order to achieve a pregnancy.
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.
Ectopic Pregnancy: A pregnancy implanted outside the uterus; 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, beta HCG, very closely during the early part of pregnancy. Left undiagnosed and untreated, an ectopic pregnancy can have serious medical consequences.
Egg Retrieval: 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 patients are sleeping during the entire process. Typically takes about 30 minutes total.
Embryo: 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.
Embryo Transfer: The procedure of transferring embryos back in to the endometrial cavity (womb) of a patient during an IVF cycle. It occurs on the third or fifth day after an egg retrieval.
Endocrinology: The study of hormones, their function, the organs that produce them and how they are produced.
Endometrial biopsy: The extraction of a small piece of tissue from the endometrium (lining of the uterus) for microscopic examination.
Endometrial Cavity: The space in side the uterus that is created by the inner lining of the uterus that responds to female hormones during the menstrual and treatment cycles. This lining, when properly prepared, forms the area of attachment and implantation of the embryo. Commonly referred to as the womb.
Endometriosis: The presence of endometrial tissue (tissue that normally lines the uterus) 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. Click here for more in depth information.
Endometrium: The inner lining of the uterus 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.
Epididymis: 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: The principal hormone produced by the growing ovarian follicle. It is frequently measured in the blood to gauge the strength and development of your follicles during treatment cycles.
Fallopian Tube: 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 conceptus in route to the uterus.
Fertilization: Union of a sperm with an oocyte (egg) to facilitate creation of a genetically unique embryo.
Fibroids: 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 in to 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.
Fimbria: The soft and supple finger-like extensions of the fallopian tube that aid in gathering in the oocyte (egg) at ovulation.
Follicle: 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 measure ovarian reserve.
Follicular Phase: 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 fertilization 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 takes place inside the fallopian tube.
Gestation: Pregnancy. Gonadotropin: Hormones that stimulate the ovary.
Gonadotropin Releasing Hormone (GnRH): Hormone produced by the hypothalamus in the brain that stimulates the pituitary gland to secrete gonadotropins.
Hamster Test: see Sperm Penetration Assay
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 a commercial preparation used by injection to facilitate development of multiple follicles in treatment cycles.
Humegon(TM): see human menopausal gonadotropin
Hypothalamus: 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.
Hysterosalpingogram (HSG): 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 through 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.
Hysteroscope/Hysteroscopic surgery: 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, the lining of the uterine cavity (the womb) – where pregnancies implant. This surgical technique is minimally-invasive, well-tolerated and performed in a day-surgery center. It allows removal of any impediments to implantation such as polyps or fibroids in the uterine cavity.
Implantation: The attachment and embedding of the conceptus (embryo) into the lining of the uterus.
Insemination: Transfer of sperm for the purpose of establishing a pregnancy. Inseminations are performed by placing a small, soft catheter through the cervix into the uterine cavity and depositing the concentrated and activated sperm.
Intracytoplasmic Sperm Injection (ICSI): Placement of a single sperm into a single oocyte (egg) by penetrating the outer coatings of the egg. This technique is used in cases where there are very low sperm numbers, motility or morphology. ICSI is also used for patients who have had previous IVF cycles with failed fertilization.
Intra-Uterine Insemination (IUI): is a technique that transfers sperm directly in to 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 ÒtargetsÓ for the sperm (eggs), perfect timing and better sperm delivery.
In Vitro Fertilization (IVF): A powerful procedure to help patients conceive pregnancies. IVF entails stimulating your ovaries to develop multiple follicles. This is achieved 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 performed in our office. 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 patient. The name in vitro fertilization refers to the fact that the oocyte is fertilized by the sperm in the laboratory, rather than inside the female reproductive tract.
Laparoscope/laparoscopic surgery: 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 on the abdominal cavity and reproductive organs. This surgical technique is minimally-invasive, well-tolerated and performed in a day-surgery center. It allows your physician to diagnose and remove endometriosis, as well as re-open a blocked fallopian tube, amongst many other indications.
LupronTM: A synthetic form of GnRH (gonadotropin releasing hormone- secreted by the hypothalamus) used to suppress ovarian function.
Luteal Phase: 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 of an ovulatory. It begins from the time of ovulation to the onset of menses, but is prolonged during pregnancy cycles. It is associated with progesterone production from the corpus luteum that facilitates implantation of embryos and supports early pregnancies.
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.
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.
MetrodinTM: Human FSH prepared in an injectable form for ovarian stimulation.
Media: Fluid containing nutritive growth substances enabling cells to survive in an artificial environment.
Menses: 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 and ovulation per month, each and every month that pregnancy is not achieved.
Micromanipulation: The name of a group of laboratory techniques that allow sperm, eggs and embryos to be performed under the guidance of the microscope.
Oocyte: The female germ cell often called an egg.
Ovary: The female sex gland with both a reproductive function (releasing oocytes) and a hormonal function (production of estrogen and progesterone).
Ovulation: The release of a mature egg from the surface of the ovary.
Ovum (ova or egg): Mature oocytes.
Pap test: A screening test to determine the presence of cervical cancer. It is done by gently touching a swab to the cervix to collect cells for examination by a pathologist.
PergonalTM: A purified extract of LH and FSH, hormones secreted from the pituitary gland which stimulate the ovary. It is a commercial preparation used by injection to facilitate development of multiple follicles in reproductive treatment cycles.
Pituitary Gland: 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: A common endocrinologic condition that causes hormonal imbalances in women of reproductive age. It can lead to dysfunctional ovulation, infertility, weight gain, pre-diabetes and an increase in the male hormone, testosterone. Click here for more detailed information.
Polyp: An overgrowth of the glandular surface of the endometrium. Polyps are often removed by hysteroscopic surgery to remove any impediments to implantation.
Polyspermy: Abnormal condition where the oocyte is fertilized by more than 1 sperm.
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 superceded by the semen analysis, but there are still some clinical indications for the PCT.
Preimplantation Genetic Diagnosis (PGD):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 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 identify explanations for Recurrent Pregnancy Loss and improve pregnancy outcomes in selected patients.
Progesterone: A hormone produced by the ovary which prepares the uterus for implantation and supports the early pregnancy.
Pronucleus: A specialized stage of the oocyte and sperm nucleus before they join to create a genetically unique embryo. After this union the conceptus is referred to as a zygote.
Pronuclear Stage Tubal Transfer (PROST or ZIFT): An older procedure in which oocytes are harvested and inseminated in the laboratory before surgically transferring these very early zygotes into the fallopian tubes. This procedure has been replaced by standard IVF.
Recurrent Pregnancy Loss (RPL): Click here for more detailed information.
RESOLVE: is a non-profit organization with an established, nationwide network of chapters mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. www.resolve.org
Semen Analysis: Examination of the male ejaculate under the microscope to determine the number of sperm, their ability to move forward (motility) and their shapes (morphology). The semen analysis is a cornerstone 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) – is a specific definition of only transferring a single embryo at the culmination of an IVF cycle. This 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 in your age group. This ensures the highest pregnancy rates, but also exposes you to the possibility of having more than one baby, such as twins or more.
Not every patient is a candidate for eSET. Typically, your physician will only consider it as a viable option for you if: 1) you are in one of our younger age groups (<37 yo), 2) you have very high-quality embryos on day 5 (ÒblastsÓ), or 3) you have a medical condition for which even twins poses a very large medical risk over and above a singleton pregnancy.
eSET is a strategy to decrease your chances of having even twins- if your physician transfers only a single embryo into your womb during IVF, the chances of having twins is reduced to almost zero. The trade-off, however, is a lower pregnancy rate; the fewer embryos you put in, the fewer chances you have of one implanting. So the true heart of the matter is the following: which his worse, voluntarily decreasing your pregnancy chances, or avoiding almost all risk of having twins?
Put in a much more informal way, which would disappoint you more, transferring a single embryo and not conceiving or transferring two embryos and having twins? There are national guidelines for how many embryos should be transferred, and eSET is gaining momentum amongst the patients with the best prognosis. This is a personal decision that requires guidance from your physician, but each patient and clinical case is different and is managed on an individual basis- there are no one size fits all answers.
Sperm Antibody Test: In some couples blood, semen and/or cervical mucus contain substances which hinder sperm action through an allergic or immune reaction.
Sperm Penetration Assay (SPA): A test where sperm are incubated with non-viable hamster eggs to determine the capacity of the sperm to fertilize.
Society for Assisted Reproductive Technology (SART): Regulatory and consultative organization of the American Society for Reproductive Medicine responsible for assisted reproduction. This organization works with the CDC to publicly post fertility rates of all IVF cebters in the USA. We encourage allof our patients to look at these rates at www.cdc.gov.
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).
Trans-tubal Embryo Transfer (TET): Replacement of a cleaving conceptus into the uterine tube rather than into the uterus. This is an older procedure that has been replaced by standard IVF
Transvaginal: Through the vagina.
Tubal Patency: Lack of obstruction of the Fallopian tubes.
Ultrasound: 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.
Unexplained Infertility: Inability to identify the cause of infertility despite a complete evaluation of semen, ovarian reserve, ovulation, endocrinologic disorders and pelvic anatomy.
Uterus: 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.
Varicocele: A varicose vein around the ductus (vas) deferens and the testes. This may be a cause of low sperm counts, motility and morphology and lead to male infertility.
Zygote: A conceptus in which the genetic material (pronuclei) of the egg and sperm have united.
Zygote Intra-fallopian tube Transfer (ZIFT): Oocytes (eggs) are aspirated, are fertilized in the laboratory and surgically transferred into the fallopian tubes before cell division. This procedure has largely been replaced by standard IVF.
Sources: Illume Fertility and RESOLVE.