Glossary of Terms
A benign disease that involves the abnormal growth of endometrial tissue (the lining of the uterus) into the uterine wall or myometrium. Can be associated with abnormal bleeding or periods and some data suggest lower pregnancy rates in women with adenomyosis. There is no medical or surgical remedy for adenomyosis.
Scarring is a result of tissue injury. The damage can be caused by infections such as Gonorrhea and Chlamydia, or by previous operations such as removal of cysts or an appendectomy. Endometriosis also causes adhesion formation. Adhesions involving the tubes and/or the ovaries can cause infertility by preventing the normal pick-up of the egg from the surface of the ovary. If adhesions are mild, they can be treated by laparoscopic surgery. If the disease is severe however, surgery will not restore normal fertility. Adhesions inside the uterine cavity are also known as Asherman’s syndrome and may result from prior surgeries of the uterine lining such as polyp or fibroid removal or dilation and curettage procedures. These adhesions can be diagnosed by saline ultrasonography or hysteroscopy and can be removed by hysteroscopy.
Alpha Fetal Protein
A protein secreted by fetal tissue that can be present in the mother's bloodstream. If present in high levels, it can be associated with congenital fetal anomalies such as neural tube defects.
Basal Body Temperature
Abbreviated BBT. Indirect evidence of ovulation can be obtained with the basal body temperature chart. The temperature can be taken orally with a digital thermometer immediately upon awakening and before any activity. This is recorded on a special graph that enables you to visualize the different temperature shifts. The temperature will drop to its lowest point, 1-2 days prior to ovulation, and then rises and remains elevated until a couple of days before impending menstruation. If the individual is pregnant the temperature will remain elevated. This elevation is not considered a fever because it will never exceed 38ºC (100ºF). This test is unfortunately not very reliable in every woman, and is therefore not used universally. Urine ovulation prediction testing is a better way to document ovulation and to determine prospectively when ovulation will occur.
A congenital abnormality of the uterus that involves a partial lack of fusion of the two parts of the uterus to varying degrees. A single cervix is present. In the majority of cases it does not cause infertility, but recurrent miscarriages have been reported in rare instances, similarly to premature births. If treatment is needed, it is through abdominal surgical repair.
An embryo that has developed for approximately five days after fertilization. At this point, the embryo has two different cell types and a central cavity. The surface cells (trophectoderm) will become the placenta, and the inner cell mass will become the fetus.
Cervical mucus is secreted by glandular cells that are present in the cervix. This mucus protects the uterus from invasion by bacteria present in the vagina. It also plays an important role in infertility. The cervical mucus, in response to the estrogen hormone, becomes thin and elastic at the time of ovulation. This allows the sperm to travel through the cervix and the uterus to reach the egg in the fallopian tube. It also helps the sperm to stay alive in the cervix for a longer period of time. A thick and dense mucus could prevent the passage of sperm through the cervix.
Narrowing of the cervical canal in such a way that menstrual flow can partially or completely be impeded. It is often the result of cervical injury due to surgery such as cone biopsy done for an abnormal Pap smear. It can cause infertility by hampering the normal passage of sperm through the cervix, and can often be treated by intrauterine insemination that bypasses the cervix altogether.
The part of the uterus that opens into the vagina. It is the segment that is checked for abnormal cells by a Pap smear. It is connected to the uterine cavity by a hollow canal called the cervical canal. The cervix secrets mucinous secretions (see Cervical Mucus) which play a major role in the transport of sperm in its journey towards the egg.
A technique which uses extremely low temperatures to preserve live tissue in storage for long periods of time. Cells are partially dehydrated and slowly brought to a temperature at which all cellular metabolic reactions cease. Upon thawing, cells are rehydrated and slowly brought back to body temperature.
D and C: Dilation and curettage
It is the process of gradually dilating the cervix to the point of being able to introduce an instrument (curette) to scrape the surface of the uterine cavity (endometrium). A suction cannula is also often used if the amount of tissue removed is great. This procedure is often used to treat abnormal bleeding, incomplete miscarriages and abnormal uterine pathology such as polyps or small fibroids. It is done under sedation and sometimes under general anesthesia. Potential complications include infection and uterine perforation.
Diminished or Decreased Ovarian Reserve (DOR)
This is an infertility diagnosis for women that have elevated basal FSH levels, low AMH levels or low antral follicle counts and/or poor responses to fertility medications. Women with this diagnosis have a reduced potential for successful pregnancy with any particular cycle’s treatment but the overall odds of conception is better related to a woman’s age. Women with very severe DOR often will need egg donation to successfully conceive, especially if they are 39 and older.
Also known as Trisomy 21. An individual that has 3 copies of chromosome 21. Physical features include mild mental retardation, heart and thyroid defects. This is the major anomaly being tested for when pregnant women undergo Chorionic Villus Sampling (CVS) or amniocentesis in early pregnancy. The incidence of Down Syndrome and other aneuploidies is increased with increasing maternal age.
A normal pregnancy results when the embryo implants inside the uterus. When implantation occurs outside the uterus, an ectopic pregnancy ensues. Such an abnormal pregnancy can be located in the tubes, the ovaries, the cervix or inside the abdomen. The most common symptoms are abnormal bleeding and lower abdominal pain. Women who have tubal damage (such a scarring from infection) are at an increased risk for an ectopic pregnancy. About one out of four conceptions after an ectopic pregnancy is a repeat ectopic pregnancy. About 2-3% of all in vitro fertilization pregnancies turn out to be ectopic.
Lay term for oocyte. The largest cell in the human body. Unites with the sperm to make a zygote and eventually a baby. Carries 23 chromosomes.
A procedure used to obtain eggs directly from ovarian follicles for use in IVF (in vitro fertilization). With the patient sedated and comfortable, the eggs are retrieved through the vagina under ultrasound guidance.
An egg fertilized with a sperm, in the early stages of fetal growth from conception to the eighth week of pregnancy.
A cause of infertility in which cells from the uterus migrate to
other regions of the body, usually in the pelvic region, causing scarring and sometimes damaging the fallopian tubes and ovaries.
An embryo transfer (ET) is a procedure by which the embryo (usually aged three to five days) is placed into the uterus.
A hollow muscular tubular organ that is connected to the uterus at one end, and opens inside the abdomen close to the ovaries at the other. The latter part is made of finger-like projections, also called “fimbria," that pick up the ovulated egg from the surface of the ovary. The egg meets the sperm at the mid-junction of the tube where fertilization occurs. The fertilized egg then travels to the uterine cavity where implantation takes place. There are normally two fallopian tubes, one on each side of the uterus. Damage to these tubes is common with sexually transmitted diseases, such as Gonorrhea and Chlamydia. They can also be easily damaged during pelvic or abdominal surgeries or in patients with severe endometriosis. Reconstructive tubal surgery for infertility can be done in some women. The success rate depends on the state of the tubes prior to the surgery. If for instance, the tubes are blocked and swollen, the success rate is extremely small in achieving pregnancy. In such cases, IVF should be the treatment of choice. Recent data has also shown that swollen tubes lower IVF success rates; therefore, it is strongly recommended that swollen damaged tubes (hydrosalpinx) be surgically removed prior to IVF.
The female egg and the male sperm.
HCG: Human Chorionic Gonadotropin
Human Chorionic Gonadotropin is the major hormone secreted by the placenta. In the early stages of pregnancy, continued survival of the corpus luteum (the follicle that releases the egg) is totally dependent on HCG and, in turn, the survival of the pregnancy is dependent upon hormones secreted by the corpus luteum during the 7th week of pregnancy. Thereafter, the corpus luteum is gradually replaced by placental hormone secretions. Studies have shown that after administering HCG intramuscularly, ovulation occurs 38 to 40 hours afterwards. This is why during an IVF cycle, egg retrieval is scheduled 30 to 40 hours after the HCG shot. Similarly, during simple ovulation induction with Clomiphene or Gonadatropins, HCG is sometimes given to trigger ovulation. HCG is chemically very similar to LH or luteinizing hormone, which signals the ovulation process to begin. Insemination or intercourse is then planned according to the time that HCG was administered.
A hysterosalpingogram (HSG) is an X-ray that allows the physician to view the size and shape of the inside of the uterus and fallopian tubes. It is also known as the tubal dye test.
A procedure by endoscopy with access through the cervix that permits a physician to view the uterine cavity. It allows for the diagnosis of intrauterine pathology and serves as a method of surgical intervention.
Intracytoplasmic sperm injection (ICSI) is a micromanipulation procedure whereby a single sperm is captured in a thin glass needle and injected directly into the egg. This procedure allows fertilization to be possible even with just one sperm.
Intrauterine insemination (IUI) is a type of artificial insemination in which washed semen is injected into the uterus using a catheter.
In vitro fertilization (IVF) is a process by which eggs are harvested from the ovaries and fertilized with sperm outside of the body. Fertilized eggs, or embryos, can be cultured for up to six days in the laboratory. At that point, embryos or blastocysts are either transferred to the uterus or frozen.
A surgical procedure in the abdomen or pelvis through small incisions (usually 0.5–1.5 centimeters) with the aid of a camera. Performed under a general anesthetic, laparoscopy can be used to inspect and diagnose a condition or to perform surgery.
Semen analysis (SA) is a laboratory test used to assess semen quality, sperm quantity, concentration, morphology (form), and motility.