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 spe