Glossary of Terms   Agglutination: the aggregation of cells or particles into clumps or masses, especially the clumping together by the action of a specific antibody directed against a surface antigen. With regard to fertility, the clumping together of sperm is commonly associated with the presence of anti-sperm antibodies.   Amenorrhea: Absence of menstruation.   Anti-sperm antibodies: Particularly common in men with vasectomy reversals or other testicular surgery or injury. Anti-sperm antibodies are created when there is contact between sperm and immunocompetent lymphocytes in the blood. Sperm can enter the blood stream as a result of trauma, surgery, or infection. And just like with any foreign cell in the blood stream, these lymphocyctes attack the sperm by creating antibodies against it. These antibodies remain in the blood stream and are able freely pass the blood-sperm barrier in the testis and attack the sperm waiting there. Once attached to the sperm, these antibodies appear to interfere with penetration through cervical mucus and with penetration of the egg. Women may also develop antibodies to sperm. IVF/ICSI is indicated in cases of high levels of agglutination and/or anti-sperm antibodies.   ART: ART stands for Assisted Reproductive Technologies and, in broad terms, refers to any therapy directed towards improving the chance of pregnancy in an infertile couple. ART has commonly come to describe only the most sophisticated of infertility treatments, where eggs and sperm are united outside the body and transferred back to the female partner when appropriate. IVF, or in vitro fertilization, is the most common of the ART procedures.   Assisted hatching: The purpose of assisted hatching is to create a small opening in the zona of an embryo so that it may easily exit or "hatch" when it has developed sufficiently.   Asthenospermia: Describes sperm which show poor movement, i.e. speed and forward progression. There isoften no clear explanation for this abnormality assuming the specimen was collected properly and was not exposed to any harmful environmental conditions. Asthenospermic men have little hope of conceiving naturally, as the sperm are unlikely to reach their ultimate destination moving at such a sluggish pace.   Azoospermia: Refers to a complete absence of sperm in an ejaculate.   Basal body temperture: In infertility, monitoring one’s temperature over the course of a cycle and recording the results. Evidence of ovulation is signaled by an increase in temperature level of 0.50 F for several days.   Blastocyst: Late developmental stage of the pre-implantation embryo, evidenced by the formation of an central fluid-filled cavity called a blastocoel followed by an increase in overall size and thinning of the zona pellucida as it readies itself for hatching and. subsequent implantation.   Blastomere: Refers to one of the cells of an early stage embryo resulting from the cellular division (or cleavage) of a fertilized egg.   Capacitation: The process by which sperm become capable of fertilizing an egg. This process involves major biochemical and biophysical changes in the sperm and occurs some time after the sperm have been ejaculated, usually while in the female reproductive tract. Capacitation can also be induced under laboratory conditions.   Chlamydia: A sexually transmitted disease with often very mild symptoms, it is often called the silent STD. Victims of a chlamydia infection may not be aware they have the disease until serious complications and unwitting transmission of the disease have occurred. In males who do have symptoms, there is usually a painful urination and a watery discharge from the penis. Women may suffer itching and burning in the genital area, an odorless, thick, yellow-white vaginal discharge, dull abdominal pain, and bleeding between menstrual periods. The bacteria which causes chlamydia is responsible for about half of all pelvic inflammatory disease. Symptoms can appear from 1 to 5 weeks after exposure to the bacteria and almost all sexual contacts become infected. If left untreated, chlamydia infection can cause scarring in the fallopian tubes and lead to infertility and tubal pregnancies. Chlamydia infection can be effectively treated with an antibiotic such as tetracycline or doxycycline.   Clomiphene citrate: An infertility medication which works as an anti-estrogen by blocking the effects of estrogen (or estradiol) in the body. During an ovulatory cycle, rising estradiol causes the pituitary gland to decrease FSH output, thereby causing most of the egg-containing follicles to stop developing. Clomiphene citrate, however, essentially "hides" circulating estradiol from the pituitary gland, causing it to think there are still low levels of estradiol present in the body. As a result, the pituitary gland "thinks" that the ovarian follicles are not being stimulated enough and increases its output of FSH hopefully prolonging follicular development to the point of ovulation.   Congenital: Present and existing at the time of birth.   Conventional IVF: Refers to the typical IVF procedure in which sperm are placed in a dish with an egg and allowed to attempt fertilization on their own as opposed to unconventional IVF, which involves mechanically injecting a sperm into an egg through a process called ICSI.   Corpus luteum: A yellow glandular mass in the ovary formed by a follicle which has matured and ovulated. The corpus luteum secretes progesterone which helps prepare the uterine lining for implantation.   Cryopreservation: The process of freezing tissue or organs to maintain their viability by storing at very low temperatures. In the field of infertility, this involves the freezing of sperm or embryos for eventual thaw and use.   Cytoplasm: The essential component of a cell which describes the thick, fluid-like area of a cell in which the various organelles and genetic material are housed.   Ectopic pregnancy: Also called a tubal pregnancy, a pregnancy in which an embryo becomes implanted outside the uterus (almost always in the fallopian tube) instead of in the wall of the uterus with the danger present that the fetus will continue to grow large enough to burst the tube. The pregnancy will sometimes resolve on its own but most often will require some intervention to remove the pregnancy either through medication or surgery.   Embryo: Generally used to describe an organism’s earliest stage of development between the time of fertilization of an egg until the beginning of the third month, after which it is referred to as a fetus.   Endocrine: Pertaining to internal secretions; hormonal. The endocrine system involves organs or groups of cells that secrete hormones into the circulatory system. Hormonal activity is mostly concerned with regulating metabolic activities by controlling the rates at which chemical reactions take place within cells, the transport of substances across the cell membrane, and the activities related to growth and reproduction.   Endometriosis: A condition in which tissue more or less perfectly resembling endometrium occurs in various locations in the pelvic cavity, including growing in and on the fallopian tubes and ovaries, sometimes debilitating them. The cause of endometriosis is not clearly known but may involve the expulsion of endometrial tissue during menstruation upward through the fallopian tubes and into the pelvic cavity where it is able to implant and grow on the ovaries and elsewhere. It may also involve a hormonal change or other event that triggers undifferentiated tissue in the pelvis to transform into endometrial tissue. Regardless of the cause, if left unchecked could lead to complete infertility and even cancer.   Endometrium: The membrane lining the uterus.   Estradiol: The most potent naturally occurring estrogen in humans secreted by the ovaries during follicular development. Pre-ovulatory levels provide a measure of follicular maturation. Determination of estradiol measurements are important in the diagnosis of amenorrhea, ovulatory disorders, and in the monitoring of ovulation induction.   Fertilization: In humans, the process by which the male’s sperm unites with the female’s egg, or ovum.   Fetus: Term used to describe the developing offspring in the uterus in the post-embryonic period. In humans, from seven to eight weeks after fertilization until birth.   Follicle: A sac or pouchlike depression or cavity. In a reproductive setting, an ovarian follicle describes the egg and its surrounding cells.   Follicular phase: That portion of the ovulatory cycle from the start of menses up until ovulation. The term follicular phase derived from the development of one or more follicles during this time.   FSH: Follicle stimulating hormone is a gonadotropin normally produced by the pituitary gland to initiate the growth and development of ovarian follicles. FSH can be administered by injection to supplement or increase the level of follicular development. Circulating levels of estradiol secreted by developing follicles control the production of FSH through a negative feedback mechanism on the pituitary gland – as estradiol levels rise, FSH production declines. In menopause, there is decreased ovarian function and a resulting decrease in estradiol secretion. This creates an imbalance in the negative feedback mechanism since, with diminished estradiol, FSH production is not controlled and circulating FSH levels become significantly increased.   Gamete: Term used to describe one of the two reproductive cells – sperm in the male, egg or ovum in the female.   Gestational Host: Term used to describe a woman who agrees to have another couple’s embryos transferred to her uterus with the desire to carry the pregnancy for the genetic mother, usually because of a uterine factor which prevents the genetic mother from being able to carry the pregnancy herself. Although technically the same meaning, the term "gestational host" is used rather than "surrogate" since the term "surrogate" implies that the woman is providing the service in exchange for money. At GYFT, "gestational hosts" are always a relative or close friend providing the service out of love, not money.   GnRH: Gonadotropin Releasing Hormone is a hormone produced by the hypothalamus which is necessary to keep the pituitary gland functioning. Some women fail to ovulate because the hypothalamus fails to produce sufficient stimulation to the pituitary gland. During intervals of high physical or psychological stress, the hypothalamus may not secrete GnRH and the pituitary gland stops producing the gonadotropins FSH and LH which are necessary for egg development and ovulation. In these instances, GnRH can be directly administered into the blood stream by injection with a high incidence of restoring pituitary function.   GnRH agonist: Medication administered to prevent the secretion of GnRH from the hypothalamus, which subsequently turns off the secretion of FSH and LH from the pituitary gland. This may be beneficial in various infertility treatments, particularly in cases where superovulation is desired.   Gonorrhea: A highly contagious bacterial infection of the genital and urinary tracts almost always contracted through sexual transmission. Symptoms usually develop within 3 weeks but many infected persons are asymptomatic. In men showing symptoms, inflammation of the genital tract causes a painful burning sensation when urinating and discharge of a whitish fluid from the penis. Symptomatic women may feel pain in the lower abdomen, with or without a burning sensation when urinating or a whitish discharge from the vagina. If the infection is allowed to reach other organs of the reproductive system, the ovaries and tubes may become inflamed or damaged resulting in sterility. Antibiotics are an effective treatment once gonorrhea is diagnosed.   Growth medium: One of the physiological media used in the culture of IVF embryos. Growth medium is formulated to provide the proper developmental environment for embryonic growth from the zygote to 8-cell stage.   Haploid: Having half the number of chromosomes in a cell. In reproduction, two haploid gametes (the egg and the sperm) join to restore the full complement of genetic material which is represented in each subsequent cell division during development of the conceptus.   HCG: Human Chorionic Gonadotropin is a hormone usually only found in the blood during pregnancy. It is secreted by the placental tissue almost from the time of implantation and serves to support the corpus luteum during the early weeks of pregnancy. Its measurement is of great value in the detection and management of pregnancy. Medicinal HCG is also often used as a "surrogate" LH since it has the same stimulatory effects on the ovary that LH does and can be administered by injection to trigger ovulation.   Hepatitis: One of a number of strains of viral infections (A,B, or C) which cause inflammation of the liver. Hepatitis A is transmitted primarily through the oral-fecal route and is especially common in environments where there is poor sanitation and overcrowding. Hep A does not usually cause lasting damage to the liver but can produce profound fatigue, fever, and aching for weeks. Bed rest is typically the only treatment recommended. Hepatitis B is qualified as a sexually transmittable disease and, unlike Hepatitis A, can persist in the body fluids for years or even a lifetime. Carriers of Hep B are a threat to others and at risk for chronic hepatitis, cirrhosis of the liver and liver cancer. Symptoms of Hep B can vary in their intensity, so many infected individuals are not aware that they have the disease. Symptoms can vary from asymptomatic to jaundice, rash, joint pain, etc. There is a vaccine that can be used to provide immunity against type B hepatitis to protect high-risk people. Hepatitis C is similar to that of type B but currently has no available vaccination to protect from it.   HIV: Human Immunodeficiency Virus: A sexually transmitted disease which can lead to the onset of AIDS, or acquired immune deficiency syndrome. HIV attacks a person’s immune system making it less able to fight diseases and infections. It can take as long as six months after infection to detect the virus and may not show any symptoms for years. HIV may manifest itself years later when the victim may develop swollen lymph nodes. As HIV infection progresses to AIDS, symptoms such as severe weight loss, headaches, nausea, dizziness, fever, discolored growths on the skin, continual coughing, coated tongue, and unexplained bleeding and bruising may occur. Not all persons infected with HIV will develop AIDS. There is currently no treatment that will destroy HIV in the human body or that will restore the immune system once it is infected with HIV. However, there are new therapies being researched and used that seem to delay the onset of HIV/AIDS symptoms.   HOS: The Hypoosmotic swelling test is a very simple procedure used in conjunction with the seminal fluid analysis which allows us to measure the ability of the sperm to transport fluid, which is essential in the fertilization process. Sperm are placed in a hypoosmotic environment. Sperm having a functional fluid transport membrane will result in a distention or curling of the tail.   HSG: A hysterosalpingogram is a commonly used method for determining whether or not an obstruction or blockage exists in the fallopian tubes. Your doctor or referred radiologist injects a liquid dye (which is visible on x-ray) into the portion of the tube where it connects to the uterus and observes to see if the fluid is able to freely spill through to the opposite end of the tube (near the ovary). If not, a blockage of some kind is usually the culprit and your doctor will determine whether or not it can or should be removed. In some cases, the simple act of flushing dye through the tubes during the HSG is enough to clear minor blockages and restore fertility.   Hypothalamus: Located in the posterior portion of the forebrain, this gland influences endocrine activity, many somatic functions; e.g. regulation of water balance, body temperature, sleep, thirst, and hunger, and the development of secondary sex characteristics. Because of its influence on the release and inhibition of pituitary hormones, the hypothalamus indirectly plays an important role in the regulation of protein, fat, and carbohydrate metabolism, body fluid volume and electrolyte content, and internal secretion of endocrine hormones.   ICSI: Intracytoplasmic sperm injection is the micromanipulatory process of mechanically injecting a single sperm into a mature oocyte with the hope of achieving fertilization. ICSI is often indicated in male factor patients whose sperm are dysfunctional to the point where they cannot adequately fertilize an oocyte on their own.   Immobilization: The rendering of a part incapable of being moved. In ICSI, sperm to be injected are prevented from swimming by immobilizing the sperm’s tail.   Implantation: The attachment and embedding of the fertilized ovum or embryo into the uterine lining.   In vitro: Literally means "within a glass." Occurring in an artificial or laboratory environment.   In vivo: Within the living body.   Injectable Gonadotropins: Often referred to as "fertility drugs," these medications are primarily composed of the gonadotropin FSH and are administered by direct injection to supplement or replace the FSH which is normally produced by the pituitary gland. Thus, by using injectable gonadotropins, it is possible to attain levels of FSH which are sufficient to stimulate follicular development, oocyte maturation, and ovulation in a vast majority of patients or induce superovulation in patients undergoing more advanced infertility treatments such as IVF.   IVF: In vitro fertilization is the process by which fertilization takes place in the laboratory as a treatment for infertility. The treatment involves the following steps: Induction of ovulation with "fertility drugs" to produce multiple eggs, retrieval of the eggs from the ovaries by transvaginal ultrasound aspiration, placing the recovered eggs with appropriate sperm in a laboratory controlled environment, culturing the resulting embryos for 3 to 6 days, then transferring the embryos via catheter to the patient’s uterus.   LH: Luteinizing hormone is a gonadotropic hormone produced by the pituitary gland that, with FSH, causes the ovulation of mature follicles and secretion of estrogen by the ovary.   LH Surge: At the midpoint of the ovulatory cycle, the pituitary gland is signaled to release a surge of LH which triggers a follicle to release its egg. Ovulation predictor kits can be used to detect this surge in urine. Since ovulation should be expected to occur sometime in the 24 to 48 hours following the surge, intercourse can be more effectively timed to improve the chance of pregnancy.   Luteal Phase: Pertaining to the presence of the corpus luteum, the portion of the menstrual cycle following ovulation until the start of menstruation (if not pregnant).   Menstruation: The periodic discharge from the vagina of blood and tissues from a nonpregnant uterus at the culmination of the menstrual cycle. Menstruation occurs every 28 days or so between puberty and menopause, except during pregnancy, and the flow lasts about 5 days with the times varying from woman to woman.   Micromanipulation: Refers to any procedure where gametes or embryos are physically and individually "operated on" using delicate microscopic tools to achieve some particular end.   Miscarriage: Term used to designate loss of the fetus before it is viable. Also called a spontaneous abortion.   Morphology: The science of the forms and structure of organisms. In infertility, the analysis of the shape and structure of the reproductive cells – particularly sperm, eggs, and embryos.   Motility: Term used to describe the percentage of moving sperm in an ejaculate. Sperm are evaluated on the basis of quantitative and qualitative motilities. Quantitative motility is the percentage of swimming sperm out of the total number of sperm in a semen sample, while qualitative motility ranks the degree of speed and forward progression of the swimming sperm.   OHSS: Ovarian hyperstimulation syndrome is almost unique to ovulation induction cycles, particularly in women who develop a large number of follicles (usually 20 or more) in response to injectable gonadotropins. This fairly rare condition is characterized by significant enlargement of the ovaries, possible fluid retention in the abdomen, and general swelling throughout the body. The syndrome usually begins about a week after ovulation and commonly occurs in cycles where the woman winds up pregnant, as there may be some unidentified characteristic of pregnancy that helps to trigger the onset of OHSS. The syndrome usually resolves on it’s own, however, and may take a few days to a few weeks before the discomfort is gone.   Oligoovulation: Term used to describe the ability to have only very irregular ovulatory cycles.   Oligospermia: Term used to describe a deficiency of spermatozoa in semen, or low sperm count.   Oocyte: The female gamete; an egg.   Oolemma: The plasma membrane immediately surrounding an oocyte.   Ooplasm: The cytoplasm of the mammalian oocyte.   Ovulator Predictor Kit: Used just like home pregnancy tests, they turn positive when an LH surge is detected in urine. Since ovulation should be expected to occur sometime in the 24 to 48 hours following the surge, intercourse can be more effectively timed to improve the chance of pregnancy.   Perivitelline Space: The fluid-filled space between the oolemma and the zona pellucida of a mammalian oocyte.   Placenta: An organ characteristic of mammals during pregnancy, joining the mother and offspring, and providing the exchange of nutrients from the mother’s blood into the fetus’s blood and waste products from the fetus back to the mother. The placenta secretes both estrogens and progesterone. After birth of the infant the placenta is cast off from the uterus and expelled via the birth canal.   Polar Body: Structure extruded into the perivitelline space as a result of oocyte maturation which contains a full half of the genetic material of the nonmature oocyte thereby creating the necessary haploid gamete in preparation for fertilization.   Pre-implantation Embryo: Term used to describe the stage of a developing embryo prior to implantation. This would encompass the stages from 2-cell to blastocyst.   Premature Labor: Expulsion of a viable infant before the normal end of gestation; usually applied to interruption of pregnancy between the twenty-eigth and thirty-seventh weeks.   Progesterone: Hormone which plays a major part in the menstrual cycle. Produced by the corpus luteum, progesterone is promptly carried to the uterus and works with estrogen to prepare the uterus for possible conception. In pregnancy, progesterone acts in a way that protects the embryo and fosters growth of the placenta. By decreasing the frequency of uterine contractions it helps to prevent expulsion of the implanted ovum. It also promotes secretory changes in the mucosa of the fallopian tubes, thereby helping to provide nutrition for the fertilized ovum as it travels through the tube on its way to the uterus. Diminished secretion of progesterone can lead to menstrual difficulties in nonpregnant women and spontaneous abortion in pregnant women.   Prolactin: Hormone secreted by the pituitary gland that promotes the growth of breast tissue and stimulates and sustains milk production in postpartum mammals. Elevated prolactin levels may indicate the presence of a pituitary tumor which can inhibit normal ovarian function.   Pronuclei: Structures in a fertilized ovum containing the nuclear material from both the male and female partners (one pronucleus from the sperm, one from the egg). Male and female pronuclei are usualy formed simultaneously following sucessful fertilization. The pronuclei may be visible as early as 5-6 hours after insemination and will remain visible up to about 20 hours until they fade and the first cleavage stage begins.   Reproductive Endocrine System: Describes the functions of those organs and glands responsible for the secretion of hormones which regulate the activities related to the reproductive process.   Reproductive Endocrinology: The study of the hormonal activity of the reproductive system.   RPR: Stands for the Rapid Plasma Reagin test used in the detection of syphilis.   Rubella: A mild systemic disease caused by a virus and characterized by a fever and a transient rash; also called German measles. If a pregnant woman contracts rubella, especially during the first trimester, the virus can damage the developing offspring through a number of means e.g. congenital heart defects, cataract, mental retardation and deafness. A vaccine against rubella is available and is given in a single subcutaneous injection to children more than a year old. It is never given to a pregnant woman, or to any woman who might become pregnant in the succeeding 2 months.   Superovulation: Process whereby the ovary is stimulated to produce a number of egg-containing follicles (rather than just one) during the same cycle. Superovulation is valuable in IUI and IVF procedures in order to improve the likelihood of obtaining enough quality oocytes for an increased probability of pregnancy.   Sperm Donor: Someone who donates sperm to a qualified recipient, either anonymously through a sperm bank or as a known friend or relative. Qualified recipients may be single women, or women whose partners have impaired sperm-producing ability.   Spermatogenesis: The development of mature spermatozoa from undifferentiated male germ cells in the seminiferous tubules of the testis.   Syphilis: A contagious venereal disease leading to many structural and cutaneous lesions. The first sign of primary syphilis is a painless sore, called a chancre, that appears 9 days to 3 months – usually 3 weeks – after infection. Even if no treatment is given, the chancre will disappear in 10 to 40 days, often leading to the false conclusion that the disease is cured. Primary syphilis can be cured with antibiotics. Secondary syphilis may begin two to six months after the primary sore disappears and may last up to 2 years. A rash is usually one of the first symptoms and may cover any part of the body and often spreads over the entire skin surface, including the palms and soles. Thin white sores in the mouth, throat, or genitalia may appear as well. Syphilis is highly contagious in this stage and generally disappears by itself within 3 to 12 weeks, but may return later if the organisms are still present. Like primary syphilis, secondary syphilis can be cured with antibiotics. Tertiary syphilis is known as "late syphilis" and its symptoms may develop soon after the secondary symptoms have vanished or they may lie hidden for 15 years or more. Late syphilis is less contagious to others but is extremely dangerous to the person who has it. It may be fatal, particularly if the central nervous system or heart is affected. Cure of late syphilis takes longer and is more difficult than that of primary or secondary syphilis but may also be successfully treated with antibiotics.   Teratozoospermia: Describes semen specimens containing a high percentage of abnormally shaped sperm, often referred to as poor morphology   Tubal Ligation: Commonly used as a method of birth control in females, it involves application of a ligature to the fallopian tubes in order to prevent the passage of eggs or sperm through the tubes thereby preventing the possibility of a pregnancy. Also known as having one’s tubes "tied."   Thyroid Hormones: Secreted by the thyroid gland in the neck, they influence many metabolic processes: stimulating the synthesis of protein, lipids, and coenzymes from vitamins, as well as regulating many aspects of carbohydrate metabolism.   Ultrasound: Employing the technique of ultrasonography. In the field of obstetrics and gynecology, where radiation is to be avoided whenever possible, the ultrasound is a safe, reliable, and fast method of examining the anatomy of the female ovaries and uterus as well as the developing fetus and placental position in pregnant women.   Uterine Lining: The membrane lining the uterus. Also known as the endometrium.   Varicocele: An enlargement of the veins of the testicle particularly in and around the spermatic cord. Varicoceles are usually located in the upper part of the scrotum and have historically been reported to occur in 24 to 41% of infertile men, although this is a controversial statistic in many circles today. The mechanism by which a varicocele produces infertility is not well known nor even well proven, but is generally believed to be related to an increase in the temperature of the sperm production centers due to the increased bloodflow in the enlarged veins.   Zona Pellucida: The covering that surrounds the oocyte, functioning as the "shell" of the oocyte.