Assisted Reproductive Technologies (ART): Infertility treatment procedures such as IUI, GIFT, and ZIFT that require laboratory handling of sperm and /or eggs.

Cervix: The part of the uterus that opens into the vagina. It is the segment that is checked for abnormal cells by a Pap smear. It is connected to the uterine cavity by a hollow canal called the cervical canal. The cervix secrets mucinous secretions (see Cervical Mucus) which play a major role in the transport of sperm in its journey towards the egg.

Cervical Mucus: Cervical mucus is secreted by glandular cells that are present in the cervix. This mucus protects the uterus from invasion by bacteria present in the vagina. It also plays an important role in infertility. The cervical mucus, in response to the estrogen hormone, becomes thin and elastic at the time of ovulation. This allows the sperm to travel through the cervix and the uterus to reach the egg in the fallopian tube. It also helps the sperm to stay alive in the cervix for a longer period of time. A thick and dense mucus could prevent the passage of sperm through the cervix. The cervical mucus is checked by the Postcoital test.

Corpus Luteum: A follicle that releases an egg at the time of ovulation is subsequently called the corpus luteum. This is initially a partially collapsed cystic space that later can become a true cyst, and is very active in hormone secretion. Its major product is progesterone. If pregnancy does not occur, the corpus luteum "dies" roughly 10 to 14 days after ovulation. This leads to a sudden drop in progesterone levels, which in turn leads to menstruation. If, on the other hand, pregnancy occurs, the newly developing placenta secretes the HCG hormone, which salvages the corpus luteum and stimulates it to continue making progesterone. This placental support of the corpus luteum is indispensable for the first 7 weeks of pregnancy. From that point on, the placenta starts making its own progesterone and the corpus luteum is no longer needed. Therefore, it shrinks and becomes the "corpus albicans".

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Egg: Lay term for oocyte. The largest cell in the human body. Unites with the sperm to make a zygote and eventually a baby. Carries 23 chromosomes.

Egg Donation: This process involves the stimulation of a women with fertility drugs, the retrieval of her eggs, their fertilization with the recipient's partner's sperm, and the transfer of the resultant embryos to the uterus of the recipient. Women who might need or will need egg donation include the following: 1) women with no ovaries, either because of their congenital absence or their surgical removal, 2) women with early (premature) menopause, 3) older women, 4) women who fail to produce adequate number of eggs after stimulation with fertility drugs, 5) women with serious transmittable genetic traits or diseases, 6) women who have decreased ovarian reserve, or 7) women who are about to undergo surgery for ovarian cancer, in which case they can freeze the resultant embryos for use at a later date. Egg donors should be young women and should ideally have had prior pregnancy. Most egg donations are done anonymously, however known donors are also acceptable in many instances.

Egg Retrieval: The process of introducing a long needle through the vagina and into the ovaries to aspirate the follicles that contain the eggs. It is done under ultrasound guidance. The ovaries are visualized on the ultrasound screen and the needle, which is aspirated with gentle suction. The aspirated fluid is sent to the embryologist who examines it and isolates the egg. The procedure is done under heavy sedation and is therefore painless. It takes about 20 minutes to complete and the patient is discharged one hour later. The patient is not allowed to drive because of slight drowsiness for a few hours after the procedure. Complications are very rare and include bleeding and infection.

Embryo: A fertilized egg that has begun the cycle of cell division.

Embryo Transfer: The process of depositing fertilized eggs (or embryos) inside the uterus. This often occurs 3 to 5 days following egg retrieval. A predetermined number of embryos are first placed inside a special catheter, which is then introduced inside the uterus through the cervix. The embryos are then gently injected and the catheter removed. This procedure is done in a position similar to a pelvic examination for a Pap smear. The patient will remain in that position for roughly fifteen minutes before being discharged. The number of embryos to be transferred depends mostly on the age of the woman and the quality of the embryos. The patient will make the informed decision regarding the number of embryos to be transferred after conferring with her physician.

Estrogen (or Estradiol): The major female hormone secreted by the ovaries. A normally menstruating woman ovulates once a month about 14 days after the start of the menstrual cycle. The egg secretes estrogen as it grows. The level of this hormone peaks at the time of ovulation, it then drops to peak again about a week after ovulation. Estrogen is responsible for the normal growth and differentiation of both the follicle and the egg. It also plays an important role in preparing the endometrial lining where implantation would occur in case of pregnancy. Estrogen also changes the quality and texture of the cervical mucus, making it thinner and more elastic. This allows the normal passage of sperm through the cervix towards the uterus and the tube where it meets the egg. The hormone estrogen is important in helping to maintain healthy vaginal tissue. It also has beneficial effects on bone and the cardiovascular system. For these reasons, estrogen replacement is recommended to most menopausal women. When estrogen is measured on the second or third day of the cycle, its level reflects the health of the eggs. Ideally, a level less than 80 ug/ml is desirable prior to the initiation of ovulation induction or IVF.

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Fertilization: The unification of sperm and egg to form a zygote (the earliest stage of human life). The zygote would then become an embryo, and then a fetus. A sperm or an egg contains half of the genetic make-up of its species. A normal human cell contains 46 chromosomes, while an egg or sperm contains only 23 chromosomes. After successful and normal fertilization, the number of chromosomes becomes 46 (23 from the egg and 23 from the sperm).

Follicle: A fluid-filled space (like a balloon) present inside the ovary that contains and nourishes the egg. In a normal cycle, a woman will usually ovulate only one egg. Very early in the cycle however (and actually before the cycle even begins), many small minute follicles containing immature eggs are recruited. During the first 5 to 7 days after the start of a period only one of these follicles will mature and grow. This leading follicle will increase and be ready for ovulation roughly 2 weeks after the start of the menstrual cycle. The follicle will then burst with ovulation and release the egg that is pick-up by the finger-like projections (fimbria) of the fallopian tube. The collapsed follicle will become the corpus luteum.

Follicle Stimulating Hormone (FSH): A hormone secreted by the pituitary gland; FSH stimulates the growth and development of ovarian follicles. It is the main hormone present in the gonadatropin medications Gonal-F and Follistim, and comprises half of the hormones in Repronex and Menopur. A blood test for this hormone on the third day of the menstrual cycle is crucial in evaluation the function of the ovaries. A significantly elevated level (>10) implies impending ovarian failure or decreased ovarian reserve. These women will not respond adequately to ovulation inducing medications. The level of FSH also assists us in determining the ideal dosage and regimen of fertility agents necessary to initiate proper ovarian stimulation in a subsequent cycle of treatment.

FSH: See Follicle Stimulating Hormone.

Follistim: Use same directions as for Gonal-f

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GIFT: Gamete Intrafallopian Tubal Tranfer: A procedure that involves introducing sperm and egg (also called gametes) inside the fallopian tube. This is accomplished by laparoscopic surgery, whereby under direct visualization via a telescope inserted through the umbilicus, eggs and sperm are deposited by a catheter in the mid-section of the fallopian tube. It can only be performed when the individual has normal tubes. The success rate with GIFT depends on the Fertility center and the expertise of the physician. In most good IVF centers, success rates with GIFT are lower than IVF. Since it is an invasive procedure (requiring laparoscopy) and is more costly, its indications are limited. It is a good alternative when a patient is undergoing laparoscopy to investigate long-standing infertility. If planned in advance GIFT can then be performed at the same time if a normal tube is present.

GnRH-Agonist: A synthetic hormone similar to GnRH. Given in a continuous fashion by daily subcutaneous injections (Lupron) or nasal spray (Synarel). It will actually suppress pituitary and ovarian function. This interesting fact is used to suppress the hypothalamic-pituitary-ovarian axis in many women undergoing ovulation induction for IVF. It allows us to control the ovaries ourselves without interference from the hypothalamus or the pituitary.

Gonal-f: This fertility medication is a gonadatropin hormone containing very pure human FSH. It is produced by cells that have been genetically engineered through recombinant DNA technology to produce large quantities of human FSH. It is administered by subcutaneous injection.

Gonadatropins: Follicle Stimulating Hormone (FSH) and Lutenizing Hormone (LH) are pituitary hormones that stimulate egg production, ovulation, and estrogen and progesterone production. The gonadatropin FSH is the hormone that is the main ingredient in Gonal-f, Follistim, Repronex and Menopur. Injections of gonadatropin medications will cause the ovaries to make multiple eggs.

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HCG: Human Chorionic Gonadotropins: The major hormone secreted by the placenta. In the early stages of pregnancy continued survival of the corpus luteum (the follicle that released the egg) is totally dependent on HCG, and in turn, the survival of the pregnancy is dependent upon hormones secreted by the corpus luteum the 7th week of pregnancy. Thereafter, the corpus luteum is gradually replaced by placental hormonal secretions. Studies have shown that after administering HCG intramuscularly, ovulation occurs 38 to 40 hours afterwards. This is why during an IVF cycle egg retrieval is scheduled 30 to 40 hours after the HCG shot. Similarly, during simple ovulation induction with Clomiphene or Gonadatropins, HCG is sometimes given to trigger ovulation. HCG is chemically very similar to LH or lutenizing hormone, the signal for the ovulation process to begin. Inseminations or intercourse is then planned according to the time that HCG was administered.

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IUI: Intrauterine Insemination: See Artificial insemination.

IVF: In Vitro Fertilization: Literally "fertilization in glass," IVF comprises several basic steps: the woman is given fertility drugs that stimulate her ovaries to produce a number of mature eggs; at the proper time, the eggs are retrieved by suction through a needle that has been inserted into her ovaries; the eggs are fertilized in a glass Petri dish, or in a test tube, in the laboratory with her partner's or donor sperm; and subsequently the embryos are transferred into the body.

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LH: Luteinizing hormone: A hormone secreted by the pituitary gland involved in the control of ovulation. The role of LH is to trigger ovulation and help prepare the endometrial lining for implantation. The level of this hormone starts to rise roughly 24 hours prior to expected ovulation. We can check this by a home using ovulation predictor kit, such as Clear Plan Easy or OvuQuick One-Step. When the test color matches the control, this signifies the presence of elevated levels of LH in the blood. The individual then can plan intercourse within 24 hours of that positive test.

Lupron: Known medically as a GnRH-agonist (see GnRH). Lupron is a commonly used medication in IVF and also for the treatment of severe endometriosis or large uterine fibroids. Lupron taken continuously either by daily subcutaneous (under the skin) injections or monthly intramuscularly depot injections will suppress the pituitary-ovarian axis. Simply stated, it will make the ovaries "go to sleep" and stop functioning, therefore stopping the secretion of hormones such as estrogen and progestrone. Lupron is frequently used in IVF to prevent premature ovulation.

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Menopause: The period in a woman's life when menstruation stops. The average age of menopause in the United States is 51. The last few years prior to menopause, also called the climacteric, menstrual cycles become irregular in many women.

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Oocyte: See Egg.

Ovarian Hyperstimulation: Complication of taking fertility drugs resulting in gross enlargement of the ovaries. It is sometimes accompanied by accumulation of fluid in the abdomen and lungs, and abnormal blood tests. It occurs in less than 1% of the time in its severe forms requiring hospitalization. Hyperstimulation occurs when the ovaries produce excess eggs in response to stimulation by fertility drugs. Monitoring the response allows us to see which patients are at risk and helps us take steps to minimize the problem from occurring.

Ovary: The small oval organs measuring 2 by 1.5 inches present in a woman's pelvis and responsible for making eggs.

Ovulation: The process when a mature egg is released from the surface of an ovary.

Ovulation Induction: Stimulation of the ovaries by fertility drugs to produce and release on or more eggs.

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Pituitary Gland: A small gland present at the base of the brain. It receives instructions from a specialized area of the brain just above it called the hypothalamus. The pituitary secretes many important hormones, such as FSH, LH, TSH and Prolactin. FSH and LH control the ovaries, TSH controls the thyroid gland and Prolactin controls milk production.

Placenta: The organ that is responsible in the nourishment of the developing embryo. Abnormalities in the placenta can result in abnormal fetal growth and death.

Progesterone: A hormone secreted by the ovaries. It belongs to the same family of hormones such as estrogen, called steroids. It is secreted by the corpus luteum (see Corpus Luteum), which is the follicle that has produced and released the egg. Progesterone is produced by specialized cells surrounding the egg and this starts just prior to ovulation. This hormone plays a major role in preparing the endometrium for implantation. It also supports the pregnancy through the first few weeks of gestation. The corpus luteum will stop secreting progesterone if pregnancy does not occur. The progesterone level in the blood will then drop and menses will start within 24 to 48 hours. This is how a regular menstrual cycle takes place. If pregnancy occurs on the other hand, the placenta will start secreting the HCG hormone, and this hormone in turn will salvage the corpus luteum and make it continue secreting Progesterone.

Prolactin: A hormone secreted by the pituitary gland. Its major role is to control milk production. Excess secretion can interfere with normal ovulation. This is why Prolactin levels are checked in every woman during the evaluation process for infertility. Certain women have elevated Prolactin levels due to a small benign tumor in the pituitary gland or the brain. These tumors are often called Prolactinomas. They are usually treated by a medication called Bromocryptine or Parlodel. In rate instances, surgery may be required.

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Recipient: A woman who receives the fertilized eggs (often by a male patner or donor) from an egg donor. These embryos are transferred to her uterus after a 2 to 3 week period of hormonal preparation to have the uterus ready to accept these embryos. The recipient will carry, nourish and deliver the infant.

Repronex: A gonadatropin fertility medication that like Pergonal, comes from the partial purification of FSH and LH from human menopausal urine. Repronex has been approved by the FDA for subcutaneous administration. See also "gonadatropins".

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Synarel: A nasal spray medication that can be used instead of Lupron to prevent premature ovulation during an IVF cycle (see also "GnRH agonist" and "Lupron".)

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TSH: A hormone secreted by the pituitary gland that controls the thyroid gland. Elevated levels imply abnormally low thyroid function. The level of this hormone in blood is checked in most women with infertility because certain thyroid diseases may be associated with infertility.

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Ultrasonography: One of the most common imaging techniques a woman undergoes during treatment of infertility. Almost all ultrasound examinations for this purpose are currently done with a vaginal transducer. An ultrasound transducer emits acoustic sound waves that bounce back when they hit different types of tissues in the body along its path. These waves are then recaptured by the transducer and sent to the ultrasound computer. The ultrasound transforms these waves into gray scale pictures that are seen on a monitor screen. The texture of the particular tissue that the ultrasound wave traverses or hits determines the way it will look on the monitor. For instance, clear fluids such as urine will appear black while bony structures will appear white. The vaginal transducer is about 15 inches long and 1 inch in diameter. Only about 5 inches will enter the vagina. The procedure is painless for most women and harmless. It enables us to see the pelvic organs, including the ovaries and the uterus. It is commonly used to diagnose the presence of ovarian cysts, tumors, uterine fibroids, and pregnancies. It is also used routinely to follow the growth and development of ovarian follicles during ovulation induction with fertility drugs in patients who are undergoing IVF.

Uterus: A hollow muscular organ (the size of a small pear) present in the pelvis. It is connected to the vagina by the cervix and to the abdominal cavity by the fallopian tubes. Its main function is to contain and nourish the fertilized egg through its stages of development towards an embryo, a fetus, and eventually an infant. The uterus is lined by a layer of specialized glandular cells, called the endometrium.

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ZIFT: The transfer of a zygote into the fallopian tube. Also see GIFT.

Zygote: A fertilized egg.