INFERTILITY

Infertility

GLOSSARY

Abortion – The premature ending of a pregnancy before the twenty-fourth week, either spontaneously or because of operative intervention. The medical profession also use the term “abortion” as a description of miscarriage.

Adhesion – An abnormal sticking together of surfaces covered by membranes. These can be fine “cobweb” like or thick and dense, and can interfere with the movement of ovaries, tubes and bowel.

Agglutination – The sticking together (clumping) of sperm. This can often indicate the presence of sperm antibodies.

Amenorrhoea – The absence of menstruation (periods).

Amniocentesis – A procedure performed around the 18-20^th week of pregnancy. A small quantity of amniotic fluid from around the developing foetus is extracted to either determine the sex of the foetus, to check for abnormalities such as Down’s syndrome and also to detect and inherited genetic diseases.

Amnion – The inner membrane lining the foetal sac.

Ampulla – A widening of the tube e.g. the end of the vas deferens in which some sperm is stored. Also the ovarian end of the fallopian tube where fertilisation takes place.

Androgen – A male sex hormone produced by the testes responsible for male characteristics e.g. hair growth, deep voice and sperm production.

Andrologist – A doctor who specialises in male infertility and sexual disorders i.e. sperm and hormone production. Currently also used to name a scientist who analyses semen, previously termed a Seminologist.

Andrology – The study of diseases specific to the male reproductive system.

Aneuploidy – The loss or gain of one or two chromosomes. In a healthy human, all cells have 46 chromosomes, but occasionally around fertilisation time mistakes sometimes occur which result in each cell having e.g. 44,45,47 or 48 chromosomes. An embryo with only 44 or fewer chromosomes never survives the whole pregnancy and is lost by spontaneous miscarriage. Most of the other abnormal numbers do also, but some do go to full term pregnancy. The best-known and most frequent examples of aneuploidy results in a Down’s syndrome baby.

Anovulation – No ovulation. Menstrual cycles in which an egg is not produced. A woman can still have periods yet not be ovulating.

Antibody – A specific protein produced by the body in response to a challenge from a foreign substance known as an antigen. Men and women may produce antibodies for example to sperm.

Antisperm Antibodies – production of antibodies to sperm – the current treatment is IVF/ICSI.

Artificial Insemination – The introduction of semen into the female genital tract by means other than sexual intercourse.

Asherman’s Syndrome – Scar tissue in the uterus causing the sides to “stick” together. This is sometimes caused by over vigorous “scraping” during a D & C following a miscarriage. Specialist surgery is needed to remove the scarring and encourage the build-up of endometrium.

Aspermia – Failure to discharge seminal fluid at orgasm.

Assisted Hatching – Technique involving the artificial creation of an opening in the outer covering of the zona pellucida of the embryo. Used to help the normal growing embryo to emerge from the covering in order to implant properly in the uterus. Can be done by use of lasers, chemicals or mechanically.

Asthenozoospermia – Poor motility (movement) of sperm in the semen.

Azoospermia – An absence of sperm in the ejaculate.

Basal Body Temperature – The body temperature taken orally, vaginally or rectally, usually after a rest and before any activity. Known as BBT.

Bicornuate Uterus – An abnormality of the uterus that occurs before birth. A partial or complete vertical division of the body of the uterus. Bicornuate means “two-horned”.

Biopsy – The taking of a small piece of tissue from the body for laboratory examination.

Blastocyst Transfer – This is performed when the embryos are cultivated for 4-5 days to approximately 64-cell stage at embryo transfer.

Blighted Ovum – A fertilised ovum that fails to develop into an embryo and usually results in an early miscarriage.

Candida – Also known as “thrush”. A minor infection of the vagina or the glans of a male penis. It causes soreness, irritation and sometimes a discharge and is easily treated with cream, pessaries or medication. It is important to treat both partners to prevent the problem recurring.

Capacitation – A process that occurs in sperm, which gives them the ability to penetrate and fertilise an ovum, as they pass through the female genital tract. This can also be mimicked in a culture medium when assisted techniques of reproduction are taking place.

Cervical Mucus – A secretion from the lining of the cervical canal.

Cervical Smear – Also known as a PAP smear “Papanicolaou test. A simple test offered to all women and involves a cell sample being taken from all around the neck of the womb. This is then tested for any infection and for pre-cancerous cells.

Cervix – The neck or opening of the womb, which protrudes into the vagina.

Chlamydia – A common sexually transmitted infection that if left untreated, can cause tubal damage in the female and affect sperm quality in the male. Tests and treatments are needed for both partners before assisted conception.

Chorionic Villus Sample (CVS) – A sample of the placenta taken for genetic testing. The range for tests is similar to amniocentesis, but CVS can be done earlier in pregnancy at around 9-11 weeks gestation.

Chromosomes – Structures within every body cell that carry the hereditary material DNA.

Cilia – Hair-like projections. Those lining the fallopian tubes assist with the movement of the egg and sperm.

Cleavage – The division of a fertilised cell. Usually after about 26 hours after fertilisation occurs.

Coitus – Sexual relations, making love, intercourse.

Conception – The joining together of the egg and sperm through to implantation.

Condom – Contraception sheath. French letter. Sheath.

Congenital – A characteristic or defect present at birth.

Cornu – The “horns” of the uterus where the fallopian tubes meet the uterus.

Corpus Luteum – A small yellow structure developing within the ruptured ovarian follicle after the egg has been released.

Cryopreservation – Preserving substances at very low temperatures in liquid nitrogen at –196 degrees centigrade. E.g. frozen sperm, embryos, eggs, testicular tissue and ovarian tissue.

Cryptorchidism – Undescended testes, for which, surgery is usually recommended and performed as a child.

Cytomegalovirus (CMV) – A virus, which can cause severe disease in unborn babies if their mother catches the infection during pregnancy. Infection is common and by childbearing age 60-80% of the population will have been exposed to the virus. Catching the virus during pregnancy is not common.

Dilatation & Curettage (D & C) – An operation to stretch the canal of the cervix and then explore the cavity of the womb to obtain a sample of the womb lining.

Diploid Cell – a cell with two sets of chromosomes, one from the mother and one from the father.

Dizygotic Twins – Non identical twins.

DNA (deoxyribonucleic acid) – The basic biological hereditary molecules, which control many cell functions.

Donor Insemination – Artificial insemination using donated sperm.

Douching – The use of fluids to irrigate the vagina.

Dysmenorrhoea – Painful menstruation – periods.

Dyspareunia – Painful or difficult sexual intercourse.

Ectopic Pregnancy – A pregnancy that occurs anywhere other than in the uterus. This can occur in the fallopian tubes, ovaries or abdominal cavity.

Egg Donation – It is a procedure in which a woman donates her eggs to another. It is typically used for an infertile patient who cannot produce her own eggs; egg quality is poor or when the woman is the carrier of a genetic abnormality.

Egg Recovery – Part of an assisted conception technique procedure. The eggs are aspirated from the stimulated ovary by laparoscopy or ultrasound – abdominally or vaginally.

Egg Sharing – A procedure where a patient needs to undergo IVF treatment and is willing to donate, usually half of her eggs harvested during a cycle of treatment to another patient. The recipient would normally cover the cost.

Ejaculation – The ejecting of seminal fluid from the penis either by masturbation or sexual intercourse – male orgasm.

Electrodiathermy – A procedure which converts electricity into heat and which is used by surgeons to stop bleeding from small blood vessels. It has recently been found that by using it to burn small holes in the ovary, ovulation can sometimes be successfully induced in some women with polycystic ovarian syndrome.

Embryo – An early stage of development of a baby in the womb.

Embryo Transfer – part of an assisted conception procedure when fertilised eggs are transferred into the uterus.

Endocrine – Pertaining to hormones. Endocrine glands produce hormones, which are passed into the bloodstream and affect parts of the body, which are often distant from the gland itself.

Endocrinologist – A doctor/scientist who specialises in disorders of the endocrine system.

Endometrial Ablation – The womb lining is destroyed e.g. by laser. This is an alternative treatment to hysterectomy.

Endometrial Biopsy – the taking of a small sample of endometrium for examination.

Endometriosis – The presence of endometrium outside the womb. This can appear anywhere within the pelvis and even the lungs.

Endometrium – The lining of the womb.

Endoscopy – The visualisation of the interior of the body using instruments such as a laparoscope (abdominal cavity) and hysteroscope (uterus).

Enzymes – Proteins produced by the cells in the body but capable of acting independently of the cells. They induce and hasten chemical changes in the body.

Epididymis – The long coiled tubule attached to the back of the testis in which the sperm undergo further maturation.

Erection – The state in the penis when it is enlarged and rigid.

Fallopian Tubes – A pair of small, fine, delicate tubes where fertilisation usually takes place. The tubes transport and nourish the egg and sperm.

Fertilisation – The penetration of an egg by a sperm.

Fibroid – A fibrous usually non-cancerous tumour of the muscle of the uterus.

Fimbriae – The wafting tentacle like ends of each fallopian tube that “collect” the egg and guide it into the tube.

Flow Cytometry – Sperm sorting

Foetus – Middle stage of development between an embryo and baby, when all main recognisable features are shown i.e. from the end of the second month of pregnancy.

Follicle – Circular fluid filled cavity within the ovary containing a developing egg.

Follicle Stimulating Hormone – A hormone produced by the pituitary gland in the brain. In women it stimulates ovulation and the production of oestrogen. In men it stimulates the production of sperm.

Fundus – The upper portion of the uterus.

Gamete Intra-fallopian Transfer (GIFT) – This treatment involves stimulation of the ovaries and then under a laparoscopy, the eggs and prepared sperm are then placed into the fallopian tubes where natural fertilisation normally takes place.

Gametes – Female and male reproductive cells – ova and sperm.

Genes – Parts of the chromosomes that control the inheritance of hereditary characteristics e.g. hair and eye colour.

Genetic – Pertaining to hereditary characteristics.

Genome – All the genetic material within the cells of an individual.

Gonadotrophin Releasing Hormone (GnRH) – This is produced by the hypothalamus in the brain to stimulate the pituitary gland to produce (LH) luteinising hormone and (FSH) follicle stimulating hormone.

Gonads – The sex glands that make sex cells. These are the ovaries in the female and the testes in the male.

Gynaecologist – A doctor who specialises in the investigation and treatment of the female reproductive organs and functions.

Hormone – A natural occurring chemical produced by the endocrine glands in the body, that circulate in the bloodstream to give an effect on a distant organ or organs. E.g. oestrogen produced by the ovaries and testosterone produced by the testes.

Hormone Replacement Therapy (HRT) – Substitute for the female hormones oestrogen and progesterone. Usually given when the levels fall due to menopause.

Hostility Mucus – This is used to describe a poor interaction between cervical mucus and sperm. This can be due to poor timing of tests, ovulation problems, poor quality sperm, infection in either partner or antibody production.

Human Chorionic Gonadotrophin (HCG) – The hormone produced by the placental cells (afterbirth) in pregnancy. Detection of this hormone in blood or urine is the basis of pregnancy testing. The hormone mimics the luteinising hormone (LH), which is normally produced by the woman at ovulation time. Preparations of HCG are used to stimulate ovulation and are sometimes given following procedures like IVF or ICSI to help the embryo implant.

Hydrocele – A swelling or accumulation of fluid around the testicle.

Hydrosalpinx – A fluid filled swelling of the outer ends of one or both fallopian tube(s).

Hydrotubation – A washing or flushing of the fallopian tubes with a sterile solution, medication or dye.

Hyperplasia – An abnormal overgrowth of tissues or organs of the body.

Hyperstimulation - This is an excessive response of the ovaries to ovarian stimulation.

Hypothalamus – A part of the brain that serves as a link between the higher centres of the brain and the pituitary gland, responsible for the control of the pituitary gland.

Hysterectomy – Removal of the uterus.

Hysterosalpingogram (HSG) – An x-ray study in which a radio-opaque fluid is injected into the uterus so that doctors can see the outline of the inside of the womb and the fallopian tubes.

Hysteroscopy – The use of a very fine telescope to view the inside of the uterus via the cervix.

Hysterotomy – A surgical opening of the uterus to perform a surgical procedure e.g. removal of fibroids.

Implantation – The embedding of a fertilised ovum in the endometrium of the uterus.

Impotence – The inability of a man to produce or maintain an erection of his penis.

Infertility – Failure to conceive after regular unprotected sexual intercourse.

Interstitial Cells – The cells between the seminiferous tubules of the testes. Some are called “Leydig cells” and produce the male hormone testosterone.

Intra Cytoplasmic Sperm Injection (ICSI) – A process in which a single sperm is inserted directly into the cytoplasm of an oocyte, thus bypassing all natural barriers a sperm has to encounter. Usually used when there is a low sperm count or reduced sperm motility.

Intra Uterine Contraceptive Device (IUCD) – A device implanted into the uterus to prevent pregnancy occurring. Can sometimes cause infertility.

Intra Uterine Insemination (IUI) – Insertion of a prepared sperm sample into the uterus through the cervix.

In Vitro Fertilisation (IVF) – A procedure whereby an egg or eggs are recovered by laparoscopy or vaginal ultrasound aspiration. This can be a natural or stimulated cycle, when drugs are used to make the ovaries produce more eggs. They are then placed with a specially prepared sperm sample – partners or donors – so that fertilisation can take place. The pre-embryo(s) is/are then transferred to the uterus when it/they may implant and develop.

Kallman’s Syndrome – Low FSH and LH levels in a male with a total lack of sperm. Treatment requires hormone injections and IVF/ICSI.

Kartagener’s Syndrome – This causes problems with sperm tails and requires treatment using ICSI. Sufferers often have poor lung function.

Karyotype – The description of chromosomes, their shape and size etc.

Klinefelter’s Syndrome – A congenital abnormality of men when there is one “X” chromosome too many. Men with this condition are usually sterile.

Laparoscopy – A technique in which the internal abdominal organs can be visualised directly, by using an instrument, which is introduced through a small incision in the abdominal wall below the navel.

Laser – Light amplification by stimulated emission of radiation. Laser light is used to cut or destroy tissue e.g. tubal surgery and endometriosis.

Luteinising Hormone (LH) – A pituitary gonadotrophic hormone, which stimulates ovulation to take place. In the male it is responsible for the release of testosterone from the testes.

Menarche – The age at which menstruation starts.

Menopause – The cessation of menstruation usually occurring around the age of 50 years. “The change of life”. The menopause is said to be premature when it occurs in a woman under the age of 35 years.

Menstruation – “The period”. The endometrium is shed if an embryo does not implant and produce a pregnancy.

Micoplasma – An infection that possibly causes fertility problems and miscarriage

Microsurgical Epididymal Sperm Aspiration (MESA)– A surgical method performed under a general anaesthetic to collect sperm from the surface of the epididymis and then used in ICSI.

Miscarriage – The loss of a pregnancy before the foetus is 24 weeks old. The medical terminology is “abortion” and is further clarified by terms such as inevitable, incomplete, missed and recurrent.

Mittelschmerz – A German term used to describe the lower abdominal pain women feel which occurs at mid-cycle and is generally assumed to be associated with ovulation.

Monozygotic Twins – identical twins formed from one egg.

Sperm Morphology – Refers to the form or shape of the sperm.

Motility – The power of movement. Usually used to describe sperm, which move under their own power.

Mucus – Cervical – A substance produced by the cells of the cervix. This changes under the influence of hormones. At ovulation time, the mucus appears clear and stretchy (like uncooked egg white). It is then capable of being penetrated by sperm.

Myomectomy – Open surgery to remove fibroids.

Necrospermia – A condition in which the semen only contains dead sperm.

Obstetrician – A doctor who specialises in the supervision of pregnancy and childbirth.

Oestrogen – The female sex hormone produced by the ovaries. Oestradiol, Oestriol and Oestrone are all forms of oestrogen.

Oligoasthenoteratozoospermia (OAT) – This relates to poor sperm count, poor motility and high numbers of abnormal sperm. Fewer than 4.8 million sperm per ml.

Oligospermia – A condition in which the sperm count is less than 20 million per ml.

Ovaries – The female reproductive organs that contain eggs, which produce the female hormones oestrogen and progesterone.

Ovulation – The release of a mature egg from an ovarian follicle. This is usually around 14 days before the onset of menstruation.

Partial Zonal Dissection (PZD) – A small hole/slit is made into the outer coat of the egg to help sperm to penetrate.

Patent – Open, unobstructed. Used in respect of the fallopian tubes and male duct system.

Pelvic Inflammatory Disease (PID) – An infection involving the pelvic organs e.g. ovaries and fallopian tubes.

Penis – The male sex organ of sexual intercourse and urination.

Percutaneous Epididymal Sperm Aspiration (PESA) – Aspiration of sperm from the epididymus.

Pessary – Medication produced for use in the vagina or rectum.

Pituitary Gland – An endocrine gland at the base of the brain that produces several hormones including follicle stimulating hormone and luteinising hormone. It is the master gland of the endocrine system of the body.

Polycystic Ovarian Syndrome (PCOS) – Also known as Stein-Leventhal Syndrome. A condition where multiple cysts appear in the ovary. Abnormal hormone imbalance can arise causing problems with ovulation. Diagnosed by blood test, vaginal ultrasound and signs such as increase in body weight, excessive hair growth and acne. These signs do not always manifest themselves in PCOS.

Polymerase Chain Reaction (PCR) – A technique used in genetic (DNA) diagnosis.

Polyp – A nodule or small usually non-cancerous growth found on a mucus membrane. These can grow on the cervix or in the uterus and often cause vaginal discharge and heavy menstruation.

Post-Coital Test (PCT) – A diagnostic test which allows observation of semen/mucus interaction. A sample of mucus is taken from the woman’s cervix just before ovulation time, 6-12 hours following sexual intercourse.

Pre-implantation Genetic Diagnosis (PGD) – A technique in which embryos are tested for specific genetic disorders before being replaced into the womb.

Pre-menstrual Syndrome (PMS) - A collection of physical and emotional signs and symptoms, which appear during the post ovulatory phase. They disappear at the onset of menstruation. Most women experience menstrual symptoms, but if they become severe it is recognised medically as Pre-menstrual Syndrome.

Progesterone – A hormone produced by the corpus luteum – where the egg leaves the ovary – after ovulation has occurred. The placenta also produces it in pregnancy.

Prolactin – A pituitary hormone produced during pregnancy and following delivery of a baby. It stimulates breast milk production. Some women with infertility have a high level of prolactin, which causes the hormones to become imbalanced and can prevent ovulation. Successful treatment can be obtained by the use of drugs.

Prostate – A gland found only in men at the base of the bladder and surrounds the first part of the urethra. It produces a slightly acid solution, which makes up around one third of the seminal fluid.

Pseudocyesis – False pregnancy. A condition, in which a woman believes herself to be pregnant and may have some signs of being pregnant, but is not.

Retrograde Ejaculation – At male orgasm, the seminal fluid containing the sperm goes backwards into the bladder. Often suffered by diabetics and men with multiple sclerosis.

Salpingitis – Inflammation of the fallopian tubes.

Scrotum – The bag of skin that lies between a man’s legs below his penis. It holds the testes, epididymis and the first part of the vas deferens.

Selective Reduction – A procedure in which one or more foetuses in a multiple pregnancy is/are destroyed to give the other(s) a better chance to develop.

Semen – The fluid ejaculated from the penis at orgasm containing sperm.

Semen Analysis – The study of fresh ejaculated semen under a microscope to count the number of sperms per cubic millilitre. It also includes the assessment of their shape (morphology) and their swimming ability (motility).

Semen/Mucus Cross Hostility (SMXH) – A test to assess sperm/cervical mucus interaction. The man’s semen is tested with partners and donor mucus. It can help to diagnose if her mucus is killing her partner’s sperm.

Seminiferous Tubules – The long tubes in the testes in which sperm are manufactured.

Speculum – An instrument used to aid examination of the vagina and the cervix.

Spermatid– An immature sperm cell.

Spermatocele – A cyst, which grows from the upper part of the epididymus or testes and contains sperm.

Spermatozoa – The medical term for sperm. The male reproductive cells.

Sperm Viability – Refers to whether or not the sperm are alive.

Split Ejaculate – A method of collecting semen so that the first part of the ejaculate is caught in one container and the rest in a second. The first portion is richer in sperm and can then be used to inseminate a woman.

Stimulated Cycle – This is when drugs are given to the female in order for the ovaries to produce more eggs.

Subzonal Insemination (SUZI) – a Procedure in which sperm is inserted into the space between the zona pellucida and the egg cell’s membrane.

Superovulation – The use of fertility drugs to produce multiple follicles on the ovaries.

Surrogacy – The process involving a woman carrying s baby for another person. In Host surrogacy, an IVF procedure is used so that the surrogate carries a child that is not genetically related to her. Part surrogacy involves the surrogate being inseminated with the man’s semen from the commissioning couple.

Syndrome – A set of symptoms and clinical signs which, taken together, constitute a particular disease or condition.

Teratozoospermia – A condition in which the semen contains a high proportion of abnormally shaped sperm.

TESE – The extraction of sperm for ICSI by first taking a testicular biopsy and then extracting sperm from the biopsy material.

Testes – The male reproductive organs producing testosterone and sperm.

Testicular Sperm Aspiration (TESA) – The extraction of sperm for ICSI by extracting testicular tissue using a wide bore needle and syringe.

Testosterone – The male sex hormone produced in the testes.

Thyroid Gland – A two-lobed gland at the base of the front of the neck, which produces hormones that, among other things, are thought to be essential for fertility.

Thyroxine – A hormone produced by the thyroid gland.

Toxoplasmosis – An infection, which if contracted in pregnancy can damage the foetus or cause miscarriage. Often found in animal excrement and unwashed vegetables.

Transcervical Endometrial Resection – A technique where the lining of the womb is shaved away as an alternative to a hysterectomy.

Transvaginal Aspiration – A method of removing eggs from ovarian follicles using a fine needle through the vaginal wall under ultrasound.

Trisomy - A condition where 3 chromosomes of one type are present in a cell. The commonest form of this is Down’s Syndrome.

Tubal Surgery – An operation to reconstruct blocked or damaged fallopian tubes. This is usually performed by an abdominal incision, however, more recently, tubal surgery is being performed via the laparscope.

Turner’s Syndrome – A congenital condition in which a woman has one less “X” chromosome rendering her infertile. Pregnancy can occur using an egg donor.

Ultrasound Aspiration – A method used instead of laparoscopy to recover eggs from the ovary. The ultrasound image is achieved by abdominal or vaginal scanning and the eggs retrieved by needle aspiration from either of these two routes.

Undescended Testicles – A term used to describe testicles, which have not descended into the scrotum. A correctional operation is usually performed in infancy.

Untrasound Scanning – High frequency soundwaves are beamed into the pelvis and as they bounce back, are used to build up a picture. This can be performed abdominally or via the vagina. Organs such as the uterus and ovaries can then be visualised.

Urethra – A narrow passage, which takes urine from the bladder to the outside. In men it also carries semen during ejaculation.

Urologist – A doctor who specialises in disorders of the urinary system.

Uterine Arterial Embolisation – A procedure that blocks the blood supply to the fibroids. This reduces rather than removes the fibroids.

Uterus – A small, hollow, muscular organ found in the female pelvis that carries the fertilised ovum through the nine months of pregnancy, enlarging to accommodate as it grows.

Vagina – Front passage or birth canal. The tube that leads from a woman’s cervix to the outside (vulva).

Vaginismus – A spasm of the vagina muscles surrounding the vaginal opening, which can make sexual intercourse or examination difficult or impossible.

Varicocele – A varicose (swollen) vein around the vas deferens often on the left hand side.

Vas Deferens – The tube from each testicle, which transports sperm towards the urethra.

Vasectomy (Male Sterilisation) – A minor operation usually carried out under local anaesthesia, to interrupt the vas deferens, so that sperm are not present in the seminal fluid at ejaculation.

Vasography – An x-ray technique for visualising the vas deferens when looking for an obstruction.

Zonal Drilling – The use of a chemical agent or a laser beam to dissolve part of the zona pellucida – egg coating – to help the embryo hatch out of the egg so that it can implant into the endometrium.

Zona Pellucida – The outside covering (shell) of a human egg.

Zygote – A fertilised egg.

Zygote Intra-Fallopian Transfer (ZIFT) – Similar to IVF but the embryo is transferred directly into the fallopian tube rather than the uterus.

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