Glossary of Terms

Infertility is defined as failure for a couple to conceive after 12 months of unprotected sexual intercourse when the female partner is under the age of 35, or 6 months of unprotected intercourse she is 35 years of age or older. Whether or not a couple describes themselves as “trying to conceive” or not, time spent in a sexual relationship in the absence of the use of an effective method of contraception does count toward these time limits.

Infertility testing should begin with an evaluation of sperm quality for the male partner, and evaluation of the fallopian tubes (checking for blockage) and of ovulation for the female partner. Further testing is individualized, based upon the results of these tests or upon the couple’s particular medical history.

Ovulation induction is a medical infertility therapy in which the ovaries are stimulated with various fertility drugs in order to initiate ovulation (egg production and release), or to augment ovulation. Women diagnosed with polycystic ovarian syndrome may be candidates for treatment with insulin-sensitizing drugs such as metformin. Clomiphene citrate is an orally administered drug which stimulates ovulation and has a very low risk of multiple births. The aromatase inhibitors, letrozole and anastrozole, are drugs which have been shown to induce ovulation but neither drug has been FDA approved for the treatment of infertility. Gonadotropins (human menopausal gonadotropins or recombinant follicle stimulating hormone) are available only in injectable form and are the most potent stimulators ovulation. Gonadotropins have a higher pregnancy rate but have a 20% frequency of twin pregnancy and a 5% frequency of triplet or even higher multifetal pregnancy.

IUI (intrauterine insemination) is an artificial insemination technique in which washed sperm is placed in the uterine cavity on the day of ovulation. Sperm washing separates the seminal plasma, which cannot be placed into uterus, from the sperm cells.

In Vitro Fertilization-Embryo Transfer treatment involves ovulation induction with gonadotropins for the purpose of producing multiple mature oocytes(eggs) from the ovaries, oocyte harvesting, incubation of the eggs and sperm in a laboratory dish to allow fertilization to occur, and then after three to five days of incubation, transferring embryo(s) into the uterus. After the embryo transfer step, the embryo(s) must continue sufficient growth and development in order to implant into the uterine wall and produce a successful pregnancy. IVF pregnancy rates (www.cdc.gov) are dependent on a number of variables, the most important of which is the age of the female partner. Still, IVF treatment currently offers the highest success rate of all fertility therapies, regardless of age.

Intracytoplasmic Sperm Injection (ICSI) is a microscopic procedure to assist the sperm in fertilizing the egg by directly injecting the sperm into the cytoplasm of the egg. This assisted fertilization is especially helpful in otherwise untreatable cases of severely low sperm counts, and produces the same pregnancy rates as conventional IVF (incubation of eggs and sperm) in the majority of cases.

Assisted Hatching is a microscopic procedure in which an opening is made in the outer shell of the embryo, the zona pellucida, in order to promote the embryo’s ability to attach itself to the uterus. This micromanipulation procedure is especially helpful for couples for whom there have been multiple failed IVF treatments, or for whom the wife is over 39 years old, or has diminished ovarian reserve.

Embryo Cryopreservation or embryo freezing offers a second chance to conceive from the one IVF treatment cycle. Not all couples going through IVF will have extra embryos that are suitable for freezing. Pregnancy rates from previously cryopreserved embryos are usually only half of what the pregnancy rate was at the time that the original cycle took place.

Polycystic Ovarian Syndrome is a clinical syndrome of irregular menstrual periods and symptoms of male hormone excess (acne, oily skin, facial hair growth), which frequently results from variable degrees of insulin resistance. A characteristic pattern of multiple small follicles arranged around the perimeter of the ovary on ultrasound imaging gives this syndrome its misleading name. Ovulation disturbances are common in this syndrome, making ovulation induction treatment necessary to promote conception.

Ovarian Reserve may be tested by checking a single FSH blood test on cycle day 3 or by the clomiphene challenge test, in which FSH is measured on day 3, clomiphene 100 mg is taken on days 5 through 9, and FSH is measured again on day 10. Both tests are utilized to predict a decline in a woman’s ability to become pregnant, independent of her age.

Donor Egg IVF may be accomplished using eggs from an anonymous donor, or with eggs from a known donor as long as that donor has no genetic relationship to the intended father. Success rates are predicted by the age of the donor, and not the age of the recipient. Donors undergo the oocyte stimulation and retrieval procedure. Then the donor’s eggs are fertilized by the intended father’s sperm and embryos are later transferred to the intended mother’s uterus. The screening procedures for qualifying potential oocyte donors, whether known or anonymous, are set forth by the FDA and the American Society of Reproductive Medicine.

Preimplantation Genetic Diagnosis (PGD) offers the opportunity to test a single cell from an eight cell embryo for certain diseases caused by a mutation in a single gene (such as Cystic Fibrosis, Sickle Cell Anemia, and Huntington’s Chorea, to name a few ) prior to the embryo transfer procedure. This technology is beneficial when an inheritable disease is known to occur in one’s family or when DNA screening tests on the couple going through IVF are positive. It is also beneficial when recurrent miscarriages are known to be due to a Robertsonian translocation.

Blastocyst is the last stage of development an embryo must reach before it implants itself into the uterine wall. Only about 40% of human embryos will be capable of reaching this stage of development in the IVF laboratory after 5 to 6 days of incubation. Transferring blastocyst stage embryos can produce the same pregnancy rates with the transfer of fewer embryos, and therefore lower the multiple pregnancy rate.

Gamete Intrafallopian Transfer, or GIFT, is a treatment for unexplained infertility that is identical to IVF up to the stage of egg retrieval. Instead of incubation of eggs and sperm (gametes) in the laboratory, the gametes are laparoscopically injected into the fallopian tube(s) on that same day. Zygote Intrafallopian Transfer (ZIFT) is the transfer of one or more one-cell embryos or “zygotes” to the fallopian tube. ZIFT requires waiting one additional day for the eggs to fertilize in the IVF laboratory before performing the laparoscopic tubal transfer procedure. These procedures require at least one of the fallopian tubes to be completely normal and accessible laparoscopically. Of the 85,826 assisted reproductive technology treatment cycles performed in 2002 only 0.2% were GIFT and 0.5% were ZIFT treatments. Disadvantages to GIFT and ZIFT are the increased surgical risks and costs of laparoscopy. The possible advantage is allowing embryo development to occur in the natural environment of the fallopian tube.