Abortion: The premature ending of a pregnancy either spontaneously or by surgical intervention. (UK Abortion Act 1967, + Amendments in HFE Act 1990)
Adhesion (above): The sticking together of surfaces in the body by fibrous tissue; often as a result of infections or surgery. Adhesions over the ovary may interfere with ovulation. Adhesions can sometimes be removed using laser surgery. When they occur over the ovary they can impede the pickup of the egg by the fallopian tubes after ovulation.They used to be a problem when egg recovery/pickup was by laparoscopy because they masked the appearance of the follicles on the surface of the ovary. Ultrsound directed methods of egg revovery over come htis difficluty.
Adoption: Procedure which allows people to become the legal parents of a child whose birth parents have given up all rights to that child. (UK Adoption Acts 1958, 1976)
Agglutination RIGHT: When sperm stick together - usually associated with antibodies which are part of the bodies fight against foreign cells -because the genetic makeup of the sperm nucleus is different from other cells in the body.
Agonist (Analogue Agonist) - LEFT: A compound which competes for the receptor sites in the pituitary and after initial stimulation brings about a reduction in the secretion of FSH and LH - referred to as down regulation. See also analogues & antagonist. See Superovulation
Amenorrhoea: Absence of menstruation
Ampulla: The widening of a tube - e.g. vas deferens, fallopian tube
Amniocentesis: A test at 18 weeks where a small amount of fluid around the fetus is extracted to test for Down's Syndrome.
Analogues: A parallel or similar thing - often used to refer to drugs which have a similar effect to GNRH and which compete for the receptor sites in the gonadotrophin secretory cells of the pituitary - e.g. Buserulin, Goserilin which suppress (down regulate) the pituitary.
Androgen: Male sex hormone responsible for male characteristics, e.g. voice, sperm production .
Andrologist: A specialist in male factor fertility.
Aneuploidy: The loss or gain of one or more chromosomes to the usual complement. In humans the normal complement is 46: the spread on the RIGHT shows 47 chromosomes (courtesy of Prof Alan Handyside) - when it is more or less than this number abnormalities occur.
Animatus: A term used to define the stage when an embryo shows animation (movement) - often used in moral theology when discussing the status of the human embryo. See also Formatus.
Anovulation: Absence of ovulation even though menstruation (periods) may continue.
Antagonist: A compound which blocks the production of gonadotrophin (FSH & LH) in the pituitary - a prospect for the future in controlling more effectively follicular stimulation. See also Analogue Agonist - see Superovulation
Antibody(ies): Proteins produced by the body's fight against infection. Antibodies challenge foreign cells and substances.
AIH: "Artificial insemination" with husband's sperm. More detail.
AID: "Artificial insemination" with donor's sperm (also known as DI, and TID)
Aspermia: Absence of ejaculated semen (see Azoospermia)
Assisted hatching: Helping the blastocyst hatch from its zona pellucida by making a hole in the zona pellucida. In some patients it may increase the chance of an embryo implanting - opinions are divided whether it helps in all cases.
Asthenospermia: Poor motility (movement or swimming) of sperm in the seminal fluid.
Azoospermia: An absence of sperm in the seminal fluid (see also Aspermia)
Basal Temperature: The body temperature (taken orally, vaginally or rectally) usually after rest and before any activity.
Bicornuate Uterus: An abnormality of the uterus that occurs before birth. A partial or complete division of the body of the uterus. Bicornuate means, "two - horned".
Biopsy: Taking small pieces of tissue for microscopic study.
Blastocyst - LEFT: The stage at which the embryo has reached 4-5 days, a fluid filled cyst has formed, and the cells have begun to differentiate into the inner cell mass (which will form the fetus) and the trophectoderm (which will form the placenta and fetal membranes).
Blighted Ovum: Fertilized ovum that fails to develop into an embryo leading to a miscarriage.
BMA: The British Medical association which represents the interests of the medical profession in the UK and whose ethics committee speak on matters of medical ethics.
Bromocriptine: (Parlodel) A drug used to treat a high prolactin level.
Capacitation: A process that occurs as sperm pass through the female genital tract which gives them the ability to penetrate and fertilize the ovum. (This can be mimicked in culture medium ) see fertilization.
Candida: A minor infection of genital tract causing minor irritation.
Caesarean section: The surgical operation to remove the fetus and placenta by excising the abdominal wall and the lower segment of the uterus.
Catheter: A thin tube for inserting materials into spaces. e.g. sperm or embryos into the uterine cavity.
Centriole: Structure at the base of the sperm head (RIGHT). We all thought that the only major contribution the sperm cell made to the human egg and its development was the 23 paternal chromosomes, at fertilization. In 1991 Henry Sathanthan discovered that a minute body called the sperm centriole (centrosome) was transmitted to the egg at fertilization, which organized the first mitotic spindle, initiating cell division within the fertilized egg,(1) the unique cell that gives rise to all cells of the human body. Sathananthan went on to demonstrate that the centriole, contained within a centrosome replicated and was perpetuated in every cell of the human embryo during each cell cycle. See the CD-ROM "Fathers contribution to Baby's Development: The Role of the Centriole" - www.webromproductions.org.
Cervix: The lower part of the uterus which projects into the vagina. - a fibro muscular structure.
Cervical Smear: Sample taken from the neck of the womb to test for precancerous cells
Chromosome - Chromosomal abnormalities: The chromosomes are thread-like structures within the nucleus which contain the hereditary material DNA. Mistakes in either chromosome numbers (46 in humans) or dammages can occur and these lead to abnormalities in the mebryo.
The chromosome spread (LEFT) shows an extra chromosome (bottom right corner) compared with the normal complement of 46 which would result in Downe's Syndrome.
Cilia: Hairlike projections from cells which have the ability to move. Those in fallopian tubes assist with the movement of the ova (eggs) and sperm, in the lungs they help to seep out mucus and dust particles.
Cleavage: The mitotic division of the zygote into two or more cells. Usually starts at about 26 hours after sperm and eggs meet.
Clomiphene: (Clomid): An infertility drug that stimulates ovulation. It acts on the hypothalamus to stimulate FSH production and hence stimulates ovulation.
Coitus: Sexual relations; making love; intercourse.
Conception: (BELOW) The joining together of the ovum and sperm - i.e. Fertilisation.- leading to implantation and pregnancy. Fertilization is a process of the fusing of genomes from the male and female and not complete until about day 3 when the male genome becomes active.
Conceptus: The product of fusion of the male and female gametes leading first to the pronucleate stage at about 18-22 hours, cleavage etc (ABOVE).
Condom: Contraceptive sheath; French letter; rubber.
Cornu: The 'horns' of the uterus where fallopian tube meets the uterus - see diiagram above = region wher the Morula is positioned.
Corpus Luteum (CL): A small body develops from the ruptured follicle (RF) after the egg has been released
from the ovary; it produces the hormone progesterone which promotes the pregnancy .
Corticosteroids: The aim is to suppress the immune system and reduce the antibody production. The main indication for using this class of drugs is when the male has sperm antibodies present, which affect sperm quality.
Counselling: A process which enables people to explore their feelings, and to consider the consequences of taking certain decisions or accepting certain treatments. Often defined as Implications Counselling, Support Counselling and Therapeutic Counselling. See Guidelines at www.eshre.com
Count: A measue of density which in reproductive medicicine usually refers to the number of sperm present as millions per ml. e.g. 20 x 106
Cryobiology: The use of low temperature techniques on cells, tissues and organs, usually by freezing and storage in ampoules (LEFT) or straws (RIGHT) which are kept in large containers of Liquid nitrogen - Dewars (BELOW RIGHT) - the 'steam' is the result of the extremel cold air released from the dewar as the cannisters are withdrawn.
Cryopreservation: Freezing tissues and storing them in liquid nitrogen at 196C. e.g. sperm & embryos, and more recently eggs. Freezing eggs is now possible although the success rates are not as high as freezing embryos - frozen/thawed eggs require microinjection (ICSI) to secure fertilization - babies have been born but many specialists suggest that the success rates are not high enough to enamble women to use this option to allow them to conceive at a later stage in their reproductive life.
Many countries have imposed restrictions on how long embryos can be stored - in the UK embryos can be stored for the patients own use for up to10 years.
The embryos are often treated with special culture media to protect them during freezing.
There are several different freezing protocols and freezing apparatus. Some lower the temperature of the embryo very slowly then at a temperature point (known as the seeding temperature) theformation of extra cellular ice is initiated by touching the ampoule or straw with a very cold metal object cooled in liquid nitrogen (-196 C) Others freeze very rapidly by immesring the embryos into supercooled liquid nitrogen (-210 C) - often referred to as flsh freezing.
Cryptorchidism: Undescended testis
Culdoscopy: The direct visualization of the pelvic organs by inserting a special instrument through the top end of the vagina into the abdominal cavity. Of diagnostic use in infertility.
Culture Medium: This is the physiological salt solution which mimics the natural conditions under which fertilization and embryonic growth occur (in vitro). The pink culture medium in the dish (RIGHT) under the microscope will support eggs, embryos and sperm for several days - the original pink marker was introduced to detect changes in pH. In vivo, the human embryo enters the uterus at either the morula stage or the blastocyst stage on Day 4 to 5 post fertilization. Since 1978, IVF embryos have primarily been transferred into the uterus at the 4-8 cell stage on Day 2-3 post-fertilization. The reason for this has been due to limitations of the culture media and conditions to sustain normal growth of blastocysts at acceptable rates. Recently developed sequential culture media have provided a successful alternative to early (Day 2-3) embryo transfers. The blastocyst development rate in this media is approximately 45%, thus providing adequate numbers of embryos that make Day 5 transfers a realistic option. Published studies using Gl.2 Tm and G2.2 Tm have reported implantation rates of greater than 50% using these media. (Courtesy: Scandinavian Science).
Discussion with Prof Lars Hamberger on development in embryo culture - file size 10.46 MB
Cyclofenil (Rehibin): A drug similar to Clomiphene, prescribed to induce ovulation; also thought to enhance the quality of the cervical mucus.
Danazol: Drug similar to clomiphene which inhibits ovulation (Danol) temporarily.
D & C:
"Dilation & curettage" a widening of the cervical canal to allow sampling of the lining of the womb - a diagnostic procedure. Often used to remove products of incomplete abortion or where the embryo has died at an early stage after IVF and embryo transfer.
Desiccator - LEFT: A glass vessel with a removal lid capable of being 'evacuated', filled with a gas, or containing a drying agent - often used with silica gel to keep things dry. Used in the early days of IVF to provide a balanced carbon dioxide environment to maintain the pH in the culture medium. Today sophisticated incubators provide accurate temperature and carbon dioxide environments.
Diakinesis: One of the stages at the beginning of meiosis when the chromosomes are lined up along the spindle - visible for only a very short time.
Differentiation: The point at which cells in the embryo become different from each other - i.e. become destined to be different parts of the body.
DIPI: "Direct Intra Peritoneal Insemination" Sperm injected through the wall of the vagina close to the ovary.
DNA: Deoxy Ribose Nucleic Acid - inherited from the mother
and the father in the nucleus. The double helix molecule (LEFT) isresponsible for hereditary
and the molecule which controls cell function; DNA also exists in the cytoplasmic mitochondria
which are inherited from the mother.
DOT: An acronym- "Direct oocyte transfer" Eggs with sperm attached to the zona are transferred to the uterus (fertilization is unconfirmed).
Douching: Fluids to irrigate the vagina: not an effective method of contraception.
Downs Syndrome: Congenital abnormality due to chromosomal disorder the majority of which are due to trisomy 21: associated with increasing maternal age. Amniocentesis or chorionic villi sampling may be indicated for women over the age of 35. More recent screening includes monitoring for alpho-feto protein or hCG .
Dysmenorrhoea: Painful menstruation.
Dyspareunia: Painful intercourse.
Ectopic Pregnancy: Pregnancy in the fallopian tubes.
Egg Donation: Some women do not produce eggs, others very poor quality eggs, or some women carry genetic abnormalities. A woman who has no fertility problem donates her eggs (oocytes) to another to enable her to have a child. Illegal in some countries - payment for eggs is allowed in some countries and prohibited in others. Egg donors may be anonymous or known donors.
Egg Recovery: Egg Collection: Egg Pickup: Also called Oocyte Recovery. The eggs are aspirated from the ovary, this is performed by laparoscopy or ultrasound (abdominally or vaginally) directed methods.
Ejaculate: The seminal fluid ejaculated from the penis: during male orgasm. Either as a result of intercourse or masturbation.
Electrodiathermy: Heat is used by surgeons to stop bleeding from small blood vessels. Burning small holes in the ovary can induce ovulation in some women with polycystic ovary syndrome.
Embryo (LEFT and BELOW): The product of fertilization. An early stage of development, usually in the womb, but also in vitro in the laboratory.
Embryo Donation: Patients who have embryos in cryopreservation which are surplus to their needs (e.g. they have already been successful in IVF) may be able to donate embryos to another couple. Counselling of donors and recipients should be offered (to consider the implications for them and future children), Discussion
Embryologist : Scientist with training and skills in handling sperm, eggs, and embryos in the laboratory (RIGHT).
Embryo biopsy (LEFT) :Taking one or more cells (blastomeres) from an embryo (often at the 8 cells stage but can now with laser techniques be at the blastocyst stage) for genetic or sex analysis. DNA hybridization (amplification technique) allows analysis in a very short time. Enables good embryos without screenable genetic abnormalities to be chosen. Animation taken from a video by Jamie Grifo.
Embryo Transfer / replacement : Stage in IVF when the fertilised eggs are transferred to the uterus The embryologist will load the catheter with the embryos in a tiny drop of culture media. The catheter is inserted through the cervical canal into the uterus (LEFT ).
Endocrine: 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 specializes in disorders of the endocrine glands and the study of hormones.
Endogenous: Naturally occurring hormones - as opposed to exogenous (added hormones or drugs by injection or inhalation.
Endometrium: The lining of the womb which develops at the beginning of each cycle so that it is ready to receive a fertilised egg. If there is no embryo then the endometrium breaks down and the woman returns to menstruation. During the cycle there are temperature changes - a fall in temperature followed by a rise schedules ovulation - it is not however an accurate method of predicting ovulation but successive temperature charts may be useful in determining the regularity of a woman's cycle. - see below:
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 the endometrium for examination.
Endometriosis: The presence of endometrium outside the womb. It can occur anywhere within the pelvis and even in the lungs and the knee.Discussion
Endoscopy: The visualization of the interior of the body using instruments such as the laparoscope, culdoscope or hysteroscope.
Enzymes: Proteins produced by cells in the body but incapable of acting independently of the cells. They induce and hasten chemical changes in the body.
Epididymis: The structure above the testis in which sperm undergo further maturation - RIGHT
Erection: The state of the penis when it is enlarged and rigid. Erectile dysfunction = a failure in erection or failure to maintain an erection,
Ethics committee: A body of independent people representing a wide range of disciplines, with a high lay representation which can advise or rule on ethical matters - can be local (i.e. considering matters for a local hospital or clinic or national.
Exogenous: Something applied from out side (ex) - usually drugs or hormones.
Fallopian Tubes: A pair of small, fine, delicate tubes where fertilisation usually takes place. The tubes transport and
nourish ova and sperm. see HSG as a means of determining their patentcy. Animated graphic pf embryos passing down the fallopian tubes >
Fertilization: The penetration of the ovum by the sperm (conception). A process which results in the formation of an embryo. The sperm goes through several stages before fertilization is complete: 1 - capacitation, 2 - acrosome reaction, 3 - decondensation. See extended discussion on fertilization.
Fetus (also spelt Foetus): The product of conception where the developing conceptus has reached the 12 week stage.
Follicle: The follicle consists of a group of cells in the ovary within which the egg (oocyte) is situated. More details.
Follicle Stimulating Hormone (FSH): A hormone produced by the pituitary gland in the brain. In women it stimulates ovulation and the production of oestrogen, in men the production of sperm. High FSH may indicate the menopause. See also Follicular Stimulation
Follicle Tracking: A series of scans which monitor the growth of the follicle(s) in the ovary. Used to confirm ovulation and monitor treatment with gonadotrophin therapy.
Formatus: A term used to determine when the embryo/fetus has reached human form. A term often used in moral theology. See also Animatus
Fostering: Fostering a child does not involve a legal process and is a means of caring for a child who cannot be with his or her parents. This can be short or long term.
Fundus: The upper portion of the uterus. The same term is also used to define the upper region of other organs (e.g. The stomach).
GIFT, Gamete Intra Fallopian Transfer: Eggs retrieved (usually under laparoscopy) are mixed with a prepared semen sample and introduced into the fallopian tube. SEE RIGHT
In the schematic representation (LEFT) the eggs and sperm are separated by a bubble of air. In the United Kingdom IVF regulations do not allow more than 3 embryos to be transferred. There are however no such regulations for GIFT and some practitioners would consider transferring more than three eggs in older women or those with multiple IVF failure. Egg pickup may be by laparoscopy or ultrasound guided methods. Transferring the eggs and sperm via a catheter is often by laparoscopy or laparotomy under general anaesthetic.
Gametes: Male and female reproductive cells - see sperm and ova.
Genes: Parts of the chromosomes that control the inheritance of specific hereditary characteristics.
Genetic: Inherited hereditary characteristics.
Genome: All the genetic material within the cells of an individual.
GNRH: Gonadotrophin Releasing Hormone responsible in the pituitary for initiating the production of gonadotrophin hormones (FSH & LH).
Hatching: The process by which the blastocyst emerges from the zona pellucida before implantation. See also assisted hatching.
HRT: Hormone Replacement Therapy:Substitute for the female hormones oestrogen and progesterone, given when levels fall due to menopause.
Hostility Factor: This is used to describe a poor interaction between cervical mucus and sperm. This can be due to poor timing of test, ovulation problems, poor quality sperm, infection in either partner or antibody production.
Human Chorionic Gonadotrophin HCG: The hormone produced by placental cells (afterbirth) in pregnancy. Detection of this hormone in blood or urine is the basis of pregnancy testing. This hormone mimics the Luteinizing Hormone (LH) normally produced by a woman at ovulation time. Preparations for this are used to stimulate ovulation and sometimes given following procedures like IVF or GIFT to help the embryo implant.
Human Fertilization & Embryology Authority (HFEA) - LEFT: In the UK The Human Fertilization & Embryology Act 1990 resulted in the formation of this authority, which approves and licenses clinics that offer IVF and treatment with donor Gametes.
Hydrocele: A swelling of the scrotum caused by an accumulation of fluid.
Hydrosalpinx: A fluid filled swelling of the outer ends of one or both fallopian tubes. See HSG Below. Courtesy of Herbert Reiss.
Hyperplasia: An abnormal enlargement of tissues or organs in the body.
Hypothalamus: A part of the brain that serves as a link between the higher centres of the brain and the pituitary gland. It controls the activity of the pituitary gland.
Hysterectomy: Removal of the uterus due hemorrhage or cancer.
HSG- Hysterosalpingogram: 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. Note the fine tubes ending in the spillage at the fimbrial end of the fallopian tubes. Also called a tubogram. Courtesy of Herbert Reiss.
Hysteroscopy: The use of a very fine telescope to view the inside of the uterus via the cervix. The tip of the hysteroscope is about to enter the cervix (the structure between the vagina and the uterus). See graphic LEFT.
Hysterotomy: An opening of the uterus to perform a surgical procedure.
ICSI: Intra Cytoplasmic Sperm Injection. Injecting the sperm directly into the egg. Major advance in male factor infertility wjere sperm numbers/quality/motility are a major factor.
Idiopathic infertility: Unexplained reasons for infertilityIdeiopathic infertility - see discussion
Immunological Response: The formation of antibodies. In infertility usually refers to those produced by the man or woman that affects sperm quality or ability to function.
Immunotherapy: Helping the body to fight infection and immunological problems. Treatment can be offered to some women who suffer recurrent miscarriages. The woman is immunized with white blood cells taken from partner's blood. It is thought that this enables the woman to develop the necessary protective factor which will prevent rejection of the growing embryo.
Implantation: The embedding of a fertilised ovum in the endometrium of the uterus - Blastocyst RIGHT, The embryo proper (the inner cell mass) is the group of cells at the bottom of the blue 'cyst' The cells around the outside of the blastocyst (the trophectoderm) will form the placenta and fetal membranes linking up with the rapidly developing blood vessels in the endometrium.
Impotence: The inability to achieve or maintain an erection for successful intercourse. Can be caused by emotional or physical problems, or both.
Incubator: A controlled environment (controlled temperature and gas content) for eggs, sperm and embryos.
Infertility: Arbitrarily defined as the inability of a couple to produce a pregnancy after one year of intercourse with no contraception. One in six couples are affected. Can be described as primary or secondary infertility. See also Causes of Infertility
Inhibin: A hormone produced by the ovaries and testes. Inhibin B is produced by the dominant follicle and results in the suppression of FSH secretion from the pituitary.
Inner Cell Mass: Cells in the blastocyst which will form the embryo. Cells on the periphery (trophectoderm) will form the placenta and fetal membranes. See the diagram above (adjacent to Implantation) and blastocyst.
Inter Country Adoption (ICA): Adopting a child from abroad or across boundaries. (e.g. Poland, Thailand, Chile). Covered by a 'Hague Convention' which is not yet ratified by all countries.
Interstitial Cells: The cells between the seminiferous tubules of the testes (Leydig cells) that produce the male hormone.
Intrauterine Device (IUCD) - Contraceptive: Used as a contraceptive. May cause infertility in some women.
IUI - Intrauterine Insemination: Insemination of a prepared sperm sample into the uterus through the cervix.
IVF - In Vitro Fertilization (below): Fertilizing the egg in the laboratory for subsequent embryo transfer. Requires egg retrieval/pickup. This can be a natural cycle or a stimulated cycle (when the ovaries are made to produce more eggs). The egg or eggs are recovered by laparoscopy or vaginal ultrasound aspiration. They are placed with a specially prepared semen sample (partner's or donor's) where fertilization may take place. The pre-embryo(s) is then transferred to the uterus where it may implant and develop further into a fetus and eventually a baby.
Kleinfelter's syndrome: A congenital abnormality syndrome in men - one X chromosome too many - men are sterile.
Lamina flow hood - RIGHT: A semi enclosed space in the laboratory where a flow of filtered sterile air flows across the working surface keeping cells and embryos in a clean environment
Laparoscopy - LEFT : Abdominal organs visualized using an instrument introduced through abdominal wall. RIGHT: Patrick Steptoe pioneering work on the use of laparoscopy in Gynaecology was to lead to the birth of the first IVF baby in July 1978 in collaboration with physiologist Robert Edwards.
Laser: Light Amplification by Stimulated Emission of Radiation - used in surgery to cut or destroy tissue, e.g. Endometriosis, adhesions etc, and in reproductive medicine to weaken the zona pellucida in assisted hatching. See BELOW. An example of its use is seen on the LEFT where the zona pellucida has been drilled with the laser set at increasing strengths from 3 O'clock through 6 O'clock. Photograph courtesy of Anna Veiga (Institut Universitari Dexeus, Barcelona, Spain) who is seen at the microscope controls above.
LHRH: Also known as GNRH. The luteinizing hormone releasing hormone - or Gonadotrophin released by the hypothalamus region of the brain and which stimulates the cells in the pituitary to release FSH and LH. The analogues (e.g. Buserulin are synthetic products with similar activity to the endogenous hormone. Application of the analogues bind competitively with the receptor sites on the secretory cells and therefore reduce the levels of secretion of FSH and LH.
Libido: The desire for sexual pleasure.
Luteinizing Hormone: A pituitary gonadotrophic hormone which stimulates both Hormone (LH) maturation and rupture of the follicle in women. High LH often produces low or absent follicle production.
Masturbation: Obtaining a sexual pleasure (which may lead to orgasm) by touching the genitals (most common method of obtaining sperm for IVF, DI, Sperm freezing etc.).
Meiosis: A form of cell division in which the cell with 46 chromosome (referred to as "diploid") gives rise to two cells with 23 chromosomes -"haploid"). More details. See also mitosis (below).
Menarche: The beginning of the menstrual cycle in girls at puberty.
Menopause: The cessation of menstruation that occurs around the age of 45 - 50, the 'change of life'. This is said to be premature when it occurs in a woman under the age of 35. Only apparently occurs in humans.
Menstruation: Vaginal bleeding which is part of a cycle of hormonal events. This normally begins at puberty & occurs throughout a woman's reproductive life unless she is pregnant or breast-feeding.
MESA: microsurgical epididymal sperm aspiration - often now replaced with PESA
Metabolism: The process by which cells carry out their functions - biochemistry and molecular biology are able to define metabolic pathways in increasing detail.
Metaphase: The stage in mitosis and meiosis when the chromosomes align themselves on the spindle in preparation for anaphase (the next stage). Often separated into two phases - Metaphase I (left) and Metaphase II (right). Fertilization (by sperm penetration or through ICSI) is optimal at the metaphase II stage. After the metaphase stages the chromosomes move along the spindle to opposite poles. See meiosis.
Micro-manipulation: Recent developments used (as an extension of IVF) for ICSI or to manipulate the embryo by blastomere biopsy (RIGHT), zona drilling etc. Precision tool-holders enable very fine and precise movement of glass needles whose diameter are considerably less than the diameter of a human hair
Micro-insemination: technique where there is a problem with sperm (MIST) quality. The egg wall is opened making sperm penetration easier or an individual sperm is injected into the outer egg covering (SUZI, or injected directly into the egg - ICSI).
Microsurgical Epididymal Sperm Aspiration (MESA): Sperm are aspirated from the testes and used in the IVF procedure. Can be simplified as PESA (peritoneal epididymal sperm aspiration) - RIGHT
Miscarriage: The loss of a pregnancy before the fetus is twenty-eight weeks old. The medical terminology is abortion and is further clarified such as inevitable, incomplete, missed and recurrent.
Mittelschmerz: A German term used to describe the 'middle pain' which occurs in some women when they ovulate.
Mitosis: The process of cell division of somatic cells where an identical copy is made with the same number of chromosomes. See also meiosis where the cell with 46 chromosome (referred to as "diploid") gives rise to two cells with 23 chromosomes
Morphology: Refers to the shape or form of cells - in particular the sperm.
Motility: The power of movement. Usually used to describe sperm which move under their own power (as %).
Mucus (cervical): Fluid produced by specialized cells in 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 able to be penetrated by the sperm.
Necrospermia: A condition in which the semen contains only dead sperm.
Natural Cycle: Natural cycle for the production of eggs - no hyperstimulation. See extended section on follicular stimulation.
Normozoospermia: Semen analysis which shows normal sperm analysis.
OBGYN: A department in a hospital/clinic specializing in gynaecology and obstetrics.
Obstetrician: A doctor who specializes in the supervision of pregnancy and childbirth.
Obstructive & Non Obstructive: Terms used to define the absence of sperm in the semen - i.e. as a result of a blockage (obstructive) or as a result of lack of spermatogenesis (non obstructive).
Oestrogens (Estrogens): A term used to describe a group of hormones produced by the ovary and adrenal glands (Oestradiol/Estradiol, Oestriol and Oestrone). Can be detected in various ways - urine, blood, and more recently saliva.
OHSS: Ovarian Hyper Stimulation Syndrome: A rare but severe response to hormone stimulation requiring hospitalization. Upsets the fluid balance in the blood causing liver and kidney problems - reversed by IV transfusion of albumin. See also below.
Oligospermia: A condition in which there are fewer sperms in the ejaculate than are considered 'normal'.
Oocyte: Female gamete or egg. In a natural cycle only one or perhaps two eggs are produced. Superovulation allows several follicles to develop so that at egg retrieval there may be typically up to 12 (or more)
Orgasm: Sexual climax. In men this is usually accompanied by an ejaculation of semen.
Ovarian Hyperstimulation Syndrome OHSS: A complication of gonadotrophin therapy in which there is excessive stimulation of the ovaries. There are three OHSS degrees of hyperstimulation - mild, moderate and severe. In order to prevent OHSS women having treatment undergo frequent scans and hormone testing.
Ovaries: The female gonads which produce ova (eggs) and hormones. Situated in the pelvis near to the fimbrial ends of the fallopian tubes. More detail.
Ovulation: The production and release of an egg from the ovary. This usually occurs around 14 days before the onset of menstruation. See also Superovulation.
Patent: Open, unobstructed. Used particularly in respect of the fallopian tubes and the main duct system.
Pelvic Inflammatory Disease (PID): An infection involving the pelvic organs e.g. ovaries and fallopian tubes. A common cause of infertility.
Penis: The male organ of intercourse and urination. The urethra also carries the seminal fluid during ejaculation. - see Male Reproductive Organs
Pentoxyfyline: A drug (similar to caffeine) which has been shown to enhance sperm motility. It also appears to have the added benefit of promoting fertilization.
PESA percutaneous epididymal sperm aspiration. Aspirating (collecting) the sperm from the epididymis
Pessary: Medication inserted into the vagina - progesterone like drugs can be applied in this way.
PIGD Pre-implantation genetic diagnosis - embryo biopsy - taking a single blastomere (cell) from an embryo for genetic screening. Still frame from video provided by Jamie Grifo. A single cell (LEFT) being removed from an embryo at about the 8-cell stage, 3 days after insemination in vitro - photograph by Alan Handyside, The Bridge Centre London.
Pituitary: An endocrine gland at the base of the brain that produces several hormones. It is the master gland of the endocrine system of the body. Receptor sites on secretory cells in the pituitary receive the GNRH signals from the hypothalamus and respond by secreting FSH and LH. Analogue agonists compete for these sites and down regulate their activity lowering the secretions. Antagonists block the GNRH and hence prevent the secretions.
Polar Body: A small structure containing mainly genetic material. The first polar body is extruded at the end of the first meiotic division. The second polar body is extruded in response to the penetration of the sperm during fertilisation. More detail.
Polycystic Ovarian Disease (PCOD): Also known as Stein Leventhal Syndrome. A Condition where multiple small cysts appear in the ovary. Abnormal imbalance can arise causing problems in ovulation.
Polyp: A nodule or small non-cancerous growth found on mucus membranes. Can occur in the cervix or uterus.
POST, Peritoneal Oocyte Sperm Transfer: Eggs and sperm are injected into the abdominal cavity in the hope that the fallopian tube will pick these up.
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 at ovulation time, sexual intercourse having taken place some hours earlier.
Pre-menstrual tension: A collection of physical and emotional signs and Syndrome (PMS) symptoms, which appear during the post-ovulatory phase and disappear at the onset of menstruation. Most women in varying degrees experience premenstrual symptoms, but if they become severe it is recognized medically as the premenstrual syndrome.
Premature menopause: The occurrence of menopause before the age of 40 affects between 1 and 2% of women. It may be caused by congenital reasons (Turner's Syndrome), nutritional disturbances auto-immune disease, hypogonadism, or following radio or chemotherapy. It is confirmed by blood hormone tests (elevated serum FSH) and by inactivity on ultrasound scanning.
Progesterone: A hormone produced by the corpus luteum after ovulation has occurred. The placenta also produces it in pregnancy.
Prolactin: A pituitary hormone produced during pregnancy and following delivery. This stimulates breast milk production. Some women experiencing infertility have a high prolactin level (totally unrelated to a pregnancy). This causes the hormone levels to become imbalanced and can stop ovulation. Treatment is possible using a drug called Bromocriptine.
Pronuclei: The stage immediately after fertilisation before the gametes have fused. Usually only visible for a short time at 18-22 hours after fertilisation. After fusion the pronuclei are no longer visible & shortly after that stage cell division (cleavage) commences. Normal fertilisation showing 2 Pronuclei (LEFT): This is a 'Nomarski interference' image which has a three dimensional appearance - sperm can still be seen adhering to the outside of the zona pellucida. A multipronucleate embryo - which might occur in 1% of fertilisations is shown on the RIGHT. This embryo still has the cumulus cells adhering to the zona pellucida.
Prostate: A gland, found only in men, that surrounds the first part of the urethra, as it leaves the base of the bladder, produces an alkaline fluid essential to the survival of sperms. Male Reproductive Organs
Pseudocyesis: False pregnancy, a condition in which the woman believes herself to be and may even have some of the signs of being pregnant.
Psychodynamics: The way in which mind and body interacts.
Psychogenic: Of mental rather than physical origin. The term is often applied to symptoms or disorders thought to be related to problems in social or personal adjustment rather than of physical (organic) origin
Psychosomatics: A relationship between mind and body and to the apparent effect of mental and emotional factors which contribute towards distress and physical disorders. An indication that mind and body are not distinct and separate entities.
Psychotherapist: Any purely psychological method of treatment for disorders - mental, emotional or physical. There are many schools of psychotherapy but results appear to suggest that the result depend on the personal qualities, experience and wisdom of the therapist than on the theoretical basis of the treatment, and on the confidence which exists between patient and therapist.
Puberty: The stage at which the reproductive organs begin activity
Receptor sites: Sites on the surface of cells which are sensitive to particular hormone signals delivered in the blood. See discussion on GNRH, Analogues, Antagonists
RETA = rete testis aspiration
Retrograde ejaculation: At male orgasm the seminal fluid is not directed through the Ejaculation penis but goes backwards into the bladder. See Male Reproductive Organs
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 parts of the vas deferentia.
Seconda Infertility: This is used to describe the man or woman who is now experiencing infertility but has proven fertility in the past.
Semen: The fluid ejaculated from the penis at orgasm - with contributions from seminal vesicles and prostate. Only a fraction of the seminal fluid contains sperm. Male Reproductive Organs
Semen analysis / Sperm count : The study of fresh ejaculate under the microscope to count the number of sperms per cubic milliliter, also to assess their shape (morphology) and to assess their swimming ability (motility). The diagram (LEFT) shows the results of bi-weekly sperm counts in a healthy normal man who was not undertaking any medication. Note that his sperm count occasionally falls into the red danger zone (below 20 million sperm per ml).
Semen Mucus Cross Test (MCT): A test to assess semen mucus interaction. The man's Hostility (SMXH) semen is tested with his partner's and with her partner's and donor's semen. Therefore this test can help diagnose where a problem lies.
Seminiferous Tubules: The long tubes in the testes in which sperm are formed.
Sertoli cells: Cells (LEFT: shown in green) which line the seminiferous tubules of the testes and nurture the generation of spermatozoa (spermatogenesis). In some men there is a condition known as 'Sertoli cell only 'syndrome - where there are no spermatogenic cells to generate spermatozoa - only the supporting Sertoli cells.
SIFT: Sperm Intrafallopian Transfer: Prepared semen is placed in the fallopian tubes (via laparoscopy or vaginal catheter).
SHIFT: Synchronized Hysteroscopic Intrafallopian Transfer: Sperm are transferred into the fallopian tube via the uterus.
Spermatocele: A cyst that grows from the upper part of the epididymis - see diagram above (SPAS).
Spermatozoa: The medical name for the male reproductive cells. Abbreviated as SPERM or SPERMS - seen in the light microscope (RIGHT) and in the scanning electron microscope ( LEFT) - more detail.
See also the section on STEM CELLS (below) where scientists have succeeded in creating MOUSE sperm from stem cells.
Speculum: An instrument used to aid examination of the vagina and the cervix.
Spindle: A delicate structure of filaments which are responsible for aligning the two sets of chromosome during metaphase in mitosis and meiosis. Can be damaged during micromanipulation and freezing.
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 often richer in sperm and can then be used to inseminate the woman.
Superovulation: Stimulation the ovaries to produce more than the one egg during a natural cycle.
Stem Cells: Undifferentiated cells which are self renewing. They divide by cell division and one of the daughter cells usually remains as a stem cell whilst the other gives rise to other types of cells. They are particularly prominent in embryos but also exist in some somatic cells so that they can maintain cell production - e.g. in homopoetic cells (those which form the components of the blood which only have a short life span,) replenish the blood cells and platelets continually. Where defects occur in those systems transplantation with fresh stem cells offers the opportunity for remarkable life saving treatments. Stem cells may be either totipotential, i.e. capable of forming any cell type, or pluripotential, i.e. capable of forming a limited number of cell types. In some tissues the regenerative cell layer (often referred to as the germinativum) can only form a specific cell type - e.g. the germinativum in the epidermis of the skin will only form epithelial skin cells. Succesful parents of IVF children who have frpzen embryos they no longer need can now consider donating those embryos to recognized stem cell research centres throughout the world. Many such parents have admitted that this possibility makes the donation of their 'spare' embryos easier to consider knowing that the stem cells derived have the potential of helping others.
Stem cell sperm success
Heidi Nicholl, Progress Educational Trust
[BioNews, London] Scientists have for the first time managed to create sperm from mouse stem cells capable of fertilising eggs and resulting in live births. A team led by Professor Karim Nayernia, now Professor of Stem Cell Biology at Newcastle University, began with mouse embryonic stem (ES) cells which they sorted in order to isolate cells that were capable of becoming sperm precursor cells. These spermatogonial stem cells were then encouraged to grow into adult sperm and, when mature, were injected into mouse eggs. The resulting early embryos were implanted into surrogate mouse mothers. Two hundred and ten eggs were injected with the artificially-derived sperm, 65 began to undergo cell division and seven live births resulted, with six of the animals achieving adulthood. The work was done in Professor Nayernia's previous position at the Georg-August University in Gottingen and is reported in the journal Developmental Cell.
Stein Leventhal Syndrome.: A Condition where multiple small cysts appear in the ovary. Abnormal imbalance can arise causing problems in ovulation.
Surrogacy: (Also referred to as gestational carrying)- A woman carrying and giving birth to a baby whom she gives to another women. Host surrogacy - the IVF procedure is used so the surrogate carries the child that is not genetically related to her. Full Surrogacy - the surrogate is inseminated with the man's semen from the commissioning couple. Illegal in many countries or not practiced. Complicated by different regulations about who is the mother. In the UK and some States in the USA the mother is defined as the woman who carries the child - therefore if she changes her mind she can keep the child. In other States of the USA the commissioning mother is defined as the mother with rights to the child. Discussion
SUZI, Sub Zonal Insemination: Sperm injected into the sub zonal space between zona pellucida and egg. See micromanipulation, ICSI.
Syndrome: A set of symptoms and clinical signs which, taken together, constitute a particular disease or condition.
T Mycoplasma: An infection that possibly causes fertility problems and miscarriage.
Terato(zoo)spermia: A condition in which less than 50% of the sperm are morphologically normal.
TESA = testicular sperm aspiration. i.e. extracting sperm directly from the testis
TESE: Testicular Sperm Extraction (from a biopsy sample)
Testicle (TESTIS): (LEFT) The testes are male gonads (situated in the scrotum) that produce and store sperm. The vas deferens carries the spermatozoa to the urethra, picking up secretions from the seminal vesicles and prostate gland on the way. See also Male Reproductive Organs
Testosterone: The main male sex hormone produced by 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 to fertility.
TID: Therapeutic Insemination with Donor sperm. An alternative description for AID, DI and which stresses that the treatment is for 'therapeutic' purposes - required in some cultures to make it permissible. A term particularly used in Israel.
TIH: Therapeutic Insemination with Husbands sperm.
Thyroxine: A hormone produced by the thyroid gland.
Toxoplasmosis: An infection which, if contracted in pregnancy, may damage a fetus or cause a miscarriage.
Transcervical Endometrial Resection: This is a new technique where the lining of the womb is shaved away as an alternative to hysterectomy.
TUFT, Trans Uterine Fallopian Transfer: A method of assisted conception in which the fallopian tubes are cannulated through the vagina and cervix (see also TEST).
Tubal Embryo Transfer: A method of assisted conception similar to IVF but the embryo is transferred to the fallopian tube.
Tubal Insuflation: See Insuflation.
Tubal Surgery: An operation performed 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 laparoscope.
Turner's Syndrome: A congenital condition in which a woman has one less X chromosome, rendering them sterile.
Ultrasound Egg Recovery: A method used instead of laparoscopy to recover eggs (aspiration), from the ovary. The ultrasound image is achieved by US Egg abdominal or vaginal scanning and the eggs retrieved by needle aspiration from either of the two routes - see IVF.
Ultrasound Scanning (Scans): High frequency sound waves are bounced into the pelvis and as they bounce back are used to build up a picture. It is used in many areas of medicine. In reproductive medicine it can be abdominally or via the vagina. and is used to monitor follicular growth, and to determine the location and number of embryos which have implanted at around day 35. Many organs - e.g. kidneys, liver, heart, uterus and ovaries etc. - can be visualized.
Undescended testicles: A term used to describe a testis which has not descended testes from the scrotum. Often corrected surgically at or after puberty.
Urethra: The narrow passage that takes urine from the bladder to the outside. In men it also carries semen during ejaculation.
Urologist: A doctor who specializes in disorders of the urinary system. He/she often has an interest in male genital disorders.
Uterus: A small, hollow, muscular organ that carries the fertilised ovum through the nine months of pregnancy, enlarging to accommodate it as it grows. Also known as the womb.
Vagina: 'Front passage' or 'birth canal' - the tube that leads from a woman's uterine cervix to the outside (vulva).
Vaginisimus: A spasm of the muscles surrounding the vaginal opening, which can make intercourse or examination difficult or impossible.
Varicocele: A varicose vein of the testes (normally the left). A cause of male infertility.
Vasa Deferentia: The Vas Deferens are a pair of muscular tubes that lead from the epididymis to the prostatic section of the urethra. They transport seminal fluid.
Vasectomy: A minor operation, usually carried out under local anaesthesia, to interrupt the vas deferens so sperm are not present in the seminal fluid at ejaculation. Attempts to reverse vasectomy are sometimes successful.
Vasography: An x-ray technique for visualizing the vas deferens when looking for an obstruction.
Vaso vasostomy: The joining together of two cut surfaces of the vas deferens after a blockage has been removed.
VEGF: Vascular Endothelia Growth Factor. Stimulated by LH and has an influence on the granulosa cells.
Viability: Refers to whether or not the sperm, eggs, embryos etc are alive, or the time when a foetus can survive outside the womb.
VOCs: Volatile Organic Compounds: Many of the solvents, paints, laminate, chipboards and cleaning agents used in everyday life are of a highly volatile nature: these agents have been shown to be harmful to cells in culture and particularly human embryos. Removal of VOC's from the environment of the embryology laboratory is important in good clinical practice.
The X and Y chromosomes determine the sex of an individual. XX determines that the embryo will be female. The presence of the Y chromosomes determines a male. XXY occurs in 1 in 700 newborn males who are taller and fertile.
ZIFT, Zygote Intra- Fallopian Transfer: Similar to GIFT but the embryo is transferred into the fallopian tube rather than sperm and eggs. The advantage is that fertilisation is established before transfer. In the UK requires an HFEA license because embryos are created outside the body.
Zona drilling: Making a whole in the zona pellucida (by acid tyrode solution or laser) to assist the hatching process. or for embryo biopsy when one or two cells are taken from an embryo for genetic analysis or chromosomal screening.
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