Choosing A Fertility Centre For IVF

When you are considering a fertility centre, it is important to find out what services are available. For the best chances at success, it is important to choose a fertility centre that can provide testing services as well as a wide range of treatment options. Being offered is an ample source of diagnostic assessments including an in house Hysterosalpingogram (HSG) Suite, Surgical Suite, Andrology and Laboratory Services. This allows for high priority rapid results and the continuity of care of patients. Because IVF and other assisted reproductive technologies are constantly evolving, the GIH IVF Clinic is committed to staying up to date and providing the most innovative treatments and traditional procedures in a safe and convenient environment.

The Egg

Causes of infertility that relate to the egg include irregular or ceased ovulation, low ovarian reserve, and poor egg quality. These are most common in women over 35, but can potentially be a problem in younger women as well. If there is an adequate supply of eggs but the body's endocrine system fails to properly regulate ovulation, fertility medications can be used to trigger the maturation and release of eggs. If this is unsuccessful, IVF may also be an option. For women who have low ovarian reserve or who release eggs that do not fertilize or develop properly, IVF with egg donation allows for a woman to become pregnant, give birth, and even breastfeed her child, despite not being able to produce viable eggs of her own.

The Sperm

Because they are relatively easy to identify, sperm problems are usually among the first causes of infertility to be tested for in new patients. Low concentration, motility, or morphology of sperm can be attributed to environmental factors, testicular malfunction, a hormonal imbalance, or other problems. It is also common for a physical barrier of some kind to prevent sperm from moving normally through the male reproductive tract. However, in vitro fertilization (IVF), either alone or with intracytoplasmic sperm injection (ICSI) or testicular epididymal sperm aspiration (TESA), is a highly effective treatment option for overcoming most types of male infertility.

Conception

The most common obstacle to conception is timing. The egg is only available for fertilization for about two out of every 21 to 35 days. Although not technically counted among the causes of infertility, difficulty pinpointing the time of ovulation is certainly a problem that many couples encounter when trying to conceive. However, even when the timing is perfect, there are other factors that may prevent the sperm and egg from successfully coming together. Blockages in the fallopian tubes, hostile cervical mucus, and anti-sperm antibodies all have the potential to interfere with conception. In some cases, such causes of infertility can be treated at our IVF Clinic with surgery or other treatments. If these are unsuccessful, in vitro fertilization (IVF) is an ideal option, because it allows conception to take place outside of the body, in a controlled laboratory setting.

Implantation & Development

Even if conception takes place, pregnancy will not occur unless the embryo is able to implant in the uterine lining and continue to develop. Of all of the stages involved in the establishment of a pregnancy, implantation is the most difficult to manipulate. Certain causes of infertility, such as uterine fibroids or scarring, may be treatable through surgical means, improving the conditions for implantation. However, when implantation consistently fails, despite the absence of any treatable condition, patients may want to consider undergoing IVF with a gestational carrier.

Secondary Infertility

People who have had at least one child without problems but are now struggling to conceive have secondary infertility. Although frequently age-related, secondary infertility can be caused by any problem or condition that develops after the first child or children are born. The testing and treatment procedures for secondary infertility are similar to those of primary infertility. The emotional issues that accompany this type of problem, however, are unique. Couples are often caught off guard when they have trouble conceiving after having had a child before. They may also receive less support from friends and family members who feel that the child or children they already have should be enough. Many do not even seek treatment because they believe that infertility is something that only childless couples suffer. At the GIH IVF Clinic, we encourage patients who encounter secondary infertility to seek the treatment and support that they need. Already having one or more children should not exclude patients from having another child if they so desire.

Unexplained Fertility

When no specific causes of infertility can be identified, a couple is diagnosed with unexplained infertility. This can be a frustrating diagnosis, because it deprives the couple of the understanding and sense of control that an identifiable problem offers.

Just because infertility is unexplained, however, does not mean that it is untreatable. The most common course of action is to begin with a minimally invasive treatment option, such as ovulation induction, and progress toward in vitro fertilization (IVF) and other advanced techniques if the initial attempts are unsuccessful.

Infertility Treatment ? When To Seek Help and When To Wait And See

People are often surprised at the amount of time it can take to get pregnant once the decision to start a family has been made. For normal healthy couples, it is not uncommon for several months to go by before pregnancy is achieved. Many begin to wonder whether there might be something wrong, adding worry to the stress of waiting. At the GIH IVF Clinic we want patients to be informed about their fertility and to know the difference between when to consider medical assistance and when to try to relax and let nature take its course. Please feel free to contact our hospital from infertility treatment if you fit any of the following: . You have been trying to conceive for a full year without success. . You have a history of miscarriage or infertility. . Your menstrual cycles are irregular of have ceased. . You are a woman over the age of 35. . You or your partner have or have had a reproductive condition. . You or your partner have or have had a sexually transmitted disease.

Understanding Male Infertility ? Common Causes and Treatment

Male infertility is a subject that many men still find uncomfortable; however, fertility problems in men are not rare. About two thirds of couples undergoing fertility treatment are trying to overcome some type of male infertility. Male infertility can range from a decrease in sperm production to a physical blockage that prevents sperm from reaching its destination. Fortunately, we are able to treat most forms of male infertility at our IVF Clinic.

Varicocele

A varicocele is a varicose vein in the scrotum. When blood flow backs up and pools in the vein, it becomes enlarged and causes overheating of the testicles. This can affect sperm production, motility, and morphology. Fortunately, this common cause of male infertility is easily diagnosed during a physical examination and is treatable with surgery.

Epididymal or Vas Deferens Defect

The epididymus and the vas deferens are two major tubes in the male reproductive system. The epididymus is tightly coiled and sits just above the testes, providing storage for sperm cells while they mature. The vas deferens carries the sperm out of the epididymus to the seminal vesicles, where they are mixed with the first of the various substances that make up semen. If either of these tubes is blocked, malformed, or absent, the sperm cells will not be carried out of the testes and male infertility will result.

A blockage can usually be corrected surgically. If the tube is absent or irreparable, it may still be possible to conceive, so long as healthy sperm are being produced. A testicular epididymal sperm aspiration (TESA) can be performed to remove sperm directly from the testes for use during in vitro fertilization.

Infection and Environmental Factors

Some cases of male infertility are due to temporary factors that, once identified, are usually reversible. Any kind of infection, from a common flu to a sexually transmitted disease, can cause a reduction in sperm production and quality. In these cases, diagnosing and treating the infection can usually restore fertility, although it may take a few months before the effects are completely reversed. Certain environmental factors can also be to blame for male infertility. Frequent and prolonged overheating of the testes, exposure to harmful substances or radiation, smoking, and heavy alcohol consumption all have the potential to reduce the number of healthy sperm a man produces.

Hormonal Imbalance

Although far more common a cause of female infertility than male infertility, a hormonal imbalance is a potential problem that can interfere with the production of sperm and seminal fluids and even decrease sex drive. Blood tests are administered to measure the levels of testosterone, FSH, and LH. Depending on the findings, the solution may involve medication, treatment for an underlying condition, or advanced reproductive technology.

Genetic Conditions

Certain rare genetic conditions, such as Klinefelter's or Young's syndrome, can result in male infertility. These are not routinely screened for unless there is a family history of the condition or a semen analysis reveals azoospermia (a complete lack of sperm in the sample). Some such conditions can be overcome with advanced reproductive technology, while others cannot.

Polycystic Ovarian Syndrome, Endometriosis, and Other Causes of Female Infertility

Female infertility is a contributing factor in about two thirds of fertility cases. However, because the female reproductive system is somewhat less accessible than that of the male, diagnosis and treatment in women can sometimes be a little more difficult. The key is to understand the common causes of infertility in women and know how to identify them. In women over 35, age-related infertility is prevalent. In younger women, reproductive conditions, such as polycystic ovarian syndrome and endometriosis, are among the most common causes of female infertility at our Clinic. Here are some of the areas that we cover: . Reproductive Conditions . Ovulation Disorders . Physical Barriers . Hormonal Imbalances . Age Related Infertility

Semen Analysis and Other Infertility Testing Procedures for Men

Like many medical problems, infertility can be caused by any of a number of conditions or factors. In order to treat the problem, we must understand its source. When a couple seeks out fertility treatment for the first time, a series of tests is performed to help identify the cause or causes of their infertility. For men, a semen analysis is the first infertility testing procedure performed at our IVF Clinic, but additional tests will most likely be necessary to pinpoint specific problems. We cover: . Semen Analysis . Physical Examinations . Hormonal Workup (Measuring the levels of testosterone)

Fertility Testing For Women

Before fertility problems can be treated, the source of the problem must be identified. In women, a series of screening tests and physical exams can help to determine what is preventing pregnancy from taking place. These fertility testing procedures are performed at our Clinic to help us recommend the most effective method to overcome infertility, tests include: . Clomiphene Citrate Challenge Test . Hormonal Workup . Ultrasound . Hysterosalpingogram . Diagnostic Laparoscopy or Hysteroscopy

Infertility Drugs and Artificial/Intrauterine Insemination (IUI)

Although in vitro fertilization, intracytoplasmic sperm injection, and other advanced procedures get a lot of attention, the majority of fertility patients will never need these complex treatments. At our IVF Clinic infertility drugs and artificial insemination (usually through intrauterine insemination, or IUI) still allow most infertile women to become pregnant without the cost, time commitment, and physical impact associated with advanced reproductive technologies.

Surgical Fertility Treatment Techniques

When infertility is the result of a physical blockage or abnormality that prevents conception or implantation, surgery is often the only method available to correct the problem. Fortunately, with minimally invasive surgical techniques and advanced microsurgical technologies, these procedures are safer, easier to recover from, and more effective than ever before. These are only some of the common fertility treatment procedures performed at our Clinic: . Hysteroscopy . Laparoscopy . Myomectomy . Selective Tubal Cannulation . Tubal Anastomosis

Indications

In vitro fertilization was initially developed as a way to allow women with blocked fallopian tubes to become pregnant. Since its introduction, however, IVF has also been beneficial for couples suffering from male factor infertility, endometriosis, premature ovarian failure, and unexplained infertility. It is also an option for patients who have had a surgical sterilization procedure and would now like to have another child.

Additionally, special techniques performed in combination with in vitro fertilization can overcome even more fertility obstacles. A woman who has a healthy uterus but no viable eggs can experience the unique journey of pregnancy and childbirth through the process of IVF with egg donation. Likewise, a woman who cannot carry a pregnancy to term despite having an adequate egg supply can hold on to her dreams of being a biological parent with the help of a gestational carrier. IVF with intracytoplasmic sperm injection (ICSI) can help to overcome all but the most severe forms of male factor infertility and preimplantation genetic diagnosis (PGD) offers couples who carry a genetic disease a way to ensure that their child will be healthy.

Ovulation Induction

The most common IVF treatment begins with the stimulation of the ovaries to prepare and release a number of mature oocytes, or eggs. This process starts about one week before menstruation with the administration of medications to prevent early ovulation. Once menstruation begins, fertility medications are given daily to stimulate the maturation of oocytes. When the eggs are fully mature, usually about eight to ten days later, an additional medication is given and the patient is prepared for egg retrieval. Visit our Ovulation Induction page to learn about this process in more detail.

Egg Retrieval

The mature eggs are collected for in vitro fertilization using a simple outpatient procedure known as ultrasound-guided transvaginal oocyte aspiration. This process takes between 10 and 15 minutes and recovery is brief. Visit our Egg Retrieval page for more information about this procedure. Semen is collected on the same day as the egg retrieval procedure.

Insemination

Once the eggs and semen have been collected, they are sent to our lab, where a brief examination and preparation process takes place before they are combined. The eggs are then monitored at intervals while, hopefully, fertilization and embryo development take place. For more information about this phase of the IVF process, please visit our Fertilization and Embryo Development page.

Embryo Transfer

If in vitro fertilization of the eggs occurs, two to three healthy embryos will be selected for embryo transfer, or placement into the uterus. Any additional embryos can be cryopreserved, or frozen, for later use in case the first IVF cycle is unsuccessful. Hopefully, one or two of the transferred embryos will implant, resulting in pregnancy.

Ovulation Induction and Fertility Drugs ? The Foundation of Fertility Treatment

Ovulation induction is the process of stimulating the ovaries to ripen and release multiple eggs in a single cycle. This process has many useful applications in fertility treatment, including in vitro fertilization. Through close monitoring and the use of fertility drugs, ovulation induction offers our patients a way to maximise their chances of conception.

Egg Retrieval ? Making IVF Possible

The ability to collect mature eggs from a woman?s ovaries for fertilization outside of the body has revolutionized fertility treatment. Originally developed as a way to help women whose fallopian tubes were irreparably blocked, IVF now allows couples who suffer from a wide range of fertility problems to successfully conceive. Egg retrieval is a vital step in the IVF process.

Preparation

In vitro fertilization begins with ovulation induction, a process of stimulating and monitoring the ovaries. Once it is determined that the ovarian follicles are the right size and the eggs ready to be collected, a dose of human chorionic gonadotropin (hCG) is administered to trigger the final maturation process and egg retrieval will take place approximately 36 hours later. Prior to the procedure, anaesthesia will be given. In most cases, egg retrieval is performed under moderate sedation (aka MAC), allowing the patient to be asleep for the procedure.

Ultrasound-guided Transvaginal Aspiration

The actual technique used to collect eggs for in vitro fertilization is known as an ultrasound-guided transvaginal aspiration. While an ultrasound probe is used to provide a visual image of the ovary and the surrounding structures, a very fine needle is inserted through the upper wall of the vagina and into the ovary. Through magnification of the ultrasound image, the physician can locate the individual follicles that contain mature eggs and apply gentle suction to remove the contents of each one, which is known as aspiration. The fluid and egg from each follicle are collected into an individual container, which will then be taken to the lab for examination and preparation for fertilization. The procedure is performed on both ovaries, usually taking between 10 and 15 minutes to complete. Once the egg retrieval process is finished, the patient will remain under observation for one or two hours before being sent home.

Recovery

Patients may experience some discomfort after egg retrieval and are encouraged to rest as much as possible. Mild soreness, cramping, and light spotting are normal. Vigorous exercise and other strenuous activities should be avoided. Specific instructions will be provided prior to the procedure and should be followed carefully. Progesterone, a hormone that would normally be released by the follicle after ovulation, is vital to the support of early pregnancy. Because aspiration of the follicles can interrupt the normal hormonal process and prevent adequate amounts of progesterone from being produced, the patient will generally be given supplemental progesterone from the time of egg retrieval through the end of the cycle. Embryo transfer, the next procedure in the in vitro fertilization process, will take place three to five days after egg retrieval.

IVF ? How In Vitro Fertilisation Takes Place

Although IVF treatment consists of a long and complex series of procedures, it is the stage that takes place in our laboratory, where sperm and egg finally come together, that defines the process. Literally meaning ?fertilization in glass,? in vitro fertilization, or IVF, is how our specialists are able to help patients overcome numerous types of fertility problems.

Preparation

After ovulation induction and egg retrieval, the collected eggs are sent to our lab, where they are examined and prepared for in vitro fertilization. The semen is collected on the same day as the egg retrieval procedure and is also examined in the laboratory. Sperm are washed and sorted to ensure that only the healthiest, most motile sperm are combined with the eggs, maximizing the chances of successful fertilization.

Insemination and Fertilisation

Once both sperm and eggs have been properly prepared, each egg is combined with a sample of selected sperm in dish containing a special IVF culture that is designed to support and nurture the embryo through the first few days of development. Each dish is placed inside an incubator while in vitro fertilization takes place. After 18 hours, the dishes are retrieved for examination. Eggs that have been successfully fertilized can be identified at this stage and will be returned to the incubator. Eggs that remain unfertilized after the initial 18 hours are unlikely to become fertilized and are therefore discarded.

Embryo Development

Once fertilization takes place, cell division begins, just as it would under natural conditions. The embryos will continue to be observed at regular intervals until at least three days after in vitro fertilization. Embryologists will monitor the rate of growth and look for any signs of abnormal development. Potential anomalies include a slow rate of cell division, failure to develop, multinucleation (when cells have two or more nuclei, instead of only one), and fragmentation (when small particles of cytoplasm become trapped inside the zona pellucida). Minor fragmentation is generally not cause for concern, although healthy embryos without any fragmentation will be selected if they are available. The transferability of embryos that develop slowly will depend on the degree of deviation from the norm as well as other factors. Multinuclear embryos and those that arrest, or fail to develop, do not qualify for transfer and will be discarded.

Most IVF practices perform embryo transfer after three days of development. At this stage, the embryos ideally have between six and nine cells and the strongest, healthiest specimens can be easily identified. For some in vitro fertilization patients, however, transfer at five days, when the embryos have reached the blastocyst stage, is a preferable option. The main benefit of blastocyst transfer is that at five days it is easier to determine which embryo(s) will most likely implant and develop, so fewer embryos need to be transferred, resulting in a lower risk of a multiple pregnancy. However, in some cases, embryos fail to develop to the blastocyst stage in the IVF culture. The best option for each patient is decided on a case-by-case basis.

Embryo Co-Culture

While the majority of IVF embryos are formed and developed in a laboratory-created culture medium specially designed for in vitro fertilization, it is also possible to use a sample of endometrial cells to support the developing embryo. For some women, this appears to increase the chances of successful implantation after embryo transfer.

IVF Embryo Transfer ? The Final Stage of In Vitro Fertilization

Once the embryos have been created in the laboratory, they are placed into the uterus. At this point, in order for pregnancy to occur, an embryo must implant into the uterine lining. For many patients, the two-week wait between the embryo transfer procedure and the initial pregnancy test is the most difficult stage of the process. At the GIH IVF Clinic, we believe that understanding IVF and all of its components is key to coping with the stress that accompanies treatment.

Frozen Embryo Transfer ? Maximising IVF Efficiency

In vitro fertilization is a highly effective fertility treatment, but it is not uncommon for more than one cycle to be performed before pregnancy occurs. One of the ways we can ease the physical, financial, and emotional burden of undergoing multiple IVF cycles is through the use of cryopreserved, or frozen, embryos. Frozen embryo transfer can be used in subsequent cycles when the initial cycle is unsuccessful, or be performed years later when the patient is ready to have another child.

Monitoring

During IVF cycles in which previously frozen embryos will be used, the ovulation induction and egg retrieval phases are not performed. For this reason, these cycles are significantly less expensive and involve fewer stages than the initial, traditional cycle. However, it is still necessary to closely monitor, or even control, the progression of the menstrual cycle. Because the frozen embryo transfer procedure must take place at precisely the time when conception would naturally occur, frequent ultrasounds and blood tests will be performed during the first 10 to 15 days of the cycle.

Frozen Embryo Transfer

When the cycle has reached the correct stage, two to four frozen embryos will be selected and thawed. The frozen embryo transfer procedure takes place in exactly the same way as a fresh embryo transfer. A thin catheter is inserted into the uterus through the cervix. The embryos are then introduced into the uterine cavity through this tube. The procedure takes very little time and there is minimal discomfort.

Chances Of Success

Roughly 70 percent of embryos survive the freezing and thawing process. However, once thawing is complete and the healthy embryos are selected, the chance of successful implantation and pregnancy after frozen embryo transfer is about equal to that of a fresh transfer procedure.

Offering Assisted Hatching, ICSI, and PGD (Preimplantation Genetic Diagnosis)

Micromanipulation is the term for advanced techniques that can be performed in conjunction with IVF to improve the chances of pregnancy or screen out unhealthy embryos. Commonly called ?cell surgery,? these procedures are conducted using powerful microscopes and specialized equipment.

GIH Welcomes Long Distance Patients

We recognize that patients will travel great distances to receive the care that best fulfills their needs. At Gulu Independent Hospital, we treat patients from all across Africa as well as the world. If you are visiting our region from another part of the country or the world and would like to receive fertility treatment from a GIH IVF physician, we would be happy to accommodate you. There are also some patients who choose to undergo their entire course of treatment at GIH and stay in the area while being treated. In this case, we can assist you with travel arrangements and hotel accommodations.

From the moment you contact Gulu Independent Hospital, you will encounter caring and knowledgeable staff members who are able to assist you with your questions and concerns and guide you toward educated decisions with which you feel comfortable. A dedicated financial counselor will assist you throughout your experience.

B

Basal Body Temperature - Used to time intercourse to increase the likelihood of conception and also as part of the rhythm method for preventing conception.
Beta hCG Test (BhCG) - A blood test to determine pregnancy, it gives a positive reading if human chorionic gonadotropin (hCG) is present in the blood.
Biochemical Pregnancy - See Chemical Pregnancy.
Blighted Ovum (EGG) - A fertilized egg that implants in the uterus, but does not develop further and dies.
Bromocriptine (Parlodel) - An oral medication used to lower the level of the hormone prolactin.

C

Cancelled Cycle - Discontinuation of an ART cycle usually prompted by poor response to hormone therapy, no egg recovery or failed fertilization.
CBC (Complete Blood Count) - A routine preoperative blood test that gives information regarding infection and anaemia.
Cervical Mucus - Secretions produced by the cervix. The thickness of the mucus varies according to the phase of the menstrual cycle. In the days just before ovulation, the mucus is easily penetrable by sperm.
Cervix - The lower section and opening of the uterus that protrudes into the vagina. Sperm pass through the cervix into the uterus during intercourse. It dilates during labour to allow the passage of the infant.
Chemical Pregnancy - A very early pregnancy detectable only by a blood test for hCG. The hCG level in the blood rises high enough to yield a positive pregnancy test, but then stops rising and does not lead to a clinical pregnancy, but may result in a very early miscarriage.
Clinical Pregnancy - A pregnancy with foetal cardiac activity within the uterus detectable only by ultrasound five weeks after egg retrieval.
Clomiphene Citrate (Clomid/Serophene) - A synthetic drug used to stimulate production of follicle stimulating hormone and lutenizing hormone. Often used to treat milder forms of ovulation failure or Polycystic Ovarian Syndrome (PCOS).
Congenital - A characteristic or defect present at birth, it may be hereditary or acquired during gestation.
Corpus Luteum - Remnant of a follicle after ovulation. It releases progesterone, a hormone that preserves the uterine lining.
Cryopreservation - A procedure used to preserve (by freezing) and store embryos or sperm.
Cycle - The period of time, about one month, when an infertility treatment is initiated and continuing until the treatment is halted or completed.

D

E

Ectopic Pregnancy - A pregnancy in which the fertilized egg implants outside the uterine cavity (usually in the fallopian tube, the ovary or the abdominal cavity). May require surgical intervention or use of medications (Methotrexate) to stop growth.
Egg and Embryo Vitrification - Recent cryo technique which "flash freezes" eggs and embryos, preventing crystals, which may hamper results.
Egg Donation - See Oocyte Donation.
Egg Retrieval - See Oocyte Retrieval.
Embryo - The developing baby in the early stages of growth, from conception to the eighth week of pregnancy.
Embryo Freezing - See Cryopreservation.
Embryologists - Professionals trained in advanced laboratory techniques who prepare and provide the necessary conditions for the fertilization of eggs. They also facilitate the growth, development, maturation, and preservation of embryos.
Endocrinologists - See Reproductive Endocrinologists.
Endometriosis - The presence of endometrial tissue (the uterine lining) in areas outside of the uterus such as the tubes, ovaries and peritoneal cavity. This condition can cause painful menstruation and infertility.
Endometrium - The glandular membrane lining the uterus where implantation occurs.
Epididymis - The elongated organ in the male that lies above and behind the testicles. It contains a highly convoluted canal four to six meters in length where sperm are stored, nourished, and matured.
Estradiol Level (E2 Level) - The amount of estradiol, a form of oestrogen, in the blood. The E2 level, measured before ovulation, correlates with how mature the follicles are.
Oestrogen - A group of female hormones responsible for the development of secondary sexual characteristics. Oestrogen is produced mainly by the ovaries from the onset of puberty until menopause.

F

Fallopian Tube - Either of a pair of tubes that conduct eggs from an ovary to the uterus. Natural fertilization takes place as an egg travels through a fallopian tube.
Female Factor Infertility - The condition when a couple's infertility is attributed to the woman.
Fertilization - Penetration of an egg by a sperm and the fusion of genetic material.
Foetal Reduction (or Selective Reduction) - A medical procedure to decrease the number of foetuses in a multiple gestation.
Foetus - The developing baby after the embryo stage, from the ninth week of pregnancy to the moment of birth.
Fibroid/Myoma - A non-cancerous muscle tumour found within the wall of the uterus.
Follicle - Fluid-filled sac on the ovary that (usually) contains a ripening egg. The follicle can release an egg at ovulation. A physician can retrieve the egg from the follicle during an ART treatment cycle.
Follicle Stimulating Hormone (FSH) - A purified or recombinant form of follicle stimulating hormone, FSH can be injected under the skin to stimulate development and maturation of follicles.
Follicular Phase - The portion of the menstrual cycle when ovarian follicle development takes place, (usually the first 14 or so days after menses begins).

G

Gamete - A sperm or an egg.
Gamete Intra-Fallopian Tube Transfer (GIFT) - A surgical procedure in which a sperm - egg mixture is transferred into the fallopian tubes where natural fertilization may occur.
Gestation - The period of foetal development in the uterus from conception to birth, usually 40 weeks in humans.
Gestational Carrier - A woman who carries the pregnancy to term but is not the genetic parent of the baby. Also called Gestational Surrogate.
GnRH (Gonadotropin Release Hormone) - A hormone that controls the synthesis and release of the pituitary hormones FSH and LH. GnRH is produced by the hypothalamus.
Gonadotropin - A hormone that can stimulate the testicles to produce sperm or the ovaries to produce an egg.

H

Hormonal Assay - Also known as hormone tests. These include tests for levels of FSH (follicle stimulating hormone), LH (luteinizing hormone), DHEA-S dehydroepiandresterone), prolactin, progesterone, oestrogen and hCG.
Hormone - A chemical substance produced by one organ in the body that regulates the activity of another organ.
Human Chronic Gonadotropin (hCG) - A hormone secreted by the placenta that preserves the pregnancy by prolonging the life of the corpus luteum and stimulating progesterone production. A pregnancy test is positive when hCG is detected. It can be administered therapeutically (Pregnyl or Profasi) to help solve some infertility problems.
Human Menopausal Gonadotropin (hMG) - A natural product containing both human FSH and LH (sold as Pergonal, Repronex and Humegon). It is used to treat both male and female infertility and to stimulate the development of multiple eggs. These hormones are extracted from the urine of postmenopausal women.
Humegon - See Human Menopausal Gonadotropin (hMG)
Hydrocele - A fluid-filled swelling in the scrotum
Hysterectomy - The removal of the uterus. A partial hysterectomy removes the uterus including, in some cases, the cervix. A total hysterectomy also removes the ovaries and fallopian tubes.
Hysterosalpingogram (HSG, Hysterogram, Tubogram) - An X-ray procedure used to determine whether the fallopian tubes are open and capable of functioning properly. The physician injects dye into the uterus through the cervix. The dye passes through the tubes if they are open. An HSG can also reveal information such as the configuration of the uterus, irregularities, and the presence of fibroids.
Hysteroscopy - A surgical procedure in which a telescope-like device is inserted through the cervix to view the inside of the uterus. This procedure is sometimes performed in conjunction with a laparoscopy.

I

Idiopathic Infertility (Unexplained Infertility) - The term used when no reason can be found to explain the cause of a couple's infertility.
Immunological Response - Condition when either partner produces sperm antibodies, which may cause infertility. Implantation - The embedding of the fertilized egg in the lining of the uterus.
Infertility - The inability of a couple to achieve a pregnancy after one year of regular unprotected sexual relations, or the inability of a woman to carry a pregnancy to live birth.
Intracytoplasmic Sperm Injection (ICSI) - A laboratory procedure in which a single sperm is directly inserted into an individual egg.
Intrauterine Insemination (IUI) - The introduction of specially prepared sperm directly into the uterus through the cervix.
In Vitro Fertilization (IVF) - A procedure in which one or more eggs, each removed from a ripe follicle, is fertilized by a sperm outside the human body.

L

Laparoscopy - A surgical procedure in which a telescope-like device is inserted through a small incision near the navel to view the pelvic cavity, the ovaries, fallopian tubes, and uterus.
Leuprolide Acetate - See Lupron.
LH - See Luteinizing Hormone.
LH Surge - A spontaneous release of large amounts of luteinizing hormone (LH) during a woman's menstrual cycle. This normally results in the release of a mature egg from a follicle (ovulation). Ovulation Predictor Kits (OPKs) measure LH in the urine.
Lupron - A hormonal medication that can create a pseudo menopause. A chemical similar to GnRH, it first stimulates the female hormones, then uppresses a woman's secretion of FSH and LH. Concurrent treatment with Lupron tends to increase the number of follicles, oocytes (eggs), and embryos during a cycle, decreasing the risk of a cancelled cycle.
Lupron "Down Regulation" - A treatment with Lupron that takes advantage of the suppression of natural hormone (LH and FSH) secretions. Used before injection of gonadotropins to stimulate follicular development.
Lupron "Flare" - A treatment with Lupron that takes advantage of the initial stimulation and rise or "flare" of the woman's LH and FSH levels after the start of Lupron administration, lasting one to three days.
Luteal Phase - The days of a menstrual cycle following ovulation and ending with menses (usually lasting between 12 and 14 days).
Luteinizing Hormone (LH) - A hormone that causes the ovary to release a mature egg (ovulation). In the male, LH stimulates testosterone production. LH is secreted by the anterior pituitary. In the female, LH stimulates progesterone production after ovulation has occurred.

M

Male Factor Infertility - The condition when a couple's infertility is attributed to the man.
Microinsemination - A laboratory technique in which sperm are injected next to the egg cell surface to increase the likelihood of fertilization.
Micromanipulation - Procedure in which a sperm, egg or embryo is manipulated under a microscope (includes ICSI, Assisted Hatching and embryo biopsy for PGD).
Motility - The percentage of all moving sperm in a semen sample. Normally, 50 percent or more sperm in a sample move rapidly.
Multiple Birth - The birth of two or more offspring produced in the same gestational period.
Multiple Gestation or Multiple Pregnancy - The conception of two or more foetuses in the same woman at the same time, whether or not they result in live births.
Myomectomy - The surgical removal of non-cancerous fibroid tumours originating from the wall of the uterus.

O

Ovarian Hyperstimulation Syndrome (OHSS) - A possible side effect of medically induced ovulation, characterized by swollen, painful ovaries and, in some cases, the accumulation of fluid in the abdomen and chest.
Oligo-Ovulation - Irregular ovulation.
Oligozoospermia - A condition in which the number of sperm in a semen sample are abnormally low.
Oocyte - The egg cell produced in the ovaries. Also called the ovum or gamete.
Oocyte Donation - The process in which eggs, removed from the ovaries of one woman, are donated for use by another.
Oocyte Retrieval - A surgical procedure, usually under sedation, to collect the eggs contained with the ovarian follicles before ovulation. The physician inserts a needle into the follicle, draws out the follicle's fluid and egg through the needle, and then places the fluid and egg into a dish for identification by the embryologist.
Ovulation - Release of a mature egg from a follicle at the surface of the ovary.
Ovulation Induction - The therapeutic use of drugs or hormones to stimulate egg development and release. Useful hormones and hormone-based medications include clomiphene citrate, Pergonal, Humegon, Repronex, Follistim, Gonal F, Bravelle and hCG (Pergonol, Pregnyl or Ovidrel).

P

Papanicolaou Smear (Pap Smear) - A screening test to evaluate the cells of the cervix to determine whether they are normal or cancerous. The physician or nurse removes some cells from the cervical canal with a brush or spatula (usually a painless process, then smears them onto a glass plate). A pathologist examines the cells under a microscope.
Pelvic Inflammatory Disease (PID) - Inflammatory disease of the pelvis, often caused by infection, which can lead to infertility.
Pergonal - See Human Menopausal Gonadotropin (hMG)
Post-Coital Test (PCT) - Microscopic study of samples of vaginal and cervical secretions taken several hours after sexual relations and examined for live, moving sperm. Also known as the Sims-Huhner Test.
Pregnyl - See Human Chorionic Gonadotropin (hCG).
Preimplantation Genetic Diagnosis (PGD) - The procedure used to detect genetic or chromosomal abnormalities on embryos created during an IVF cycle. This is a delicately precise micro-manipulative procedure, in which embryologists remove either necessary DNA from the egg shortly after fertilization (polar body biopsy) or a single cell from a three-day old embryo (embryo biopsy). Molecular biologists examine
Premature Ovarian Failure (POF) - The occurrence of menopause before the age of 40.
Profasi - See Human Chorionic Gonadotropin (hCG).
Progesterone - A hormone secreted by the corpus luteum of the ovary after ovulation has occurred. Also produced by the placenta during pregnancy.
Prolactin - A hormone produced by the pituitary. The level of prolactin in the blood can reveal hypothalamic-pituitary disorders that may hinder ovulation.

R

Reproductive Endocrinologists (RE) - Physicians trained in obstetrics and gynaecology who further specialize and are certified to treat infertility with surgical procedures and technologies associated with physician-assisted reproduction.
Rubella Titer - A blood test that determines if the patient is immune to rubella (German measles), a viral disease that can cause severe birth defects. If a woman is not immune to rubella, she may be advised to have a rubella vaccination, wait one month before attempting pregnancy, and then re-test for immunity.

S

Secondary Infertility - The inability to conceive or carry a pregnancy after having given birth to one or more children.
Selective Reduction - See Foetal Reduction.
Semen - The sperm and seminal secretions ejaculated during orgasm.
Semen Analysis (SA) - A microscopic examination of freshly ejaculated semen to evaluate the number of sperm (count), the percentage of moving sperm (motility), and the size and shape of the sperm (morphology).
Sims-Huhner Test - See Post-Coital Test.
Sperm Antibodies (Immunological Response) - Entities that may attack and destroy sperm cells. These antibodies can be produced by women and by men against their own sperm, often seen in men who have had a vasectomy.
Sperm Wash - A technique for separating sperm from seminal fluid.
Split Ejaculate - A method of collecting a semen specimen so that the first portion of the ejaculate is caught in one container and the rest in a second container. In most men the first specimen will contain the vast majority of the sperm.
Spontaneous Abortion - A miscarriage or the unintended termination of a pregnancy before the twentieth week.
Sterility - The total inability to reproduce. Not to be confused with infertility.
Stimulation - Administration of hormones that induce development of multiple ovarian follicles.
Surrogate - A woman who becomes pregnant through insemination with the sperm of the husband of an infertile woman, and then following delivery, turns the child over for adoption by the couple. Also called "Traditional Surrogate."
Swim-up Test - A technique that separates motile sperm from non-motile sperm and cellular debris in a semen sample. The most motile sperm will "swim up" and are more easily separated for insemination.

T

Testicles - The two male sexual glands contained in the scrotum. They produce the male hormone testosterone and produce the male reproductive cells, the sperm.
Testicular Biopsy - A small excision of testicular tissue to determine the ability of the cells to produce normal sperm. Or to retrieve sperm for use in IVF/ICSI.
Testosterone - The most potent male sex hormone; produced in the testes.
Tubal Embryo Transfer (TET) - A surgical procedure in which a fertilized and divided egg is transferred to the fallopian tubes.
Therapeutic Insemination (TI) - A procedure in which sperm from a male partner or from a donor (Therapeutic Donor Insemination-TDI) are placed into a woman's vagina or cervix. Also called artificial insemination, but distinct from Intrauterine Insemination.

U

Ultrasound - Technique used to view the follicles in the ovaries or the foetus in the uterus. See also Vaginal Ultrasound.
Unexplained Infertility - See Idiopathic Infertility.
Uterus - The hollow, muscular organ in the woman that holds and nourishes the foetus until the time of birth.

V

Vaginal Ultrasound - Technique used to view the follicles, foetus, and other soft tissues by projecting sound waves through a probe inserted into the vagina. A baseline ultrasound shows the ovaries in their normal state. A follicular ultrasound shows egg follicle maturation. A pregnancy ultrasound shows if a pregnancy is in the uterus or in a fallopian tube (an ectopic pregnancy). Ultrasound pictures can be used to measure growth.
Varicocele - A collection of varicose veins in the scrotum. Blood flows in an abnormal direction in these veins towards the testicles.
Vas Deferens - A pair of thick-walled tubes about 45cm long in the male that lead from the epididymis to the ejaculatory duct in the prostate. During ejaculation, the ducts make wave-like contractions to propel sperm forward.

Z

Zygote Intrafallopian Transfer (ZIFT) - The surgical transfer of a zygote, or fertilized egg, into a fallopian tube one day after fertilization.