Abnormality: A departure from whatās normal - in a more or less exact medical sense. An abnormality can be quantitative (or measurable with a number), qualitative (not measurable but still apparent or obvious), or a matter of timing. Statistically, we define an abnormality as signifying either a measurement or a yes-or-no quality that is outside what, for example, 90 or 95 or 99 percent of the population exhibits (see also statistical significance). Itās a word without added value, unlike Īdefectā, for example, which has a negative connotation; so if you want to avoid a gratuitous, negative effect itās preferable, using this example, to say Ībirth abnormalityā instead of Ībirth defectā. See also anomaly.
Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American BooksAbnormal forms: An estimate of the percentage of sperm that have an abnormal shape of the head, mid-piece or tail; part of the routine sperm count. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Abortion: Strictly, synonymous with Īspontaneous abortionā or miscarriage. Loosely (and in this book), an induced abortion for early termination of pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Abortion rate: The percentage chance that a pregnancy will end as a spontaneous abortion, or miscarriage. The normal rate of clinically apparent miscarriage for young women is about 12 percent. The rate rises independently with age, the number of previous pregnancies, and especially the number of previous miscarriages experienced. The rate is also higher with many causes of infertility when conception occurs with or without treatment. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Absolute infertility: Sterility, or 100 percent infertility; also called complete infertility. See also relative infertility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Absolute risk (syn. risk): Your actual chance of having something or being affected by something (so it does not usually mean Īabsolutelyā in the sense of Īone hundred percentā, as in absolute infertility). Usually given as a ratio, proportion or percentage: for example, the (absolute) risk of having at least some visible endometriosis for a woman in her 40s is about 20 in 100, or 20 percent; the chance or the risk of pregnancy each month for a normal young couple (normal fecundability) is also about 20 percent, usually expressed as 0.2 (i.e. as a proportion); the risk of a woman developing cancer of the ovaries by the time she reaches her seventies, in North America, Europe or Australia, is about 1-in-90 (or about 1.1 %). See also relative risk. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Accountability: The sequel to responsibility, in which responsibility for the making of a decision continues to rest with the decision-maker as the effects or consequences from the decision unfold. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Acrosome: Consider it to be the mature spermās crash-helmet, present over the sperm head until the successful sperm binds to the coating of the egg known as the zona pellucida; imagine it to be like a balloon into which your fist is pushed (the fist being the spermās head) - bursting only when bound like Velcro to the Īzonaā (see acrosome reaction). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Acrosome reaction: If the acrosome is a balloon-like crash-helmet for the mature sperm, the acrosome reaction is the bursting of that balloon, releasing enzymes that digest a path for the capacitated, highly motile sperm to push through the zona pellucida into the perivitelline space, where it can directly fertilize the egg. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Acute: Medically, means sudden and quick. An acute inflammation is usually red, tender and may form pus. Opposite to chronic.
Adenohypophysis: The glandular part of the pituitary gland, lying towards the front, so in medical speak called the Īanterior pituitaryā; produces follicle stimulating hormone, luteinizing hormone and prolactin. Other hormones include hormones that: (1) cause normal childhood growth (Īgrowth hormoneā), (2) drive the thyroid gland (Īthyroid stimulating hormoneā, or TSH), and (3) drive the adrenal gland (Īadrenocorticotropic hormoneā, or ACTH). See also hypothalamus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Adenomyoma: See adenomyosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Adenomyosis: An abnormal condition of the uterus in which glands from the endometrium grow into the muscle of the wall of the uterus (the myometrium), causing local or general enlargement of the uterus, pain with periods, and perhaps heavier periods. A localized area of adenomyosis is called an Īadenomyomaā and can be hard to distinguish from a fibroid on transvaginal ultrasound; unlike a fibroid it is not easily removed at surgery, because itās not clearly separable from surrounding tissue. Thereās no satisfactory long term treatment for adenomyosis: hysterectomy may be chosen if symptoms are bad enough. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Adhesions: Scar tissue, in particular between the serosa (surface lining) of abdominal or pelvic organs in the peritoneal cavity, which can interfere with the access the fallopian tube has to the ovary at ovulation. Adhesions may be thin and transparent (sometimes called Īfilmyā or ĪGrade 1ā), a little like thin plastic wrap; thicker, and containing more scar tissue and blood vessels (ĪGrade 2ā); or thick, dense and tough (ĪGrade 3ā). Adhesions are caused by infections, endometriosis or a previous operation. Not all adhesions are important; it depends on where they are. See also intrauterine adhesions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Adrenal gland: A paired gland lying above each kidney, responsible for the essential hormone cortisol. Equally important with the ovaries in producing androgens in women. See also serum 17-hydroxyprogesterone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
AFP: See alpha fetoprotein.
AI: See assisted insemination.
AID: Artifical insemination, donor (or assisted insemination, donor); see donor insemination.
AIDS: Acquired immune deficiency syndrome (see HIV).
AIH: See assisted insemination, husband.
Alleles: Genes come in pairs, one on each of the chromosomes that make up a chromosome pair. The two genes of the pair are not always the same. The many different forms that a particular gene can take (and still function, for better or for worse, as a gene within that geneās job description) are referred to as its alleles. If your alleles are identical, you are homozygous for that gene; if they are not, you a heterozygous. Abnormal alleles cause genetic disease or disability: if one allele is enough to cause abnormality then the gene is dominant (inherited with dominant inheritance) and the abnormality is present in the heterozygous and the homozygous state; if two alleles are needed to cause abnormality, then the gene is recessive (inherited with recessive inheritance) and the abnormality is present only in the homozygous state. In the case of alleles found on X-chromosomes but not on Y-chromosomes, which are smaller, a recessive gene will be unopposed in males (and so will act as a dominant gene), whereas female carriers of the allele will be unaffected except in the extremely unlikely event that they inherit (or gain by mutation) a second abnormal allele; this mode of inheritance is called Īsex-linked recessive inheritanceā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Alpha fetoprotein (AFP): A form of albumin (a protein in the blood) produced only by the fetus, but crosses the placenta and so is detectable in the motherās blood, as well as being usefully measured in amniotic fluid by amniocentesis; detectable in higher than usual concentration with certain Īopenā abnormalities involving the fetusās brain and spinal cord (namely Īanencephalyā and Īspina bifidaā); present in lower than usual concentration in Downās syndrome, or trisomy 21. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Amenorrhea. Absent menstrual periods, either because of absent ovulation (anovulation) or because of absence of, destruction of or obstruction to the menstrual flow from the uterus, such as with intrauterine adhesions (when itās known as Ashermanās syndrome). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
AMH. See anti-Müllerian hormone.
Amniocentesis: Sampling the fluid from the amniotic or gestational sac, possible with difficulty from about 10 weeks pregnancy, but more usually performed at about 14 weeks; cells from the fetus can be set up in culture for a karyotype, or for special diagnoses can be examined more quickly by fluorescent in situ hybridisation (FISH) or by polymerase chain reaction (PCR); other substances in the amniotic fluid (such as alpha fetoprotein, or AFP) can be measured to indicate whether the fetus is normal or not. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Amniotic cavity: See gestational sac.
Amniotic fluid: The fluid in the Īamniotic cavityā, or gestational sac; sampled with amniocentesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ampulla: The wide outer part of the fallopian tube, lying between the fimbrial end and the narrow isthmus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ampullary-isthmic junction (AIJ): The point at which the wide ampulla of the fallopian tube meets the narrow isthmus; the place where fertilization of the egg by a sperm cell normally takes place.
ANA: See antinuclear antibody. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Androgen: Male sex hormones, including testosterone (the main androgen circulating in the blood in men and in women) and androstenedione (which is weaker); produced in women more or less equally by the adrenal glands and the ovaries (in thecal cells and hilus cells); produced in much greater quantity in men by the testes (testicles). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Androstenedione: A weak androgen, produced in women by thecal cells in the ovary and by the adrenal glands. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Aneuploid: The gain or loss of one or more chromosomes, including trisomy (47 chromosomes) and monosomy (45 chromosomes); see also polyploid. The noun of this adjective is Īaneuploidyā (the state of being aneuploid). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ANF: Antinuclear factor; see antinuclear antibody.
Angular pregnancy: When implantation occurs in the Īlateral angleā of the uterus (out to one side, very close to where the fallopian tubes enter the uterus); miscarriage is common; discussed in chapter 14, with ectopic pregnancies. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anomaly: Distinguishable from an abnormality in that the outcome in the case of an anomaly may not lead to disease or disability. An Īanomalousā kidney, for example, is in the wrong place but does its job perfectly well. The distinction between an anomaly and an abnormality, however, is loose and is not strictly observed. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anorexia nervosa: ĪAnorexiaā means a profound loss of appetite, followed by loss of weight; Īnervosaā means that there is a nervous or mental basis for the state, in this case a belief by the person affected, and contrary to the perception of others, that she is overweight. She stops eating, may induce vomiting, and uses laxatives to keep the intestines empty and the stomach flat. The menstrual periods stop for two reasons: the weight loss and the underlying mental disturbance. Medical complications from induced vomiting and laxative abuse can be serious, occasionally fatal. Treatment, which includes psychological and psychiatric counseling, is difficult and is not always completely accomplished. Itās a condition chiefly of adolescent girls; the younger the patient the better the chance of cure. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anovulation: Absence of ovulation.
Anovulatory cycles: Menstrual cycles caused by ovarian activity (or ovarian cycles) not accompanied by ovulation; serum progesterone stays low, whereas some development of tertiary follicles and production of estradiol takes place; see also anovulatory dysfunctional uterine bleeding. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anovulatory dysfunctional uterine bleeding: Irregular and generally heavy bleeding caused by anovulatory cycles. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anticardiolipin antibody: Antibody made by the bodyās immune system that acts against components in the cell membrane. Looked for in the blood as a possible immune cause of recurrent miscarriage; see also lupus anticoagulant. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anti-Müllerian hormone (AMH): A hormone produced by the Sertoli cells of the testes in a male embryo to suppress the development of the Müllerian ducts. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Antinuclear antibody (ANA): Syn. antinuclear factor (ANF). Antibody made by the bodyās immune system that acts against components in the nucleus of the bodyās own cells (thus sometimes producing an Īautoimmune diseaseā). Looked for in the blood as a screening test for a possible immune cause of recurrent miscarriage (for which also see anticardiolipin antibody) as well as for the potentially serious autoimmune disease Īsystemic lupus erythematosisā (SLE; see also lupus anticoagulant). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Anti-sperm antibodies: Means the same as sperm antibodies.
Antral follicle: A tertiary follicle.
Antrum: A fluid-filled space between the follicle cells, the development of which marks the transformation of a tertiary follicle from a secondary follicle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ART: See assisted reproductive technology. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Artificial insemination: See assisted insemination.
Artificial insemination, husband (AIH): See assisted insemination, husband.
Aseptic necrosis of the femoral head: Literally, noninfective death of the bone tissue of the top end of the thigh bone (where it forms the hip joint); a rare but serious complication from continued high dosages of cortisone-like drugs, including cortisone, prednisone and prednisolone, sometimes used for treating, for example, sperm antibodies. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ashermanās syndrome: The combination of intrauterine adhesions and amenorrhea. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Aspermia: An absence of semen despite male orgasm; thus, different to azoospermia, an absence of sperm. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Assisted conception: A group of medical treatments ranging from assisted insemination to in vitro fertilization, with its technical variants, with the following common characteristics: (1) they are aimed at increasing the chance of pregnancy each month, thus overcoming the medical disability of infertility; (2) there is little or no Īspilloverā of therapeutic effect beyond the cycle or month in which treatment is invoked; and (3) there is some form of procedural intervention, with sperm, eggs or embryos spending some time outside of the body. Itās not necessary for there to be stimulation of the ovaries for multiple development of follicles. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Assisted hatching: An IVF micromanipulation in which a small opening is made in the zona pellucida of the pre-embryo to help the blastocyst emerge prior to implantation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Assisted insemination (AI): Insemination, or injection of semen or prepared spermatozoa, into the vagina, cervix, uterus or fallopian tube, to aid fertility. A basic form of assisted conception. The husbandās (or male partnerās) sperm (AIH) or donated sperm (DI) can be used. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Assisted insemination, husband (AIH): Assisted insemination in which the semen from the husband or male partner is used. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Assisted reproductive technology (ART): The term is essentially synonymous with assisted conception, but tends to emphasize the technology instead of the medical help to which the technology is put. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Asthenozoospermia: See oligospermia.
Atresia: Process by which a tissue stops growing, loses its function and degenerates. Synonymous with atrophy. Aee also follicular atresia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Atretic follicle: A tertiary follicle that: is no longer growing; no longer secreting estradiol; and no longer contains a healthy oocyte, or egg; see also follicular atresia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Atrophy: Literally, an absence of nutrition, but in particular the result of such lack in a tissue, which shrinks and loses its normal function. For examples, see endometrial atrophy, follicular atresia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Autonomy: An ethical principle in which value is given to maximizing an individualās contribution to the making of decisions that affect them; can be overdone by abrogating professional responsibility through misuse of the device of informed consent. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Autosome: A chromosome other than one of the sex chromosomes (which are X or Y); numbered from 1 to 22. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Azoospermia: A complete absence of sperm (spermatozoa) in the semen. Detectable only by performing a sperm count, as semen looks the same whether it contains sperm or not. Due either to an obstruction (usually in the epididymis or vas deferens) or to failure of sperm to form or to mature in the testis (called Īmaturation arrestā). See also spermatogenesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Balanced chromosomal translocation: Remember chromosomes occur in pairs in all cells except sperm and eggs. If part of one chromosome is found as part of a completely different chromosome itās Ītranslocatedā; for that person there is no net gain or loss of genetic material, so the translocation is Ībalancedā and there is no problem. But when that person makes eggs or sperm, some of these will have too much or too little genetic material. The same will be true for an embryo that results. The chromosomal translocation will then be unbalanced and the embryo will sooner or later be miscarried. See also chromosomal cross-over and chromosomal embryopathy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Basal body temperature chart (BBT): An inexpensive way of detecting ovulation through the effect progesterone has on the hypothalamus, increasing the bodyās temperature a few tenths of a degree; best recorded using a BBT thermometer (with a smaller scale than thermometers used to record fevers or high temperatures) first thing in the morning before rising, and preferably in the vagina for accuracy; day 1 of the chart is the first morning when there is menstruation (a period); commonly thereās a dip in the temperature just before the sustained rise that indicates that ovulation has occurred (a Ībiphasicā chart); the chart typically records the days you are menstruating, when you have sex and when youāre aware of mucus or ovulation pain; best used to document: (1) the presence and length of the luteal phase, especially if clomiphene is being used for ovulation induction; and (2) the timing of symptoms such as premenstrual spotting; not as good for predicting ovulation as LH-testing in urine. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
BBT: See basal body temperature chart.
Beneficence: The ethical value that comes from doing good. See also non-maleficence and suffering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Bicornuate uterus: A uterine anomaly in which the Müllerian ducts, before birth, do not join properly, with the consequence that there is a double uterus, in which each of the two sides is smaller than a normal uterus and receives just one fallopian tube. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Biochemical pregnancy: A somewhat insensitive term for when conception has occurred, producing a positive pregnancy test, but without sign of a gestational sac appearing on transvaginal ultrasound; in other words, a subclinical miscarriage or a menstrual miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Biopsy: Taking a small sample of tissue for diagnosis under the microscope. Biopsies of the endometrium can be done without anesthetic, through the cervix (see premenstrual biopsy); biopsies of the ovary or of the lining of the peritoneal cavity (e.g. to detect subtle endometriosis) are done at laparoscopy; a testicular biopsy is done to determine why thereās azoospermia. Using microscopic techniques, even a pre-embryo can be biopsied (see pre-embryo microbiopsy and preimplantational diagnosis). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Blastocyst: Stage of development of the embryo from the pre-embryo in which a fluid-filled cavity forms in the formerly solid ball of cells (the morula), about 5 days after fertilization. For the first time, a distinction can be made between a sheet of cells to one side, which will form the embryo proper, and the remaining, peripheral cells, which - after the blastocyst Īhatchesā through the zona pellucida and undergoes implantation - will form the trophoblast. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Blighted ovum: An old-fashioned term for an inevitable miscarriage, meaning that the ovum (in its classical sense for professional embryologists) has not developed normally after fertilization, there being present just the supporting tissues and no embryo. The term is descriptive, it has no diagnostic value as to the cause of the miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Blood group and antibody screen: Most commonly done before an operation that may cause significant loss of blood, especially if an ectopic pregnancy is suspected, because a blood transfusion may be needed; also done for investigation of recurrent miscarriages, when the rare but important antibody Īanti-TjAā needs to be excluded or detected. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
BMI: Body mass index.
Body mass index (BMI): An estimate of a personās amount of fat calculated by dividing his or her weight (expressed in kilograms) by the square of the height (expressed in meters). Normally between 20 and 25, although the upper limit is higher with age. A BMI below 20 generally causes oligomenorrhea, then amenorrhea, through anovulation. A BMI much over 25 indicates obesity. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Bowel: The intestines. The small intestine (or small bowel) runs from the stomach to the wider large intestine (or large bowel), which starts with the cecum, in the region of the appendix on the right side of the lower abdomen, ascends (ascending colon), turns left (transverse colon), turns downward (descending colon), becomes the sigmoid colon (as it sweeps from side to side a bit), then the rectum, before emerging at the anus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Breakthrough bleeding: Bleeding (usually light, or Īspottingā) while on the oral contraceptive pill or taking a progestogen. With regard to the pill, it is common (and of no sinister importance) in the first few months of pill use; but if it happens after many monthsā satisfactory use of the pill then it may signal: (1) interference with the efficacy of the pill (i.e. a risk of ovulation and pregnancy) due to an intercurrent illness (involving, typically, diarrhea), simultaneous taking of antibiotics, or taking additional medications that speed up the pillās metabolism; or (2) coexisting pathology of the cervix or the uterus. Unexplained or persistent breakthrough bleeding means you should see your physician. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Bromocriptine: A drug that mimics dopamine, which inhibits production of prolactin by the pituitary gland. Specific treatment for hyperprolactinemia: the tablets are given by mouth unless they cause side effects, in which case the same tablets (but not the capsules) are used vaginally; made by Sandoz as Parlodel. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Buserilin: a GnRH-agonist, made by Hoechst as Suprefact. Administered as a nasal spray. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
CA125 antigen: A mucus-like protein produced in some circumstances by surface cells of tissues derived from the Müllerian ducts; its function is obscure but measurement as serum CA125 antigen can useful in diagnosing adenomyosis, endometriosis and some cancers of the ovary. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Caecum. English spelling for cecum (see bowel).
Canalization: See tubal canalization.
Capacitation: An invisible change mature sperm undergo to acquire accelerated movement and the ability to undergo the acrosome reaction; brought about naturally when sperm swim up through the uterus and fallopian tubes, or brought about in the laboratory by spinning and washing the sperm through a series of solutions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
CAH: Congenital adrenal hyperplasia.
Cautery: Short for electrocautery, or diathermy.
CAVD: See congenital absence of the vasa deferentia.
CBAVD: Congenital bilateral absence of the vas deferens; see congenital absence of the vasa deferentia.
Cecum: See bowel.
Cervical incompetence: Weakness of the cervix of the uterus, usually because of previous operations on it, but sometimes without prior injury, leading to miscarriage, typically in the second three months of pregnancy; diagnosed by examining the cervix during pregnancy, repeatedly if necessary; often causes no symptoms until the waters break (the pregnancy membranes bulge through the opening cervix), when itās usually too late to treat; treated with a cervical ligature. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervical ligature: A suture placed circumferentially around the cervix to strengthen and support it for the treatment of cervical incompetence. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervical mucus: Sticky scretion from the canal of the cervix, the job description of which is to keep sperm out unless ovulation is about to take place, when it becomes voluminous, watery, stretchable (spinnbarkheit) and forms a crystalline ferning pattern when allowed to dry on a glass slide. See also cervicitis, Kremer test, Insler score and postcoital test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervical mucus sperm antibodies: Estimation of sperm antibodies in the cervical mucus; the presence of these antibodies can cause negative tests of cervical mucus-sperm interaction, including a negative postcoital test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervical polyp: A polyp of the canal of the cervix. A cause of bleeding after sex (postcoital bleeding). Sometimes accompanied by an endometrial polyp, which can cause infertility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervical pregnancy: An ectopic pregnancy located in the wall of the cervix. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervicitis: Inflammation of the cervix, usually because of infection. Sperm may or may not have trouble getting through the cervical mucus: this can be tested with a postcoital test. Occasionally cervicitis may mean that there is endometritis and salpingitis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cervix: The neck of the uterus, lying between the body of the uterus (its fundus) and the vagina. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chlamydia: A germ, or infective agent, responsible for infection of, and damage to, the fallopian tubes. In men, chlamydial infection can cause Īnonspecific urethritisā, with a transient feeling of burning during the passing of urine or a transient yellow-colored discharge from the penis. In women, there may be a vaginal discharge or there may be mild or moderate abdominal pain from acute salpingitis; it should be suspected whenever there is yellow-colored mucus in the cervix during the taking of a PAP smear. There may be no symptoms in either sex. The diagnosis is made by testing cell scrapings from the canal of the cervix or from the urethra. As a germ, chlamydia is like a virus in some ways (it grows only inside cells) and like a bacterium in others (it responds to some antibiotics - especially tetracyclines and erythromycin). When itās diagnosed, both partners should be treated. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chorionic gonadotropin: A gonadotropin produced by the trophoblast of the placenta that acts like luteinizing hormone; see human chorionic gonadotropin (hCG). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chorionic villus (pl. villi): ĪTonguesā of tissue of the placenta (trophoblast) that Īlapā the motherās blood in the uterus, exchanging oxygen, nutrients and waste products between the fetusās blood vessels (in the villi) and the motherās blood; this tissue is sampled for genetic testing with chorionic villus sampling.
Chorionic villus sampling (CVS): A test done at about 9 weeks pregnancy at which, under ultrasound guidance, a catheter is passed through the cervix of the pregnant uterus to obtain a small sample of tissue from the placenta (the afterbirth) for genetic testing, such as a karyotype.
Chromatid: See chromosomal cross-over and mitosis.
Chromosomal cross-over: Remember that the ordinary cells of the body have 46 chromosomes in 23 pairs. The members of each of the pair donāt contain the same genes (this is why you can carry a gene for something recessive without being sick, but if you have both genes thereās trouble). During the cell divisions that produce the germ cells (the process of meiosis), the 46 chromosomes first double to 92 before they end up with the 23 present in an egg or a sperm. Two of the four sibling chromosomes (we call them Īchromatidsā) then randomly exchange bits of themselves: thereās a Īcross-overā. Nature is jumbling up where the genes will go so that in the long run you donāt always have to inherit two particular genes just because they live next door to each other on a chromosome. Over the generations, there will sooner or later be a split between them during cross-over. Cross-over does not mean that genes can end up in any chromosome they like: unless Ītranslocatedā, they will remain in pairs (of alleles) within a particular pair of chromosomes. See also balanced chromosomal translocation and linkage analysis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chromosomal embryopathy: When the embryo or fetus is abnormal because of a mistake in its chromosomes, with too much or too little genetic material. Usually causes miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chromosome: The mixture of a single long strand of genetic material (DNA) and supporting proteins. There are 46 chromosomes (23 pairs) in every normal human cell (other than the germ cells). Each cell therefore contains all the genetic information needed to make a human being. But itās only in the first few days of the pre-embryo - if then - that all of a cellās DNA is accessible: once cells differentiate to have special purposes only the DNA they need remains unmasked. Chromosomes are located in the cellās nucleus and come in pairs, so that each cell has two alleles of each gene. See also chromosomal cross-over. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Chronic: Medically, means slow to develop and lingering or long-lasting; opposite to acute. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cilium (pl. cilia): Tiny hair-like projections on the surface of some cells, which are thus called Īciliatedā; coordinated beating of the cilia moves mucus and mucus-like substances (such as the cumulus mass) on the surface of ciliated cells in the direction of the cilial beat. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cleavage: Process by which a fertilized egg divides repeatedly over several days, forming (for a time) smaller and smaller cells; the process begins at the stage of the zygote and ends with a morula. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Clomid: Clomiphene made by Marion Merrell.
Clomiphene: A drug that blocks the action of estrogens and so tricks the pituitary gland into thinking the ovaryās follicles arenāt producing enough estradiol, so that natural FSH production is temporarily increased, the ovaries thereby are stimulated, and follicles grow; trade names: Clomid (Marion Merrell) and Serophene (Serono). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Coitus: Latin for sex.
Colon: See bowel.
Complete infertility: Absolute infertility (100 % infertility), when thereās no chance of pregnancy happening without help - generally because of no sperm, no ovulation or a complete blockage to egg and sperm getting together. See also sterility (which is a synonym). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Complete miscarriage: Traditionally, any miscarriage revealed to be complete upon careful inspection of the expelled pregnancy tissue, meaning that a uterine curettage was not necessary to avoid the risk of retained tissue causing more bleeding or infection. Nowadays we can distinguish a complete from an incomplete miscarriage (and whether or not a curettage should be done) with a transvaginal ultrasound, which is able to reveal significant retained tissue. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Conception: Occurrence of pregnancy as indicated by a positive pregnancy test that detects human chorionic gonadotropin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Conception rate: The percentage of months or treatment cycles that result in conception, including biochemical pregnancies, ectopic pregnancies, miscarriages and all potentially viable pregnancies (twins are not counted twice); less important for most purposes than the implantation rate, pregnancy rate, viable pregnancy rate and the take-home-baby rate. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Conceptus: Another word for embryo or pre-embryo. Literally, the Īproduct of conceptionā, so refers to any stage from the fertilized egg (or zygote) to the fetus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Congenital: An adjective meaning that something, especially an abnormality or anomaly, is present from birth. The cause for such a condition may be hereditary (genetic) or it may be an environmental factor operating before birth. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Congenital abnormality: Abnormal development of a body part during embryonic and fetal life, usually but not always apparent at birth. It may be inherited genetically or be acquired by exposure to a physical or chemical insult, such as the action of a teratogen (a drug or other substance in the environment), during development in the motherās uterus. Few congenital abnormalities can be associated with a specific cause, and an apparent cause may not be the true one. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Congenital absence of the vasa deferentia (CAVD): Congenital (present from birth) absence of the two vasa deferentia, which conduct sperm from the testes to the ejaculate; hence a cause of obstructive azoospermia; because the vas deferens on each side is usually affected, the word Ībilateralā (medical speak for both sides) is often inserted, as ĪCBAVDā. Infertility is inevitable, but can be overcome using IVF with testicular sperm extraction. The cause, however, is usually the presence among the manās genes of one of the serious alleles for the genetic disease cystic fibrosis (which, having a recessive inheritance pattern, results when there are two such alleles present); it may also come about when there are one or two of the less serious abnormal alleles for this condition. The more common of the abnormal alleles should therefore be screened for (using a specially set up polymerase chain reaction on white blood cells): should an abnormal allele be present (Īdelta F508ā is the most common seriously abnormal one), the woman should be screened too in order to predict the chance of cystic fibrosis occurring in the offspring. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Congenital adrenal hyperplasia: See serum 17-hydroxyprogesterone.
Congenital anomaly: See congenital abnormality.
Control group: When a research study is done (an experiment, maybe), the procedure, drug or process being tested or examined on the Ītreatment groupā needs to be compared with a similar group that doesnāt receive the Ītreatmentā; we call this group the Īcontrol groupā. The groups can consist of people, embryos, research animals, for example. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Corpus luteum (pl. corpora lutea): Latin for Īyellow bodyā, the description being that of the solid or cystic structure in the ovary after ovulation; derived from the ovulating Graafian follicle; at first red and friable, as arteries and veins invade the collapsed follicle, before it matures into a little gland thatās very efficient at producing progesterone, a hormone thatās soluble in the fat, which gives the corpus luteum its yellow color. Provides its name to the second, or luteal phase of the ovarian cycle, as well as to luteinizing hormone, which causes the corpus luteum to be formed and sustains it until, in the event of pregnancy, itās supported instead by human chorionic gonadotropin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Corpus luteum defect: See luteal phase defect.
Cryostorage: Storage (at the very low temperature of liquid nitrogen) of sperm, eggs or (very recently) unfertilized eggs, after special preparation of these cells during cooling to replace much of the water they contain with a Īcryoprotectiveā substance such as dimethylsulfoxide, propanediol or glycerol. Storage is biologically safe for a decade or more, but the existence of Ībanksā (especially of embryos) has been a concern of some in society. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cryptomenorrhea: Literally, Īhidden menstruationā; apparent amenorrhea caused by an obstruction to the outflow of periodic bleeding from the uterus. Causes include an obstruction in the vagina. Typically there is periodic pain coinciding with the timing of the hidden menstrual flow. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cryptorchidism: Literally (from the Greek), Īhidden testicleā, a condition in which thereās incomplete descent of the testis or testes from the abdomen into the scrotum; synonymous with Īundescended testisā; see also orchidopexy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
CT scan: A special form of x-ray taken with the person enveloped in the x-ray apparatus, which builds up a particularly good image of any cross-section or series of cross-sections through the body, by a process of Īcomputed tomographyā. Particularly useful for investigation of the anatomy of the pituitary gland and hypothalamus when a tumor is suspected and needs to be excluded. More widely available than an MRI scan, which may give even clearer results in some cases. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Culture medium (pl. media): The fluid in which cells or tissues, including eggs, sperm and embryos, are grown. It consists of water, salts and nutrients. Different media have turned out best for different purposes. On the other hand, several different media seem to produce equal results for IVF; examples include Hamās F10, Whittinghamās T6 and Quinnās medium (said to be based on Īhuman tubal fluidā, though in reality different to the fluid in the fallopian tube). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cumulative chance of pregnancy: The accumulating chance, month after month, of successfully having gotten pregnant. With a monthly fertility (a monthly chance of pregnancy, or fecundability) of, say, 20 %, thereās a 20 % chance of pregnancy by the end of the 1st month, a 20 % of 80 % chance of pregnancy in the second month (16 %), and so a (cumulative) 36 % chance of pregnancy by the end of the 2nd month. And so on. The details are in Appendix 1. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cumulus mass: A collection of specialized granulosa cells, surrounding the ovulating egg in a sticky, mucus-like matrix; sticks to the fallopian tubeās fimbrial end after ovulation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Curettage: Also called simply a Īcuretteā (as in "having a curette/curettage done") or a ĪD and Cā (which is jargon for dilatation of the cervix and curettage of the uterus). When a curettage is done to empty the uterus of normal or abnormal pregnancy tissue, a special suction apparatus is used and we refer to the operation as a Īvacuum curettageā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Curette: Instrument for carrying out curettage.
CVS: See chorionic villus sampling.
Cyproterone acetate: A progestogen that is particularly effective at blocking the effect of male sex hormones on the skin, and therefore reducing abnormal hair growth and acne. Found singly in Androcur and in combination with an estrogen in Diane-35, a formulation used for oral contraception. Dangerous if taken in pregnancy, because it stops male fetuses from developing normal genital organs. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cystic fibrosis: A serious genetic disease (with a recessive inheritance pattern) characterized by a major disturbance of the bodyās mucus secretions, and thus a cause of incapacitating disease of the lungs. Important in our context because the heterozygous (or Īcarrierā) state in men may manifest with azoospermia due to congenital absence of the vasa deferentia - the infertility of which is nowadays able to be overcome with testicular sperm extraction and IVF, thus risking inadvertent transmission. See also [delta]F508. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Cytoplasm: The part of a cell that is not the nucleus (the nucleus contains the chromosomes). The cytoplasm is contained by the cellās Īplasma membraneā and contains all the other cellular structures, including the mitochondria. Genetic inheritance is mostly by way of the nucleus (with a contribution from mother and father); a small part is by way of the cytoplasm (with a contribution only from the mother). Itāis the cytoplasm of the egg (as a secondary oocyte) into which a sperm cell (spermatozoon) is injected in the process of intracytoplasmic sperm insertion. See also mtDNA. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Danazol: A hormonal drug used for treating endometriosis. Related to male sex hormones (its a weak androgen), it has occasional androgenic side effects, including weight gain and increased muscle bulk (itās an anabolic steroid), and increased facial hair; less commonly their may be deepening of the voice or enlargement of the clitoris. Made by Sanofi Winthrop as Danocrine. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
D and C: See curettage.
Danocrine: See danazol.
Decapeptyl: A GnRH-agonist, made by Ipsen Biotech as Triptorelin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Decidua: Differentiated endometrium of pregnancy which is shed (like a deciduous tree sheds its leaves) at childbirth or miscarriage, as part of the afterbirth; during pregnancy it has important hormonal functions (see decidual cells). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Decidual cells: Plump endometrial stromal cells, lying between the glands of the endometrium, formed under the prolonged influence of progesterone, especially with establishment of pregnancy; constitutes the decidual reaction to form the decidua of pregnancy, and produce prolactin (important for regulating water entering the amniotic cavity) and Īrelaxinā, which keeps the myometrium quiet. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Decidual reaction: Complete confluence of endometrial stromal cells (lying between the endometrial glands), caused by prolonged (14 days or more) exposure to progesterone or a progestogen; normally happens only with pregnancy; see also predecidual reaction. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Deontological ethics: A set of ethical beliefs, in which principles and values are seen by adherents to be self-evident and not in need of more basic proof; the ethical principles are duty-binding, innately known, and by nature resistant to change. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Deoxyribonucleic acid: See DNA.
Depletion of eggs: The natural process in which the older the female fetus, girl or woman gets the fewer are the eggs left in the ovaries; the huge majority of eggs are lost because of atresia, only a tiny fraction by ovulation. When the eggs are more or less depleted there will be primary ovarian failure and, in women who have had periods, the menopause will take place. Infertility, however, usually precedes total egg depletion by up to 10 years. See also mitochondrion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
DHT: See dihydrotestosterone.
DI: See donor insemination.
Diathermy: Use of a high voltage, high frequency electric current to coagulate or evaporate tissue during surgery. Useful because it can be used during laparoscopy, particularly for stopping bleeding (by coagulation) and for treating endometriosis (by evaporation). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Diane-35: A formulation of the oral contraceptive pill that contains, as well as an estrogen, the progestogen known as cyproterone acetate, which is particularly effective at blocking the effects of male hormones on the skin. Made by Schering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dihydrotestosterone (DHT): The most active male sex hormone or androgen; formed in target tissues from testosterone (which is the main form of androgen circulating in the blood); testosterone must be converted to DHT before it can do its job. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dilatation and curettage (D&C): Before curettage (of the uterus), the cervix is dilated to admit the curette. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Diploid: The full, normal complement of chromosomes, numbering 46 (as 23 pairs); see also haploid. The noun form of this adjective is Īdiploidyā (the state of being diploid). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Distributive justice: Justice dispensed in the community to confer maximum value to those in need through the notions of fairness and consistency. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dizygotic twins: Twins formed from two fertilized eggs, or zygotes; non-identical twins. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
DNA: The stuff of which genes are made. DNA is an abbreviation of Īdeoxyribonucleic acidā, a molecule made of a variable sequence of units, the nature and order of which forms the "genetic code". DNA is located chiefly in the chromosomes, which form a cellās nucleus. A small amount of DNA (coding for about 14 genes) is found in the mitochondria (see also mtDNA). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dominant follicle: The tertiary follicle, or Graafian follicle, that has won the responsibility for producing estradiol for the rest of that particular ovarian cycle; chosen by the end of the first week of the follicular phase of the normal ovarian cycle; its destruction (whether accidental or intentional) means that a new follicular phase must start, with ovulation two weeks later, whereas destruction of one of the tertiary follicles before one has become dominant causes no interference with the timing of ovulation for that cycle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dominant inheritance: A pattern of inheritance of a characteristic (such as brown eye color) or abnormality in which just one gene or allele is needed to confer the characteristic or abnormality, in contrast to recessive inheritance, which requires two abnormal genes. See also heterozygous. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Donor insemination: Assisted insemination in which semen from a sperm donor (who is not the husband) is used. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Downās syndrome: Mongolism, due to trisomy 21. Chromosome 21 is the smallest of the autosomes (the non-sex chromosomes): trisomies of the other autosomes tend to be lethal at an earlier stage of embryonic or fetal development, and so are seen much more rarely. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
DUB: see dysfunctional uterine bleeding.
Duration of infertility: One of the two most important variables (the other is time left for conception) that determines the chance of still getting pregnant naturally in relative infertility, including unexplained infertility. The longer the duration of infertility, the smaller the chance each month as time goes on. Explained in Appendix 1. See also fecundability and time to pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Duty: A moral compulsion for ethical action that is innate; the basis for deontological ethics. See also suffering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dysfunctional uterine bleeding (DUB): Heavy bleeding from the uterus; see anovulatory dysfunctional bleeding (often painless and irregular) and ovulatory dysfunctional bleeding (usually regular and can be associated with dysmenorrhea). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dysmenorrhea: Painful menstruation. Can be Īprimaryā, present in teenagers, generally in spasms around the start of the period; or it can be Īsecondaryā, developing only as a woman gets older, and then typically lasting more than a day or so into the period, with prolonged aching as well as spasms. Primary dysmenorrhea may have no medical importance beyond the suffering the actual pain causes, and typically gets better as a woman reaches her 20s. Secondary dysmenorrhea can signify, for example, endometriosis, fibroids, adenomyosis or peritubal adhesions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Dyspareunia: Painful sexual intercourse that persists after the first few times or which develops after months or years of painless sex. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ectopic pregnancy: A pregnancy implanted in an abnormal location, such as the fallopian tube, the cervix, the ovary or the peritoneal cavity (abdomen). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ectopic pregnancy rate: The percentage of ectopic pergnancies among total clinical pregnancies (excluding biochemical pregnancies). The rate is about 0.3 percent in normal women and is increased with abnormalities of the fallopian tubes, assisted conception, and other circumstances. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Efferent ducts: Fine passages in the rete testis conducting sperm cells from the tubules of the testis to the epididymis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Egg depletion: See depletion of eggs.
Egg pick-up: See follicle aspiration.
Embryo: The word is used loosely to describe everything from a fertilized egg to a fetus, including the pre-embryo. What nowadays we call the embryo has for long been called the ovum by professional embryologists! Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Embryo biopsy: See pre-embryo biopsy.
Embryopathy: Literally, pathology of the embryo (or fetus). Can underlie a miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Embryo transfer: Procedure by which the embryo (age 1 to 2 days, and strictly a pre-embryo) is placed in the uterus or into the fallopian tube after IVF. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Empirical: An awkward adjective that can have contrary meanings in medicine. The word comes from the Greek for Īexperienceā. On the one hand, empirical medical practice is that which is based only on observation and experiment (praiseworthy); on the other, it can refer to medical practice thatās based on very personal experience without taking scientific principles into account (not praiseworthy); at worst it refers to treatment thatās chosen on no other basis than: ĪLetās see if it might workā. In this book I use it in its first sense unless I draw attention to a contrary use of it by others. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endocrinology: The study of hormones. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrial atrophy: Shrinkage of the endometrium through lack of support by, especially, the hormone estrogen, or by the loss, through injury, of receptiveness to estrogen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrial biopsy: See premenstrual endometrial biopsy.
Endometrial cavity: The space inside the uterus lined by the endometrium. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrial hyperplasia: Overgrowth of the endometrium, caused usually by prolonged action of estrogen unopposed by progesterone (i.e. prolonged anovulation), as is the case in, particularly, the polycystic ovary syndrome. Potentially dangerous, because it may turn to cancer of the endometrium. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrial polyp: A polyp of the endometrium (lining of the uterus), sometimes without symptoms, sometimes with abnormal bleeding such as intermenstrual bleeding, premenstrual spotting or heavy periods; a cause of infertility (and of failure of assisted conception to result in pregnancy); diagnosable with transvaginal ultrasound. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrial stroma: Loose connecting-type tissue that lies between glands of the endometrium; contains stromal cells that eventually respond to progesterone by becoming plump to form a more or less continuous sheet towards the end of the menstrual cycle (the predecidual reaction) or, more completely, with successful implantation and pregnancy (the decidual reaction); see also decidua. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometriosis: A common condition in which tissue like the lining of the uterus, or endometrium, grows somewhere else, sometimes causing dysmenorrhea, premenstrual spotting, infertility, dyspareunia and ovulatory dysfunctional uterine bleeding; the subject of Chapter 14. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometritis: Inflammation of the lining of the uterus, or endometrium. Can be acute or chronic. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endometrium: The lining of the uterus, which contains the endometrial glands and the endometrial stroma. Distinct from the myometrium. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Endorphins: Opium-like substances produced naturally in the brain, which give a feeling of well-being. Production of endorphins is stimulated by many natural circumstances, and also by profound exercise (to which people can become Īaddictedā!). Depressed in premenstrual tension. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Epididymal sperm aspiration: See microscopic epididymal sperm aspiration.
Epididymis: A finely coiled tubular structure, lying next to the testis in the scrotum, which connects the testis to the vas deferens, and through which sperm cells pass and gain in maturity. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ERT: See estrogen replacement therapy.
Estradiol: The most powerful natural estrogen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Estrogen: The general name for one of the two principal female sex hormones (the other is progesterone), responsible for stimulating growth of the female reproductive system (the vagina, the cervix, the uterus and the fallopian tubes) and growth of the breasts; the main estrogen is estradiol, produced by the developing follicle in the ovary, as well as by the corpus luteum (to a lesser extent), by the placenta and by the bodyās fat tissues (through conversion from male sex hormones, or androgens, in the blood); after the menopause the main estrogen is the weaker one, estrone, largely derived from conversion by the bodyās fat of the weak androgen androstenedione. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Estrogen replacement therapy (ERT): The therapeutic use of estrogen to stop the effects of menopause after the ovaries have been removed or have stopped functioning. If the uterus is still present the hormone regimen must include at least 11 daysā progestogen usage each month, or there will be a risk of endometrial hyperplasia and cancer. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Estrone: A weak estrogen, which needs to be converted (in target tissues such as the uterus) to the strong estrogen estradiol before, as a hormone, it causes an estrogen effect; the main estrogen in blood after the menopause; formed from estradiol when that hormone in tablet (or oral) forms is absorbed across the intestines. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ethics: A set of principles and values that govern behavior to accord with a notion of morality; see especially deontological ethics, teleological ethics and utilitarian ethics, and also see beneficence, non-maleficence, justice and suffering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ethics committee (Britain and Australia): A mandated committee of an institution (hence institutional ethics committee, or IEC) that conducts medical research. It meets regularly and is composed of specialist and lay individuals who consider the ethical implementation of protocols for research, according to the requirements of the 1975 Declaration of Helsinki (on clinical research and human experimentation) and any other official determinations relevant to the particular environment of the researchers. Its purpose is to gauge and to minimize risks run by the subjects of research; its decisions are binding on researchers; in the US this committee is called an institutional review board, or IRB. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ethics committee (US): A socially derived, multidisciplinary committee of a hospital. It meets irregularly, often at short notice, to help in the making of ethically difficult clinical decisions aimed at ascertaining and preserving the patientās best interest. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ethinylestradiol: Orally effective form of estradiol that resists being converted to estrone; generic (Īno frillsā) name for Estigyn. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Extra-Y-chromosome syndrome: A trisomy with a karyotype of 47,XYY - i.e. a male with an extra Y-chromosome. Affected men tend to be tall. Surveys of penal institutions have indicated a higher than expected frequency, implying that affected men are at increased risk of being criminals. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
[Delta]F508: The commonest allele to result in cystic fibrosis (when two [delta]F508 alleles are present) or congenital absence of the vasa deferentia (when one [delta]F508 allele is present in a man). A woman heterozygous for this gene (with one [delta]F508 allele) will be a Īcarrierā for cystic fibrosis (and for CAVD) but will herself be otherwise normal. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fallopian tube: The hollow organ, about 10 to 12 centimeters long, that effectively joins the ovary to the uterus on each side; composed of the fimbrial end, the ampulla, the isthmus and the interstitial segment. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Falloposcopy: Looking inside the fallopian tube with a tiny (half a millimeter diameter) flexible, fiberoptic instrument, from the direction of the uterus. See also salpingoscopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fecundability: Technical speak for the Īmonthly chance of pregnancyā, or monthly fertility, either for an individual (measured over time) or for a population (the number of conceptions occurring in one month). For any individual with unexplained infertility and in milder cases of relative infertility, chiefly determined by the duration of infertility (or, in cases of secondary infertility, in which past fecundability is being estimated, determined by time to pregnancy); once calculated this way (the details are in Appendix 1), an estimate of the chance of still getting pregnant naturally (as opposed to undergoing assisted conception) will chiefly be determined by the time left for conception. See also normal monthly fertility, cumulative chance of pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fertinex: Highly purified Metrodin, with no residual luteinizing hormone, thus equivalent in activity to recombinant FSH; called Metrodin HP outside the U.S. Made by Serono. See also serum estradiol. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fertilization: Entry of a sperm cell into an egg: their Īmarriageā; the egg is Īactivatedā by this event, so that: (1) Īcortical granulesā are expelled that stop further sperm binding to the egg; (2) the second division of meiosis is completed, with expulsion of the second polar body; and (3) the machinery of the egg is got going, which will form pronuclei of the male and female chromosomes prior to syngamy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fetal reduction: Also called Īselective abortionā and Īselective feticideā. A controversial and emotionally hazardous way of dealing with a higher-order multiple pregnancy (such as quadruplets, quintuplets, or higher) in which, because all the embryos or fetuses are at risk of being lost before viability, and while carrying out transvaginal ultrasound, a lethal substance such as air or a solution of potassium is injected into the visibly beating heart of one or more of the embryos, so reducing the number of surviving embryos to three, two or one. Generally regarded as a more stressful procedure than even an induced abortion, both for the person undergoing the operation and for the ultrasound doctor asked to do it. Few people regard the availability of fetal reduction to mean that the greatest care does not need to be taken to avoid higher-order multiple pregnancies in assisted conception programs. Thereās a hazard: loss of the remaining fetuses from miscarriage; but the risk of this, with an experienced ultrasound doctor, is low. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fetus: An unborn baby, from the time the embryo is fully formed (from head to limbs - about 8 weeks from the last menstrual period) until delivery. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fetus or Foetus?
In the mistaken belief that the word for fetus was derived from the Latin foveo (to cherish), rather than feo (to beget), Isodurus (ad 560 to 636), Archbishop of Seville, started spelling it Īfoetusā. So thatās where this way of spelling it comes from. So, whether you are British or American or Australian, Īfetusā is etymologically better. (Iām indebted to Dr Thomas Firth Baskett, editor of the Journal of the Society of Obstetricians and Gynaecologists of Canada from 1988 to 1990, for this authoritative en passant.) Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fibroid: A benign Ītumorā of the muscular wall of the uterus (the myometrium). More common with increasing age, but can occur in women in their twenties. Can be single or multiple, and can be located on the outside of the uterus (a subserous fibroid), within the wall of the uterus (an Īintramuralā fibroid), or protruding into the cavity of the uterus (a submucous fibroid). The closer it is (or they are) to the cavity, the more likely it is that a fibroid will disturb reproduction (either as miscarriages or sometimes as infertility) and disturb menstrual bleeding. Surgery for removal of a fibroid, or Īmyomaā, is called a myomectomy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fimbria (pl. fimbriae): See fimbrial end.
Fimbrial end: Also Īfimbriated endā; the open, outside end of the fallopian tube in contact with the surface of the ovary, from which it Īpicks upā the ovulated egg from the ruptured follicle; itās composed of delicate Īfimbriaeā - finger-like projections of the tube lined by cells with tiny hairs (cilia), which beat towards the inside of the tube, carrying the sticky cumulus mass into the ampulla before fertilization; easily damaged by infection (salpingitis) or careless surgery, after which it may be blocked, resulting in a hydrosalpinx, or have its correct movement inhibited by adhesions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fimbriectomy: An operation for sterilization or Ītubal ligationā in which the fimbrial end of each fallopian tube is removed. It has a higher failure rate than most other sterilization operations on the tubes. It can result in a hydrosalpinx in later life, especially if estrogen replacement therapy is used after the menopause. The operation to reverse it, salpingostomy, is much less often followed by pregnancy than other reversal operations are. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Fimbriolysis: Microsurgery of the fallopian tubeās fimbrial end, involving careful dissection of fimbriae that have become stuck together from adhesions. Generally gives a better outcome than salpingostomy (which must be resorted to if the fimbriae are too damaged to dissect). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
FISH: See fluorescent in situ hybridization.
Fluorescent in situ hybridization (FISH): A technique of genetic diagnosis in which a special region of a chromosome is stained with a dye that emits colored light when exposed to ultraviolet light; a marker for chromosome 21 will normally show two spots of light, whereas three spots of light would indicate trisomy 21 (Downās syndrome); useful because the technique is accurate with just one cell, making diagnosis possible in an IVF embryo before transfer (see preimplantational diagnosis). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Foetus: See fetus; and ĪFetus or foetusā.
Follicle: Normal structure in the ovary that contains the egg, or oocyte; all are formed as primordial follicles 20 weeks before birth and remain microscopic in size until growth starts (folliculogenesis), a week or two before the cycle in which the particular follicle will be a candidate to ovulate; about 3 mm in diameter at the start of a cycle, and about 2 cm in diameter when ready to ovulate; makes more and more estrogen (particularly estradiol) as it grows; the number growing and their rate of growth are monitored by transvaginal ultrasound. See also primary follicle, secondary follicle, tertiary follicle, Graafian follicle, atretic follicle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Follicle aspiration: Procedure for obtaining eggs, involving the passing of a needle into a mature (or Graafian) follicle, either directly at laparoscopy or via the vagina guided by transvaginal ultrasound; known as Īegg pick-upā or Īovum pick-upā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Follicle cells: Cells of the follicle that surround the egg; an increase in number is what causes the follicle to grow; in tertiary follicles they are responsible for converting androgens (from surrounding ovarian thecal cells) into estrogens, particularly estradiol; a tertiary follicleās cells are also called Īgranulosa cellsā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Follicle stimulating hormone (FSH): The hormone, or gonadotropin, produced by the pituitary gland that makes the (tertiary) follicle grow; obtained from human sources in a mixture with luteinizing hormone (LH) as (1) human menopausal gonadotropin (hMG), extracted from the urine of women who have been through the menopause (Humegon and Pergonal); and (2) human pituitary gonadotropin (hPG), from human pituitary glands removed at autopsies (now obsolete). Pure FSH can be made synthetically with gene technology (see recombinant FSH). See also serum FSH. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Follicular atresia: The process by which a primary follicle or a tertiary follicle stops growing, leading to disappearance of its follicle cells and the oocyte, or egg, they contain. Such a follicle is called an atretic one. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Follicular phase: The part of the ovaryās monthly cycle before ovulation, dominated by the presence of firstly, a cohort of growing tertiary follicles, then the dominant follicle, and the estradiol these follicles produce. Normally around 14 days in length, but quite variable, often being much longer for the first few menstrual cycles after the first period (menarche), and typically getting shorter in the months or years leading up to egg depletion and menopause. Corresponds with the proliferative phase of the endometrial, or menstrual cycle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Folliculogenesis: Strictly, the process by which follicles are first formed in immature ovaries, 20 weeks or so before a female fetus is born; in the woman, it means the growth of a primordial follicle into an early tertiary follicle - a transition that confers receptiveness of the follicle to follicle stimulating hormone (FSH); the stimulus for folliculogenesis and its timing for individual follicles remains a mystery. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Free androgen index: Not often carried out at no cost, Īfreeā here means the androgen (testosterone) in blood that is not bound to carrier proteins, so itās immediately available for action in the tissues; more likely to be increased in the polycystic ovary syndrome than serum testosterone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
FSH: See follicle stimulating hormone.
Fundus: The Ībodyā, or the main part, of the uterus (leaving out the cervix), particularly its topmost part. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Galactorrhea: Demonstrable milk production from the breasts other than while purposefully breast-feeding; caused by hyperprolactinemia or, sometimes, by local disease in the breast or wall of the chest. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gamete intrafallopian transfer (GIFT): A procedure for assisting conception in which unfertilized eggs plus sperm (i.e. gametes) are transferred to the fallopian tube, so that fertilization occurs in the normal place, with several possible advantages: (1) better, stronger and faster-growing embryos could result compared with those after vitro fertilization; (2) these embryos arguably reach the uterus at the right time after fertilization; and (3) they reach the uterus in an anatomically correct direction; some of these advantages, if they are real, may also apply to the procedure of zygote intrafallopian transfer (ZIFT). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gärtnerās duct: See mesonephric duct.
Gender: Politically correct term for distinguishing the male from the female sex. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Genetic-plus-gestational surrogacy: See traditional surrogacy.
Germ cell: The gender-neutral word for ova and spermatozoa. See also haploid. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gestation: Pregnancy.
Gestational sac: A fluid-filled bag of membranes in which the embryo forms; visible on transvaginal ultrasound from about 5 weeks from the last menstrual period; technically, the Īamniotic cavityā (and later in pregnancy able to be sampled with amniocentesis). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gestational surrogacy: Surrogacy in which the woman who is the surrogate for the intended pregnancy receives embryos from the commissioning infertile couple, who have undergone IVF, then, by becoming pregnant, carries (or Īgestatesā) the pregnancy, gives birth, and then gives up the baby to the babyās genetic parents. In principle the practice can be done for altruistic or commercial reasons. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
GIFT: See gamete intrafallopian transfer.
Glucose tolerance test: see plasma glucose.
GnRH: see gonadotropin releasing hormone.
GnRH-agonist: A GnRH-analog that briefly stimulates the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH), but then quickly puts a clamp on it, stopping these hormones from competing with administered hormones - and, particularly in women, suppressing the LH-surge, which otherwise can spoil the timing of egg pick-up in an assisted conception program (such as IVF or GIFT). Examples include: leuprolide (Lupron, made by Abbott, used in the US) or leuprorelin (Lucrin, made by Abbott, used in Australia and UK); nafarelin (Synarel, by Syntex); goserelin (Zoladex, by ICI); triptorelin (Decapeptyl, by Ipsen Biotech) and buserelin (Suprefact, by Hoechst). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
GnRH-analog: Synthetic hormones related to the natural hormone GnRH, or gonadotropin releasing hormone; see GnRH-agonist and GnRH-antagonist. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
GnRH-antagonist: A GnRH-analog that immediately suppresses the pituitary gland from releasing follicle stimulating hormone (FSH) and luteinizing hormone (LH); not available commercially yet, but likely to replace GnRH-agonists for many gynecological purposes (especially assisted conception) when clinical trials are completed. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gonad: A gender-neutral word for the organ that produces germ cells; see ovary and testis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gonadotrophin: English spelling for gonadotropin; a trophic effect of a hormone implies a nourishing action, whereas a tropic effect of a hormone implies a switching action; arguably itās the latter (American) usage that is now known to be the more physiologically correct. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gonadotropin: Any hormone that switches on the function of the gonads. There are two main families of gonadotropins: (a) the gonadotropin that stimulates the growth of the follicle, or follicle stimulating hormone (FSH), and (b) those that cause ovulation from the mature follicle and stimulate the corpus luteum that results to develop and to produce progesterone, namely luteinizing hormone (LH) and human chorionic gonadotropin (hCG); FSH will cause growing follicles to produce the estrogen estradiol provided that a small amount of LH (or hCG) is present; FSH and LH are produced in the pituitary gland, whereas hCG comes from the placenta in pregnancy. In men, FSH stimulates the Sertoli cells of the testicular tubules, and hence drives spermatogenesis; LH and hCG stimulate the Leydig cells to produce testosterone. See also the individual named hormones. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gonadotropin releasing hormone: A hormone produced by the hypothalamus of the brain to regulate FSH and particularly LH production. Can be administered to induce ovulation when it is deficient (particularly in amenorrhea due to weight loss or excessive exercise), but it has to be given in small amounts directly into a vein, every 60 to 90 minutes for the two weeks of a normal follicular phase (with an electronic syringe-driver), mimicking its natural pattern of secretion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Goretex®: Not just the stuff of ski clothing, but used (in a special surgical specification) as a barrier to the formation of adhesions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Goserelin: A GnRH-agonist, made by ICI as Zoladex. Administered by monthly injection. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Gonal-F: Recombinant follicle stimulating hormone (rFSH) made by Serono.
Graafian follicle: A large, mature tertiary follicle that will respond to an adequate LH-surge or injection of human chorionic gonadotropin (hCG) by undergoing ovulation, releasing its egg; produces estradiol and, with exposure to LH or hCG, progesterone; named after Reijnier de Graaf (1641-1673), the first person to see and to appreciate the importance of the ovarian follicle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Granulosa cells: Follicle cells from a tertiary follicle.
HA: see hypothalamic anovulation.
Habitual abortion: A rather insensitive way of saying recurrent miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Haploid: The state of a cell with 23 chromosomes (half the normal diploid chromosome state), found normally only in sperm cells and eggs (as secondary oocytes); see also meiosis. The noun form of this adjective is Īhaploidyā (the state of being haploid). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hazard: An event, usually unwanted, sometimes in the sense of a penalty. Unlike risk, which has a number attached to it (itās quantitative), a hazard is Īyesā or Īnoā: itās either realized, or experienced, or itās not; although one hazard can be worse to experience than another, you canāt put a figure on it (itās said to be qualitative). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
hCG: see human chorionic gonadotropin.
Heterozygous: An adjective to describe the genetic state when the pair of genes under consideration consists of two alleles that are different. Disease or disability can follow if one of the alleles is at once seriously abnormal and dominant (see dominant inheritance) over the other allele. See also homozygous. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hermaphrodism: See intersex.
Heterotopic pregnancy: The coexistence of a normal pregnancy in the uterus with an ectopic pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
High multiple pregnancy: See multiple pregnancy.
Hirsutes: See hirsutism.
Hirsutism: Hair on the face, chest (between the breasts or around the nipples), abdomen or thighs that is getting worse, or is worse than other family members, or is worse than usual for oneās race; more likely to be important medically if the periods are disturbed (i.e. if thereās oligomenorrhea or amenorrhea). See also polycystic ovary syndrome. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
HIV: Human immune-deficiency virus, the virus that causes acquired immune deficiency syndrome, or AIDS. Type 1 and type 2 viruses are recognized, and both are usually tested for in serum HIV antibodies. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
hMG: see human menopausal gonadotropin.
Homozygous: An adjective to describe the genetic state when the pair of genes under consideration consists of two alleles that are the same. Disease or disability can follow if both alleles are seriously abnormal - a condition known as recessive inheritance (and a good example of which is cystic fibrosis). See also heterozygous. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hormone: A chemical substance, natural or not, which acts as a signal from one part of the body to another, via the bloodstream. The study of hormones is the science of endocrinology, and the hormone systems of the body are collectively known as the endocrine system. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hormone replacement therapy (HRT): See estrogen replacement therapy.
hPG: see human pituitary gonadotropin.
hrFSH: See recombinant human follicle stimulating hormone (rhFSH).
HRT: Hormone replacement therapy; see estrogen replacement therapy.
Huhnerās test: See postcoital test.
Human chorionic gonadotropin (hCG): A gonadotropin produced by the placenta in pregnancy (specifically itās produced by the trophoblast); the generic (Īno frillsā) name for Pregnyl and Profasi, which are preparations of hCG obtained by extracting it from the urine of pregnant women; mimics the action of luteinizing hormone, but has a very much longer duration of action - which has considerable advantages; given as an injection to stimulate ovulation from a mature follicle 38 hours after the injection; or to stimulate ongoing function of the corpus luteum, particularly its production of progesterone. Typically given after a course of follicle stimulating hormone in assisted conception (GIFT and IVF) programs 36 hours before the expected time of egg pick-up, and then in further, smaller doses to support the corpus luteum (or corpora lutea) that follow; no cases of transmitted (infectious) disease have been recorded after its use. Also the hormone of pregnancy thatās measured in a pregnancy test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Human menopausal gonadotropin (hMG): A mixture of follicle stimulating hormone (FSH) and luteinizing hormone (LH) extracted from the urine of menopausal women (who normally produce these hormones in high concentration) for therapeutic use; marketed as Humegon (Organon) and Pergonal (Serono). Metrodin (Serono) is hMG from which LH has been removed, and Metrodin-HP (Serono) is Metrodin from which other urinary proteins have been removed too, resulting in more or less pure FSH. No cases of transmitted (infectious) disease have been recorded after the use of any of these preparations. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Human pituitary gonadotropin (hPG): A mixture of follicle stimulating hormone (FSH) and luteinizing hormone (LH) extracted directly from pituitary glands obtained at autopsies; not used in Australia or elsewhere since 1986, when it was shown that Creutzfeldt-Jakob disease (CJD), a deadly form of dementia, had been transmitted from its use, presumably due to contaminating and infected brain tissue; before 1986 it had been used mostly for ovulation induction in women with amenorrhea (absent periods) for which other hormones or drugs had not been effective, although sporadic instances of its use for IVF are known. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Human recombinant FSH: See recombinant human follicle stimulating hormone.
Humegon: Mixture of human menopausal gonadotropins containing follicle stimulating hormone made by Organon; virtually equivalent to Pergonal. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hydatidiform mole, complete: A product of fertilization of an egg by one or more sperm in which the eggās chromosomes are excluded from syngamy. Instead syngamy involves either a single X-chromosome-bearing sperm, which first divides into two, giving a 46,XX hydatidiform mole; or into two sperm, one X-bearing, one Y-bearing, giving a 46,XY hydatidiform mole. In either case, no embryo forms, just trophoblast, the chorionic villi of which thus have no fetal blood vessels to take fluid away, causing the villi to swell and to look like a soggy bunch of grapes. The clinical manifestation is a uterus that is (usually) big for the gestational duration, often with vaginal bleeding. The diagnosis is made by a characteristic appearance on transvaginal ultrasound. In a small proportion of cases, a hydatidiform mole becomes invasive and malignant (cancerous), so after treatment by vacuum curettage careful follow-up for 12 months with serial measurements of hCG is usually advised before another pregnancy is attempted. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hydatidiform mole, partial: See triploidy.
Hydrosalpinx: Blockage of the outer, or fimbrial end of the fallopian tube, resulting in its distension by watery contents. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hyperplasia: Pathologists use this word to mean an abnormal increase in the number of cells seen in a sample of tissue. See also endometrial hyperplasia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hyperprolactinemia: An increase in serum prolactin; may be accompanied by galactorrhea; causes are described in chapter 10. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hypospadias: A congenital abnormality in males in which the urethra does not reach the tip of the penis, but opens near its base; the penis is usually short and curved, which may make sexual intercourse difficult, contributing to infertility in extreme cases. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hypothalamic chronic anovulation: See hypothalamic anovulation.
Hypothalamic anovulation: Absence of ovulation caused by insufficient GnRH drive from the hypothalamus, so that the pituitary gland doesnāt produce enough follicle stimulating hormone; usually acompanied by absent periods (amenorrhea); causes are described in chapter 10. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hypothalamus: Part of the brain lying immediately above (and connected to) the pituitary gland; responsible for producing gonadotropin releasing hormone, among other hormones and substances (including the endorphins, serotonin, etc.); in women (when conditioned to cyclical function by a lack of exposure to male sex hormones before birth) it resonates with the ovarian cycle and cooperates with the pituitary gland to cause corresponding cyclical production of follicle stimulating hormone and, particularly, a timely LH-surge; responds to progesterone by raising the bodyās temperature (see basal body temperature chart). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hysterectomy: A surgical operation at which the uterus is removed, usually including the cervix (hence a Ītotal hysterectomyā), but not necessarily including the fallopian tubes and ovaries. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hysterosalpingogram: An x-ray of the endometrial cavity and the internal outline of the fallopian tubes; performed by injecting a fluid medium that blocks x-rays through the cervix, so that it first fills the endometrial cavity and then flows out along the tubes, finally casting shadows between the loops of intestine if the tubes are open. The test is uncomfortable, because of contractions of the uterus, which can be partially overcome by taking one of the same drugs that are used to overcome dysmenorrhea (such as an NSAID). See also selective salpingogram. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Hysteroscopy: An examination of the endometrial cavity of the uterus by a thin fiberoptic instrument, similar to the instrument used for laparoscopy; can be done in the operating room under general anesthesia (often in association with laparoscopy), or with or without sedation in the office. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ICSI: See intracytoplasmic sperm insertion.
IEC: Institutional ethics committee (see ethics committee).
IMB: See intermenstrual bleeding.
Immunobead tests: Tests that look for human antibodies attached to cells, especially (in our context), antibodies attached to sperm cells (see sperm antibodies). The test involves tiny plastic beads coated with antibodies to human antibodies: if they are seen to attach to sperm cells then the presence of antisperm antibodies on the sperm cells is inferred by the observer. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Implantation: The process by which the embryoās trophoblast attaches to the motherās endometrium and penetrates it, establishing contact between the trophoblastās developing chorionic villi and the maternal blood. See also blastocyst. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Implantation bleeding: A small to moderate amount of vaginal bleeding at the time implantation becomes established; can be confused with a menstrual period. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Implantation rate: The proportion of transferred embryos in an IVF procedure that produce a gestational sac visible on transvaginal ultrasound. Unlike for the conception rate and the pregnancy rate, twins (with separate sacs) are counted separately. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Impotence: Inability to sustain an erection of the penis and hence to ejaculate. Occasional impotence is of no special psychological or medical importance. Although persistent impotence is most often due to psychological causes, medical tests are important. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Incomplete miscarriage: Any miscarriage before all miscarriage tissue has been expelled. Traditionally a uterine curettage was done after a miscarriage, in the belief (often accurate) that there would still be some immature pregnancy tissue left in the uterus that could cause more bleeding and get infected. Nowadays we can distinguish an incomplete from a complete miscarriage (and whether or not a curettage should be done) with a transvaginal ultrasound, which is able to reveal significant retained tissue. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Induced abortion: See abortion.
Inevitable miscarriage: Traditionally any bleeding from the vagina during early pregnancy with, on vaginal examination, opening of the cervix. Today, the diagnosis can be made much sooner (and distinguished from a threatened miscarriage) by not detecting a normal embryo on transvaginal ultrasound. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Infertility: Not getting pregnant as quickly as expected. See also suffering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Informed consent: An administrative and legal device by which approval to proceed based on known or predicted consequences is obtained and recorded from a patient or from a volunteer for medical research (thus avoiding an accusation for what otherwise might be an assault). Just what Īinformedā means can be the subject of much legal and ethical wrangling. One modern interpretation is that it means as much as the person giving the consent demonstrates that he or she wants to know (although most physicians, ethics committees, institutional review boards and courts underpin this with a minimum everyone should be told about the procedure being consented to). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Insler score: A score (out of 12) for the quality of cervical mucus, gauged by scoring each of the following fom 0 to 3: the cervix should be open and the volume of mucus should be good (although every woman will be different for both these parameters, they will be consistent in one woman from ovulation to ovulation); the mucus should be clear, watery and stretchy (Spinnbarkheit); and the mucus should produce a complete Īferningā pattern when itās allowed to dry on a microscope slide. The first two criteria vary at ovulation in different women (so anything above a score of 9 or 10 can be normal), but the same woman should achieve the same Insler score from one ovulation to the next. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Institutional Ethics Committee (IEC): See ethics committee.
Institutional Review Board (IRB): The US equivalent of an institutional ethics committee, set up to govern the ethical conduct of medical research. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Integrity: A systematic ethical goal that preserves the values of truth, accountability, equity and consistency. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Interceed ®: Used for minimizing adhesions in the peritoneal cavity after a surgical operation involving the fallopian tubes or ovaries. The material is woven from fibers of modified cellulose and, after being placed over abdominal surfaces the serosa of which is likely to have been damaged, dissolves in about a week or two into simple sugar molecules (which are then absorbed by the body and metabolized); in the meantime, the cloth keeps the covered surfaces apart while the serosa reforms. Controled trials have shown Interceed to be effective in preventing or reducing adhesions, but an adhesion-free result is not guaranteed. In my experience Interceed is exceptionally useful when dense adhesions resulting from previous operations are being treated. Made by Johnson and Johnson. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Intermenstrual bleeding (IMB): Bleeding between periods that are usually otherwise regular; if it happens while on the oral contraceptive pill itās called breakthrough bleeding; if it happens over a few days before a period starts properly itās premenstrual spotting; if it happens after sex itās postcoital bleeding; these forms of IMB have different, usually important, causes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Intersex (syn: hermaphrodism): A state of confusion regarding the assigning of gender, usually because of ambiguity of the genital organs at birth. There is Īmale intersexā if the karyotype is 46,XY, Īfemale intersexā if itās 46,XX. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Interstitial segment: The innermost part of the fallopian tube, passing through the wall of the uterus (the myometrium) to join the isthmus to the endometrial cavity. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Intracytoplasmic sperm insertion (ICSI): An IVF technique involving sperm microinjection (SMI), in which one or more sperm are injected through the zona pellucida, across the perivitelline space, through the vitelline membrane (the egg cellās membrane), and into the substance (or cytoplasm) of the egg itself; has largely replaced subzonal sperm insertion (SUZI) because it does not seem to be a requirement for the sperm to have to have undergone the acrosome reaction. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Intramural segment: See interstitial segment.
Intrauterine adhesions: Adhesions inside the endometrial cavity caused by prior infection (endometritis), especially if there has been a curettage during the period of infection. The circumstances in which this combination is most common are treatment for a missed abortion and treatment of a postpartum hemorrhage (bleeding a few weeks after the birth of a baby). See also Ashermanās syndrome. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Intrauterine insemination (IUI): Assisted insemination into the uterus, either for donor insemination (DI) or with husbandās semen (AIH). IUI can be carried out with a womanās natural cycles or with ovarian stimulation (superovulation) using clomiphene or follicle stimulating hormone. A form of assisted conception. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
In vitro: Latin for Īin glassā, meaning Īin the laboratoryā.
In vitro fertilization (IVF): Fertilization of the egg by sperm Īin glassā, i.e. in the laboratory (although nowadays in plastic!); necessary if the fallopian tubes are diseased or missing; useful if sperm fertilizing capacity is doubtful, because evidence of fertilization can be seen before the egg is transferred as an embryo. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
In vitro maturation (IVM): Maturation in the laboratory of the egg (as a primary oocyte) obtained from an immature tertiary follicle until becomes a secondary oocyte competent to be fertilized by sperm using IVF. The smaller the follicle, the lower the proportion of eggs that mature successfully. ICSI can be used to increase the proportion of eggs that will fertilize, but the embryos on average do no better, and so no advantage is conferred by ICSI in this situation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
In vitro penetration test: One of several tests of the ability of sperm to penetrate cervical mucus at the time of ovulation or under the influence of estrogen; see Kremer test, postcoital test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
IRB: See institutional review board.
Irritable bowel syndrome (syn. Īspastic colon syndromeā): A distressing dysfunction of the intestines, in which thereās both overactivity of the involuntary contractions of the intestinesā muscular wall and increased pain signals coming from those contractions. Treatment is based on decreasing the contractions (with a diet high in fiber, sometimes with antispasmodic drugs) and attempting to reduce the action of the pain-carrying nerves, both by sedating them (this means general sedation too, so itās often not very acceptable) and by re-educating them to be less sensitive. Treatment is time consuming and, ultimately, not always satisfactory. The symptoms of the irritable bowel syndrome are often confused with those of endometriosis; they are sometimes made worse with, and at the time of, premenstrual tension. Typically (but not always), there is an alternating tendency towards diarrhea or constipation; sometimes there is nausea with the spasms. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Isthmus: The narrow, inner part of the fallopian tube, about 3 to 4 cm long; lies between the ampulla and the interstital segment of the tube. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
IUD: Abbreviation either for Īintrauterine deathā (death of a fetus, prefacing a stillbirth) or for Īintrauterine (contraceptive) deviceā, which, to thwart this ambiguity, is sometimes (though not in this book) abbreviated ĪIUCDā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
IUI: See intruterine insemination.
IVF: see in vitro fertilization.
IVM: see in vitro maturation.
Justice: For this book, the ethical value to be had in a community from conferring rights and obligations in a way thatās fair and accords to other ethical values (e.g. non-maleficence, beneficence); see also distributive justice. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Kallmannās syndrome: Congenital absence of gonadotropin releasing hormone in the hypothalamus (causing, in women, primary amenorrhea and anovulation and, in men, failure of puberty) together with a congenitally absent sense of smell. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Karyotype: A test that displays the chromosomes after relevant cells are grown in tissue culture; a normal female karyotype is designated 46,XX and a normal male karyotype 46,XY. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Klinefelterās syndrome: A trisomy with a karyotype of 47,XXY - i.e. a male with an extra X-chromosome; a cause of azoospermia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Kremer test: An in vitro (laboratory) test of the interaction between sperm and cervical mucus, in which the mucus to be tested is drawn into two very fine glass tubes (another two tubes are filled with mucus that is known to be good) to give a 4-way test between: husbandās (or male partnerās) sperm and wifeās (or female partnerās) mucus; husbandās sperm and known good mucus; known good sperm with wifeās mucus; known good sperm with known good mucus. Because of the laboriousness of the test itās usual to administer estrogen for at least a weak to the wife to ensure that the mucus is optimal. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
K-Selection: A reproductive strategy where survival of a species is optimized by placing a premium on individual survival despite fluctuations of the environment. Favors large animals (and large animals favor this strategy) - animals that get pregnant more than once and the offspring of which require postnatal care before sexual maturity is reached. Spacing of pregnancy is important for survival of mother and offspring, and thus favors the evolution of relative infertility. The opposite reproductive strategy to r-selection. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Laparoscopy: A Īminimally invasiveā surgical operation at which instruments are passed through the wall of the abdomen: (1) for the diagnosis of abnormalities of the abdominal or pelvic organs (such as the fallopian tubes, ovaries and uterus) and to diagnose endometriosis; or (2) therapeutically, to reach the fallopian tubes for certain assisted conception procedures (see gamete intrafallopian transfer and zygote intrafallopian transfer). Carries the risks of surgery (damage to internal organs, hemorrhage, infection) and the risks of general anesthesia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Laparotomy: A surgical operation in which the abdomen is opened. Needed for microsurgery operations on the fallopian tubes (although some operations formerly done only at laparotomy are now possible at laparoscopy). For infertility surgery, the scar from a laparotomy is usually a low, horizontal one, just above the pubic bone. Several days in hospital are needed; most people are off work about 3 weeks; and some numbness or sensitivity below the scar can be expected for several months, as nerves to the skin regrow. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Large bowel: The colon; see bowel.
Last menstrual period (LMP): The normal period immediately preceding conception. For convenience, obstetricians calculate the duration of a pregnancy as starting with this date, even though of course it does not truly begin until fertilization (or, some would say, implantation). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Leuprolide: See leuprorelin.
Leuprorelin: A GnRH agonist , made by Abbott and sold as Lucrin in Australia and UK. called Īleuprolideā in US and sold there as ĪLupronā. Administered by daily injection under the skin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Leydig cell: Cells of the testis lying between the tubules in which sperm are formed (hence their other name, Īinterstitial cellsā), and responsible for the production of the male sex hormone testosterone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
LH: see luteinizing hormone.
LH-surge: A sudden and huge increase in production of luteinizing hormone by the pituitary gland in response to sustained and substantial levels of estradiol in the blood; causes ovulation about 36 hours after it starts (about 20 hours after its peak); if not suppressed during assisted conception (see GnRH-agonists and GnRH-antagonists) it can start before human chorionic gonadotropin has been given, so spoiling the timing of egg pick-up; timely production of the LH-surge in adult women depends on female conditioning of the hypothalamus and/or the pituitary gland before birth. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Linkage analysis: Read chromosomal cross-over first, then come back. Because it can take lots of cross-overs (i.e. lots of generations) to send two genes that live as neighbors on a chromosome into different directions (i.e. they end up in different people), we can do family studies to work out how closely people are related by seeing how long the runs are of identical genes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
LMP: See last menstrual period.
Long protocol: The Īlong protocolā for using GnRH-agonists involves their use for more than a week before injections of follicle stimulating hormone (FSH) start for induction of superovulation in assisted conception programs. The advantage is that any temporary rise in luteinizing hormone levels and progesterone levels has dissipated before the development is uder way of those ovarian follicles from which eggs will be removed. The disadvantage, compared with the short protocol, is that higher (hence more expensive) doses of GnRH-agonist and FSH are needed. The GnRH can be started with menstruation or during the luteal phase of the previous cycle. See also ultrashort protocol. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
LPD: See luteal phase defect.
Lucrin: See leuprorelin.
LUF: See luteinized unruptured follicle.
Lupus anticoagulant: An antibody first noted in the disease Īsystemic lupus erythematosusā that has the ability to stop blood clotting; also called the Īlupus inhibitorā; closely related to a family of anti-phospholipid antibodies, especially anticardiolipin antibody, and a cause of recurrent miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Lupus inhibitor: See lupus anticoagulant.
Luteal phase: The part of the ovaryās cycle between ovulation and the start of a new follicular phase, so dominated by the presence of the corpus luteum and the progesterone it produces; normally between 11 and 16 days in length; extended by the action on the corpus luteum of human chorionic gonadotropin (hCG) if implantation of the embryo is successful; shorter cycles can interfere with implantation (a luteal phase defect). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Luteal phase defect (LPD): Syn: luteal phase insufficiency. A luteal phase that is shorter than optimal for a fertilized egg to undergo implantation; very likely if the luteal phase is shorter than normal (11 to 16 days), but not all luteal phases within this range are innocent; often caused by a prior defect of the follicular phase or of the development of the ovulating tertiary (or Graafian) follicle - and hence by implication there may be a defect of the egg itself, any of which may cause infertility for the cycle or an increased chance of miscarriage. Also associated with the luteinized unruptured follicle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Luteinized unruptured follicle (LUF): Occurs when a reasonably mature tertiary (or Graafian) follicle recieves an LH-surge thatās enough to make it start producing progesterone, but is not enough to cause it to release its egg through ovulation; the result is that the egg is trapped in the follicle, which to a greater or lesser extent then functions like a corpus luteum, though this stage of the follicleās life is often shorter, giving rise to a luteal phase defect (LPD). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Luteinizing hormone: The hormone, or gonadotropin, produced by the pituitary gland to cause ovulation of a mature follicle in the ovary, resulting in formation of the corpus luteum; suppressed by GnRH-agonists and GnRH-antagonists, so that (for ovulation-induction) an injection of human chorionic gonadotropin (hCG, which acts the same way) has a predictable time course of action; see also serum LH. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Macrophage: A cell in the body (a bit like the one-celled animal called an ameba) thatās able to: (1) wander about; (2) engulf and digest a huge range of foreign material and junk that gets into the bodyās tissues (including sperm cells). They are present in almost every tissue in the body, especially if thereās inflammation. We see them as scavenging cells - the cells that do the ultimate tidying up inside the body - but they can be programmed to swallow very specific targets, sometimes comitting suicide for the greater good! There are normally lots of macrophages in the peritoneal cavity. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Magnetic resonance imaging: See MRI scan.
Maturation arrest: See azoospermia.
Medical vocabulary: See vocabulary.
Medroxyprogesterone acetate (MPA): A progestogen of a type related to progesterone itself. Marketed as Provera (tablets) and Depo-Provera (injections) by Upjohn. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Meiosis: (pl. meioses) A process similar to mitosis in which two successive divisions of a diploid cellās nucleus result in four Īdaughterā cells, each with a haploid number of chromosomes; unlike mitosis, each chromosome therefore duplicates just once (before the beginning of meiosis). Meiosis in humans (and other higher animals) takes place only among the germ cells (oogonia and spermatogonia, which will have been multiplying by mitosis. By differentiating into, respectively, primary oocytes or primary spermatocytes, each with 92 chromosomes, meiosis commences. With completion of the first meiotic division the products (including secondary oocytes and spermatocytes) each contain 46 chromosomes. With completion of the second meiotic division the haploid number (23) of chromosomes, suitable for fertilization, is reached. In the testis, meiosis and the production of new sperm cells (spermatozoa) can continue throughout life, but in the ovary all egg cells that survive commence meiosis about 20 weeks before birth, spending the remaining time (up to 50 years or more) locked up in follicles as primary oocytes. Whereas a primary spermatocyte gives rise to four haploid sperm cells, a primary oocyte produces just one secondary oocyte (the spare 46 chromosomes are dumped into the first polar body just before ovulation), and then one egg cell (the spare 23 chromosomes are dumped into the second polar body after fertilization). See also chromosomal cross-over. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Menarche: The first natural menstrual period (pronounced Īmenarckyā).
Menopause: The last natural menstrual period, so often a retrospective diagnosis; hence Īmenopausalā, the natural state a woman is in after the ovaries have stopped ovulating. The normal age of menopause is between 40 and 55 years, with an average in Western societies of 50 or 51 years. See also premature menopause and estrone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Menorrhagia: Traditional medical term for dysfunctional uterine bleeding, or, simply, heavy periods. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Menstrual abortion: See menstrual miscarriage.
Menstrual cycle: The ovarian cycle as itās expressed by the endometrium of the uterus. It consists of the menstrual phase, the proliferative phase and the secretory phase. Like the ovarian cycle itself, itās normally 24 to 35 days in length - typically 28 days, but there are lots of normal exceptions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Menstrual miscarriage: For our purpose in this book, the loss of an early embryo at or before the expected time of a period. Not noticeable without specially measuring levels of serum human chorionic gonadotropin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Menstrual phase: The phase of the endometrium during which there is menstruation, caused by withdrawal of progesterone at the end of the ovarian luteal phase as a new ovarian follicular phase starts; in anovulatory cycles or during treatment with estrogens, menstrual bleeding can occur from withdrawal, insufficiency or downward fluctuations of estrogen alone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mesonephric duct: A duct on each side of the developing embryo that leads from the embryoās Īmesonephrosā, or temporary kidney. In male fetuses the duct persists as the Wolffian duct to form the rete testis, the epididymis, the vas deferens and the seminal vesicle. In female fetuses it usually disappears completely (in favor of the Īparamesonephric ductā, better known as the Müllerian duct), though portions of mesonephric duct may remain as harmless cysts, called ĪGärtnerās duct cystsā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mesonephric duct cyst: See mesonephric duct.
Mesonephric remnant: See mesonephric duct.
MESA: See microepididymal sperm aspiration.
Metaphase: The third (of four) stages of mitosis or meiosis, at which the chromosomes, attached in a plate-like formation to a structure in the cell called a spindle, are easily distinguished with a microscope, and can be photographed to construct a karyotype. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Metaplasia: The metamorphosis of a tissue to take on a different form, perhaps more characteristic of a tissue some distance away. One of the theories of the cause of endometriosis is based on metaplasia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Metrodin: Human menopausal gonadotropin (hMG) from which luteinizing hormone (LH) has been removed, leaving follicle stimulating hormone (FSH) as the active substance. Metrodin HP (Fertinex in the U.S.) is more purified, other urinary proteins having been extracted too. Made by Serono. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Metrodin HP: Highly purified Metrodin, with no residual luteinizing hormone, thus equivalent in activity to recombinant FSH; called Fertinex in the U.S. Made by Serono. See also serum estradiol. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Metroplasty: A plastic operation on the uterus to change the shape of its cavity, usually for a uterine septum or for a bicornuate uterus, if there have been a number of miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Metrorrhagia: Traditional medical term for intermenstrual bleeding.
Microepididymal sperm aspiration (MESA): Using microsurgery to dissect the epididymis or rete testis (or sometimes the tubules of the testis itself - see also testicular sperm extraction) to find motile sperm cells suitable to be Īaspiratedā, isolated and prepared for an assisted conception procedure, usually involving sperm microinjection, especially intracytoplasmic sperm insertion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Microsurgery: Literally, operating under the magnification of tissues provided by an operating microscope; the magnification is typically in the range of 6x to 16x for infertility surgery; the term also implies keeping the tissues wet with physiological salt solution during the operation, using fine, nonreactive stitches or sutures, being meticulous about stopping bleeding from small blood vessels, and avoiding trauma to the serosa. See also fimbriolysis, microepididymal sperm aspiration, salpingolysis, salpingostomy, and sterilization-reversal (which includes tubal anastomosis and vasovasostomy). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Minilaparoscope: An instrument for carrying out laparoscopy that is just a few millimeters in diameter, making it possible to perform such operations in an ambulatory setting, without general anesthesia. The reliability of diagnoses made this way will need careful evaluation, especially if done to exclude endometriosis, which can be difficult to find even with conventional laparoscopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Miscarriage: The loss of (or the process of losing) a pregnancy before the fetus is viable. See also threatened miscarriage, inevitable miscarriage, incomplete miscarriage, complete miscarriage, menstrual miscarriage, subclinical miscarriage, missed abortion and recurrent miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Missed abortion: A miscarriage that should have happened but hasnāt. As a result, the pregnancy tissue in the uterus gets tougher and more difficult to get out with a uterine currettage - which is the only treatment for it. The pregnancy test may stay positive for many weeks or even months. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Missed miscarriage: See missed abortion (in this context one almost never hears the word Īmiscarriageā). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mitochondrion: (pl. mitochondria) A tiny structure resembling a bacterium and responsible for burning carbohydrates with oxygen to produce carbon dioxide and providing energy for the cellās use; each cell has hundreds or thousands of mitochondria. If thereās a single aspect of a cell that reveals the process of aging, itās the mitochondria, which get less efficient as a person (and specifically a tissue) gets older. Mitochondrial aging in egg cells may be the reason why eggs in women over the age of 40 so often seem unable to produce healthy embryos. See also mtDNA. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mitosis: (pl. mitoses) Usual process by which a cell (more strictly the nucleus of a cell) divides into two; each chromosome duplicates before the beginning of mitosis, and mitosis involves separation of the resulting duplicates so that one goes into each Īdaughterā nucleus [adapted from The Penguin Dictionary of Biology, 6th edition, Penguin Books Australia Ltd, Ringwood, Victoria, 1973]. At the third (of fourth) stages of mitosis, called metaphase, the chromosomes are easily distinguished with a microscope, and can be photographed to construct a karyotype. See also meiosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mixed reproductive loss: Repeated loss of pregnancies at different stages of development of the embryo or fetus, i.e. at different stages of pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Monoamniotic twins: Identical or monozygotic twins in which the split has occurred after formation of the blastocyst, so that the twins share the same gestational sac (or Īamniotic cavityā); there is a higher risk of complications than in the more usual situation where twins do not share the same sac. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Monosomy: An abnormality of the chromosome complement due to a loss of one chromosome from a diploid set, resulting in 45 chromosomes instead of 46. The only mosomy compatible with fetal development and continued survival is that of Turnerās syndrome, the karyotype of which is 45,X (i.e. a monosomy of the sex chromosomes). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Monozygotic twins: Twins formed from the splitting of a single fertilized egg, or zygote; identical twins; see also monoamniotic twins. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Monthly fecundity: American for the Īmonthly chance of conceptionā; see also fecundability. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Monthly fertility: The monthly chance of conception, the technical term for which is fecundability. See also normal monthly fertility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Morula: A stage of the embryo or pre-embryo that consists of a ball of cells, still enclosed by the zona pellucida, before the next stage of blastocyst; formed from the fertilized egg, or zygote, by the process of cleavage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Motility: The quality of movement, especially forward propulsion, shown by sperm cells and caused by effective beating of their tail, or Īflagellumā; analyzed as part of the routine sperm count. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
MRI scan: Magnetic resonance imaging is a special form of imaging the bodyās internal structures, taken with the person enveloped in a huge and powerful magnet; a picture is built up of any cross-section, or series of cross-sections, through the body, using a technique that detects and pictures structures by their different content of atoms with certain resonances to induced magnetic fields. Particularly useful for investigation of the anatomy of the pituitary gland and hypothalamus when a tumor is suspected. More expensive and less widely available than a CT scan, which gives adequate results in most cases. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
mtDNA: Mitochondrial DNA. The small amount of DNA found in the mitochondria. mtDNA is the genetic code for about 14 genes involved in metabolism. Because mtDNA is much less stable than the DNA in the chromosomes (where the huge bulk of genetic code is stored), mutations accumulate with time at a greater rate than that for chromosomal DNA - and eventually limit how well a particular cell or tissue can function with increasing age. Because all of the mtDNA you have you inherited from your mother (you derive your mitochondria from the egg you came from), we may have an explanation: (1) why all eggs are formed before birth (so the mitochondria donāt have to keep on dividing too often and risking genetic errors); and (2) why miscarriages and infertility get commoner with age (as the eggās several thousand mitochondria begin to succumb to genetic errors). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Mucus: Jelly-like secretion that is at once both sticky and slippery; see cervical mucus and cumulus mass. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Müllerian duct: (pronounced "mool-air-ian") Syn. paramesonephric duct. The internal female sex duct, which forms on each side of a female embryo to connect the peritoneal cavity with the outside of the embryo, starting at a point close to the ovary and forming first a fallopian tube then meeting its fellow from the other side to form the uterus, and then extending downwards to form the upper part of the vagina before finally connecting with a little dimple between the urethra (in front) and the anus (behind) to reach the exterior at the vulva. Passage of eggs from the ovaries (which ovulate into the peritoneal cavity of all vertebrate species) to the outside world through this duct is how animals, including humans, reproduce. Oddities in the development of the ducts cause congenital anomalies of any or all of these organs. In males the ducts do not develop because the Sertoli cells of the testes produce anti-Müllerian hormone. See also mesonephric duct. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Müllerian inhibiting factor: See Müllerian duct.
Myoma: See fibroid.
Myomectomy: An operation to remove a Īmyomaā, or fibroid. A myomectomy for submucous fibroid is often possible at hysteroscopy; a myomectomy for an Īintramuralā fibroid (located within the wall of the uterus), usually requires an open operation, or laparotomy; a myomectomy for a subserous fibroid may be possible at laparoscopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Myometrium: The muscular wall of the uterus, surrounding the endometrium; see also myoma (or fibroid) and adenomyosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Nafarelin: A GnRH-agonist, made by Syntex as Synarel.
Naturalistic fallacy: The philosophical term coined by G.E. Moore early in the twentieth century to devalue drawing ethical conclusions from empirical observation - i.e. by moving from what is (facts that are observed) to what ought (morality). Moore felt that ethics should be intuitive, not inferred - therefore presumably deontological rather than teleological. Practical ethicists find this constraint unnaturally crippling as it prevents them making a value judgement. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Negative history: If you have a negative history for a disease or symptom it means that you do not have or have not had that disease or symptom. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Negative test: In medicine generally it may be best for tests to be negative (like tests for brain tumors or tests for sexually transmitted diseases such as HIV - as for Īhistoriesā, compare negative history), but this is not always so in infertility. Infertility tests are generally better if theyāre positive, like the postcoital test, tests for ovulation, tests for tubal patency, and (not least) a pregnancy test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
NET: See norethinodrel.
Neurohypophysis: The neural (nerve-containing tissue) part of the pituitary gland, lying towards the back so, in medical speak, called the posterior pituitary; produces the neurohormones Īoxytocinā (which causes contraction of the uterus) and Īvasopressinā (which helps maintain blood pressure and conserves the bodyās water in the kidneys). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
NOA: See non-obstructive azoospermia.
Non-maleficence: The ethical principle that comes from not doing harm. See also beneficence and suffering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Non-obstructive azoospermia (NOA): Azoospermia caused by low sperm production rates in the testis, including Īmaturation arrestā. Can often be overcome with testicular sperm extraction followed by IVF utilizing intracytoplasmic sperm insertion (ICSI). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Norethindrone (NET): A progestogen of a type weakly related to the male hormone testosterone. Progestogens of this class are commonly found in the oral contraceptive pill. Norethindrone acetate is marketed as Primolut N and is made by Schering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Normal monthly fertility. Nature gives fertility a wide range, normally from about 7 % to 45 % per month for women in the early 20s, to about 3 % to 25 % per month for women in the early 30s; for women in the early 40s, it ranges from less than 1 % to about 5 % per month. See also monthly fertility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
NSAIDs: Nonsteroidal anti-inflammatory drugs, e.g. aspirin, mefanamic acid (Ponstan), naproxyn sodium (Naprosyn, or in Naprogesic in combination with dextropropoxyphene), which stop the production of prostaglandins; useful for dysmenorrhea and prior to a hysterosalpingogram. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Nucleus: Structure within a cell that contains the chromosomes. The non-nuclear part of the cell is called the cytoplasm - which thus contains other cellular structures, including the mitochondria. Genetic inheritance is mostly by way of the nucleus (with a contribution from mother and father); a small part is by way of the cytoplasm (with a contribution only from the mother). See also mtDNA. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Obligation: A moral compulsion for ethical action, sometimes usefully distinguished from a duty by its derivation from example or external enforcement; according to this distinction, obligations are derived chiefly from the considerations of teleological ethics and utilitarian ethics. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oestrogen: See estrogen.
Oestrone: See estrone.
OHSS: See ovarian hyperstimulation syndrome.
Oligomenorrhea: Infrequent menstrual periods. By convention, a menstrual cycle that is consistently longer than 35 days. Oligomenorrhea always reflects irregularity of hormonal events coming from the ovaries. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oligospermia: Strictly, Īoligozoospermiaā, meaning a reduced number of sperm cells in the ejaculate (compared with azoospermia, which means no sperm in the ejaculate); more generally, a decrease in normal, motile sperm, and more or less encompassing laborious terms such as Īasthenozoospermiaā (weak motility) and Īteratozoospermiaā (abnormal sperm), and even more laborious ones, such as Īoligoasthenoteratozoospermiaā, which do not reward the effort of concocting them. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oligozoospermia: See oligospermia.
Oocyte: The form of the ovum, or egg, which is undergoing a halving of the number of chromosomes through the process of meiosis; see also primary oocyte and secondary oocyte. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oogenesis: The multiplication (by the process of mitosis) of ova, or eggs, in the ovaries of the fetus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oogonium: (pl. oogonia) The earliest recognizable form of the ovum, or egg; present only in the ovaries of fetuses; multiplies by the process of mitosis before developing into oocytes by the process of meiosis; the male equivalent (the spermatogonium) normally persists in the testicles till old age. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oophorectomy: See ovariectomy.
OPU: Ovum pick-up: see follicle aspiration.
Orchidopexy: An operation to move an undescended testis down into the scrotum, so that it has more chance of developing normally and producing sperm cells; see also cryptorchidism. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Osteoporosis: An abnormal condition of the bones, which are weakened by a loss of calcium. The loss of estrogen, such as after the menopause or after primary ovarian failure (premature menopause), eventually causes osteoporosis, with a tendency to bone fractures, especially of the wrist, the thigh and the backbone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovarian cycle: The ordered sequence of timely development of tertiary follicles to maturity of a dominant follicle (the (follicular phase, characterized by increasing production of the estrogen, estradiol), through ovulation (when estradiol falls and progesterone starts to rise), followed by the development and then decline of the corpus luteum (with the further production of progesterone); because estradiol and progesterone control the growth and development of the endometrium in the uterus, the ovarian cycle determines the menstrual cycle (normally lasting from 24 to 35 days in length, and with a typical duration of about 28 days) and also the cycle of the normal female hypothalamus and pituitary gland. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovarian hyperstimulation syndrome (OHSS): A complication of ovulation induction with, usually, follicle stimulating hormone, especially in cycles of superovulation for assisted conception when more than one egg is to be obtained. The ovaries become too large, they may be painful and there is excessive fluid released into the abdomen (the peritoneal cavity); either removing this fluid or the occurrence of vomiting can cause dehydration, thickening of the blood and, occasionally, a serious thrombosis, such as a stroke; there have been deaths. Moderate to severe OHSS is treated in hospital, with administration of fluid intravenously, sometimes including albumin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovarian pregnancy: An ectopic pregnancy located in the substance of the ovary, presumably because an egg has been fertilized while still in a follicle. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovariectomy (syn. oophorectomy): Surgical removal of the ovary. If the other ovary remains, ovulation and menstrual cycles usually continue as before. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovary: The female organ that produces eggs. Located on each side of the uterus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Oviduct: Another name for fallopian tube. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovulation: Natural process by which a mature follicle opens to release the (secondary) oocyte, or egg, enclosed in a sticky blob of mucus-like material, the cumulus mass; see also luteinizing hormone and human chorionic gonadotropin. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovulation induction: The use of drugs to stimulate follicles in the ovaries to undergo ovulation, such as clomiphene, various preparations containing follicle stimulating hormone (FSH), and human chorionic gonadotropin (hCG). The two main situations for it are: in the treatment of infertility due to anovulation (typically when there is oligomenorrhea or amenorrhea); and for superovulation in assisted conception (e.g. IVF and gamete intrafallopian transfer). See also ovarian hyperstimulation syndrome. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovulatory dysfunctional uterine bleeding: Heavy but generally heavy bleeding caused either by pathology in the uterus, such as fibroids, or by a generalized bleeding disorder, such as Īthrombocytopeniaā (a low platelet count), von Willebrandās disease (may run in families), or treatment with anticoagulant drugs. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovum (pl. ova): The female sex cell, or egg, from the earliest stage (the oogonium in the fetus), through its release from the follicle (ovulation), and (to professional embryologists) through fertilization up to and sometimes beyond the stage of implantation. See also blighted ovum. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ovum pick-up (OPU): see follicle aspiration.
Parlodel: see bromocriptine.
Parthenogenesis: Can occur when an egg is Īactivatedā (by itself, with some nonspecific stimulus, or through fertilization by a sperm) and starts to divide (it undergoes cleavage), but the male chromosomes are not incorporated and the egg remains haploid; its further development will soon stop, probably well before implantation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Paternalism: A method of medical or administrative practice in which the values of the practitioner or administrator are imposed upon the person most affected by the decisions to be made, without adequately heeding that personās own values or power to make decisions that directly affect them. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
PCB: See postcoital bleeding.
PCO: See polycystic ovaries.
PCOD: Polycystic ovary Īdiseaseā. See polycystic ovary syndrome.
PCOS: See polycystic ovary syndrome.
PCR: See polymerase chain reaction.
PCT: See postcoital test.
Pergonal: Mixture of human menopausal gonadotropins containing follicle stimulating hormone made by Serono; virtually equivalent to Humegon. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Peritoneal adhesions. See adhesions.
Peritoneal cavity: The general abdominal cavity in which lie the stomach, the intestines, and the uterus, ovaries and fallopian tubes, each covered by a thin, moist, slippery surface layer, the peritoneal serosa, or peritoneum. An examination of the peritoneal cavity is called a laparoscopy. See also adhesions. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Peritoneal serosa: The serosa of the peritoneal cavity.
Peritoneum: The smooth, moist lining of the peritoneal cavity that forms the serosa of the organs this cavity contains. For purists, such serosa is Īvisceral peritoneumā and the part of the peritoneum covering the wall of the abdominal cavity away from organs is called the Īparietal peritoneumā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Peritubal adhesions: Adhesions around the fallopian tube.
Perivitelline space: The space between the egg (the Īvitellusā) and the zona pellucida; sperm are injected into this space with subzonal insertion, or SUZI. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pituitary gland: Gland located at the base of the brain and responsible for driving the ovaries by way of the pituitary hormones follicle stimulating hormone (FSH) and luteinizing hormone (LH), which are under the influence of gonadotropin releasing hormone from the hypothalamus. Composed of two parts, the adenohypophysis, or truly glandular part, in front, and the neurohypophysis, which is a down-growth of the brain, behind. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Placenta: That part of the products of conception apart from the fetus composed of trophoblast. Together with the membranes and the umbilical cord composes the afterbirth. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Plasma glucose: A measurement of sugar (glucose) in the blood plasma to detect diabetes, an occasional cause of recurrent miscarriage; usually checked a few hours after a meal or, more formally, with a glucose tolerance test that involves a standard drink of glucose (after prior fasting) followed by serial measurements of plasma glucose over 3 hours. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
PMS: Either premenstrual spotting or premenstrual syndrome (see premenstrual tension, PMT). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
PMSP: See premenstrual spotting.
PMT: See premenstrual tension.
Polar body: A tiny, compact packet of excess chromosomes discarded first by the primary oocyte as it becomes a secondary oocyte just before ovulation (the Īfirst polar bodyā, with 46 chromosomes); and second by the secondary oocyte immediately after itās fertilized or otherwise Īactivatedā (the Īsecond polar bodyā, with 23 chromosomes); see also meiosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polycystic ovaries (PCO): The full name is Īmicro-polycystic ovariesā; itās a diagnosis made on transvaginal ultrasound, with lots of medium-sized follicles visible around the rim of the ovaries; can be part of the polycystic ovary syndrome (the Īcystsā are not real cysts and donāt themselves need treatment). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polycystic ovary syndrome (PCOS): Polycystic ovaries associated with any clinical symptom or sign of too much male hormone effect: long or absent cycles (oligomenorrhea or amenorrhea), acne or excess body hair (hirsutism). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polymerase chain reaction (PCR): A method of Īamplifyingā a single piece of DNA (the stuff of genes) to get enough of it to analyze physically or chemically. A machine is used that uses alternate cycles of high temperature (to separate DNAās two strands) and medium temperatures (to combine each of the two single strands with free nucleic acids to make new complementary strands), doubling the amount of DNA in the machineās soup each cycle. A few hours in the machine automatically creates millions of identical DNA molecules from just one specimen. Needless to say, itās extremely important that you start with the right bit of DNA, so youāre not inadvertently amplifying a bit of contamination! In the film Jurassic Park, PCR was used to amplify bits of dinosaur DNA recovered from the bellies of contemporary insects, which had been trapped and preserved for millions of years inside pieces of amber. A biopsy of a single cell from an embryo after IVF can, with PCR, produce enough DNA to test it for certain genes that cause serious genetic disease. See also preimplantational diagnosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polyp: A benign growth of tissue, usually of the lining of a hollow organ such as the intestine or the uterus. The presence of a polyp of the cervix (Īcervical polypā) increases the chance that there is a polyp of the endometrium (see endometrial polyp). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polyploid: A multiple of the haploid number of chromosomes in a cell other than the normal diploid state. Includes triploid (three times the haploid number, or 69 chromosomes) and Ītetraploidā (four times the haploid number, or 92 chromosomes). The noun form of this adjective is Īpolyploidyā (the state of being polyploid). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Polyspermic fertilization: See polyspermy.
Polyspermy: Syn: polyspermic fertilization. Fertilization of an egg (a secondary oocyte) by more than one sperm. In in vitro fertilization, more common if eggs are recovered that are either immature or overly mature; evident later, with the appearance of more than two pronuclei. In natural conditions, a cause of a polyploid state in the embryo. See also triploid. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Positive history: If you have a positive history for a disease or symptom it means that you have or have had that disease or symptom. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Positive test: In medicine, generally it may be best for tests to be negative (like tests for brain tumors or tests for sexually transmitted diseases, such as HIV - as for Īhistoriesā, compare positive history) - but not so in infertility. Infertility tests, such as the postcoital test, tests for ovulation, tests for tubal patency, and (not least) a pregnancy test, are generally better if theyāre positive. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Postcoital bleeding (PCB): Bleeding after sex; typically the result of abrasion of the cervix (which may be abnormal and you should have an examination and a PAP smear) or of trauma to the vagina; sometimes due to a cervical polyp. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Postcoital contraception: Using a contraceptive after intercourse instead of before intercourse to interrupt implantation of the embryo. Taking two oral contraceptive pills the morning and the night after the unanticipated opportunity for pregnancy is reasonably effective, but see your physician for details to carry this out safely. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Postcoital test (PCT): A test of: (1) receptiveness of the cervical mucus to sperm; and (2) sperm motility - both of which are needed for the test to be positive; itās essential that the test be done to coincide with ovulation, tested with a urinary LH-kit or measurements of serum estradiol (high), serum LH (preferably high) and serum progesterone (still low), because the job description of the cervical mucus at other times is to be impenetrable to sperm (i.e the PCT will be negative for normal reasons). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Postimplantational embryopathy: An abnormality of the embryo (or fetus) that arises after the embryo implants in the endometrium, the lining of the uterus. Might, sooner or later, cause a miscarriage or birth abnormality. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Predecidual reaction: A partial confluence of stromal cells of the endometrium (lying between the endometrial glands), caused by prolonged exposure(10 days or more) to progesterone or a progestogen; see also decidual reaction. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pre-embryo: The embryo or ovum from the stage of fertilized egg up to the stage of implantation. During this time any of the cells of the fertilized ovum can develop into a whole new embryo - they are Ītotipotentā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pre-embryo biopsy: A biopsy, or removal of one or two cells, from a pre-embryo for pre-implantational diagnosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pregnancy rate: The percentage of months or treatment cycles that result in clinical pregnancy, excluding biochemical pregnancies, but including ectopic pregnancies, miscarriages and all potentially viable pregnancies (twins are not counted twice; stillbirths and all livebirths are included); less important for most patientsā purposes than the take-home-baby rate. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pregnancy test: Nowadays a measurement of human chorionic gonadotropin in serum or urine, usually as a simple Īyesā or Īnoā test. In principle it cannot distinguish a normal pregnancy from an ectopic pregnancy or one destined to miscarry (a miscarriage). See also serum hCG. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pregnyl: Human chorionic gonadotropin (hCG) made by Organon.
Pre-implantational diagnosis: Genetic diagnosis of an IVF embryo (or, really, pre-embryo) before transfer, made possible by removing one or two cells of the embryo (embryo microbiopsy). See also fluorescent in situ hybridization (FISH) and polymerase chain reaction (PCR). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pre-implantational embryopathy: An abnormality of the embryo (or fetus) that arises before the embryo (or pre-embryo) implants in the endometrium, the lining of the uterus. Usually causes miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Premarin: A mixture of estrogens in tablet form (from Ayerst Laboratories) with the reputation of being Īnaturalā, though in reality extracted from the serum of pregnant mares (horses); the main estrogen it contains is estrone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Premature labor: The onset of labor, leading to delivery, before at least 37 weeks have elapsed since the last menstrual period; the more prematurely babies are born, the greater the difficulty they have surviving, even with expert care. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Premature menopause: Menopause before the age of 40. See primary ovarian failure.
Premenstrual biopsy: See premenstrual endometrial biopsy.
Premenstrual endometrial biopsy: A small sample (or biopsy) is taken of the lining of the uterus (the endometrium) just before a period is expected, aiming to show advanced stages of progesteroneās effect on it, in the form of an adequate predecidual reaction; a very sensitive test of the adequacy of the luteal phase; can be combined with a laparoscopy or carried out in isolation as an office procedure; itās best to be sure that there is no possibility of pregnancy during the cycle the test is conducted, as occasionally the biopsy jeopardizes a pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Premenstrual spotting (PMSP) (syn. premenstrual staining): A form of light intermenstrual bleeding consistently timed over a few days to a week before the period starts properly, although it may not happen every month; about 80 percent of the time it signals the presence of endometriosis; about 10 percent of the time it means an abnormality of the uterus such as fibroids, an endometrial polyp or endometritis; the remaining 10 percent of the time there is no explanation found; it has nothing to do with premenstrual tension, which if present is a coincidence. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Premenstrual syndrome (PMS): See premenstrual tension.
Premenstrual tension (PMT): A distressing group of symptoms usually timed for the lead up to a period, then relieved as menstruation takes place, although many women experience different timing; includes downheartedness or depression (certainly an absence of well-being), aggression, fluid retention and weight gain, painful breasts (Īmastalgiaā), headaches and pain in the pelvis; caused by a periodic fall in the brainās endorphins, in turn usually precipitated by falling levels of progesterone in the second half of the luteal phase, although similar symptoms often accompany the use of progestogens, especially in older women; may be better during superovulation cycles because of generally higher hormone levels, but this is not always the case and PMT at the end of an unsuccessful cycle of assisted conception is particularly hard to put up with. Usually treated (up to a point) symptomatically, with perhaps fluid tablets (diuretics) and analgesics, although itās claimed that the drug Prozac has a specifically beneficial effect on mood, and encouragement of endorphin release with exercise can also be useful. Because progesterone and progestogens are the culprits, an operation to remove the ovaries (plus hysterectomy to simplify estrogen replacement therapy without needing progestogens) is usually curative, but drastic. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary: The word Īprimaryā is used medically in one of three ways: (1) part of a sequence, as in primary follicle, secondary follicle, tertiary follicle; (2) Īdo novoā, or Īright from the startā, when a person has no precedent for a contrary state (e.g. primary amenorrhea means no prior menstruation; primary dysmenorrhea means periods that have more or less always been painful; primary infertility means no prior successful or potentially successful pregnancy); or (3) the source of dysfunction (e.g. primary ovarian failure means ovaries that do not function because they are themselves faulty - the dysfunction is not secondary to dysfunction of, for this example, the pituitary gland or the hypothalamus). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary amenorrhea: Amenorrhea when a woman has never had a spontaneous menstrual period, that is, a period not brought on by hormone treatment. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary infertility: Trouble getting pregnant (infertility) in someone who has never had a successful pregnancy. Although the exact definition can vary among gynecologists, for me the distinction between primary infertility and secondary infertility is most useful if a prior ectopic pregnancy or a prior miscarriage is consistent with the state of primary infertility, whereas a prior induced abortion (which, the odds are, would otherwise have developed normally) means the state is secondary inferility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary follicle: The first stage of growth or further development of the follicle, in which the egg is enclosed by a single layer of round-shaped follicle cells, which are multiplying. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary oocyte: The form of the ovum, or egg, produced in the ovaries of fetuses by oogonia that have begun the first part of the cell division known as meiosis (by which the chromosomes will eventually halve in number); persists into childhood and adult life by containment in follicles. Gives rise to a secondary oocyte and the first polar body just before ovulation. See also in vitro maturation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary ovarian failure: Failure of the ovaries to produce enough follicles, because of a problem in the ovary itself, and resulting in depletion of eggs before the age of 40 years (known as premature menopause, a cause of secondary amenorrhea), or maybe even before the age puberty is expected (causing failure of puberty to happen, including primary amenorrhea). Sometimes occurs in spite of good numbers of primordial follicles that (inexplicably, so far) wonāt develop (the Īresistant ovary syndromeā). The younger the woman, the more likely that an aneuploidy will be found if a karyotype is done on blood or on a biopsy of the ovary. Estrogen replacement therapy is very important. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primary spermatocyte: The form of the sperm cell at the first stage of spermatogenesis, by which spermatogonia enter meiosis to start to reduce the number of chromosomes for the more mature sperm cells that will eventuate. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primolut N: Norethisterone acetate (UK, Australia) or norethindrone acetate (US) made by Schering. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Primordial follicle: The resting, unstimulated stage of the follicle, in which the egg is enclosed by just a few thinly stretched follicle cells. Primordial follicles persist in the ovary from fetal life to the time of menopause, declining in number every day during this time, as some start to develop into primary follicles, most of which then are lost through the process of follicular atresia. What the stimulus or signal is for primordial follicles to start growing remains completely unknown. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Profasi: Human chorionic gonadotropin (hCG) made by Serono.
Professionalism: For this book, the practice of maximizing the involvement of a client or patient seeking the service of a professional in making decisions that will directly affect them. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Progesterone: The ovaryās second main hormone, produced only after ovulation and during pregnancy (first by the corpus luteum, then by the placenta); sometimes administered by injection or by intravaginal pessary to supplement natural production; see also estrogen and progestogen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Progestin: See progestogen.
Progestogen: A progesterone-like substance, usually more active when given by mouth than natural progesterone is. Used with an estrogen in the oral contraceptive pill. Commonly used examples have a structure like progesterone itself (e.g. medroxyprogesterone acetate, or Provera; cyproterone acetate, or Androcur) or have a structure distantly related to the male hormone testosterone (e.g. norethindrone, or Primolut N; norgestrel). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Prolactin: Hormone produced by the pituitary gland to stimulate milk production in the breasts; produced in increasing amount during pregnancy, although milk secretion is postponed until levels of estrogen and progesterone fall after the baby has been born. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
The fishy side of prolactin
Prolactin is an old hormone in the animal kingdom. It has had many and varied roles. In fish itās important in regulating water entering and leaving the tissues.
In mammals, including women, prolactin produced by decidual cells in the endometrium during pregnancy seems to be important in regulating the passage of water into the gestational sac - a function that seems to have been inherited down the millions of years since our ancestors were fish. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Proliferative phase: The phase of development of the endometrium during which, after the menstrual phase, the endometrium grows to regain thickness under the influence of estradiol (therefore it corresponds in time with the follicular phase in the ovary). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pronuclear-stage transfer (PROST): A form of assisted conception in which in vitro fertilization (IVF) is used to produce fertilization of one or more recovered eggs; useful if the potential fertilizing ability of sperm is in doubt; transfer is made on the day after egg pick-up and IVF, before the fertilized egg divides (itās at the Īpronuclearā stage); the transfer is made to the fallopian tube to obtain advantages similar to gamete intrafallopian transfer (GIFT) and is made possible by laparoscopy (with anesthesia) or by transvaginal ultrasound (without anesthesia); synonymous with zygote intrafallopian transfer (ZIFT); see also pronucleus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pronucleus (pl. pronuclei): A visible blob (or Īvacuoleā) - there are usually two of them - inside a fertilized or otherwise activated egg and enclosing the chromosomes from the egg (the female pronucleus) and from the sperm (the male pronucleus); if three pronuclei are observed, the chances are that two sperm have entered the egg (polyspermy). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
PROST: See pronuclear-stage transfer.
Prostaglandins: Substances, first isolated from the prostate glandās contribution to semen, now known to be universally present throughout the body, being especially produced during inflammation (when they cause pain); drugs that stop prostaglandins being produced are used as analgesics (so called Īnonsteroidal anti-inflammatory drugsā, or NSAIDs, which are useful also in minimizing contractions of the uterus in dysmenorrhea and premature labor. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Prostate gland: The male sex gland located just below the bladder, in front of the rectum, through which the urethra runs; it contributes secretions to the semen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Provera: Medroxyprogesterone acetate, a progestogen made by Upjohn.
Pseudohermaphrodism: Synonymous with intersex, except that intersex also includes true hermaphrodism. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Pyosalpinx: A fallopian tube obstructed at its outer end and containing pus as a result of acute salpingitis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Puregon: Recombinant follicle stimulating hormone (rFSH) made by Organon.
Qualitative: Something you canāt put a number on to give it its meaning or value, such as suffering. See also hazard. Opposite to quantitative. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Quantitative: Something you can give meaning or value to by giving it a number, such as pregnancy rate. See also risk. Opposite to qualitative. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Recessive inheritance: A pattern of inheritance of a characteristic (such as blue eye color) or abnormality (such as congenital absence of the vas deferens) in which two abnormal genes or alleles are needed to confer the characteristic or abnormality, in contrast to dominant inheritance, which requires just one abnormal gene. See also homozygous. In the case of alleles found on X-chromosomes but not on the smaller Y-chromosomes, a recessive gene will be unopposed (and so will act as a dominant gene) in males, whereas female carriers of the allele will be unaffected except in the extremely unlikely event that they inherit (or gain by mutation) a second abnormal allele; this mode of inheritance is called Īsex-linked recessive inheritanceā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Recombinant follicle stimulating hormone (rFSH): Follicle stimulating hormone derived from genetic engineering instead of being extracted from the urine of postmenopausal women (human menopausal gonadotropin, or hMG) or from the pituitary glands of cadavers (human pituitary gonadotropin, or hPG). Being marketed by the two pharmaceutical companies Organon (as Puregon) and Serono (as Gonal-F) to replace their hMG preparations. Has the advantage over hMG (and its purified derivatives) of being standard in biological structure and activity, and of not being of a human source (hPG having been implicated in transmission of Creuzfeldt-Jakob disease). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Recombinant human follicle stimulating hormone (rhFSH): See recombinant follicle stimulating hormone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Recurrent miscarriages: A series of three or more consecutive miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Rectum: Connects the large bowel (the colon) to the anus; lies behind the vagina in women. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Relative infertility (Syn. subfertility): Infertility that is not absolute or complete infertility (see also sterility- these 3 terms are synonyms), but nevertheless thereās a reduced chance of getting pregnant each month. More or less definite causes can include oligospermia, polycystic ovary syndrome and other causes of oligomenorrhea, endometriosis, peritubal adhesions, fibroids (especially submucous fibroids) and increased age, especially of the woman. See also monthly fertility and cumulative chance of pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Relative risk: The chance of having something or being affected by something compared with people in a comparable situation. Usually given as a ratio, proportion or percentage (as in the chance of having endometriosis; if your sister has it, you have a relative risk of 7:1 - or seven times the risk - compared with the general population of women of the same age; your relative risk of developing cancer of the ovaries if youāve accumulated 10 years on the oral contraceptive pill is 1:5, 0.2 or 20 %). See also absolute risk. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Resistant ovary syndrome: See primary ovarian failure.
Rete testis: Tiny ducts (about 20 in number) connecting the tubules of the testis with the epididymis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Retrograde ejeculation: Ejaculation in which semen, instead of spurting out from the penis during male orgasm, spills upwards into the bladder. Usually has a medically important cause, which requires investigation. Treatment may be successful by isolating sperm from the urine and carrying out some form of assisted conception, such as assisted insemination or IVF. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Retroverted uterus: A uterus that lies more towards the back than the front. Retroversion of the uterus may be normal and, of itself, this is not a cause of infertility; rarely it may repeatedly get in the way during sex and cause pain, in which case there are operations available to bring it forward, out of the way. Retroversion may also develop from scarring caused by endometriosis, in which case there can be pain with sex (dyspareunia) and infertility (caused by the endometriosis). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
rFSH: See recombinant follicle stimulating hormone.
Right: The reciprocal, or other side, of a duty or obligation, often conferred by society on the basis of equity or consistency, and matched either by intuitive duties or by conferred obligations. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Risk: Chance - expressed as a ratio, proportion or percentage. If the word is unqualified, it usually means absolute risk (the actual risk in a group of the population), in contrast to relative risk (which measures one personās risk compared with another personās). See also hazard. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ROSI: See round spermatid injection.
ROSNI: See round spermatid nuclear injection.
Round spermatid nuclear injection (ROSNI): Experimental form of testicular sperm extraction (TESE) followed by intracytoplasmic sperm insertion (ICSI) in which the nucleus of a round (very immature) spermatid is isolated for injection into the egg. Intended to be used in treating non-obstructive azoospermia with severe Īmaturation arrestā, when more mature sperm cells are not obtainable. Animal studies show higher pregnancy rates than with round spermatid injection, but limited studies in humans still indicate very high rates of embryopathy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Round spermatid injection (ROSI): Experimental form of testicular sperm extraction (TESE) followed by intracytoplasmic sperm insertion (ICSI) in which a round (very immature) spermatid is isolated for injection into the egg. Seems to be less successful than a similar procedure in which the nucleus is isolated from the spermatid and used instead (see round spermatid nuclear injection). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
r-Selection: A reproductive strategy where survival of a species is optimized by explosive increases in numbers of animals whenever environmental circumstances are favorable; favors small animals that reach sexual maturity quickly, which reproduce just once but with many progeny, and which do not need to tend to their progeny after birth. In extreme cases (seen in many lower animals such as insects), death of the father follows impregnation and death of the mother follows parturition (or giving birth). The opposite reproductive strategy to K-selection. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Rubinās test. See tests for tubal patency.
Rudimentary horn: The small part of a bicornuate uterus in which one side is very small; with regard to the side that is bigger (see unicornuate uterus), it may be Īcommunicatingā or Īnon-communicatingā depending on whether it has a cavity that joins with the main endometrial cavity. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingectomy: Surgical removal of the fallopian tube (the Latin for which is Īsalpinxā). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingitis: Inflammation of the fallopian tubes, usually due to infection. May be acute (e.g. gonorrhea, chlamydia and other infections) or chronic (e.g. persisting chlamydia, tuberculosis, various fungus infections). Leads to blockage of the tubes and adhesions around the tubes if not treated promptly and effectively with antibiotics. See also distal tubal obstruction, pyosalpinx, hydrosalpinx and proximal tubal obstruction. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingitis isthmica nodosa: A nodular (Īnodosaā) thickening of the fallopian tubeās isthmus (Īisthmicaā), probably due to previous salpingitis. Can cause localized obstruction of the tube and, if the obstruction is partial, an ectopic pregnancy can be caused. Overcomeable with microsurgery (see tubal anastomosis) or tubal canalization. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingogram: An x-ray of the fallopian tube. See hysterosalpingogram and selective salpingogram. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingolysis: Microsurgery to remove peritubal adhesions or perifimbrial adhesions; see also fimbriolysis, with which the term Īsalpingolysisā overlaps; sometimes carried out at laparoscopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingoscopy: Looking inside the fallopian tube with a fiberoptic instrument through its relatively wide outer fimbrial end. Carried out at laparoscopy or laparotomy. See also falloposcopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingostomy: Microsurgery to make a permanent, new opening at the outer fimbrial end of the tube after it has become blocked (see hydrosalpinx) from salpingitis or, uncommonly nowadays, from fimbriectomy. Sometimes attempted at laparoscopy, though mostly with a reduced chance of success. See also fimbriolysis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Salpingotomy: An operation involving a temporary opening along the length of the fallopian tube, usually for the treatment of a (tubal) ectopic pregnancy; occasionaly performed for a pyosalpinx. Can be carried out efficiently at laparoscopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary: The word Īsecondaryā is used medically in one of three ways: (1) part of a sequence, as in primary follicle, secondary follicle, tertiary follicle; (2) when a person has a precedent for a contrary state (e.g. secondary amenorrhea, when a woman has had at least one spontaneous menstrual period, but then menstruation stops; secondary dysmenorrhea means periods that have painful after having been not so - or not-so-much; secondary infertility means having trouble getting pregnant despite having become pregnant successfully in the past); or (3) when the source of dysfunction lies elsewhere (e.g. Īseconday ovarian failureā means ovaries that do not function because, in this example, the pituitary gland on which the ovaries depend is not functioning). See also primary. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary amenorrhea: Amenorrhea when a woman has had at least one spontaneous menstrual period, but then menstruation stops. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary follicle: The second stage of growth of the follicle, in which the egg is enclosed by a layer thatās more than one cell thick of round-shaped, multiplying follicle cells; virtually all secondary follicles will go on to become tertiary follicles. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary infertility: Trouble getting pregnant (infertility) in someone who has previously had a successful or potentially successful pregnancy. Although the exact definition can vary among gynecologists, for me the distinction between secondary infertility and primary infertility is most useful if a prior ectopic pregnancy or a prior miscarriage is consistent with the state of primary infertility, whereas a prior induced abortion (which, the odds are, would otherwise have developed normally) means the state is secondary inferility. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary oocyte: The form of the ovum, or egg, produced from the primary oocyte late in the life of the maturing follicle, just before ovulation; the egg stays at this stage until fertilization by a sperm cell; see also meiosis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary ovarian failure: Failure of ovulation along with low estrogen production from the ovaries because of insufficient signaling from the pituitary gland by its hormones, the gonadotropins. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secondary spermatocyte: The form of the sperm cell in the second stage of spermatogenesis (through which the sperm cells are formed in the testes), produced from primary spermatocytes in the first cell division of meiosis, and giving rise to spermatids, which have just half the normal cellās complement of chromosomes, through the second division of meiosis; enveloped by Sertoli cells in the tubules of the testes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Secretory phase: The phase of development of the endometrium during which, after the proliferative phase, the endometrium stops growing but starts producing secretions (which nourish an implanting embryo) under the influence of progesterone (therefore it corresponds in time with the luteal phase in the ovary). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Selective catheterization: An x-ray-directed technique for placing fine catheters in veins of the body to sample the local production of hormones from a particular gland. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Selective feticide: See fetal reduction.
Selective salpingogram: An x-ray like a hysterosalpingogram in which a catheter is passed through the cervix and uterus, and then wedged into the fallopian tube to fill it with fluid visible on x-ray. High pressure can be applied, so some tubes that seem blocked on hysterosalpingogram (or on passing dye at laparoscopy) can be shown in fact to be open. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Semen: Fluid produced by the male genital tract at ejaculation; contains spermatozoa., as well as many other substances, including those that make the ejaculate coagulate. Sperm cells account for only about 1 percent of the volume of the ejaculate, so itās not possible to be confident about a manās sperm count just on the basis of the volume of the semen ejaculated. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Semen analysis: See sperm count.
Semen sperm antibodies: A test for detecting sperm antibodies in semen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Seminal fluid: See semen.
Seminal vesicles: Male sex organs that are joined to the vas deferens on each side as they enter the prostate gland to join the urethra; once thought to act as receptacles for storing sperm, they are now known to be more important for contributing constituents of semen. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Septate uterus: See uterine septum.
Septum: Latin for a Īwallā. For example see uterine septum. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serological test for syphilis: One of a number of tests to detect previous or untreated syphilis, an important (though nowadays rare) cause of birth defects and recurrent miscarriages; the chance of detecting unsuspected syphilis may be very low, but the penalty for missing it is very high, so itās still a routine test in early pregnancy; tests are done on serum and include the venereal disease research laboratory (VDRL) test and the Wasserman reaction (WR) test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serophene: Clomiphene made by Serono.
Serosa (syn: peritoneal serosa): The delicate, one-cell-thick outside lining of an organ in the body, particularly (in this book) the organs of the peritoneal cavity. Unlike other body surfaces such as the skin and the lining of the stomach or intestines, an ulcer (or missing part) of the peritoneal serosa always heals in 8 days, however big the ulcer, or defect, is. See also peritoneal adhesions and peritoneum. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sertoli cell: Cells lining the tubules of the testes that nurture the developing sperm cells; responsible in fetal life for the production of anti-Müllerian hormone, which stops the male fetus from developing fallopian tubes, a uterus and a vagina; a source of estradiol in men. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum: That part of blood thatās left after it clots; distinct from plasma, which is that part of unclotted blood that remains on top when blood is spun down in a centrifuge (which will still clot and leave serum unless an Īanticoagulantā is added); various serum tests are described below. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum alpha fetoprotein: Measurement of AFP in blood serum; high levels may indicate a birth defect involving the brain or spinal cord, such as anencephaly or spina bifida (confirmed if amniocentesis shows high AFP levels in the amniotic fluid); low levels, especially in conjunction with measurements of serum hCG and a metabolic product of estrogens known as Īestriolā, can indicate an increased risk of Downās syndrome (or trisomy 21), signaling the need for a karyotype of the fetusās tissues by chorionic villus sampling (CVS) or amniocentesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum anticardiolipin antibody: A test done to investigate recurrent miscarriages; see anticardiolpin antibody and lupus anticoagulant. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum CA 125 antigen: Measurement of CA 125 antigen in serum. A test done to investigate, particularly, adenomyosis and cancer of the ovary. Levels can also be increased with endometroisis, normal menstruation and normal early pregnancy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum copper: Done to screen for Wilsonās disease, in which there is abnormal retention of copper in the body - a rare cause of recurrent miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum creatinine: See serum urea and creatinine.
Serum estradiol: Measurement of estradiol in blood serum; used especially in assisted conception to estimate development of follicles happening naturally or in response to ovulation induction; for this purpose the result should be available within 4 hours of the test. Levels are influenced mainly by follicle stimulating hormone (FSH), high levels also require the action of a small amount of luteinizing hormone (LH), usually present naturally, and in most preparation of human menopausal gonadotropin, including Metrodin, but absent in Fertinex (Metrodin HP) and from preparations of recombinant FSH. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum FSH: Measurement of follicle stimulating hormone in blood serum; useful at the time of menstruation for indicating a significantly decreased number of eggs left in the ovaries in the few years leading up to the menopause (i.e. indicative of impending ovarian failure); continuously high in women after the menopause. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum hCG: Measurement of human chorionic gonadotropin in serum: essentially a pregnancy test, but carried out more precisely (quantitatively) than is the case with a Īyesā or Īnoā test (which is qualitative). Often carried out serially, to determine if a pregnancy is: thriving (hCG levels double every two or three days in normal early pregnancy); languishing (levels rise more slowly, seen with an ectopic pregnancy and with an inevitable miscarriage); or resolving naturally (levels that are falling). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum HIV antibodies: A test for HIV, the virus that causes AIDS, and which comes in two strains, type 1 and type 2. They need separate tests, but mostly both are done as a routine. The test looks for the development of an immune reaction against the virus, it does not look for the virus itself, so itās possible, for a few weeks, to have been infected (and to be infective) with the test itself still negative, that is, clear. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum 17-hydroxyprogesterone: 17-hydroxyprogesterone is formed from progesterone in the adrenal glands (mostly as an intermediary substance on the way to making the adrenalās main hormone, cortisol) and in the ovaries (on the way to making androgens and estrogens). A congenital lack of one or other of the enzymes needed to make cortisol in the adrenal causes androgens to be made instead, in turn causing hirsutism and oligomenorrhea in women, maybe with the polycystic ovary syndrome (in mild cases), or (in severe cases) causing intersex at birth; the adrenal glands enlarge in an attempt to maintain production of cortisol (hence Īcongenital adrenal hyperplasiaā, CAH). An inappropriately high level of 17-hydroxyprogesterone in serum is diagnostic of CAH. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum LH: Measurement of luteinizing hormone in blood serum; used to judge the occurrence of the LH-surge; the result should be available within 4 hours of the test for this purpose. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum progesterone: Measurement of progesterone in serum; often done to check the occurrence of prior ovulation (see also premenstrual endometrial biopsy; used to infer the onset of ovulation in ovulation induction or assisted conception programs, and attaches extra significance to an apparently raised serum LH in judging the onset of the LH-surge; the result should be available within 4 hours for these purposes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum prolactin: Measurement of prolactin in serum. An increase is called hyperprolactinemia. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum sperm antibodies: Estimation of sperm antibodies circulating in the blood; generally not as useful as estimating semen sperm antibodies (for men) or cervical mucus sperm antibodies (for women), as these fluids have more immediate contact with sperm cells. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum testosterone: Measurement of testosterone, the chief male sex hormone (androgen) circulating in the blood; if increased in women with oligomenorrhea or amenorrhea, indicative of the polycystic ovary syndrome; the free androgen index is a more sensitive test. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum TSH: Measurement of thyroid stimulating hormone in serum; see thyroid function tests. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Serum urea and creatinine: A test of kidney function; sometimes measured when screening for a kidney (Īrenalā) cause of recurrent miscarriages. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sex: Sexual intercourse (coitus, or Īhaving sexā, see ĪPositioningā); or, gender or relating to it (as in sex chromosome). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Positioning missionaries for sex
Thereās much talk about the correct position to adopt for sex when youāre trying to get pregnant. You can forget most of it. The so-called missionary position works, thereās no doubt; but thereās no evidence that many other positions are not equally as effective. With equally good credentials is the particularly comfortable one of the woman on top and able to measure her own response, which Germaine Greer describes as particularly satisfying. For each of you to lie on your side with intercourse from the rear can also be very satisfying for your husband, especially when you may be too tired to try for full orgasm yourself. All allow deep penetration at ejaculation. There are others too. Getting pregnant doesnāt have to be tedious. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sex chromosome: A chromosome thatās either the X-chromosome (a pair confers normal femaleness in a normal diploid complement of chromosomes) or the Y-chromosome (just one confers maleness in a normal diploid complement of chromosomes); distinct from the non-sex chromosomes, or autosomes (which are numbered from 1 to 22); aneuploidies give rise to Turnerās syndrome, Klinefelterās syndrome, triple-X syndrome, extra-Y-chromosome syndrome); examined in a test called a karyotype. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sex-linked recessive inheritance: See recessive inheritance.
Short protocol: The Īshort protocolā for using GnRH-agonists with injections of follicle stimulating hormone (FSH) for induction of superovulation in assisted conception programs involves starting the GnRH-agonist a day or two before the injections of FSH start. The advantage is one of cost: less FSH (and less GnRH-agonist) are used compared with the long protocol. The disadvantage is that luteinizing hormone levels and progesterone levels may rise, possibly (in some cycles of treatment) spoiling optimal development of ovarian follicles. The GnRH-agonist is continued (in contrast to the ultrashort protocol) until follicles are mature and human chorionic gonadotropin is given to start the process of ovulation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Simms-Huhner Test: See postcoital test.
Small bowel: The small intestine, leading out of the stomach; narrower than the large intestine (or colon), to which it connects. See also bowel. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Small-for-dates: A general term used by obstetricians or pediatricians to refer to a fetus or newborn baby that seems smaller than it should be for the assumed duration of the pregnancy so far. The three main causes are a genetic abnormality of the fetus; insufficient nutrition for an otherwise normal fetus; and an incorrect calculation of the dates, maybe because ovulation and conception took place later than the usual two weeks after the last menstrual period. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
SMI: ĪSperm microinjectionā, either intracytoplasmic sperm insertion (ICSI) or subzonal insertion (SUZI, now obsolete). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spastic colon syndrome: See irritable bowel syndrome.
Sperm (pl. sperm or sperms): Colloquial abbreviation for spermatozoon (or for the plural form, Īspermatozoaā). Also used in the form Īsperm cell(s)ā. For Īimmature spermā, read spermatid(s). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sperm antibodies: The result of a reaction of the immune system against sperm and, by limiting the ability of sperm to show motility, a contributory or (occasionally) sole cause of infertility; may be present in serum, in cervical mucus or in semen; may be Īagglutinatingā (which make sperm stick in clumps), Īimmobilizingā (which cripple sperm particularly effectively and kill them), or Īcoatingā, which interfere with sperm attachment to the egg. The screening test for sperm antibodies involves immunobeads. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sperm count: Semen analysis, measuring the volume of the ejaculate, the density of sperm in it (expressed as so many million sperm per milliliter), the proportion of sperm swimming normally (the motility), and the proportion with normal shape. A normal sperm count consists of a volume of more than 1 ml; a density of more than 20 million per ml; a motility of more than 50 percent; and normal forms of more than 50 percent (casual examination) or more than 14 percent (critical examination by the Īstrict criteriaā recently advocated by the World Health Organization). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sperm microinjection (SMI): either intracytoplasmic sperm insertion (ICSI) or subzonal insertion (SUZI, now obsolete). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermatid: The product of the spermatocyte when it has completed meiosis (by which the number of chromosomes is halved, so itās in the haploid state), and also enclosed in the tubules of the testis by the Sertoli cells; early spermatids are round-shaped, whereas late spermatids closely resemble mature spermatozoa; see also spermiogenesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermatocyte: The sperm cell equivalent to the oocyte stage of the egg; see also primary spermatocyte, secondary spermatocyte and spermatogenesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermatogenesis: Development of a sperm cell, in the tubules of the testes, from spermatogonium and spermatocyte to spermatozoon (the last part of this process, from spermatid to spermatozoon, is called spermiogenesis). The process of spermatogenesis takes 56 days. At any one location in a tubule there are cells at four different stages of maturity, so mature sperm are released from a particular location every 14 days. A systematic interruption of spermatogenesis is called Īmaturation arrestā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermatogonium (pl. spermatogonia): The replicating phase of the sperm cell, equivalent to the oogonium in the ovaries, but, unlike the oogonia, spermatogonia normally persist until old age; located among the supporting cells (Sertoli cells) in the tubules of the testis; divides by the process of mitosis until it begins to undergo meiosis by changing into the primary spermatocyte. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermatozoon (pl. spermatozoa): The final stage of development of the maturing sperm cell, as it leaves the tubules of the testis, to mature in the epididymis; composed of a head (including the acrosome), a midpiece loaded with energy, and a tail, for propulsion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spermiogenesis: The final part of the formation of a mature sperm cell, by which the spermatid (already haploid) loses its round shape to acquire the features of the mature, spermatozoon, with a head, a mid-piece and a tail. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spinnbarkheit: One of the measurable qualities of cervical mucus that indicates receptiveness to sperm; itās German for Īability to be spunā, meaning Īstretchabilityā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Spontaneous abortion: See miscarriage.
Statistical significance: A point at which statistics indicate that a set of measurements or observations actually differs from normal (i.e. itās abnormal) or from a control group, and is unlikely to have come about just by the effects of chance. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Statistics: (As in Īliesā, damned liesā, and Īstatisticsā.) The science - and art - of using arithmetic and probability theory to work out how likely an association between sets of measurements or between sets of observations is to have happened by chance alone. See also statistical significance and the box, Significant or important? Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
ĪSignificantā or Īimportantā?
In considering statistical significance, we conventionally regard a 1-in-20 chance of an association as being safe enough not to be just a coincidence. This represents a ĪP-valueā, or probability measurement, of 0.05 or less, which is represented as P < 0.05. More conservative cut-offs (e.g. P < 0.02, or 1 in 50; or P < 0.01, or 1 in 100) need to be used: if the data accumulating as a research study continues are examined more than once, instead of just at the end of the study; and if more than one association is being looked for at the same time. For example, among the babies born from IVF in its earlier days, the frequency of birth defects of the neural tube type (such as spina bifida) appeared to be significantly increased (and cleft lip or palate appeared to be significantly decreased), but it was only because more than 100 individual birth defects were looked at, several of which you might then expect to have a 1-in-100 chance of being too high or too low; with more babies born, the numbers slipped back into statistical insignificance.
Showing that there is a statistically significant Īassociationā between one observation and another does not of itself imply Īcauseā and Īeffectā. The two observations may both be Īeffectsā, with a yet-to-be-looked-for shared Īcauseā. For example, thereās a statistically significant association between smoking and salpingitis (inflammation of the fallopian tubes), but no-one believes that one is the cause of the other. For another example, we know that IVF is significantly associated with pre-term birth (even when the effects of multiple births are excluded), but we do not know that IVF causes premature birth: there may be a common reason for the prematurity and for the need to employ IVF (various hypotheses, including pelvic adhesions or poor sperm, are under investigation).
The size of the statistical significance is quite different from the size of the actually demonstrated difference (a large sample size can make even the most trivial difference statistically significant at P < 0.01), although generally itās easier to show significance for a smallish sample if the difference itself is sizable! Conversely, failing to show a statistically significant difference is not the same as saying that there is no difference: the size of the sample may just have been too small to make a safe conclusion either way.
For other reasons too, Īstatistical significanceā is not the same as Īmedical importanceā. Tall people may get significantly more bumps on the head than short people, but that does not necessarily mean that tall people should wear crash helmets - let alone that wearing crash helmets should for this reason become a matter of public policy (which we might distinguish as Īadministrative importanceā). In setting our clinical policies at Sydney IVF, we take more account of medical importance than statistical significance of certain outcomes, so that satisfying a probability level of 1 in 5 (P < 0.2) is often enough for us to change our clinical or laboratory practices (the different outcome thus becomes Īadministratively importantā) if intuitively the change makes sense or if other effects from making the change are likely to be trivial.
For these reasons, as medical writers who are proud of precision, we avoid the use of the word Īsignificantā, outside a statistical sense, when the word Īimportantā will serve our purpose better.
Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books Sterility: The state of absolute infertility or complete infertility, with no chance of getting pregnant naturally without special help; causes include azoospermia, anovulation (especially primary ovarian failure), and blocked fallopian tubes.. (Although words like Īsterilityā and Īsterileā sound insensitive, especially for a book like this, itās important in medicine to avoid ambiguity; see the box on vocabulary for a discussion of the medical authorās dilemma.) Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sterilization: An operation designed to induce sterility. In men, usually carried out by removing small segments of each vas deferens (vasectomy); in women, usually carried out by removing, crushing or otherwise destroying a small segment of each fallopian tube, preferably close to the uterus (often called Ītubal ligationā). See also fimbriectomy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Sterilization reversal: An operation involving microsurgery to rejoin the healthy ends of the vas deferens or fallopian tube to reverse the effects of a previous sterilization operation. See also tubal anastomosis and vasovasostomy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
STDs: Sexually transmitted diseases, such as gonorrhea, chlamydia and HIV.
Subclinical miscarriage: An early miscarriage, usually within a week or two of the period that had been expected. Traditionally, no curettage was needed; these days a subclinical miscarriage is one that has not resulted in a gestational sac visible on transvaginal ultrasound. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Submucous fibroid: A fibroid (or Īmyomaā) that grows from the wall of the uterus inwards to distort the endometrial cavity; can be a cause of menorrhagia (heavy periods), intermenstrual bleeding, premenstrual spotting, infertility and miscarriage. See also myomectomy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Submucous myoma: See submucous fibroid.
Subseptate uterus: See uterine septum.
Subserous fibroid: A fibroid (or Īmyomaā) that grows from the outside surface of the uterus, into the cavity of the abdomen, or peritoneal cavity. The least likely of any sort of fibroid to affect reproduction, but may cause symptoms of pressure or pain should it twist or degenerate suddenly. See also myomectomy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Subserous myoma: See subserous fibroid.
Subzonal insertion (SUZI): An IVF technique involving sperm microinjection (SMI), in which one or more sperm are injected through the zona pellucida into the perivitelline space of the egg; now obsolete (because its efficiency is limited by sperm having to have undergone the acrosome reaction) and replaced by intracytoplasmic sperm insertion (ICSI, where the acrosome reaction is not a requirement). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Suffering: The prevention from and alleviation of personal suffering by a patient is the physicianās ultimate duty and the principal purpose of the professional practice of medicine. The suffering can be physical or mental. The ethical values of beneficence, non-maleficence, justice and equity, for many thoughtful physicians, become subordinate to the duty of making the patient better. For the infertile couple, prevention from or relief of suffering most obviously means the physician helping them to have a baby; this is not always possible, however, in which case other medical and personal strategies need to be explored if the suffering is to be lessened. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Superovulation: Intentional induction of multiple ovulations at once, using injections of follicle stimulating hormone and human chorionic gonadotropin, for assisted conception; inevitably there is a risk of multiple pregnancy. See also ovulation induction and ovarian hyperstimulation syndrome (OHSS). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Suprefact: See buserilin.
Surrogate: ĪA person who acts for or takes the place of anotherā [Oxford English Dictionary]. In reproductive medicine, a woman who has a baby on another womanās behalf. See also gestational surrogacy and traditional surrogacy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
SUZI: See subzonal insertion.
Synarel: A GnRH-agonist, made by Syntex. Administered as a nasal spray.
Syngamy: If fertilization is the Īmarriageā between egg and sperm then syngamy is its Īconsummationā, as the male and female pronuclei come together for the respective haploid sets of chromosomes to combine into a diploid set; an event of legislative importance in the state of Victoria, after which permission for embryo research becomes much harder to obtain. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Take-home-baby rate: The percentage of treatment months or treatment cycles that result in the woman taking home one or more babies (twins are not counted separately, though!); the statistic of most interest to patients and, in an age of skepticism in the community, the most politically correct statistic for clinics to quote, but itās less useful for clinicsā quality control purposes than the conception rate, the implantation rate, and the viable pregnancy rate, because: (1) it excludes obstetric misadventures often beyond the control of the infertility clinic; and (2) there is a long lag before it can be calculated, making results at best about 9 months old. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Teleological ethics: A set of ethical beliefs based on the goodness or badness of consequences, whether actual, intended or predicted; for purposes here, restricted to consequences to individuals, in contrast to utilitarian ethics; open to change according to empirical observation of outcomes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Teratozoospermia: See oligospermia.
Tertiary follicle: The third stage of growth of the follicle, in which the egg is enclosed by a thick layer of round-shaped follicle cells among which an antrum, or fluid-filled space, has formed; this antrum will come to dominate the size of the follicle; the first stage of the follicle visible with transvaginal ultrasound (when it reaches about 4 mm in diameter); further growth of the early tertiary follicle is determined by follicle stimulating hormone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
TESE: See testicular sperm extraction.
TEST: See tubal embryo stage transfer.
Testicle: Diminutive of testis, a word with which it is interchangeable.
Testicular biopsy: A biopsy of the testis to work out the reason behind an absence of sperm cells (azoospermia). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Testicular feminization: A state of intersex in which the karyotype is male (i.e. 46,XY), the gonads are testes (hence also male), but the body is completely unresponsive to testosterone and to its metabolite dihydrotestosterone, so it develops in the female way, with a normal vulva and vagina apparent at birth, and with normal development of the breasts at puberty. Invariably these children are raised as females, normal except for their primary amenorrhea and their infertility - because the testes still secrete anti-Müllerian hormone and so thereās no uterus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Testicular sperm extraction (TESE): Dissection into the testis itself, in men with azoospermia due to maturation arrest, to recover (by Īteasing outā) immature sperm cells from the (often small) fraction of tubules there which still contain such cells. The sperm cells are used for IVF using intracytoplasmic sperm insertion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Testicular tubules: The main constituent of the testis, lined by Sertoli cells and containing the developing sperm cells; see spermatogenesis. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Testis (pl. testes): The male gonad, located normally in the scrotum; produces the hormone testosterone as well as the male germ cells, or spermatozoa. Interchangeable with Ītesticleā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Testosterone: The main male sex hormone, or androgen, in the blood (where it is measured as serum testosterone), secreted in large amounts by the testes in men and by the thecal cells of the ovary in women. Before it acts on the tissues it is converted to dihydrotestosterone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tests for tubal patency: Tests that check if the fallopian tubes are open, usually by passing fluid through the cervix to fill the endometrial cavity and then demonstrate it coming out the ends of the tubes. The most common test is to pass a blue dye at laparoscopy. The second most common is a hysterosalpingogram. Once upon a time, carbon dioxide gas was used and listened for with a stethoscope (a ĪRubinās testā); a high-tech version of Rubinās test uses ultrasound to show the gas. See also falloposcopy. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Theca interna: A layer of cells in the ovary lying immediately around the follicle; under the influence of luteinizing hormone itās responsible for producing the weak male sex hormone androstenedione, which is then converted by the follicle cells (the granulosa cells) into estrogen, principally estradiol. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Thecal cells: Cells that make up, or come from, the theca interna.
Threatened miscarriage: Traditionally, any bleeding from the uterus during pregnancy while the cervix is (still) closed. Today, as well, there would need to be a normal embryo and, a little later, normal fetal heart movement pattern on transvaginal ultrasound to separate it from an inevitable miscarriage. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Thyroid function tests: Usually two tests: a serum thyroxine (low for underactivity, high for overactivity) and a serum thyroid stimulating hormone (TSH, high for underactivity based primarily in the thyroid gland, low for overactivity based primarily in the thyroid gland and low for underactivity based in the pituitary gland). As a screening test for malfunction of the thyroid gland a serum TSH will generally suffice. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Thyroid stimulating hormone (TSH): A hormone produced by the adenohypophysis (the front, glandular part of the pituitary gland) that switches on the thyroid gland, causing it to make and release thyroxine; see also thyroid function tests. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Thyroxine: The main hormone of the thyroid gland; responsible for controling the rate of metabolism in the body; activity of the thyroid gland is measured with thyroid function tests. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Time left for conception: One of the two most important variables that determines the chance of still getting pregnant naturally in relative infertility and Īunexplained infertilityā (the other is duration of infertility). The longer the time still available the better the chance that, sooner or later, pregnancy will happen. Broadly limited by the female partnerās age, but personal circumstances and ambitions within the biologically available timeframe may shorten it, leading to a decision to seek treatment with assisted conception. Explained in Appendix 1. See also fecundability. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Totipotent: See pre-embryo.
Traditional surrogacy: Surrogacy in which the woman who is the surrogate for the intended pregnancy provides the eggs (through her own ovulation); is impregnated by assisted insemination; carries (or Īgestatesā) the pregnancy, gives birth; and then gives up the baby to the person who commissioned the surrogacy arrangement. Also known as Īgenetic-plus-gestational surrogacyā. The surrogate is as much the biological mother of the child as if she had conceived in natural circumstances, except that the male by whom she has been impregnated has no prior social relationship with her. No countries other than the US, where commercial surrogacy can be legal, have encouraged the practice, whether for altruistic or commercial reasons. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Transvaginal ultrasound: Ultrasound imaging of the pelvic organs for diagnosing abnormalities of (particularly) the uterus and the ovaries, and for monitoring the development of ovarian follicles with ovulation-induction and assisted conception programs; among the pioneers were Dr Karl Popp, who used a mechanical sector scanner vaginally in Hamburg in 1984, and Dr John Anderson, who used the first vaginal linear array scanner in Australia at Sydney IVF in 1985, leading to its widespread use subsequently in Australia and the US. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Trimester. Literally, a three-month period; so the nine months of pregnancy are divided into the first, second and third trimeters. Most miscarriages take place in the first trimester (up to 12 or 13 weeks). Pregnancies that reach the third trimester (beyond 27 weeks) have an increasingly good chance of being viable (though nowadays, with intensive care, survival has occurred from about 24 weeks). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Triple-X syndrome: A trisomy with a karyotype of 47,XXX - a female with an extra X-chromosome; the old description of Īsuper femaleā is misleading, because fertility, if affected, is likely to be reduced; primary ovarian failure is more common than with a normal chromosome complement and premature menopause that follows. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Triploid: A state of 69 chromosomes, or three times the haploid number, most commonly caused by fertilization of the egg with two sperm; the pre-embryo that results, although a fetus may form, is doomed to miscarry; the trophoblast of the placenta often undergoes Īhydatidiform degenerationā (resembling a hydatidiform mole but without the sinister consequences); the result is often called a Īpartial hydatidiform moleā, in contrast to the more dangerous complete hydatidiform mole. The noun form for this adjective is Ītriploidyā. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Triptorelin: A GnRH-agonist marketed by Ipsen Biotech as Decapeptyl.
Trisomy: An abnormality of the chromosome complement in which there is an extra chromosome seen on the karyotype. The extra chromosome may be an autosome, such as in Downās syndrome (trisomy 21), or a sex chromosome, such as triple-X syndrome (47,XXX), Klinefelterās syndrome (47,XXY) and extra-Y-chromosome syndrome (47,XYY). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Trisomy 21: Trisomy for chromosome number 21, or an extra chromosome-21. This is the most common of the trisomies and gives rise to Downās syndrome, or Īmongolismā. Research has shown that the commonest source of the extra chromosome is a mistake in the first division of meiosis in the egg cell (during the many years it rests as a primary oocyte). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Trophoblast: As the cells of the pre-embryo specialize, they soon differentiate into: (1) central ones that will form the embryo or fetus itself; and (2) peripheral ones (the trophoblast) that will be responsible for invading the motherās tissues (see implantation) and will form the placenta and the membranes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
True hermaphrodism: Intersex when tissue typical of an ovary and a testis is found in the one person. The genital organs may appear to be normal female, normal male, or somewhere in between. Intersex states where there are either normal ovaries or normal testes (but not both) are sometimes called pseudohermaphrodism. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Truth: A self-evident ethical principle, which has value provided no substantial harm is done; not to be dispensed with for expediency alone. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal abortion: A tubal ectopic pregnancy that is in the process of being expelled out the fimbrial end of the fallopian tube. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal anastomosis: Microsurgery of the fallopian tubes in which an area of blockage is cut out and the healthy bits of tube on each side of the blockage are sewn back together. Can be done for localised salpingitis, including salpingitis isthmica nodosa, and for sterilization reversal. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal canalization: Overcoming a localized obstruction of the isthmus or the interstitial segment of the fallopian tube by pushing a wire or a catheter through it, enabling (in some cases) the tube to be Īre-canalizedā and so to remain open after being blocked before; itās an attractive alternative to tubal anastomosis and can be performed either during the investigation of tubal infertility with hysteroscopy, laparoscopy and falloposcopy or at the time of carrying out a hysterosalpingogram. Because not all tubes that seem to be blocked are in fact blocked (sometimes a normal tube will not allow fluid to pass through it for hormonal reasons or because of a spasm), care needs to be taken to investigate the tube properly before canalization is undertaken. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal embryo-stage transfer (TEST): A variation of zygote intrafallopian transfer (ZIFT) in which, usually a day after that upon which ZIFT (or PROST) would be carried out, cleaving pre-embryos (at a two-cell to four-cell stage) are transferred to the fallopian tube as part of an IVF program. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal ligation: Sterilization operation in a woman involving interruption of the fallopian tubes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Tubal patency: See tests for tubal patency.
Tubule: For those of the testis, see testicular tubules.
Turnerās syndrome: The combination of primary ovarian failure with consitutional (genetically determined) short stature; often with other clinical abnormalities, including Īwebbingā of the neck; an increased Īcarrying angleā at the elbow; short fourth metacarpal (hand) and metatarsal (feet) bones, and sometimes abnormalities of the heart and the thyroid gland. Associated with a karyotype that is 45,X (a monosomy, with one sex chromosome missing) or with partial loss (Īdeletionā) of one of a pair of X-chromosomes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Unexplained infertility: Infertility for which no obvious cause has been found after the following tests have been done with normal results: a sperm count or postcoital test; a test of ovulation, such as a serum progesterone that is satisfactorily high; and a laparoscopy (used to show that the tubes are open and that there is no endometriosis or other obvious abnormality. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Uterine septum: A septum or wall separating the cavity of the uterus into two halves; a cause of recurrent miscarriages. See also septate uterus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Uterus: The womb, in which pregnancy is gestated from the time of implantation of the embryo until delivery or miscarriage; formed from the joining of the two Müllerian ducts (in the absence of anti-Müllerian hormone); composed of the main, upper part (the uterine fundus) and a lower neck, or cervix, which connects it to the upper part of the vagina; most of its wall is made of muscle tissue (the myometrium), but with an inner lining of glands (the endometrium) and, on the outer surface, a thin covering of uterine serosa. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ultrashort protocol: A variation of the short protocol for using GnRH-agonists with injections of follicle stimulating hormone (FSH) for induction of superovulation in assisted conception programs. The GnRH-agonist is started with menstruation, a day or two before the injections of FSH start, and is discontinued after about 5 days from starting it (i.e. often a week or more before ovulation). There are no special advantages, whereas thereās a potential disadvantage: a much more thorough suppression of the womanās own luteinizing hormone (and maybe FSH) than if the GnRH-agonist is continued - perhaps causing stimulated follicles to Īrun out of puffā before they are fully mature. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Ultrasound: An imaging procedure like radar, but using high frequency sound waves; used for diagnosis; see also transvaginal ultrasound. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Unicornuate uterus: A uterine abnormality that comes about when it forms (in the embryo) from just one Müllerian duct; the uterus will be a little smaller than normal (making a miscarriage or premature labor more likely), and will be connected by a fallopian tube to just one ovary, contributing slightly to infertility. Reproduction, howver, can be normal. Diagnosed by hysteroscopy and laparoscopy or by hysterosalpingogram. (Often there is a simultaneous abnormality of the kidneys, such as one kidney instead of two, diagnosable by transvaginal ultrasound or, more specifically, by a special kidney x-ray study called an Īintravenous pyelogramā.) Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Urinary LH-kit: A home test for ovulation in which the urine is tested for luteinizing hormone. If the urine shows a positive test, ovulation will usually take place within 24 to 36 hours. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Uterine anomaly: Abnormality of the shape of the uterus a woman is born with (it is congenital); some uterine anomalies tend to cause recurrent miscarriages, premature labor or breech births; discussed in chapter 18. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Uterine curettage: See curettage and vacuum curettage.
Utilitarian ethics: A set of ethical beliefs based on maximizing good for the greatest number of people; for purposes here, similar to teleological ethics or consequential considerations but with a community-wide reference instead of a context of individual priority; in modern times concerned with the equitable and consistent distribution of restricted public resources; open to change according to the systematic assessment of outcomes. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Vacuum curettage: Curettage in which the contents of the early pregnant uterus are sucked out using a soft plastic catheter. Used in the treatment of miscarriage, in the treatment of hydatidiform mole, and to induce abortion. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Values: See ethical values.
Value judgment: A philosophical device for moving from what is to what ought. It bridges what philosophers call the naturalistic fallacy - but not with the approval of all philosophers. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Varicocele: A varicose vein in the scrotum, which in some cases may increase the temperature of the testis, causing oligospermia; more common on the left side than on the right. One of the few treatable causes of male infertility (the treatment is to tie off the vein), although not all sperm counts improve. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Vas deferens (pl. vasa deferentia): The long duct that transports sperm cells from the epididymis to the seminal vesicles; may be missing from birth (congenital absence of the vasa deferentia) or blocked as a result of infection or intentional interruption (vasectomy). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Vasectomy: Sterilization operation in a man involving surgical interruption of each vas deferens in the upper part of the scrotum. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Vasectomy-reversal: See vasovasostomy.
Vasovasostomy: The operation for reversing a sterilization operation (a vasectomy) in a man involving removal of the blocked part of each vas deferens, in the upper part of the scrotum, and joining by microsurgery one cut end or the vas to the other cut end. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Vocabulary: See box.
Medical vocabulary - sensitive, precise and correct?
Innocent messengers can be shot for the message they deliver! Experienced and wise messengers learn to give their message with discretion. Physicians, like other professionals, sometimes must deliver bad news. The judgement a physician uses in his or her vocabulary will affect how the information thatās there to be conveyed is received. This is part of the art of medicine: the adept physician draws on a substantial vocabulary to match the message to the needs and receptiveness of the patient at the moment of the consultation, taking continuing account of how itās being understood. This flexibility is not as open to the author, who anticipates a wider and more remote audience - a readership with a wide range in interests, experience, education and emotional state.
To soften an unwelcome message the language is sometimes softened. This can happen systematically (being deaf becomes being Īhearing impairedā), but in time, as the new vocabulary takes over, the realities of the message re-surface and thereās the same temptation to come up with another substitute. Because this process can be at a different stage for different people in different places and at different times, the vocabulary of a book can never be right (or be to the taste of) every reader. So however careful I am with vocabulary I know I will never please everybody.
My priority is to be unambiguous. I take Mark Twainās advice to find the facts first and then, at leisure, to rationalize them later. So Iām concerned in a book like this to deliver a precise message first, and second to try and to anticpate your response to it. Having said this, many physicians will use vocabulary among themselves that they would not (or ought not) use with patients: habitual abortion is seen more commonly in the medical literature than its kinder and no less precise synonym, recurrent miscarriages. Many stark descriptions come to us from a previous era - a time of much less communication between physicians and patients than we expect today. But as medical language comes to be shared more with lay readers, physicians have to modify their discussions. We do not want to exclude everyone without a medical education, yet above all we should aim to remain exact.. On the one hand this means avoiding medical jargon; on the other hand it means avoiding oversensitivity that jeopardizes clarity.
Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books Wasserman reaction: A serological test for syphilis.
Wilsonās disease: See serum copper.
Wolffian duct: See mesonephric duct.
ZIFT:Ssee zygote intrafallopian transfer.
Zoladex: See goserelin.
Zona pellucida: The tough but glassy-looking membrane that starts to surround the egg while itās still in the follicle, protects it against sperm which have not undergone the acrosome reaction at its surface, and keeps the cells of the early embryo (pre-embryo) together until the embryo, as a blastocyst, hatches through it in preparation for implantation. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Zygote: Fertilized egg up to the the first cleavage division; this stage of development of the embryo takes about 22 hours, and for the last few of these hours itās at the Īpronuclear stageā; see also pronucleus. Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books
Zygote intrafallopian transfer (ZIFT): A form of assisted conception in which in vitro fertilization (IVF) is used to produce fertilization; transfer is made on the day after egg pick-up and IVF, before the fertilized egg divides (itās at the zygote, or Īpronuclearā, stage); useful if the potential fertilizing ability of sperm is in doubt; the transfer is made to the fallopian tube to obtain advantages similar to gamete intrafallopian transfer (GIFT) and is made possible by laparoscopy (with anesthesia) or by transvaginal ultrasound (without anesthesia); synonymous with pronuclear-stage transfer (PROST). Copyright © 1998 Robert Jansen Overcoming Infertility Scientific American Books