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NEW HOPE GYNAECOLOGY AND FERTILITY HOSPITAL
LOCATION OF THE IN VITRO FERTILIZATION UNIT The New Hope Gynecology & Fertility Hospital is located in Sharjah Patients referred to the IVF Unit must first register at the Admission Office located on the ground floor near the Al Sondoz Bldg main entrance, Sharjah. Further instructions on where to go for the procedure will be given when you check in.
INTRODUCTION New Hope Gynecology and Fertility Hospital IVF Unit delivers advanced care with personal touch. We offer a full range of diagnostic testing and therapies for state-of-the-art infertility treatment. As professional consultants in assisted reproduction therapy, we diagnose, and formulate an efficient, effective care plan. The Assisted Reproduction technology (IUI, IVF, ICSI) may seem a simple process in theory. but in practice, IVF/ICSI demands a high level of expertise and attention to detail. Most of all, it requires a precisely coordinated effort between the couple and the ART team. Patient education also plays a big role; you should understand the options, procedures, and prognosis. Attempting a pregnancy with IVF/ICSI requires your understanding, commitment and patience. It is an intense, emotional, and stressful experience. Our team is aware of this, and is very supportive. The process also requires a significant amount of time and energy. Normal activities may be briefly curtailed during the IVF cycle. While the overall health risk is low. IVF/ICSI does require a minor surgical procedure and the administration of fertility drugs. We will try simplifying your treatment plan and minimizing the number of visits to our center. You should, however, expect three to five visits to the IVF Unit for blood tests and ultrasound scans. Most women are able to continue working, but it may be necessary to alter the time that you start work each day. Both the husband and wife will require time off work one day for egg recovery, and the wife will need time off for few days when embryos are transferred to the womb. ART offers many couples the hope of pregnancy when other pathways are blocked. It is important that you understand the process. This patient guide will review the program and the steps in the ART process. Some less familiar terms are explained in the glossary, which also includes terms that our staff may use when speaking with you. Of course we will be happy to review any of this material with you, or answer any questions that you might have.
GENERAL HEALTH ADVICE
CONFIDENTIALITY You will be asked to give full personal, family, and medical data. Also, you will be asked to sign various consent forms. All this information will be treated confidentially. EXPECTED INVESTIGATIONS A series of basic tests are needed by the doctor before treatment starts; these tests may be time consuming, and will be made after a medical history and physical examination with a fertility consultant. In an effort to determine the best course of treatment, different tests will be conducted on both the man and the woman, as either may contribute to the infertility problem.
To provide protection to babies born after ART, couples accepted for treatment must be screened for rubella, hepatitis B, hepatitis C, HIV and Thalassemia (if indicated). We may also ask for screening for syphilis, gonorrhea, Chlamydia, and other tests if required. TREATMENT OPTIONS AT NHGFH OVULATION INDUCTION AND TIMED INTERCOURSE "Induction of ovulation" is the stimulation of the ovaries to produce eggs, and is done in women who do not ovulate regularly but do have normal (patent) tubes and whose husband's semen is normal. It can also be used in couples with unexplained infertility to induce development of multiple eggs and increase their chances of conception. The drugs used vary according to the cause of the problem. The couple can then be advised for timed intercourse or the husband's semen sample can be prepared for intrauterine insemination. INTRAUTERINE INSEMINATION (IUI) For intrauterine insemination, suspension of the husband's washed and concentrated sperm is placed in the uterus through a soft catheter that has been passed through the cervix. This technique may be used to overcome cervical mucus problems, unexplained infertility, and erectile or ejaculatory disorders and mild to moderate oligo asthenozoospermia (low count and low rapid motility. Also in cases when husband is not available at the time of insemination, his sample can be frozen for the use at the proper time This type of insemination is only suitable for women with healthy and open fallopian tubes
IN VITRO FERTILIZATION (IVF) WHAT IS IN VITRO FERTILIZATION? The "test tube" baby technique is medically termed as in-vitro fertilization (IVF). This term refers to the process where, the egg and sperm are placed together outside the body. Under normal circumstances, a single egg develops in the ovary during natural ovulation. When "ripe", the follicle is released and it travels down the fallopian tube; this process is known as ovulation. The size of the follicle can be monitored using ultrasound scans. As it develops, the follicle produces the hormone "estrogen", which can be measured in samples of blood. Fertilization, and the subsequent development of an embryo, occurs when the egg and sperm meet in the fallopian tube. As the embryo passes down the fallopian tube to the uterus, its cells divide and grow. If the embryo implants into the lining of the uterus, a pregnancy is established about 7 days after ovulation. In IVF, however an attempt is made to recruit follicles (3-12) to be able to get at least 6-8 eggs this needs serial monitoring by ultrasound and at times blood tests. After achieving the optimum size of the follicles. The ultrasound guided egg collection is done directly from the ovary and fertilized by the husband's sperm in the laboratory. The fertilized egg (zygote) will be incubated for 2 to 5 days. The resulting embryo is then transferred into the uterus gently passing a soft catheter through the vagina and cervix. HOW IS AN IVF TREATMENT CYCLE PERFORMED? IVF consists of a series of steps over a 2-6 week period, each one occurring at a specific time. Every IVF cycle has different programs, known as protocols, each one is designed to result in the best possible outcome. Therefore, the protocol each couple will follow is designed specifically for them, and may differ from protocols of other couples, or even friends. Each individual's schedule will require a personal calendar, and according to each woman's response to treatment, the protocol being followed may be modified consequently. Three days before the eggs are recovered; the husband must refrain from ejaculation. Some couples may be advised that for a specified period they should avoid unprotected intercourse, in accord with some treatment protocols. One frequently used program is known as the "long" protocol, which begins in the month preceding the IVF treatment cycle, at the same time of ovulation. First, the ovarian function is suppressed or controlled by injections or a nasal spray. Inactivation is initiated on day 21 of the cycle, and normally lasts for 2 to 3 weeks. If ultrasound clearly shows that the ovaries are inactive and the lining of the uterus is thin, the stimulation phase is initiated. During suppression, the woman may experience "hot flushes," which will pass with no lasting complications. Then, the ovary is stimulated with a second kind of hormone injection and the dose of the previously started injections (or nasal spray) may be lowered. Both injections continue for an additional 10 to 12 days. The Short protocol ( Antagonist e.g. Cetrotide): Hormonal stimulation starts from D2-D6. Scan on D6 and the injections are continued. Another injection (antagonist) will be added once the follicles have started growing. The Dr. will inform you of your follicular response when you come for the scan. The following is provided as general guide to the steps of an IVF treatment cycle:
MONITORING EGG DEVELOPMENT Egg development is monitored to determine the woman's response to the injections, the progress of her treatment cycle, and to avoid excessive ovarian stimulation. At each monitoring visit, a vaginal ultrasound examination will evaluate the number and size of developing follicles and the thickness of the womb lining. Serial blood samples may be taken to measure estrogen levels in the blood. By combining the results from the estrogen levels and the ultrasound, the ideal time for egg collection is determined.
FINAL EGG MATURATION AND hCG ADMINISTRATION Human chorionic gonadotrophin (hCG) is the hormone that stimulates the final maturation of the eggs. Optimal egg maturity occurs when we administer the hCG. When more than two follicles measures at least 18 mm, the drug is given as a single injection in the muscle, usually 34 to 36 hours before egg collection. EGG COLLECTION AND INSEMINATION. Egg collection is performed in the IVF operating room by a doctor under general anaesthesia or analgesia. The doctor inserts a vaginal ultrasound probe and guides the aspiration needle through the vaginal wall into the fluid- filled follicles of the ovaries. The majority of women will experience a moderate degree of pain, so, you may prefer egg collection under conscious sedation. The procedure takes between 10 and 30 minutes, depending on the number of follicles in the ovaries. Not all follicles contain eggs. The retrieved eggs are washed and then placed in culture medium. After egg collection, the woman will rest for 4 to 6 hours before being allowed to go home. In the evening, just before bedtime, she will start using vaginally inserted medication, which contains a hormone called progesterone that supports the implantation of embryos. After egg collection, laboratory personnel will select the most active sperm, and the eggs and sperm will be mixed and incubated overnight. The next morning, the couple will be told the number of fertilized eggs. The developing embryos will be kept in an incubator for an additional 24 to 96 hours. The best-developed and most suitable embryos are then selected and transferred to the woman's womb. A) Microscopic view of sperm approaching the egg
B) Normally fertilized egg (Levkov)
INTRACYTOPLASMIC SPERM INJECTION (ICSI) Failure of fertilization using "conventional"IVF (the standard way of mixing sperm and eggs) might be due to the sperm being unable to penetrate the outer layers of the egg. In ICSI, a single sperm is injected directly into the egg's cytoplasm under the microscope. ICSI is used in couples with reduced sperm count and quality, and in whom the risk of fertilization failure is increased. This technique is also used for couples with decreased fertilization in previous IVF treatment attempts,in cases of sperm retrieved from testes and in some cases of female infertility.
FAILED FERTILIZATION After 17 to 20 hours, our laboratory staff will look for evidence of fertilization under the microscope. In our laboratory about 80% of oocytes (or female "eggs") fertilize, but this figure is lower for patients with severe infertility factors. Sometimes fertilization does not occur despite "normal" looking eggs and sperm, even after the ICSI technique is used. (In 2% of cases) there is no guarantee that 'conventional' IVF or ICSI will result in fertilization or a pregnancy. The most common cause of failed fertilization is the inability of the sperm to penetrate the barriers that surround the egg or failure of sperm PN (pronucleus) to decondense. It can also depend upon the egg quality. For the same man sperm quality may vary over time, and the same man can unexpectedly produce a semen sample of poor quality.
Human embryos have transparent, protective coating called the zona pellucida. Not only does this coating become tougher with increased female age, the thickness will vary between each patient. An embryo must hatch out of this coating before it can implant. Hatching may be impaired if the zona is excessively thick, or hard. Failure of hatching may be considered as the cause for good quality embryos failing to implant. The process of assisted hatching uses a mechanical needle or a laser beam to create a precise opening in the outer coating allowing the embryo to escape and hatch. In certain circumstances, assisted hatching may be offered at the New Hope Gynecology and Fertility Hospital IVF Unit. These circumstances include patients where good quality embryos have failed to implant after three or more IVF cycles or to couples where the female partner is over 42 years old.
The embryo transfer (ET) procedure is usually performed 2 to 5 days after egg retrieval. It is a painless procedure and does not require anesthesia. The best result occurs when embryo transfer is performed under direct ultrasound guidance with a full bladder. A trial, or mock ET, can be arranged if found necessary before the real ET to maximize the chances to success. The doctor passes a soft catheter gently through the cervix and deposits the best quality embryos into the womb. Studies have indicated that the highest pregnancy rates occur with the transfer of two to three embryos. This depends on your age and other factors like the quality of embryos or having previous failed IVF attempts. A maximum of three embryos can be transferred under Islamic Sharia law. This limit exists because transferring four or more embryos increases the likelihood of a multiple pregnancy, which has adverse effects on the health of the fetuses and the mother. Patients above 35 years can have a maximum of 4 embryos. All remaining high quality embryos maybe frozen and the remaining embryos are kept for observation for a maximum of 10 days and will be discarded properly when they degenerate (die). WHAT'S AFTER EMBRYO TRANSFER? (LUTEAL PHASE SUPPORT) The 2 weeks after embryo transfer are known as the "luteal phase."In this period implantation occurs. To support this critical phase hormonally, the woman will be asked to take another daily medicine starting from the day of egg retrieval. This medicine could be either progesterone (administered as vaginal suppositories, oral tablets, or an injection) these help prepare the womb lining for implantation. This daily medication will continue until a pregnancy test. During these 2 weeks, we suggest that you do not engage in strenuous activity or have intercourse until the outcome of the treatment cycle is known. The pregnancy test is done 10 – 14 days after embryo transfer by a simple blood test. If the test is positive, the woman will be advised to continue taking progesterone for several more weeks. On occasions, we may repeat the pregnancy test every 2 to 4 days. Two weeks after a positive test, an ultrasound examination is performed to confirm that the pregnancy is inside the womb and to count the number of pregnancy sacs (due to the possibility of multiple pregnancy). An additional scan will be done 1-2 weeks later to confirm the viability of the pregnancy. This close scrutiny is necessary to try to identify miscarriages and ectopic pregnancies, which unfortunately may occur with IVF treatment. The woman will be sent back to her referring obstetrician around the 12th week of pregnancy, if all is going well. If the woman doesn't have an obstetrician, our dedicated and well experienced obstetrician at New Hope Gynecology and Fertility Hospital will take care of her very special pregnancy.
If the treatment has been unsuccessful and the pregnancy test is negative, please contact the IVF unit to let us know, so we can plan the next step and ask you to stop all medications. If you experience vaginal bleeding before the pregnancy test, please contact the IVF unit as soon as possible for further instructions. BLASTOCYST STAGE EMBRYO TRANSFER A blastocyst is an embryo that has developed for 5 days after fertilization. You may undergo blastocyst culture and transfer procedure to facilitate selection of the best quality embryos for transfer to the uterus. The concept of embryo quality is a very important one for couples experiencing infertility. With blastocyst embryo transfer, we can transfer fewer embryos, thus reducing risks of a pregnancy with multiple fetuses while keeping overall pregnancy rates high. The female's suitability to implementing this protocol will be evaluated by the treating doctor and the senior embryologist.
SPERM RETRIEVAL TECHNIQUES SEMEN COLLECTION A sample of semen for evaluation purposes will be required before an IVF cycle starts, and the husband should make an appointment accordingly. A private place is provided in the IVF Unit for semen collection. To improve the quality of the sperm in the sample, the husband should refrain from ejaculation for two to three days before the sample is required. The husband will need to provide a semen sample, through masturbation, on the day of egg retrieval. The sample will go through a series of standard tests. Depending on the individual sample, the healthiest sperm is recovered using the most appropriate sperm processing method. RETROGRADE EJACULATION In certain cases of male infertility, semen ejaculation occurs into the urinary bladder (retrograde ejaculation). This can happen in patients with diabetes or neurological disorders. To retrieve the sperm patient is given a medicine that changes the pH of the urine. After masturbation, the patient empties the contents of the urinary bladder into a container. The urine is placed in test tubes and the contents of the test tubes are analyzed and washed. Viable sperm are recovered and used for ICSI.
SURGICAL SPERM RECOVERY One of two things can result in the absence of sperms in the ejaculate:
Sperm may be obtained from the epididymis or the testis directly, in cases such as those mentioned previously. The acquired sperm may then be used in an IVF cycle employing ICSI, if the sperms are suitable. Surgical sperm recovery is performed under local or general anesthesia. A fine needle is used to aspirate fluid and tissue, which is examined under a microscope to detect sperm. When sperm is retrieved from the epididymis the procedure is known as PESA (percutaneous epididymal sperm aspiration): when from the testis it is known as TESA (testicular sperm aspiration). If the fine needle obtains no sperms, a small surgical incision is made in the scrotum and a small amount of testicular tissue is removed to search for sperms. This procedure is known as TESE (testicular sperm extraction).
POSSIBLE UNDESIRABLE TREATMENT EFFECTS
This transient and temporary condition is characterized by ovarian enlargement, which causes discomfort and bloating. Pain and accumulation of fluid in the abdomen and around the lungs can happen. Some women will experience nausea, vomiting, abdominal swelling, shortness of breath, other signs of dehydration requiring admission to the hospital in about 2% of cases. The condition usually subsides over time as the ovaries return to their normal size, but this condition can get worse if you become pregnant. Occasionally, an enlarged ovary may become twisted. This condition is called "ovarian torsion". When this occurs, surgery is required to save the ovary. In some cases it may be necessary to cancel the cycle or to abandon it. Resulting embryos might require freezing and transfer to the womb after the condition subsides. At New Hope Gynecology and Fertility Hospital, precautions are taken to avoid this condition. If it develops, the excellent medical facilities and staff here can deal with it professionally and competently.
Whenever more than one embryo is transferred, the chance of multiple pregnancy exists. In fact, about 25% of births from IVF are twins, a rate much greater than in the general population. Triplets and quadruplets have also been conceived through (app. 2-5%) IVF. However, the majority of IVF pregnancies (70%) are singletons. Multiple pregnancies pose an increased risk for both mother and baby. For the mother there is an increased chance of miscarriage, bleeding, hypertension, early labor, and other complications of pregnancy. For the babies, there is an increased chance of prematurity and associated problems.
In few cases, an embryo implants outside the womb, in the fallopian tubes. Although this is rare in IVF, all care will be taken to manage it in the very early stages so that the woman's health will not be affected. CANCELLATION OF IN-VITRO FERTILIZATION CYCLES All IVF programs have criteria for cancelling stimulation cycles that do not produce an adequate number of follicles necessary for egg retrieval procedure and in vitro fertilization. Rarely, fertilization fails or the embryos do not continue dividing and growing. Consequently, there will be no embryos to be transferred to complete the treatment. In very rare cases, we do not proceed with embryo transfer to protect the woman from developing or aggravating ovarian hyperstimulation syndrome. The safety of the woman is the top priority for us at New Hope Gynecology and Fertility hospital.
Different treatment options offer different rates. The highest rate is with IVF and the lowest is with fertility pills combined with timed intercourse.
In addition, success rates in assisted reproductive techniques vary according to the case of the couple's infertility, the duration of infertility, the age and weight of the woman, the number of fertilized eggs, and the number of high quality embryos transferred. In general, one – third of couples undergoing their first IVF treatment cycle become pregnant and one- quarter will have a baby. GENETIC COUNSELLING Helping infertile couples to achieve parenthood with healthy babies is our primary goal at New Hope Gynecology and Fertility Hospital. Genetic counseling is an integral part of assisted reproduction. Recent evidence suggests that a genetic fault can be the reason why some men have an absent or very low sperm count. This genetic abnormally can be passed on to male offspring through IVF procedures. Genetic counseling and testing can help identify couples at such risk. In addition, all men with bilateral congenital absence of the vas deferens should undergo genetic screening related to cystic fibrosis before starting an IVF treatment. If both parents carry the same faulty gene, they will be at risk of having a baby who suffers from cystic fibrosis. Couples with infertility related to recurrent miscarriage or repeated unsuccessful IVF cycles will have the benefit of this service. It can identify a variety of unrevealed chromosomal abnormalities that may effect one or both parents, resulting in repeated failure to achieve normal pregnancy. PREIMLANTATION GENETIC DIAGNOSIS For couples with infertility problems related to unsuccessful IVF cycles, repeated miscarriages, or couples who have a high risk of passing a genetic disease on to their baby, pre-implantation genetic diagnosis helps improve the likelihood of a successful pregnancy. Using this technology, the husband's sperm is used to fertilize multiple eggs, which are produced as part of an IVF cycle and retrieved from the ovaries. In order to access the embryo, IVF, along with the microinjection technique, is necessary. By means of a procedure called embryo biopsy, one or two cells are removed from each embryo during the early stages of development. In order to determine which embryos are free of genetic abnormalities, the cells are analyzed in the genetic laboratory, thereby by increasing the possibility of the couple having a healthy baby. A FINAL WORD Many of our staff members are involved in your treatment. You will meet some of them on your visits to the IVF Unit, but many more are "behind the scenes." Where possible, the staff will go to great lengths to keep you informed of your progress. Our caring staff are aware of the stressful and emotional difficulties that effect couples dealing with the issue of having a family. All of the services at New Hope Gynecology and Fertility Hospital are offered in a warm and friendly atmosphere with individual treatment plans. Our patients are our priority and supporting their physical and emotional needs is one of our primary goals. We wish you a successful treatment and all the best from New Hope Gynecology and Fertility Hospital.
GLOSSARY Anovulation – The inability of the ovary to release the egg from the follicle. Assisted Reproduction Technologies (ART) – All treatments that include laboratory handling of gametes or embryos or both. Some examples of ART are in vitro fertilization (IVF) and ICSI. Azoospermia – The complete absence of sperm in the ejaculate. Blastocyst – The day five embryo. Cervix – The lower end of the uterus that connects the uterine cavity to the vagina. Chlamydia – A sexually transmitted disease. Coasting – The follicle stimulating injections are omitted for a maximum of 3 days in order to prevent ovarian hyperstimulation syndrome (OHSS) and cancellation of the treatment cycle. Cystic Fibrosis – Cystic fibrosis is caused by a mutation in a gene that regulates the electrolyte transport across membranes, which leads to abnormal mucus in the airways. Corpus Luteum – A mass of yellow tissue formed in the ovary from a ruptured follicle that has released an egg. The corpus luteum secretes progesterone, a hormone that prepares the lining of the uterus (endometrium) to support a pregnancy. Cryopreservation – The programmed freezing of oocytes / embryo down to - 190°C, using liquid nitrogen as a cooling agent and a cryopreservation media containing a cryoprotectant. Gametes or embryos are stored for future use by the couple. Ectopic Pregnancy – A pregnancy that occurs outside the uterus, most commonly in the fallopian tube. Egg Aspiration or Collection – The part of the in-vitro fertilization (IVF) procedure in which eggs (oocytes) are collected from the ovaries by a fine needle inserted through the top of the vagina using ultrasound guidance, also known as oocytes retrieval. Ejaculation – The expulsion of semen from the urethra at the time of male climax. The seminal fluid is called ejaculate. Electro – ejaculation – The stimulation of the erection of the penis and the ejaculation sequence by specially designed electrical equipment. Embryo Transfer (ET) – Part of the in-vitro fertilization (IVF) procedure in which the embryos are transferred into the woman’s uterus through her vagina and cervix. Embryo- The earliest cleavage stages in human development, from the day after fertilization until day five in culture before transfer to the uterus. Endometrium – The lining of the uterus that is shed each month as the menstrual period. Epididymis – A tightly coiled system of tiny tubes where sperm collect after leaving the testicles. Estrogen – The female sex hormone which is responsible for the development of female sex characteristics. Fallopian Tubes – A pair of hollow tubes attached one on each side of the uterus through which the egg travels from the ovary to the uterus. Fertilization usually occurs in the fallopian tube. Fertilization – Normal fertilization occurs when a single sperm penetrates the layers that surround the egg and enters into the cytoplasm. Follicle – The fluid-filled cysts, located just below the ovary’s surface, in which an egg matures and from which it is later released or collected at the time of egg collection. Follicle Stimulating Hormone (FHS) – In women, FSH is the pituitary hormone responsible for stimulating follicular cells in the ovary to grow, triggering egg development and production of the female hormone estrogen. Gonorrhea – A sexually transmitted disease caused by the gonococcus bacteria. Hepatitis B and C – Viruses that may be sexually transmitted and can cause infection of the liver, which leads to jaundice and liver failure. Human Immunodefiency Virus (HIV) – Human immunodeficiency virus is an infection that leads to acquired immunodefiency syndrome (AIDS). The virus infection lowers the patient’s immune system, which normally protects against infections. HIV can be transmitted sexually or via other human body fluids (blood transfusions). Human Chrorionic Gonadotrophin (hCG) – A hormone that increases early in the pregnancy. Its detection is the basis of pregnancy tests. This hormone is also used as an injection in ovarian stimulation regimens to cause the final maturation of the oocyte (egg) and its follicle and eventually cause ovulation. Human Menopausal Gonadotropin (hMG) – A fertility drug that contains follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hysterosalpingogram (HSG) – An x –ray procedure in which a special solution is injected through the cervix into the uterine cavity to show the inner shape of the uterus and the degree of openness (patency) of the fallopian tubes. In Vitro Fertilization (IVF) – A method of assisted reproduction that involves combining an egg with sperm in a laboratory dish. If the egg fertilizes and begins cell division, the resulting embryo is transferred into the woman’s uterus where it will hopefully implant in the uterine lining and develop further. Intracytoplasmic Sperm Injection (ICSI) – A micromanipulation technique that involves injection of a single sperm directly into an egg’s cytoplasm in order to facilitate fertilization. Intrauterine Insemination (IUI) – The process whereby a sperm preparation is injected directly into the uterine cavity in order to bypass the cervix and place the sperm closer to the egg. Lutheal Phase – The last 14 days of an ovulatory cycle, associated with progesterone production from the corpus luteum. Lutheal Phase Support – When progesterone is given to prepare the lining f the womb, to improve the implantation rate of the embryos and thereby increase the possibility of establishing a pregnancy. Luteinizing Hormone (LH) – A hormone produced and released by the pituitary gland. In the female, it is responsible for ovulation and the maintenance of the corpus luteum. In the male, it stimulates testosterone production and is important in the production of sperm cells. Motility – The percentage of moving sperm in a semen sample. Oocytes – The female germ cell, often called an egg. Ovarian Hyperstimulation Syndrome (OHSS) – A condition that may result from ovulation induction, characterized by enlargement of the ovaries, fluid retention and weight gain. Ovaries – The paired female sex glands in the pelvis, located on each side of the uterus. Ovulation – The release of a mature egg from its developing follicle in the outer layer of the ovary. This usually occurs approximately 14days before the next menstrual period. Percutaneous Epididymal Sperm Aspiration (PESA) – Aspiration of sperm from the epididymis using a syringe and a needle introduced through the skin into the lumen of the epididymal duct. Polycystic Ovarian Syndrome (PCOS) – A disorder in which the ovaries produce an excess amount of male hormones (androgens) and ovulation does not occur regularly. It is often associated with irregular menstrual cycles, infertility, or obesity. Preimplantation Genetic Diagnostic (PDG) – Examination of the genetic status of one or more cells from embryos at different maturation stages, before embryo transfer. Progesterone – A hormone produced by the ovary that prepares the uterus for implantation and supports the early pregnancy. Retrogate Ejaculation – A condition that causes the ejaculate to be released into the urinary bladder. Rubella – An infectious viral disease characterized by general redness and swollen glands. Infection with this virus during the first few months of fetal life can cause severe congenital abnormalities. Semen Analysis – The examination of a semen sample for volume, sperm count, sperm motility, and sperm morphology. Semen – The sperm and secretions that come out of the uretha when a man ejaculates. Spermatid – Immature sperm found in the testes. Sperm Count – The number of sperm per milliliter of semen. A normal count is usually 20 million or more per milliliter. Sperm Morphology – The shape of individual sperm. Sperm – The male reproductive cell that fertilizes a woman’s egg. The sperm head carries chromosomes; The mid-piece produces the energy for movement; and the long thin tail wiggles to propel the sperm. Spina Bifida – A defective closure of the spine. Syphilis – A sexually transmitted disease. Testes – The two male reproductive organs that are situated in the scrotum. They produce testosterone and sperm. Testicular Sperm Aspiration (TESA) – The aspiration of testicular tissue with a syringe and needle for the recovery of sperm or spermatids from men. Testicular Sperm Extraction (TESE) – An open biopsy to recover testicular tissue for extraction of sperm or spermatids from men. Trial Transfer – A measurement performed to determine the length and direction of the uterine cavity. Ultrasound – A picture of internal organs produced by high frequency sound waves, Unexplained Infertility – No apparent reason for the couple’s infertility can be found in either the man or the woman. Uterus (Womb) – The hollow, muscular female organ in the pelvis where an embryo implants and develops during pregnancy. The lining of the uterus, called the endometrium, produces monthly menstrual blood flow when there is no pregnancy. Vas Deferens – The muscular tube that carries sperm from the epididymis to the uretha. Viscosity – The thickness of a fluid. Zona Pellucida – The outer barrier enclosing and protecting the egg cell. Zygote – An egg that has been fertilized but has not yet cleaved. |
