Glossary of Terms

AMH stands for Anti-Müllerian Hormone, which is produced by follicles in the ovaries which contain eggs. AMH declines with age and falling egg numbers, and is absent with the onset of menopause. 

Andrology is the medical specialty that deals with male reproductive health. It is often dealt with by both Reproductive and Urology specialists.

Anti-sperm Antibodies bind to the cell membranes of sperm, coating them and affecting sperm function. They are produced in an auto-immune response to semen. This can reduce the chance of fertilization and prevent pregnancy.

Blastocyst is a term describing a stage in embryonic growth which an embryo reaches five or six days from fertilisation.

Cleavage Stage is a Day 2 or three embryo. Embryos may be transferred at this stage of development.

Clinical Pregnancy is defined as evidence of pregnancy by clinical or ultrasound parameters (ultrasound visualisation of a gestational sac). It includes ectopic pregnancy. Multiple gestational sacs in one patient are counted as one clinical pregnancy.

Cryopreservation (Vitrification) is the process by which embryos or eggs are frozen. They are then stored in liquid nitrogen to enable them to be used in future treatment cycles. Sperm is also frozen and stored for future use.

Embryology is the scientific study of the development of the embryo, from the fertilisation of the ovum to a fully developed foetus.

Endometriosis is a disease of the female reproductive system in which the cells that normally line the uterus grow outside the uterus. These cells cause bleeding in the pelvis during menstruation, which can cause pain, bladder and bowel symptoms, and infertility and miscarriage. It is diagnosed and treated by laparoscopic surgery.

Fresh Embryo Transfer is a procedure in which an egg is harvested during ovulation and fertilised in the laboratory, before being reinserted in the same menstrual cycle, and is done as part of a standard IVF or ICSI cycle.

Frozen Embryo Transfer (FET) is an embryo transfer where, instead of using a 'fresh' embryo created from the patient's current menstrual cycle, an embryo that has been cryopreserved from a previous cycle is used.

HSG stands for Hysterosalpingogram, which is a radiological procedure where radio-opaque dye is injected into the uterus and then an X-ray taken to see if the Fallopian tubes are open.

Hysteroscopy is a procedure done under anaesthetic whereby the inside of the uterus is examined with a telescope, and any abnormality can be treated. It is usually done at the same time as laparoscopy.

Infertility is defined by the World Health Organisation as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.” It describes any condition relating to male or female reproductive health that interferes with or prevents pregnancy.

Intracytoplasmic Sperm Injection (ICSI) is an IVF procedure in which a single sperm is injected straight into the ovum, and is used in cases of male factor infertility, advanced maternal age, and if resulting embryos are to have PDG/PGS.

Intrauterine Insemination (IUI) is an artificial insemination procedure in which washed, concentrated sperm is injected directly into the uterus via the vagina and is used to treat mild male factor infertility or unexplained infertility.

In Vitro Fertilisation (IVF) is a procedure in which fertilisation occurs outside the body. "In Vitro" is a Latin phrase meaning "in glass," which relates to the laboratory dishes used for fertilisation instead of the uterus.

Laparoscopy, also known as "keyhole surgery," is a procedure used to examine and operate on the interior of the abdomen and/or pelvic cavity. The advantage of a laparoscopy is the procedure uses only small incisions and heals comparatively quickly with less post-operative pain.

Next Generation Sequencing (NGS) The NGS Technique can sort the sequence of DNA base to check the number and structure of chromosomes.

Ovulation Induction (OI) is a procedure that stimulates ovulation, used to treat ovulatory dysfunction.

Ovulatory Dysfunction is the term that describes any abnormality of the menstrual cycle and ovulation.

Phlebotomy is the process of taking blood through a needle in the vein, for the purpose of blood testing.

Pre Implantation Genetic Diagnosis (PGD) is a sophisticated scientific technique which can be used to test embryos for either a specific known genetic condition or chromosome abnormality.

Pre Implantation Genetic Screening (PGS) is a technique that screens all 24 chromosomes of an embryo.

Semen Analysis is the assessment of certain features of a man's semen to find issues that affect fertility.

Single Nucleotide Polymorphisms, (SNP’ s) are the most common type of genetic variation among people. Each SNP represents a difference in a single DNA building block, called a nucleotide.

Trans-vaginal Oocyte Retrieval (TVOR), sometimes referred to as TVOA, egg collection or egg pick-up (OPU), is the collection of a woman's eggs which are subsequently to be used in fertility procedures where the embryo is grown outside the uterus, such as IVF and ICSI.

Ultrasound is a sound wave used in detecting and measuring objects, and is used extensively in medical imaging. Ultrasound examinations for fertility treatment are usually vaginal because higher frequency sound, that has less tissue penetration, can be used to see the ovaries, uterus and pelvic structures in high detail.

Unexplained infertility is a fertility diagnosis made when all the investigations looking into reasons for infertility have been completed and are found to be normal. It represents the diagnosis found in about 30% of affected couples.

ICSI (intracytoplasmic sperm injection)

A subsidiary part or specialized form of In Vitro Fertilization, ICSI is used for the treatment of male infertility. A simple procedure of injecting a single live sperm into an egg is known as Intracytoplasmic Sperm Injection (ICSI).
Followed by IVF, ICSI requires mature eggs from female partner and semen sample from male partner.

Embryologist separate live healthy moving sperm from the semen sample and after 2 to 3 hours of egg retrieval, he/she removes the outer coating of eggs to ensure that eggs are mature enough to undergo ICSI because immature eggs cannot be injected. With great precision, Embryologist inserts a needle holding sperm into the egg. These injected eggs are then placed in an incubator in laboratory overnight.

The technique is likely to be recommended in case of low sperm count and other male infertility factors including damaged or missing vas deferens and previous attempt of IVF failure.

ICSI require more handling and care than standard IVF, however during the procedure there is a very small chance that egg may be damaged resulting in non-viable egg. The woman’s age matter a lot for the success of ICSI and there is yet no convincing evidence regarding the birth defects in children born as a result of ICSI.

IVF (in vitro fertilization) Infertility Treatments

IVF (In Vitro Fertilization) was first performed in the year 1978 and now millions of babies have been born with the wonder of this assisted reproductive technology. Recommended to especially woman has failed to respond other medical methods, IVF also help where male factors contribute to infertility.

A step by step procedure, Infertility treatment starts from developing and monitoring the follicles. In order to stimulate multiple follicles, medications are prescribed to woman that increases the number of eggs and have ability to fertilize and develop into embryos. This treatment may require 8 to 12 days followed with several ultrasounds and blood tests. For the final maturation of eggs, you will receive hCG (human chorionic gonadotropin) and after 36 hours egg retrieval procedure is done.

Egg retrieval is the second step in IVF where mature eggs are retrieved by a needle guided through the vagina into the ovary located by ultrasound. In the ART (Assisted Reproductive Technology) laboratory where the retrieved eggs are placed with male sperm and then cultured for 2 to 5 days (5 days or blastocyst stage) in Petri Dish. Once embryos are formed, one or two embryos of good quality then transferred back into the female uterus with the help of a small fine catheter which is inserted into the uterine cavity via cervix to place embryos, known as Embryo Transfer.

Risks associated with IVF Treatment

To stimulate the egg production, the medications which are prescribed have been proven to safe however there are some possible side effects include ovarian hyperstimulation, laparoscopy risks, ectopic pregnancy, multiple gestation or pregnancies and ovarian torsion.

In Vitro Fertilization is considered as the most successful ART method, but actually numbers of factors are there that have to be taken into consideration to analyze the success and failure of IVF that may include patient’s age, egg and sperm quality and failure of embryos implantation.

PGD (preimplantation genetic diagnosis)

Many women are out there facing frequent pregnancy loss. Genetic issues are one of the reasons for repeated pregnancy loss. Loss in pregnancy is frustrating and emotionally draining experience, but a big thanks to advanced medical science that provides you treatment options that can help you for the same such as preimplantation Genetic Diagnosis.

An advanced IVF procedure called preimplantation genetic diagnosis (PGD) for short is a genetic test performed by an embryologist where retrieved eggs during IVF are screened for genetic abnormalities. Some genetic diseases are directly linked to X or Y chromosomes and therefore it will be useful to check also the sex chromosomes.

How PGD/Preimplantation Genetic Diagnosis works?

During IVF cycle, occytes are collected and fertilized with sperm to form embryos. After 5 days eggs are usually grow to its blastocyst stage which consist 120-150 cells. The blastocyst cells are differentiated as fetal cells and placental cells. From placental cells, 5-10 cells are removed for assessment. However this removal does not alter the embryos ability for developing into a complete pregnancy.

An embryologist analyzed the removed cells for 13, 18, 21, X and Y chromosomes with the help of FISH (fluorescent in situ hybridization) technique. The embryos free of genetic disorders are separated and transferred back to the uterus on 6th day or blastocyst stage of egg retrieval. The procedure is done prior to the stage when embryos material becomes active.

PGD is secure and reliable method

With 99% of accuracy rate of PGD (preimplantation genetic diagnosis) has no evidence that leads to an increase in chromosomal disorders or birth defects. The technique is mostly recommended where multiple pregnancy losses occur for unknown reasons.

MESA (Micro Epididymal Sperm Aspiration)

An open operation, MESA is usually performed under general anaesthesia if the sperm transportation between epididymis and the urethra is blocked. It involves the micro surgical aspiration (suction) of sperm from the epididymis. A long cut (approx 3cm) is made in the scrotum to access epididymis and liquid is crave from the ducts. During the procedure, the retrieved liquid is carefully analyzed. If contains live sperm, can only be used for fertilizing the eggs via IVF or ICSI method. May be you feel some discomfort for few days after operation that will settle with mild painkillers. MESA is suitable for men with no vas deferens or if it is blocked, also suitable for men who have had a vasectomy.

TESE (testicular sperm extraction)

A surgical sperm retrieval procedure carried out under local anesthesia. During the procedure a sperm sample may be retrieved from the testes using a small needle aspiration without making a skin incision. The retrieved sperm which have been extracted from the testes is injected in each egg using ICSI (Intra cytoplasmic Sperm Injection) technique for fertilizing the eggs.

When there is no sperm was retrieved by MESA technique, the TESE is performed. Sometimes there is no sperm, either due to blockage in the route between sperm production and ejaculation or partial or complete failure in the sperm production, these men with obstructive and non- obstructive azoospermia is suitable for TESE.

Sperm Bank

Donor sperm and artificial insemination makes it possible for couples to experience pregnancy even when man’s semen has no sperm or for any other reason, his sperm cannot be used. The procedure is most commonly recommended when the pregnancy is not achieved by the female due to sperm abnormality or agenesis of sperm. The baby produced with the sperm donor is naturally or biologically related to the donor.

With the artificial insemination, the sperm is donated by the donor and prior to this, semen analysis will be performed and samples are collected for infection tests. A technique of sperm storage was introduced more than thirty years ago that allows a man to preserve his potential for indefinite period of times whether for days, months or years, this is known as sperm banking and cryopreservation