Department of Obstetrics and Gynecology -
WVU Center for Reproductive Medicine

Glossary

Amenorrhea: This is the absence of menses. Never having had a period is primary amenorrhea and having menses in the past but none at the present is secondary amenorrhea. The causes of absence of menses can be classified as: 1) conditions affecting the hypothalamus and pituitary preventing stimulation of the ovaries; 2) Inability of the ovaries to respond to signals from the pituitary; and 3) absence or abnormalities of the uterus, cervix, or vagina.

Assisted Reproductive Technologies: These are procedures utilized to improve the chances for getting sperm and eggs together. Included are procedures such as superovulation plus intrauterine insemination, gamete intrafallopian transfer, Zygote intrafallopian transfer, In-Vitro Fertilization and Intracytoplasmic sperm injection.

Basal Body Temperatures: This is a method that is used to determine if ovulation has occurred during a given cycle. Exposure to the hormone progesterone "resets" the person's thermostat to a higher level. Thus, the person's baseline temperature will increase after ovulation. In order to detect this change, temperatures are taken each day of the menstrual cycle at the same time (usually upon awakening) and recorded. Special BBT thermometers are available, but a regular oral thermometer will do.

Clomiphene citrate: This is an oral medication used to initiate ovulation. The medication is an "anti-estrogen" so tricks the hypothalamus into thinking that there is not enough estrogen. The hypothalamus responds by increasing the signals to the pituitary. This in turn results in increased stimulation of the ovary. Because of this increased stimulation, more than one egg may be released and this can result in multiple gestation. The rate of twins with this medication is 6-8%. The anti-estrogen nature of this medication can lead to abnormalities of cervical mucus and the endometrium.

Corpus luteum: After the follicle ruptures, the cells that originally surrounded the egg undergo changes and form a structure called the corpus luteum. The corpus luteum may exist as a cystic structure of varying sizes and primarily secretes the hormone, progesterone, which causes the endometrium to change and become secretory.

Donor Insemination: This is a procedure that is performed when sperm is unavailable or if a genetic abnormality of the male is present. We work with sperm banks across the country to provide a variety of donors. Donor profiles are available for patients interested in this service. Once the donor is selected, the specimen is ordered in advanced and stored within our facility so that it will be available at the time of ovulation. Donor sperm is usually administered by intrauterine insemination but can also be used with Assisted Reproductive Technologies.

Dopamine agonists: The presence of pituitary tumors, medications, or other medical conditions can lead to excess production of the hormone prolactin by the pituitary. This can lead to abnormal breast discharge and irregular or absent menses. The chemical dopamine normally maintains normal prolactin levels. When excess prolactin is being secreted, medications can be used to return prolactin levels to normal. Since these chemicals act like the chemical dopamine, they are called dopamine agonists. Different medications are available and have different treatment schedules. The medications are usually used orally, but can be used vaginally if the patient is unable to tolerate the side effects from oral administration.

Endometrial biopsy: This is a procedure utilized to obtain a specimen of tissue from the lining of the uterus so that it can be evaluated by pathology to determine if any abnormalities are present. A speculum is placed, the cervix is cleansed with an antiseptic solution, and a small plastic catheter is passed through the cervix into the uterine cavity. Suction is applied to the catheter and tissue is removed. The procedure usually causes cramping so pretreatment with a medication such as Motrin approximately one hour prior to the procedure is recommended. There are no restrictions on activities for the remainder of the day.

FSH: Follicle Stimulating Hormone

GIFT: Gamete Intrafallopian transfer

Gonadotropins: Gonadotropins are the hormones FSH and LH that are normally produced by the pituitary to stimulate the ovary. This group of medications can consist of both FSH and LH or FSH or LH alone. They can be administered by subcutaneous or intramuscular injection. Because their use causes a marked increase in ovarian stimulation, there is a higher risk of multiple gestation. Careful monitoring with ultrasound and hormone tests are required to prevent overstimulation of the ovary leading to the hyperstimulation syndrome.

GnRH: Gonadotropin releasing hormone

Gonadotropin Releasing Hormone: This is the hormone that is used by the hypothalamus to stimulate the secretion of FSH and LH from the pituitary. The hormone is usually released in pulses at precise intervals. The fertility drug, Clomiphene citrate, increases the size of the GnRH pulses. Pumps have been used to initiate ovulation by administering this hormone either subcutaneously or intravenously. The pump is programmed to give precise amounts of hormone at precise intervals.

Gonadotropin Releasing Hormone Agonists and Antagonists: Minor alterations in the chemical structure of GnRH are used to create GnRH agonists or GnRH antagonists. A GnRH agonist acts like GnRH at the level of the pituitary, but because the analog stimulates the pituitary on a continuous basis rather than with pulses of GnRH as in the normal situation, the pituitary essentially becomes exhausted and will stop secreting FSH and LH after 7-10 days. GnRH agonists are commonly used to shut down the production of FSH and LH by the pituitary in the treatment of conditions such as endometriosis and fibroids as well as part of the superovulation protocols that are used with Assisted Reproductive Technologies. Because GnRH analogs initially cause an increase in FSH and LH, they have been used at midcycle instead of hCG to cause the LH surge. GnRH antagonists differ from analogs in that they block the effect of GnRH upon the pituitary. This leads to an immediate drop in levels of FSH and LH.

HCG: Human chorionic gonadotropin

Human Chorionic Gonadotropin: The hormone hCG is the hormone that is produced by the early pregnancy and is what is measured in pregnancy tests. This hormone is similar in appearance to the gonadotropin LH so is used to trigger ovulation.

HMG: human menopausal gonadotropins (derived from the urine of menopausal women)

HSG: Hysterosalpingogram

Hyperstimulation Syndrome: This is a potentially serious complication associated with the use of gonadotropins, but can also happen with Clomiphene citrate. The usual clinical situation involves the development of multiple follicles with high levels of estrogen. If hCG is given to trigger ovulation, the ovaries and surrounding tissue may start weeping large amounts of fluid into the peritoneal cavity. This can result in circulatory, vascular, or respiratory difficulties in addition to the discomfort associated with enlarged ovaries. Severe hyperstimulation requires intensive in-hospital care.

Hysterosalpingogram: This is a procedure performed in Radiology that evaluates the structure of the uterine cavity and fallopian tubes. A sterile speculum is placed in the vagina and the cervix is cleansed with an antiseptic solution. A small instrument is then attached to the cervix. Various types of cannulas or catheters can then be used to inject dye through the cervix into the uterine cavity. X-rays are taken during the course of this procedure. Cramping should be expected so pretreatment with a medication such as Motrin approximately one hour prior to the procedure is recommended. It is recommended that someone accompanies you to the hospital and that you not return to work for the rest of the day.

Hysteroscopy: This is an outpatient surgical procedure that involves placing a scope into the uterine cavity to look for abnormalities. Surgical therapy of scar tissue, polyps, fibroids, and birth defects can be performed through the hysteroscope.

ICSI: Intracytoplasmic sperm injection (placing a sperm directly into the egg).

Insulin Sensitizing Agents: These are drugs that are used in patients with polycystic ovaries in an attempt to reduce their resistance to insulin. Use of such medications can result in return of normal ovulatory cycles or make the individual more responsive to fertility drugs.

Intrauterine Insemination: This office procedure involves washing and concentrating sperm in the lab and placing them into the uterine cavity. A speculum is placed into the vagina and a small flexible catheter attached to a syringe containing the prepared semen is then introduced into the endometrial cavity. The semen is slowly injected and the patient then remains lying down for 10 minutes following the procedure. There are no restrictions on activities for the remainder of the day.

IUI: Intrauterine insemination

IVF-ET: In Vitro Fertilization and embryo transfer

Laparoscopy: Laparoscopy is an outpatient surgical procedure that involves placing a scope through the umbilicus (belly button) into the peritoneal cavity in order to look at the uterus, tubes, and ovaries. Surgical therapy such as division or removal of scar tissue, repair of tubes, and treatment of endometriosis can be performed by laparoscopy. Some surgical procedures are still best performed by open laparotomy.

LH: Luteinizing Hormone

Luteal Phase Defect: It has been proposed that abnormalities of the luteal phase can result in infertility or early pregnancy loss. The theory is that either the corpus luteum does not make enough progesterone or else the endometrium does not respond in a normal fashion which leads to a situation where the lining of the uterus in inadequate to allow or maintain a pregnancy.

Luteinized unruptured follicle: This is a condition where there has been apparent normal growth of the egg and follicle, a mid cycle surge of pituitary hormones, and conversion of the cells surrounding the follicle to function like the corpus luteum; but failure of the follicle to rupture. This results in the egg not being released.

Ovarian Drilling: The use of lasers or electrosurgery to reduce the amount of hormonal producing tissue in the ovary in an attempt to restore ovulation in patients with the polycystic ovary syndrome. Surgical therapy for treatment of anovulation (wedge resection) originally involved removing a wedge shaped piece of the ovary and then sewing the ovary back together. Today's procedures are performed through the laparoscope.

Ovarian Reserve: This is a term that is used to describe the presence of responsive eggs within the ovary. Thus, decreased ovarian reserve implies a deficiency in responsive oocytes. The medical history, menstrual history, or prior response to ovarian stimulation may suggest the presence of decreased ovarian reserve. Pregnancy rates in spontaneous cycles or with Assisted Reproductive Technologies in such a situation are poor.

Ovarian Reserve Testing: Hormones produced by the cells surrounding the egg inhibit the release of pituitary hormones. When the number of eggs is diminished, the levels of these hormones are diminished, so the levels of FSH begin to increase. Methods to assess ovarian reserve include baseline hormone testing (FSH and estrogen levels on day 3 of the cycle) and the levels of FSH on day 10 of the cycle after having used the fertility drug, clomiphene citrate, days 5-9 of the cycle (Clomiphene citrate challenge test)

Ovulation: The hypothalamus releases the hormone, gonadotropin-releasing hormone in pulses of precise amounts and at precise intervals. This causes the release of pulses of Follicle Stimulating Hormone and Luteinizing Hormone from the pituitary gland. Within the ovary are multiple small immature eggs (oocytes) who are waiting for the pituitary to tell them to begin growing. Although many eggs are available, there is usually only one that is selected to continue growing. The cells surrounding the chosen egg secrete fluid so that the egg becomes surrounded by a collection of fluid. The egg, the fluid, and the surrounding cells then form a structure called the follicle. As the follicle develops, it secretes the hormone Estrogen which stimulates the lining of the uterus, the endometrium, to thicken (proliferate). When the follicle reaches a critical size and is making critical levels of estrogen, it is as though the ovary was telling the pituitary that the egg is ready to be released. The pituitary responds with a sudden release of large amounts of LH and FSH. This surge of hormones completes the egg's development and causes the follicle to rupture (ovulation) so that the egg can be released and to be picked up by the fallopian tube. The hormonal surge also causes the cells that originally surrounded the egg to change into a structure called the corpus luteum. This structure primarily secretes the hormone Progesterone. The progesterone causes the uterine lining to change its appearance and begin secreting various substances that will allow the fertilized egg to invade under its surface and to survive (implantation).

Ovulation Predictor Kits: This test is used to determine when ovulation will occur. The usual test is a urine test. The woman's urine is tested to determine the sudden release of hormones from the pituitary that occurs just prior to release of the egg. Other tests are also becoming available that look for other changes that occur prior to ovulation. Ovulation will usually occur within 24 hours of when the test becomes positive.

Polycystic Ovary Syndrome: (PCOS) The usual definition of this condition includes absent or infrequent ovulation and evidence of increased male hormones. The ovaries are usually enlarged and have multiple small, incompletely developed follicles immediately underneath the surface of the ovary with gives the appearance of multiple (poly) cysts. Insulin resistance appears to play a critical role in the development of this condition.

Post-Coital Test: The couple usually is instructed to have intercourse the night before the test. The following morning mucus is aspirated from the cervix. A speculum is placed, a soft plastic catheter is placed at the opening of the cervix and a syringe is used to aspirate mucus, which is placed on a slide and observed under a microscope.

SO: Superovulation

Sonohysterography: This is a procedure that utilizes ultrasound to evaluate the inside of the uterine cavity. A speculum is placed into the vagina, the cervix is cleansed, and a small catheter is inserted into the uterine cavity. A syringe filled with fluid is then attached to the catheter. The speculum is removed and is replaced with a vaginal ultrasound probe. Fluid is then injected into the uterine cavity while watching with ultrasound.

Superovulation: The initial attempts to perform IVF-ET were performed during natural cycles. This meant that the IVF team was dependent upon the women to develop a healthy egg and that they and the patient would be available at any time day or night to retrieve the egg. Success rates using this method were poor. The use of fertility drugs to make multiple eggs available (superovulation) for each attempt at IVF-ET markedly improved pregnancy rates. On occasion, the elevated levels of estrogen associated with the development of multiple eggs would trick the pituitary into thinking that a group of incompletely developed eggs was in fact a single large follicle so the pituitary would release the surge of hormones that would usually result in ovulation. This premature LH surge made the eggs unacceptable for fertilization so the treatment had to be discontinued. Other medications were added to prevent this premature surge. Another problem with superovulation is the potential for development of the ovarian hyperstimulation syndrome, particularly in patients with the polycystic ovary syndrome. The use of oral contraceptives and other changes in the types and amounts of hormones used during superovulation are attempts to decrease the risk for this complication. Careful monitoring with ultrasound and hormonal evaluation is required.

Vaginal Ultrasound: This is a method of using sound waves to observe the uterus, the uterine lining, and the ovaries. The vaginal probe is cleansed in an antiseptic solution, covered with a condom, and then inserted into the vagina. The discomfort of a vaginal ultrasound is similar or less to what is experience with placement of a speculum during routine pelvic examinations. The images obtained with vaginal ultrasound are superior to what are obtained by abdominal ultrasound and do not require a full bladder.