Obstetrics and Gynecology



Walter Reed Army Medical Center
Washington, D.C.

National Naval Medical Center
Bethesda, Mar...
MANUAL
                                           Introduction

The Division of Reproductive Endocrinology of the National...
The Division of Reproductive Endocrinology and Infertility is the branch of the Department of
Obstetrics and Gynecology th...
Instructions for Semen Analysis with the Embryology Laboratory

All couples entering the IVF program are required to have ...
If the men anticipate a problem with collection or their sample they must talk to the laboratory
staff as soon as they com...
The incisions are closed with several stitches which will absorb in several weeks. The surgery is
scheduled before ovulati...
NNMC ER        301-295-4810

NNMC OB-GYN Urgent Care               301-295-1438

REI Division and IVF FAX 202-782-3492

WE...
As with your other medical care, medical ethics mandates that the care you as a couple receive
through Walter Reed Army Me...
definite evidence of genetic factors being the cause of male factor infertility the ICSI procedure
may permit the transfer...
CRYOPRESERVATION (Freezing) of EMBRYOS

Cryopreservation of embryos is a viable alternative to discarding "extra" embryos ...
program. If no sperm is found, you will need to make an appointment to discuss your
alternatives.

In certain circumstance...
Anovulatory bleeding: The type of menstruation associated with the failure to ovulate. May be
scanty and short or heavy wi...
Estradiol (E2): A hormone released by the developing follicles in the ovary. Plasma estradiol
levels are used to help dete...
In vitro fertilization (IVF): A procedure in which an egg is removed from a ripe follicle and
fertilized by a sperm cell o...
Testicle: The male sexual glands of which there are two. Contained in the scrotum, they produce
the male hormone testoster...
1209 Montgomery Highway

Birmingham, AL 35216-2809

Tel: 205-978-5000

FAX: 205-978-5005

http://www.asrm.org

e-mail:asrm...
Upcoming SlideShare
Loading in …5
×

IVF Manual.doc

2,876 views

Published on

Published in: Health & Medicine
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
2,876
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
114
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

IVF Manual.doc

  1. 1. Obstetrics and Gynecology Walter Reed Army Medical Center Washington, D.C. National Naval Medical Center Bethesda, Maryland IVF / ICSI / GIFT INFORMATION & ORIENTATION
  2. 2. MANUAL Introduction The Division of Reproductive Endocrinology of the National Capital Residency Program in Obstetrics and Gynecology initiated an Advanced Reproductive Technology (ART) program that began January 1996. It offers In Vitro Fertilization (IVF), Gamete Intra Fallopian Transfer (GIFT), and Intracytoplasmic Sperm Injection (ICSI). Our program utilizes an independent contractor to provide our embryology services. Because of this collaboration, all patients are required to pay for the laboratory services prior to starting the treatment. This cost is approximately $3500 to $5000.00. You may also be required to provide a portion of your fertility medications, which may cost another $50-150. Detailed financial information can be obtained by calling (202) 782-9244. Not all infertility patients require IVF for their treatment. Many conditions may be treated with simpler and less expensive modalities. If you are unsure whether you need IVF, you should consult your local gynecologist before applying to our program. Unfortunately, not everyone is a candidate for our program. Women who are age 42 or older have little chance for success with conventional IVF and will not be accepted. Women who do not have a uterus or who have no functioning ovaries also are not candidates. Significant medical problems can be a reason for exclusion; such conditions should be evaluated by the patient’s primary physician and /or obstetrician to determine whether their health may be worsened by pregnancy or the IVF procedure itself. We are happy to care for you at Walter Reed Army Medical Center during your evaluation and we sincerely hope that it will be a rewarding experience. We also recognize that this may be an anxiety –producing time for you. Remember that our primary purpose is to serve you. We can do a better job if you understand why we do what we do. Some general explanations are included in this booklet that, in conjunction with your clinic visits will answer most of your questions. There are many other resources available such as books, magazines, support groups and the Internet. It is very important that you understand that some of what you may read in these sources may be opinion and not entirely based on good data. Our training is long and rigorous precisely so that we can help guide your evaluation and treatment in the most efficient manner possible. It is very important that you are an active participant in your care. Together, we hope to help you achieve your goal of a happy and healthy child. Division of Reproductive Endocrinology and Infertility Walter Reed Army Medical Center
  3. 3. The Division of Reproductive Endocrinology and Infertility is the branch of the Department of Obstetrics and Gynecology that deals with issues of infertility, repetitive pregnancy loss and hormonal abnormalities in women. The division offers a full range of treatments, from basic clinical evaluations through high tech assisted reproductive technologies, including in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), preimplantation genetic diagnosis (PGD), and embryocrypreservation. More than 400 assisted reproductive technology (ART) cycles are managed yearly. Cycles are batched four times yearly in January, April, July and October. Candidates for this procedure include couples who have either failed more conservative therapeutic approaches or those for whom other modalities are inappropriate. The ART program primarily serves military beneficiaries from the northeast, although anyone eligible for care anywhere in the world may participate. Since its inception in 1995, pregnancy rates have been consistently in the top 10 percent in the nation. The division has five board-certified or board-eligible Reproductive Endocrinologists on staff. In addition to the assigned faculty, a very close relationship is maintained with the National Institutes of Health (NIH). Physicians from the NIH participate in all aspects of patient care and conferences. A vibrant program of research is maintained in conjunction with WRAMC, NNMC, NIH and the Uniformed Services University of the Health Sciences (USUHS). A fellowship program in Reproductive Endocrinology and Infertility, the oldest in the nation, continues to provide training for both the military and the civilian sectors. The division also provides training to the National Capital Area military residency in Obstetrics and Gynecology. Since the Division is staffed by sub-specialists, we have a responsibility to teach others. Residents are physicians who are training to become specialists in Obstetrics and Gynecology. Given the nature of a training hospital and the multitude of responsibilities that each staff member has within the program, Residents or staff members cannot be your personal or private clinician. Rest assured that the professional scrutiny under which medicine is practiced in our program is equivalent if not better than that found in any large group practice/HMO training program found anywhere in the United States. With cutting-edge research and superb teaching, the Division of Reproductive Endocrinology and Infertility is able to provide the best care available anywhere to its patients.
  4. 4. Instructions for Semen Analysis with the Embryology Laboratory All couples entering the IVF program are required to have a comprehensive semen analysis with our Embryology laboratory. We cannot accept semen analysis reports from outside institutions. The purpose of this analysis is to look at the semen parameters and to determine whether fertilization should be attempted with standard in vitro fertilization or with intracytoplasmic sperm injection. It also helps to ascertain if men are unable to produce a sample on Ward 43. Appointments for semen analysis for the IVF program are made through the administrative office only. All appointments are Monday through Thursday and run from 9:00 to 13:00. Appointments are generally scheduled the month prior to the beginning of your cycle. Men should abstain from ejaculation for 48-72 hours prior to their appointment. Shorter abstinence periods will reduce the volume and count of the sample and longer period s will reduce the motility and numbers of viable sperm, in both instances leading to an inaccurate analysis. No lubricants can be used except those that are provided by the laboratory. No condoms can be used since they contain spermicides and will kill the sperm. Even non-lubricated over-the- counter condoms will kill sperm. Sexual intercourse with withdrawal is not encouraged since premature ejaculation can occur with resulting sperm loss. It can also lead to contamination of the sperm sample, which is detrimental for the eggs. Ideally the sample should be collected by masturbation using the laboratory provided sterile specimen container. Men should report to ward 43 at the time of their appointment. Facilities for sample collection are provided. The men will be required to fill in certain paper work. After the analysis a report will be generated and placed in the patient file with the IVF nurses. If there are any problems with the sample the men will be contacted by the laboratory staff. Men with adequate semen analysis will be designated for IVF. Those with sub-optimal analysis will be designated for ICSI. On the day of the woman’s oocyte (egg) retrieval this may be changed if there is a major change in the semen parameters. Men who have no sperm in their ejaculate will need to have an aspiration (MESA or TESA). In order to schedule this and assure that a urologist is available, the patient must make an appointment with the urology clinic. Contact the IVF nurse who will assist you in making arrangements for scheduling the male retrieval.
  5. 5. If the men anticipate a problem with collection or their sample they must talk to the laboratory staff as soon as they come on the ward. Clomiphene citrate challenge test (CCCT) This test is used to screen out patients who may have inadequate egg production (what we term "diminished ovarian reserve") and therefore may require a donor egg. The test is completed by: 1. A day 3 follicle stimulating hormone (FSH),LH, and Estradiol is drawn. Day 1 is the first day of bleeding during the menstrual cycle. 2. 100 mg (two tablets) of Clomid are taken daily on days 5 through 9 of your menstrual cycle. 3. Another FSH, LH, Estradiol is drawn on day 10 of the menstrual cycle. The results of the test will be discussed with you either by one of the IVF nurses or by one of our physicians. Laparoscopy Laparoscopy is a surgical procedure done under general anesthesia. A small cylindrical telescope is passed into the abdominal cavity through a tiny incision at the "belly button". A second instrument is usually introduced through a puncture at the pubic hair line. Through fiberoptic lenses and lights, the physician is able to view directly the outside of the uterus, the tubes, the fimbriated ends, the ovaries and the pelvic cavity in which they lie. Laparoscopy may establish the need for medical or surgical treatment by identifying tumors, cysts, endometriosis, infection and/or scar tissue. If any abnormalities are found, they can generally be fixed at the time they are found.
  6. 6. The incisions are closed with several stitches which will absorb in several weeks. The surgery is scheduled before ovulation and usually is done as same day surgery. A sore throat, shoulder pain, bloated or swollen-feeling abdomen and generalized stiffness and soreness are commonly experienced for a day or more, but normal work activities can soon be resumed. A companion must come with you because you may be drowsy from the anesthesia, so you will need someone to drive you home. You will not be allowed to drive after the procedure. Hysteroscopy If indicated, transvaginal visualization of the uterine cavity, searching for tumors, adhesions (scar tissue) or congenital abnormalities may be performed. This may be performed at the same time as a laparoscopy or as a procedure by itself. The device used contains lenses and a light source in order to clearly visualize the uterine cavity. If any abnormalities are found, they can generally be fixed at the time they are found. ADMINISTRATIVE DETAILS Appointments The OB-GYN Department and Reproductive Endocrinology and Infertility Division operate on an appointment system. If you cannot keep your appointment, please call and cancel within 24 hours if possible. To schedule appointments relating to an upcoming IVF cycle or if you have any general questions regarding IVF, call the ART Institute's administrative staff at 202-782-6198. T Change of address, telephone number or name There may be times that we need to get in touch with you urgently and at those times we need an accurate phone number or address. Therefore it is crucial that you update your registration information. You may easily do this at WRAMC by calling (202) 782-6160. Important Phone Numbers Reproductive Endocrinology / Infertility office 202-782-3360 GYN appointments 202-782-6114/5/6 In vitro Fertilization 202-782-6198/3600 Obstetrics Service NNMC 301-295-4400/1 WRAMC ER 202-782-1199
  7. 7. NNMC ER 301-295-4810 NNMC OB-GYN Urgent Care 301-295-1438 REI Division and IVF FAX 202-782-3492 WEB SITE ADDRESS WWW.WRAMC.AMEDD.ARMY.MIL The laboratory contractor is committed to providing you the best quality service available. This service begins with information about our services as well as any medical treatments available. The information process starts with this booklet and continues through your consultation with the physician, and the orientation where you will be given more specific information about your upcoming cycle. Just as treatments vary from patient to patient, your information may vary to make it more specific to your case. Risks and benefits will be discussed in relation to your treatment. A contracted company will provide your laboratory and nursing services. Please feel free to ask questions at any time during your treatment. Please read this booklet in full. Prior to beginning an IVF treatment cycle, you will be required to attend an orientation at Walter Reed Army Medical Center. The purpose of the orientation is to familiarize yourself with our program, to meet and discuss the financial issues regarding your upcoming cycle. Before you can attend this orientation (which is by appointment only), you need to have completed all blood tests requested by us on your checklist. If you have questions that arise while reading this handbook, please write them down so you may ask a staff member at you next visit. FINANCIAL The fees charged are the sole responsibility of the couple receiving the services. The physician’s service, plus clinical lab services are provided for you by the military healthcare system. Again, the fees charged are for the Embryology lab, and staff. We do not accept or bill insurance. We can however, provide you with a statement of services received. CONFIDENTIALITY
  8. 8. As with your other medical care, medical ethics mandates that the care you as a couple receive through Walter Reed Army Medical Center is confidential except where written authorization is received to release the information. Such is the case when we report our statistics to SART (Society for Assisted Reproductive Technologies). In keeping with Federal regulations our data is sent to this national registry which is supervised by the American Society for Reproductive Medicine. This data is collected from all IVF centers and provides couples as well as other centers info by which they can determine their overall success. Should you wish to look into this registry more closely you can access it via www.ASRM.com. The aim of our program as well as ART in general, is to help you as a couple achieve a normal pregnancy. The following information will serve to acquaint you with all the possible variations of assisted reproductive technologies. Some measures are used to address female infertility causes, i.e. IVF, GIFT, Assisted Hatching, whereas ICSI is designed to deal primarily with male factor infertility. InVitro Fertilization ( IVF) In vitro fertilization constitutes the placement of both egg and sperm within the same space, a petri dish outside the body. This is where fertilization occurs. This was first begun as means to bypass the female fallopian tubes for normal fertilization and passage of the subsequent embryo into the uterine cavity. As time passed it has increased in scope to include treatment for endometriosis, for donor egg, donor embryos and gestational surrogates. During IVF, a woman is given specific medications to stimulate her ovaries to produce multiple eggs. These eggs are then harvested and placed in the embryology laboratory. Three to 4 hours later sperm is placed with the eggs and allowed to fertilize the egg overnight. The following morning they assessed for fertilization. Fertilized zygotes are grown in special culture media for a further 3 or 5 days. Following this period of growth, the resulting embryos are transferred into the wife’s uterus, generally on day 3 or day 5 following retrieval. IVF may provide significant information about the cause of infertility by giving direct visualization of female eggs, male sperm, and their subsequent interaction. INTRACYTOPLASMIC SPERM INJECTION (ICSI) Intracytoplasmic sperm injection is a specialized form of IVF developed and used to overcome male factor infertility. In this procedure each egg is injected with only one sperm, thereby bypassing the need for the sperm to penetrate the "shell" of the egg to achieve fertilization. ICSI is considered by most to be a safe procedure. However, there are studies showing small but significant increases in non-lethal genetic abnormalities but no increase in birth defects or congenital abnormalities associated with babies conceived via the ICSI procedure. If there is
  9. 9. definite evidence of genetic factors being the cause of male factor infertility the ICSI procedure may permit the transfer of these factors. Some of these include the genes that cause the condition known as cystic fibrosis or micro-deletions of the Y chromosome. If this is the case then genetic counseling should be pursued prior to doing ICSI. If the male is carrying the cystic fibrosis genes his wife must also be tested prior to any procedures since the likelihood of having an affected child if both partners are carrying the genes is very high. Affected children do not live long. ASSISTED HATCHING To easily understand the concept of assisted hatching one must first think of the human egg/embryo as that of a chicken egg, including the "shell". The shell surrounding the embryo is thought to open while in the uterus and allow the embryo to implant in the uterine wall. In assisted hatching, part of this "shell" is opened or removed prior to embryo transfer thereby assisting the embryo in it’s ability to implant and ultimately produce a pregnancy. However, this procedure is not necessary for all patients. Data indicates that assisted hatching is most likely to help in those cases where the "outer shell" of the embryo is thickened. Any procedures where handling of embryos is involved have associated risks. Embryo damage may occur in spite of meticulous care by our embryology staff. As assisted hatching is one of these procedures, there are risks. For some couples however the benefits of pregnancy may outweigh these risks. Talk to your doctor if you have questions about this procedure. GAMETE INTRAFALLOPIAN TRANSFER (GIFT) This procedure most closely resembles natural fertilization as the egg and sperm are both placed within the confines of the woman’s fallopian tubes. This procedure is therefore limited to those couples where the diagnosis remains "unknown" following complete evaluation of both partners. GIFT is not possible in cases of tubal factor or male factor. The female undergoing GIFT will have general anesthesia for the procedure as a laparoscopy will be performed to access the fallopian tubes. The pre-surgery preparation for retrieval is the same as for IVF or ICSI, where the woman will take medications to promote multiple egg production on her ovaries. Sperm evaluation is done approximately one hour prior to the woman’s surgery. Retrieval and transfer are accomplished all in one day. Occasionally GIFT may not be performed due to unforeseen circumstances. It may become apparent only upon direct visualization that the tubes are in some way abnormal and unable to be used for transfer. In these circumstances the resulting eggs from the retrieval and the male sperm would then be placed in a petri dish for IVF fertilization and either transfer or cryopreservation of the resulting embryos. GIFT may not be advisable for those couples for whom fertilization is a question as the fertilization cannot be observed. In this case IVF would provide much more information.
  10. 10. CRYOPRESERVATION (Freezing) of EMBRYOS Cryopreservation of embryos is a viable alternative to discarding "extra" embryos not used in a fresh IVF cycle. In this way we can maximize the stimulation of the woman’s ovaries and eliminate the incidence of transferring too many embryos, resulting in a high-order multiple pregnancy. Cryopreservation of embryos has been available for many years, with the first birth resulting from a thawed embryo in Australia in 1985. Since 1990 there have been increased numbers of these resulting pregnancies, though there is still limited information on long-term effects of cryopreservation. There is no data available to support any increased risks of birth defects resulting from the transfer of cryopreserved embryos. In animal models the use of cryopreserved embryos for over 20 years has not resulted any in birth defects. During a woman’s natural menstrual cycle only one egg is generally produced each month. With IVF stimulation, the ovaries may produce upwards of 10-20 eggs and with fertilization may result in many more embryos than can be safely returned to her uterus. The use of cryopreservation then affords the couple another opportunity of achieving pregnancy without having the woman undergo the stimulation portion of a cycle. It should be noted that all embryos frozen may not survive the thawing process. As a general rule of thumb, a 50% survival rate may be expected. The more developed the embryo is prior to freezing, the greater its chances are of surviving the thaw. The decision to have embryos cryopreserved requires informed consent. The decision is made by the laboratory staff which embryos are suitable for cryopreservation. Only embryos deemed suitable for freezing and thawing can be cryopreserved. Not all "spare" embryos will meet these criteria. Laws dealing with cryopreserved embryos are still in their infancy. Our policies with regard to frozen embryos are no different than those in most centers. The frozen embryos are the joint property of the man and woman and any disposition regarding these embryos requires the consent of both parties. Since they are the property of the couple, the couple is free to move them to another site if they desire. Any expenses incurred in the shipment of embryos must be borne by the couple. The embryology lab cannot guarantee the shipment or resultant handling of embryos once they leave this facility. MALE FACTOR INFERTILITY OPTIONS If a diagnosis of male factor infertility has been given, there are several options open to the couple. Depending on the causative factor, it is possible that the ICSI procedure would be all that is necessary. In certain males, it may be necessary to have the sperm extracted surgically with a procedure known as MESA or TESA. Because there is a small but real chance of not finding any sperm at the time of the male retrieval, we require that men who need a MESA or TESA undergo their procedure (and freeze sperm that is obtained for use later) before entry into the IVF
  11. 11. program. If no sperm is found, you will need to make an appointment to discuss your alternatives. In certain circumstances the male partner may be sterile. In these cases, we do provide donor sperm services. While we do not maintain our own sperm bank, we do have the names of several sperm banks that you can contact if this is necessary. You and your spouse should discuss the use of donor sperm with your doctor. The participating sperm bank carefully screens donor sperm. Detailed descriptions of the donors are available by mail or on the internet. The descriptions are meant to help you make an informed choice. It is the couple’s responsibility to order and pre-pay for any sperm specimens shipped to Walter Reed for use in the IVF procedure. It is important that you contact us before you have donor sperm specimens shipped to us so that we can make sure that we are available when it is delivered. Please call 202-782-5090/5424 to make these arrangements. We will assist you in any way we can. Abortion (threatened): symptoms such as vaginal bleeding which may end a pregnancy Abortion (habitual/recurrent): a pattern of 3 consecutive miscarriages Adhesion: an abnormal attachment of scar tissue, usually inside the peritoneal cavity which may interfere with normal fertilization. Often caused by surgery or infection. Amenorrhea: the absence of menstruation Anovulation: Total absence of ovulation.
  12. 12. Anovulatory bleeding: The type of menstruation associated with the failure to ovulate. May be scanty and short or heavy with an irregular pattern. Anti-sperm antibodies: A protective protein that exists naturally which causes agglutination of sperm, thus preventing or inhibiting fertilization of the egg. Artificial insemination by donor: The instillation of donor sperm into a woman’s uterus for the purpose of conception. Artificial insemination by husband: The instillation of a husband’s sperm into the wife’s uterus for the purpose of conception. Assisted Reproductive Technologies (ART): Techniques and procedures which are available to help infertile couples achieve pregnancy after other surgical and hormonal methods have failed. These include IVF and GIFT. Azoospermia: The absence of sperm in the ejaculate of the male. Corpus luteum: The special gland that forms in the ovary at the site of released egg. This gland produces the hormone progesterone during the second half of the normal menstrual cycle. Dysmenorrhea: Painful menstruation. Dyspaerunia: Painful intercourse for either the woman or the man. Ectopic pregnancy: A pregnancy in which the fertilized egg implants anywhere but in the uterine cavity (usually the fallopian tube, the ovary or the abdominal cavity). Ejaculation: The male orgasm during which approximately two to 6 milliliters of semen are ejected from the penis. Embryo: The term used to describe the early stages of fetal growth, from conception to the eighth week of pregnancy. Embryo transfer: Introduction of an embryo into a woman’s uterus after in vitro fertilization. Endometrium: The membrane lining the uterus. Endometrial biopsy: The extraction of a small sample of tissue from the uterus for examination. Usually done to show evidence of ovulation or to diagnose endometrial hyperplasia. Endometriosis: The presence of endometrial tissue (the normal uterine lining) in abnormal locations such as the tubes, ovaries and peritoneal cavity, often causing painful menstruation and infertility.
  13. 13. Estradiol (E2): A hormone released by the developing follicles in the ovary. Plasma estradiol levels are used to help determine progressive growth of the follicle during ovulation induction. Fallopian tubes: A pair of narrow tubes that carry the ovum (egg) from the ovary to the body of the uterus. Fibroid tumor (Leiomyoma): A benign tumor of fibrous tissue that may occur in the uterine wall. May be totally without symptoms or may cause abnormal menstrual patterns or infertility. Fimbriated ends: The fringed and flaring outer ends of the fallopian tubes which capture the egg after it is released from the ovary. Follicle: The structure in the ovary that has nurtured the ripening egg and from which the egg is released. Follicle stimulating hormone (FSH): A hormone produced in the anterior pituitary that stimulates the ovary to ripen a follicle for ovulation. Follicular phase: The first half of the menstrual cycle when ovarian follicle development takes place. Gonadotropin: A hormone capable of stimulating the testicles or the ovaries to produce sperm or an egg, respectively. Human chorionic gonadotropin (hCG): A hormone secreted by the placenta and extracted from the urine of pregnant females. hCG stimulates the ovarian secretion of estrogen and progesterone and maintains the corpus luteum. This hormone accounts for pregnancy tests being positive. It may be administered therapeutically to males who have undescended testes and as an aid to trigger ovulation in women. Human menopausal gonadotropin (hMG): An injectable medication obtained from the urine of postmenopausal women. It is used in the treatment of both male and female infertility and to stimulate the development of multiple follicles in ovulatory patients participating in an IVF program. Hysterosalpingogram (HSG): An x-ray study in which a contrast dye is injected into the uterus to show the delineation of the body of the uterus and the patency of the fallopian tubes. Idiopathic (unexplained) infertility: When no reason can be found to explain the cause of a couple’s infertility. Implantation: The embedding of the embryo in the endometrium of the uterus. Infertility: The inability of a couple to achieve a pregnancy after one year of regular unprotected sexual relations or the inability of the woman to carry a pregnancy to live birth.
  14. 14. In vitro fertilization (IVF): A procedure in which an egg is removed from a ripe follicle and fertilized by a sperm cell outside the human body. The fertilized egg is allowed to divide in a protected environment for 2-5 days and then is inserted back into the uterus of the woman who produced the egg. Also called "test tube baby" and "test tube fertilization". Laparoscopy: The direct visualization of the ovaries and the exterior of the fallopian tubes and uterus by means of inserting a surgical instrument through a small incision below the naval. Luteal phase: The days of the menstrual cycle following ovulation and ending the menses during which progesterone is produced. Luteinizing hormone (LH): A hormone secreted by the anterior lobe of the pituitary throughout the menstrual cycle. Secretion of LH increase in the middle of the cycle to induce the release of the egg. Oligo-ovulation: Infrequent ovulation, usually less than six ovulation cycles per year. Oligospermia: An abnormally low number of sperm in the ejaculate of the male. Oocyte: The egg. Oocyte retrieval: A surgical procedure, usually under deep sedation anesthesia, to collect the eggs contained within the ovarian follicles. A needle is inserted into the follicle and its fluid and egg are aspirated and then placed in a media-containing dish in the laboratory. Ovarian failure: The inability of the ovary to respond to gonadotropic stimulation, usually due to the absence of eggs. Pelvic inflammatory disease: Inflammatory disease of the pelvis, often caused by infection. Progesterone: A hormone secreted by the corpus luteum of the ovary after ovulation has occurred. Also produced by the placenta during pregnancy Secondary infertility: The inability to conceive or carry a pregnancy after having successfully conceived and carried one or more pregnancies. Semen: The sperm and seminal secretions ejaculated during a male’s orgasm. Semen analysis: The study of fresh ejaculated under the microscope to count the number of million sperm per milliliter (density), to check the shape and size of the sperm (morphology) and to note their ability to move (motility). Sperm: The male reproductive cell that has measurable characteristics such as motility, morphology, density and viability (whether the sperm is alive or dead).
  15. 15. Testicle: The male sexual glands of which there are two. Contained in the scrotum, they produce the male hormone testosterone and produce the male reproductive cells, the sperm. Tuboplasty: The surgical repair of fallopian tubes. Uterus: The hollow, muscular organ in the woman that holds and nourishes the fetus until the time of birth. Vagina: The birth canal opening in the woman extending from the vulva to the cervix of the uterus. ADDITIONAL RESOURCES RESOLVE has provided help to thousands of people experiencing the crisis of infertility. RESOLVE’s mission is to provide timely, compassionate support and information to individuals who are experiencing infertility and to help them recognize that they are not alone. RESOLVE The National Infertility Association Since 1974 1310 Broadway Somerville, MA 02144 617-623-0744 http://www.resolve.org e-mail: mailtoresolve@aol.com The American Society for Reproductive Medicine (ASRM) is an organization devoted to advancing knowledge and expertise in reproductive medicine and biology. Established in 1944, the Society has since achieved national and international recognition as the foremost organization in promoting the study of reproduction and reproductive disorders. The ASRM is a voluntary non-profit organization. The American Society for Reproductive Medicine
  16. 16. 1209 Montgomery Highway Birmingham, AL 35216-2809 Tel: 205-978-5000 FAX: 205-978-5005 http://www.asrm.org e-mail:asrm@asrm.org

×