Glossary

Anti-Mullerian Hormone (AMH)

This a hormone level which will be measured early in a donor’s cycle to determine her ovarian reserve. This will be one of the first tests done to determine eligibility to donate once selected.

Calendar

This is a program of events which patients/donors will follow while they are undergoing ovarian stimulation protocols. It is computer generated, so that as adjustments are made while the patient is in cycle, the calendar can be continuously updated in terms of dosages and duration of medication administration. The calendar allows all parties to easily plan around the treatment. It allows the patient to know exactly what she is expected to do on each day and project the anticipated dates of egg retrieval and/or embryo transfer. It also helps the medical team prepare for patients in cycle.

Chemical Pregnancy

The term given to a pregnancy which is evident based on a positive blood or urine pregnancy test. Pregnancy is not confirmed or considered a clinical pregnancyuntil visualized by ultrasound.

Clinical Pregnancy

A pregnancy that has been confirmed by ultrasound examination. At this point the doctor can visualize fetal heartbeat.

Cycle

A cycle is a generic term which usually includes everything a patient undergoes for her treatment through 1 full attempt. A cycle either begins with the onset of menstruation in ‘un-programmed’ treatments, or at the commencement of medication in ‘programmed cycles’. Most busy centers batch cases and are able to do so using a combination of birth control pills and/or Lupron and/or GnRH antagonists (a class of drugs to rapidly prevent the release of GnRH from the hypothalamus). The cycle usually ends roughly 14 days after an embryo transfer or with the onset of the next menstrual flow.

Cycle day three blood tests

These tests are usually performed to indicate ovarian reserve. Cycle day 3 is the third day of a full menstrual flow. Tests usually include any or all of serum FSH levels, Serum Estradiol levels, and Serum Inhibin B levels. Studies have been done which allow doctors to interpret the results of such tests (along with other tests such as antral follicle counts which is the number of small follicles as seen on ultrasound at the beginning of a cycle), to anticipate that the patient will be a poor responder or not, while undergoing stimulation with gonadotropins.

Ectopic Pregnancy

A pregnancy that occurs when the embryo implants in a location other than the uterus. Often the embryo implants in the fallopian tube. In almost all instances, these cases require surgical intervention.

Egg

The egg is a single cell and contains 23 chromosomes. It exists in the follicle in a state of “suspended animation,” waiting for the appropriate hormonal signals and triggers to result in the final maturation events just prior to fertilization by the sperm, which also has 23 chromosomes. Therefore, the resulting embryo will have 46 chromosomes. Occasionally, there are errors in this process, which result in chromosomal abnormalities. (e.g. Down’s syndrome)

Egg Retrieval

This is a procedure performed using ultrasound guidance to remove mature eggs from the follicles and the body. It is usually performed through the vagina under light general anesthesia. A needle is inserted through the wall of the vagina, into each follicle, under ultrasound guidance and using a suction apparatus, the contents of the follicle are aspirated (removed). This is then inspected under the microscope and the eggs are identified.

Embryo

The term given for a fertilized egg from the time of initial cell division through the first six to eight weeks of gestation. After that time, the embryois referred to as a fetus.

Embryo Transfer

This is the second part of the IVF process where the embryos that have been grown in the lab are transferred into the uterus of the patient or a gestational surrogate.

Estradiol(E2)

This is the main hormone secreted by the ovary from the growth of the follicles under the influence of FSH. It circulates in the blood stream and can be measured as a marker of ovarian activity. It has targets around the body, so called estrogen sensitive organs, which include: breasts, vagina, uterus and the brain. It feeds back to the pituitary gland and hypothalamus, which are very sensitive to estradiol levels and will result in changes in the levels of FSH secreted by those glands. Estradiol functions by binding with estrogen receptors, to result in target organ responses.

Fibroid Tumor

A benign tumor in the uterus, which may prevent the embryo from properly implanting into the endometrium or cause pain, bleeding, miscarriage, and symptomatic enlargement of the uterus.

Fluid Ultrasonography (FUS)

This is a screening procedure that a gestational surrogate or recipient would have to undergo before receiving the any embryos. Saline is injected into the uterus and fallopian tubes, allowing ultrasound evaluation of the cavity to ensure there are no fibroids or adhesions.

Follicle

The structure on the ovary which houses the egg. It is surrounded by cells (granulosa cells), which secrete hormones responsible for the development and maturation of the egg. Each follicle houses 1 egg. Occasionally follicles may be empty (no egg inside) but that is usually related to the stimulation protocols and increases in frequency with advancing age.

Follicle Stimulating Hormone (FSH)

This is a hormone that is released by the pituitary gland to stimulate the ovaries or testicles. The donor most likely will be tested for her FSH level on cycle day 3 of her menstrual cycle. Most likely she will be taking an FSH derivative while being stimulated for the cycle as well.

FSH

This is a peptide hormone secreted by the anterior pituitary gland, under the influence of a releasing hormone secreted from the hypothalamus (GnRH –gonadotropin releasing hormone). It is acutely sensitive to feedback signals from estrogen circulating in the blood. Therefore, as the estrogen levels increase, FSH levels decrease. As the ovary ages and becomes more resistant to stimulation, baseline FSH levels rise and can be used as in index of “ovarian reserve.” It is important however, that this be done on specific days of the menstrual cycle (day 2 or 3), because under normal circumstances, FSH levels fluctuate markedly during the cycle. FSH is the main component in the medications used to stimulate patients and egg donors involved in fertility treatments.

Gonadotropins

These are hormones secreted by the pituitary gland and stimulate the gonads (hence the term gonadotropins). The two main gonadotropins are FSH and LH (Luteinizing hormone). The levels of gonadotropins fluctuate dramatically through the course of the cycle. Gonadotropins have profound and dramatic effects on the growth and function of the ovarian follicles. The ratio of FSH and LH at various times of the cycle will result in the changes of estrogen, progesterone and androgen levels secreted by the ovary.

Gestational Surrogacy

The process by which in vitro fertilization is used with a host carrier and Intended Parents. The parents use either their own gametes (egg and sperm) or those of a donor and transfer the embryos into the uterus of a host carrier. The carrier will have no biological connection to the baby and will carry the fetus to term.

Human chorionic gonadotropin (hCG)

A hormone, produced by the implanting embryo. When hCG is present in a woman’s blood it typically indicates a possible pregnancy. hCGis also given to egg donors and recipients right 36 hours before may egg retrieval to trigger ovulation. Injections of hCG may also be administered to encourage the production of progesterone the hope of promoting implantation following embryo transfer.

Implantation

This is the process that occurs when the embryo burrows into the uterine lining and hopefully stays there.

Infertility

This is term given to the inability to conceive after one full year of normal, regular heterosexual intercourse without the use of contraception.

In Vitro Fertilization (IVF or IVF/ET)

This is the process of giving a woman fertility drugs to stimulate her ovaries. The hope is she will produce a large number of mature eggs. After careful monitoring, those eggs will be retrieved and fertilized in the lab with either her partner’s sperm or a sperm donor. Those subsequent embryos are then transferred back into her uterus or the uterus of a gestational surrogate.

IVF surrogacy

That is the term given to IVF when the embryo transfer is done into a gestational surrogate.

Lupron

This is a synthetic decapeptide (10 amino acid) compound. It is very similar to a natural hormone (GnRH), which is secreted by the hypothalamus. The natural hormone is secreted every 90 minutes in pulsatile bursts and these pulsations change the amount of gonadotropins secreted by the pituitary gland. By using this synthetic analogue of the natural hormone, we are able to modify the secretions of the gonadotropins in a way to facilitate the growth of multiple follicles from the ovary. Lupron can also be used to treat certain diseases, such as endometriosis and fibroids.

Miscarriage

When an embryo or fetus spontaneously is released or ejected from the uterus.

MMPI

This is one of several psychological screening tests which can be performed on individuals/egg donors to give some assessment of their Intelligence Quotient (IQ) and psychological stability. The entire area of psychological screening tests is complex and different tests measure different psychological attributes of individuals.

Multiple Pregnancy

The presence of more than one pregnancy within the woman’s uterus at the same time.

Ovary

The organ located in the pelvis, which stores the eggs in the follicle. The ovary is also responsible for significant hormone production (estrogen, progesterone and androgens). A woman is born with all the eggs she will ever have in her life. The number then declines dramatically after birth until she enters puberty. At that time there are roughly half a million eggs in the ovaries, and each month, under the influence of appropriate hormonal signals, a cohort (group) of follicles will mature, resulting usually in the ovulation of a single mature egg, at the mid cycle. For people undergoing fertility treatments and for egg donors, it is possible to stimulate the ovaries with hormones to result in the maturation of a large number of mature eggs, which can then be removed and fertilized in vitro (in the laboratory). At the time of entering menopause, all of the eggs have been depleted. The post-menopausal ovary is responsible for hormone production.

Ovulation

This happens midcycle. It is when your ovary releases one or more eggs.

Polyps (uterine)

Outgrowths that protrude into the uterus and may cause pain and bleeding or prevent an embryo from implanting.

Profile

This is the application that the donor candidate fills out in order to participate in the ovum donor program. When the completed profile is received, the identifying information (i.e. last name, address, phone number, etc.) is removed and the data is entered into a registry for the patients to view. The recipient will select her donor based on the information provided.

Progesterone

A primary female sex hormone produced by the corpus luteum that induces secretory changes in the glands of the endometrium. Progesterone may also be given by injection or in the form of vaginal suppositories to enhance implantation and reduce the risk of miscarriage.

Prolonged Coasting

The discontinuation of hMG/FSH medication and deferring hCG administration for a number of days, while continuing GnRH agonist therapy in cases where severe ovarian hyperstimulation occurs following COH.

Quantitative beta hCG blood pregnancy test

A test that detects and measures the amount of hCG produced by an implanting embryo) in the woman’s blood. Measured nine to 11 days after embryo transfer, it can diagnose a possible pregnancy before the woman has missed a menstrual period.

Psychological Evaluation

This is an evaluation which can be performed by trained professionals to determine the mental stability of individuals. For example, if a couple wishes to have a child using an egg donor, it is important to evaluate that they are indeed ready to proceed in this direction from a psychological standpoint. This will address issues such as their acceptance of the loss they will have had to deal with by not being able to have a child using their own eggs, how this may impact their relationship in the future, their acceptance of the child, which will impact their relationship with the child and so forth. It is also important to evaluate the potential egg donor from a psychological perspective, to ensure that she wishes to become an egg donor for appropriate reasons and that she has considered this matter carefully. Trained professionals are able to guide donors and recipients through this process.

Recipient

This refers to a patient who will receive the embryos in cases where egg donation is used. They will carry the pregnancy to term and be able to breast feed the baby.

Screening

This is a general term and refers to any tests which are performed for patients or ovum donors entering treatment. It may include assessments of the uterus, ovarian function, cultures and blood tests to screen for the presence of either past or present infections (HIV, hepatitis etc.), psychological examination, etc. Screening tests are frequently tailored to the specific needs of a particular patient. For example, if there is a history of previous thyroid disease, the patient needs to have a screen of her thyroid status to ensure she is taking adequate medication and so forth. In the case of previous failed IVF attempts, an immune screen may be performed to determine that there is no evidence of immune problems which may be causing either the failure of treatment, or pregnancy losses.

Sonohysterogram (also called fluid ultrasoundexamination [FUS])

This is a screening procedure that a gestational surrogate or recipient would have to undergo before receiving the any embryos. Saline is injected into the uterus and fallopian tubes, allowing ultrasound evaluation of the cavity to ensure there are no fibroids or adhesions.

Stimulation

This is the process the of the hormonally induced development of a number of follicles through the administration of fertility drugs.

Ultrasound

This is a procedure performed by a machine which sends very high frequency sound waves (approximately 5 megahertz in wavelength) in a painless fashion, into the body. Sound travels differently through solids than it does through liquids, creating so-called echo-dense and echo-lucent patterns, respectively. Also, sound will reflect off solid and liquid interfaces and the resultant echoes can then be “captured.” By computer analysis of these echo patterns, an image can be constructed which is remarkably similar to the tissue events in the body. Because there is a strong correlation between the size of follicles and egg maturation, using ultrasound technology, accurate depictions of ovarian follicle growth patterns can be obtained, to allow doctors to change medication dosages and also to decide when to retrieve eggs. Ultrasounds can also be used to minimize the risks of Ovarian Hyperstimulation syndrome, which can occur in some patients taking these gonadotropins.

Uterus

The muscular organ that enlarges during pregnancy to accommodate a full-term fetus.