GLOSSARY
A
Adenomyosis
: Growth of endometrial cells in the muscular wall of the uterus. Can cause
pelvic pain, dysmenorrhea.
Adhesions:
Scar tissue that holds two anatomic structures together. Often caused by endometriosis.
A frequent cause of infertility. Usually corrected by laparoscopic surgery.
Amenorrhea:
Lack of menstrual bleeding. May be primary (never had a period) or secondary (previously
had periods). Causes include polycystic ovarian disease, hypothalamic problems,
anorexia, menopause, uterine scar tissue and low thyroid function.
Anovulation:
Lack of ovulation, resulting in rare or no menstrual periods.
Antiphospholipid
Syndrome: Diagnosed with Lupus-Anticoagulant, and anti-cardiolipin antibodies
in women with recurrent pregnancy losses and/or vascular blood clots. Treated
with baby aspirin and also heparin.
Artificial Insemination:
Placement of washed sperm into the uterus, through the vagina, with a small
plastic catheter. Often used in conjuction with ovulation induction medication.
Often effective therapy for abnormal semen.
Asherman's
syndrome: Intrauterine scar tissue. Cause of implantation
failure, and absent periods. Consequence of uterine surgery
and prior miscarriages.
Assisted
hatching: Thinning of the embryo's outer egg shell (zona
pellucida) prior to embryo transfer. Indicated for couples
with advanced maternal reproductive age, elevated FSH levels,
and prior repetitive IVF failures.
Asthenospermia:
Decreased number of motile sperm in the ejaculate.
Azospermia:
Absence of sperm in the ejaculate.
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B
Balanced translocation: Parental chromosomal abnormality
found in 2 - 5% of couples with recurrent pregnancy losses.
The total amount of DNA in each cell is normal. However,
DNA material is missing from its normal chromosomal location
and is found attached to another chromosome.
Basal body temperature
chart (BBT): Woman measures her oral temperature each morning upon awakening.
With ovulation, temperature rises approximately one half degree during the second
half of the menstrual cycle.
Beta
three (ß3) integrin: Marker of uterine receptivity.
Its absence in endometrial biopsies taken during the window
of implantation identifies reduced uterine receptivity.
Diminished b3 levels are found in women with endometriosis,
blocked fallopian tubes (hydrosalpinges), recurrent pregnancy
losses, unexplained infertility, and polycystic ovarian
disease.
Bicornuate uterus:
An uncommon congenital uterine anomaly consisting two uterine horns and one uterine
cervix. Relatively favorable prognosis for carrying a successful pregnancy. Can
be repaired by abdominal surgery.
Blastocyst:
Well developed embryo, formed five to six days after fertilization. Blastocyst
stage embryos hatch out of their "egg shell", called a zona pelucida,
then implant into the uterine wall.
Bromocriptine:
Oral medication for treatment of elevated prolactin levels. Pills taken once or
twice a day.
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C
Cervical
Mucus: Cells within the cervix secrete mucus. At ovulation, the mucus is thin
and watery, making it easy for sperm to get from the vagina to the uterus. At
other times in the menstrual cycle, the mucus is thick. Clomid can cause thick
cervical mucus at ovulation, which can be overcome with artificial inseminations.
Chlamydia: Common sexually diseases which can cause pelvic inflammatory disease,
damaged fallopian tubes, infertility, and an increased risk of ectopic pregnancy.
Clomiphene
citrate: Oral ovulation induction medication started
on cycle days three, four, or five. Doses range from one
to three pills a day. Side effects include thinning the
endometrial lining, dried up cervical mucus, headache, blurred
vision and moodiness.
Clomiphene citrate
challenge test: Definitive test of ovarian reserve. Blood is drawn on cycle
day two, three or four for estradiol and FSH. Two tablets of clomiphene citrate
are taken on cycle days five through nine. FSH redrawn on cycle day ten. High
FSH levels are indicative of poor ovarian reserve and a low likelihood of establishing
a pregnancy through in vitro fertilization.
Congenital absence of vas deferens: Men with a congenital absence of the vas deferens
produce sperm in the testicle, but have a blockage in the tubing (vas deferens)
that connects to the urethra. Fifty percent of men with congenital absence of
the vas deferens are carriers for cystic fibrosis. Pregnancies are easily established
using testicular sperm with intracytoplasmic sperm injection
Congenital absence
of vas deferens: Men with a congenital absence of the vas deferens produce
sperm in the testicle, but have a blockage in the tubing (vas deferens) that connects
to the urethra. Fifty percent of men with congenital absence of the vas deferens
are carriers for cystic fibrosis. Pregnancies are easily established using testicular
sperm with intracytoplasmic sperm injection
Corpus luteum:
After ovulation the dominant follicle transforms into a corpus luteum that makes
progesterone, critical for implantation and early pregnancy. Progesterone supplementation,
given by oral or vaginal routes, is often used for women undergoing ovulation
induction, in vitro fertilization, and for women with recurrent pregnancy losses.
Cryopreservation:
Freezing of biologic material for future thaw and use. At present, embryos
can be safely frozen for at least five years. Sperm can be frozen indefinitely.
Eggs do not freeze or thaw well, and are not routinely cryopreserved.
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D
Day
3 FSH: Blood drawn on cycle days two, three, or four
for measurement of follicle stimulating hormone is highly
predictive of ovarian reserve. Women with high FSH levels
have diminished ovarian reserve and a low likelihood of
establishing a pregnancy through in vitro fertilization.
May be done as part of a clomiphene citrate challenge test.
Dermoid
cyst: Benign ovarian cyst, consisting predominantly
of fat. May also contain bone, teeth, thyroid and hair.
Ovary containing dermoid cyst is at increased risk of twisting
(torsion). Often removed by laparotomy with ovarian reconstruction.
MRI useful in making pre-operative diagnosis.
Donor egg:
Women with diminished ovarian reserve or premature menopause have an extremely
low likelihood of establishing a pregnancy. For that reason, eggs from a young
donor can be utilized. Donor egg pregnancy rates, in our experience, have been
greater than 60% per cycle.
Donor sperm:
Commercially available donor sperm which is screened for all known sexually transmitted
diseases, is available from many suppliers. Patients select their own donor for
insemination.
Dostinex:
Oral medication for treatment of elevated prolactin levels. Pills taken twice
a week.
Dysmenorrhea:
Pain with menstrual periods. May be caused by endometriosis,
fibroids, and adenomyosis.
Dyspareunia:
Pain with intercourse. May be caused by endometriosis, fibroids,
and adenomyosis.
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E
Ectopic
pregnancy: Pregnancy found in a location outside the
uterus. Occurs almost exclusively in the fallopian tube.
Can be treated by laparoscopy or with methotrexate. Methotrexate,
a folic acid antagonist given by a single intramuscular
injection, works best in small ectopics with low bhCG levels.
Egg:
The mature female gamete, also called an oocyte.
Egg
retrieval: Minimally invasive procedure to retrieve
eggs for IVF using ultrasound guided needle aspiration through
the vagina. Typically takes 15 to 30 minutes. Painless because
of intravenous and local pain medicines.
Embryo
transfer: Placement of embryos (usually no more than
3) through the cervix into the uterine cavity under ultrasound
guidance The final step in an in vitro fertilization cycle.
Endometrial
ablation: Outpatient surgical procedure to destroy the
lining of the uterus so that it is no longer able to bleed.
Indicated for women no longer interested in childbearing
in whom excessive menstrual bleeding is a problem.
Endometrial
biopsy: Office procedure in which a small amount of
cells lining the uterine cavity are removed and sent for
pathologic evaluation.
Endometrial
polyp: An overgrowth of normal tissue lining the uterine
cavity. Polyps can cause abnormal bleeding and implantation
failures. They are easily removed by outpatient hysteroscopy.
Endometrioma:
Chocolate ovarian cyst, lined by endometiosis.
Endometriosis:
The presence of tissue usually found in the lining of the
uterus (the endometrium), in sites outside the uterus Common
endometriosis locations include the front and in back of
the uterus, pelvic sidewalls, and ovarian surfaces. More
severe endometriosis results in chocolate ovarian cysts
(endometriomas) and pelvic adhesions. Endometriosis is a
frequent cause of infertility, pain with menses (dysmenorrhea),
pain with intercourse (dyspareunia), and premenstrual spotting.
Laparoscopic laser vaporization, cauterization, or excision
are the treatments of choice. Pregnancy rates double after
laparoscopic treatment of milder forms of the disease.
Endometrium:
The tissue that lines the uterine cavity.
Estradiol:
The estrogen produced by the dominant follicle during the
first half of the menstrual cycle. Estradiol levels rise
prior to ovulation. Estradiol levels are carefully monitored
during ovulation induction and IVF cycles.
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F
Fallopian
tube: Thin elongated structure running from the uterine
cavity to the ovary. Fertilization occurs in the ampullary
portion of the fallopian tube. Fallopian tubes may be blocked
(hydrosalpinges) as a consequence of sexually transmitted
diseases. Ectopic pregnancies occur almost exclusively in
the fallopian tube.
Fertilization:
Fusion of egg and sperm membranes resulting in an embryo.
Fertilization normally occurs in the ampullary portion of
the fallopian. In vitro fertilization can be achieved by
incubating one mature egg with >100,000 motile sperm,
or by direct injection of a single sperm into an egg (intracytoplasmic
sperm injection, ICSI).
Fibroids: Also
called myomas. Benign tumors arising from the muscular wall of the uterus. Location
can be on the outside of the uterus (subserosal), in the uterine wall (intramural),
or pressing into the uterine cavity (submucosal). Fibroids cause uterine enlargement,
heavy and abnormal vaginal bleeding, bladder pressure, need for frequent urination,
and pelvic pain. May interfere with reproduction, especially if submucosal in
location.
Fimbria:
Finger-like projections at the end of the fallopian tubes. Normal fimbria are
critical for normal tubal function. Fimbria are often destroyed by pelvic infections
including gonorrhea and chlamydia.
Fimbrioplasty:
Surgical repair of damaged fimbria, often performed laparoscopically.
Folic
acid: Vitamin started preconceptionally by women of
reproductive age, which reduce the fetuses' risk of a neural
tube defects by 80%.
Follicle:
Structure within the ovary that houses an egg. The follicle
fills with fluid and makes estrogen as the egg inside it
gets closer to ovulation. Followed with serial transvaginal
ultrasonography during ovulation induction and IVF cycles.
Follicular
phase: The first half of the menstrual cycle prior to
ovulation.
Follicle
stimulating hormone (FSH): Released by the pituitary
gland in response to GnRH released by the hypothalamus.
Measured to assess ovarian reserve either on cycle day 3
or as part of a clomiphene challenge test. Responsible for
the selection and growth of follicles/eggs. Clomiphene citrate
works by increasing pituitary secretion of FSH. Women take
FSH injections for ovulation induction and IVF.
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G
Galactorrhea:
Breast milk secretion in women not breast feeding. Caused by benign brain tumor
(prolactinoma), psychiatric medications, chest surgery, and excessive breast stimulation.
Gametes:
eggs and sperm
Gonadotropin:
The hormones
FSH (follicle stimulating hormone) and LH (lutinizing hormone) needed for ovulation
and sperm production. FSH and LH are made in the pituitary gland in response to
Gonadotropin Hormone Releasing Hormone (GnRH) made in the hypothalamus. Gonadotropin
Hormone Releasing Hormone (GnRH): Small protein hormone made in the hypothalamus
part of the brain. GnRH release causesd the pituitary to make FSH and LH, with
subsequent ovulation.
Gonorrhea:
Common sexually diseases which can cause pelvic inflammatory
disease, damaged fallopian tubes, infertility, and an increased
risk of ectopic pregnancy.
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H
Human
chorionic gonadotropin (hCG): The hormone produced by
the placenta. hCG levels normally double every other day
in early pregnancy. Slowly rising hCG levels indicative
of an impending miscarriage or an ectopic pregnancy. Purified
hCG is injected to trigger ovulation or egg maturation during
ovulation induction and IVF cycles respectively.
Human
menopausal gonadotropins (HMG): Urinary FSH products
utilized for ovulation induction and in vitro fertilization.
Common brand names include Humegon, Repronex, and Pergonal.
Hydrosalpinges:
Blocked dilated fallopian tubes frequently result of chlamydia or gonorrhea
infection, prior pelvic surgery and ruptured appendix. Opening hydrosalpinges
by a laparoscopic laser procedure results in low pregnancy rates. In vitro fertilization
is the treatment of choice. Frequently, hydrosalpinges are removed prior to in
vitro fertilization to maximize the likelihood that an embryo will implant in
the uterus.
Hyperprolactinemia:
Elevated prolactin levels cause by small benign tumor (prolactinoma) in the pituitary
part of the brain. Hyperprolactinemia causes infrequent or absent menstrual periods
and production of breast milk in a woman who is not breast-feeding (galactorrhea).
Hyperprolactinemia is usually treated with the medications Parlodel or Dostinex.
Hypothalamic
amenorrhea: Infrequent ovulation due to lack of the
pituitary releasing follicle stimulating hormone. Can be
caused by abnormalities in prolactin and thyroid function.
Frequently noted among athletic young women with little
body fact. Treated successfully with injectable gonadotropins
if pregnancy is desired.
Hypothalamus:
Small area of the brain responsible for regulating many
different hormones including luteinizing hormone, follicle
stimulating hormone, thyroid stimulating hormone, cortisol
and prolactin.
Hysterosalpingogram:
Outpatient test performed in radiology to asses the shape
of the uterine cavity and whether the fallopian tubes are
open.
Hysteroscopy:
Procedure in which a telescope is inserted through the vagina
into the uterine cavity to carefully examine the shape of
the uterus. Fibroids and polyps can be identified. Frequently
performed in our office using a very small flexible hysteroscope.
This procedure results in minimal discomfort. It is video
taped so that patients can view the images as well as the
physician. If abnormalities of the uterine cavity are identified,
hysteroscopy in the operating room can result in the safe
removal of polyps, fibroids, or correction of structural
congenital uterine anomaly.
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I
Implantation: Invasion of the human embryo (a blastocyst) through the uterine
lining, and into the muscle of the uterus. The uterus is receptive to implantation
six to ten days after ovulation during a normal menstrual cycle.
Infertility:
Unprotected intercourse for more than one year without establishing
a pregnancy.
Intracytoplasmic
sperm injection (ICSI): In vitro fertilization method
to allow men with low sperm count, motility, or normal forms
to achieve fertilization. Direct injection of a single sperm
into an . In our experience pregnancy rates are essentially
the same for conventional IVF and ICSI.
Intramuscular
Injection: Injection into the muscle of the backside.
Method to administer human menopausal gonadotropins and
hCG.
Intrauterine insemination: Painless, quick, office
procedure where concentrated sperm is placed into the uterus
with a small flexible catheter. Indicated for infertile
couples with abnormal semen analyses, or in conjunction
with ovulation induction.
In vitro fertilization (IVF): Fertilization of egg and sperm outside of
the body. The most effective form of infertility therapy. Indicated in couples
with male factor infertility, unexplained infertility, endometriosis, and damaged
fallopian tubes, among others.
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L
Laparoscopy:
An out-patient surgical procedure where a small camera
is inserted through the umbilicus to visualize the pelvis.
Typically one to three additional small incisions are made
above the pubic hair line so that other instruments can
be placed. Very effective method for treating endometriosis,
pelvic adhesions, ovarian cysts, hydrosalpinges, and pelvic
pain.
Laparotomy:
Surgical opening of the abdominal wall. Frequently needed
for treating fibroids and ovarian dermoid cysts.
Lupron:
A GnRH agonist. This subcutaneous medication is usually
started one week after ovulation as a twice daily injection.
Lupron desensitizes the hypothalamus thereby creating a
pseudo-menopause. Estradiol levels are consequently undetectable.
Lupron is an important medication for in vitro fertilization
and in selected patients undergoing ovulation induction
with injectable FSH.
Luteal
phase: The second half of the menstrual cycle, after
ovulation.
Luteal
phase defect: Inadequate progesterone production or
effect that does not allow normal implantation. Cause of
recurrent pregnancy loss. Diagnosed by two consecutive out
of phase endometrial biopsies, or repetitively low serum
progesterone levels in the mid-luteal phase.
Luteinizing
hormone (LH): Released by the pituitary. Causes ovulation.
Elevated in women with polycystic ovarian disease.
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M
Menopause:
Total depletion of eggs resulting in the cessation of menstrual periods. The average
age of menopause in the United States is 52 years, and 50 years for smokers.
Menstrual Cycle:
Orchestrated sequence of release of hormones made in the brain (FSH and LH) that
leads to ovulation, and ovarian production of estrogen and progesterone. If pregnancy
is not established, regular menstrual bleeding occurs.
Microsurgery:
Delicate surgery using a microscope or glasses with high magnification. Most commonly
needed for putting fallopian tubes back together after tubal ligation.
Myoma:
Also called fibroid. Benign tumors arising from the muscular
wall of the uterus. Location can be on the outside of the
uterus (subserosal), in the uterine wall (intramural), or
pressing into the uterine cavity (submucosal). Fibroids
cause uterine enlargement, heavy and abnormal vaginal bleeding,
bladder pressure, need for frequent urination, and pelvic
pain. May interfere with reproduction, especially if submucosal
in location.
Myomectomy:
Surgical removal of fibroids either hysteroscopically or
by an abdominal approach.
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O
Oligomenorrhea:
Infrequent periods. See anovulation.
Oligospermia:
Low sperm count.
Oocyte:
An egg.
Ovarian reserve:
The number and quality of eggs remaining in a woman. Ovarian reserve diminishes
over time, especially in the transition from the late 30's to the early 40's.
Ovarian reserve can be assessed with measurement of follicle stimulating hormone
(FSH) on cycle day 3, or by clomiphene citrate challenge test.
Ovary: Pelvic
organ where eggs are ovulated and the hormones estrogen and progesterone made.
Ovulation:
The release of mature egg from a follicle.
Ovulation
induction: Use of medication to recruit and develop
of many eggs. Clomiphene citrate, Lupron, and injectable
FSH are used for ovulation induction and IVF. Frequently
coupled with intrauterine inseminations.
Ovulation
predictor kit: A way to measure for luteinizing hormone
in urine. Ovulation occurs twenty-four to thirty-six hours
after detection of a change in the ovulation predictor kit.
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P
Pap
smear: Performed during a routine pelvic examination.
Cells from the cervix are scraped, fixed on a slide, and
sent to a laboratory for careful microscopic analysis. Pap
smears detect precancerous changes of the cervix that can
be treated before the lesion
progresses to frank cancer.
Pelvic
inflammatory disease (PID): Infection of the fallopian
tubes and ovaries by gonorrhea or chlamydia. Characterized
by fever and lower abdominal pain. Frequently requires hospitalization.
Most common cause of hydrosalpinges with resultant infertility
and increased risk of ectopic pregnancy.
Pituitary:
The master gland of hormonal regulation. Releases luteinizing
hormone, follicle stimulating hormone, thyroid stimulating
hormone, prolactin, ACTH, vasopressin, and oxytocin.
Polycystic ovarian
disease (PCO): Characterized by infrequent menstrual periods, excess facial
hair growth, obesity and infertility. Recent studies have shown that insulin plays
a central role in the development of polycystic ovarian disease. Serum free testosterone
and LH levels are elevated. Most women with PCO ovulate with clomiphene . Metformin,
a drug that lowers insulin levels, can be added in women who don't respond to
clomiphene alone.
Post-coital
test: A small sample of cervical mucus is looked at under the microscope within
12 hours of intercourse. Ideally the mucus is thin and watery, and 10 to 20 motile
sperm are seen.
Preimplantation
Genetic Diagnosis (PGD): A single cell from an embryo created with In Vitro
Fertilization (IVF) can now be tested for extra chromosomes, such as 21 (Down's
syndrome) as well as others. PGD may be considered for women with multiple prior
miscarriages, advanced maternal age, and women with many prior failed IVF cycles.
In addition, couples with known histories of severe inherited genetic diseases
can also be tested, and normal embryos transferred.
Premature
ovarian failure: Menopause occurring before the age
of 40. Occurs in 1% of the general population. Associated
with other endocrine abnormalities including low thyroid
levels, abnormal adrenal function, diabetes, and abnormal
parathyroid hormone release.
Presacral neurectomy:
Laparoscopic removal of nerve tissue overlaying the sacrum. An effective form
of pain relief for women with chronic midline pelvic , dysmenorrhea, and endometriosis.
Dr. Freedman has safely performed over 100 laparoscopic presacral neurectomies.
Primary infertility:
Lack of pregnancy after one year of unprotected intercourse, for a woman who has
never been pregnant before.
Progesterone:
Hormone produced by the corpus luteum after ovulation. Progesterone
levels should be at least 10 ng/ml one week after ovulation.
Serum progesterone levels are carefully monitored during
ovulation induction and IVF cycles. Progesterone is often
supplemented either orally or by vaginal gel in the second
half of the menstrual cycle after ovulation induction or
in vitro fertilization.
Prolactin:
Pituitary hormone that regulates breast milk production.
When prolactin levels are elevated, ovulatory dysfunction
may result. Frequently caused by small benign pituitary
tumor (prolactinoma). Successfully treated with oral medicines,
such as bromocriptine.
Provera:
Synthetic progesterone medication. Can be used to bring
on a period for women who have polycystic ovarian disease
and infrequent menstrual periods.
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R
Recombinant
FSH: Injectable gonadotropin used for ovulation induction
and in vitro fertilization. Can be administered subcutaneously.
Results in recruitment and growth of many follicles and
eggs.
Recurrent
pregnancy loss: Two or three consecutive miscarriages.
Causes are multiple including structural uterine abnormalities,
antiphospholipid syndrome, thyroid disease, balance translocations,
and sporadic chromosomal abnormalities of the fetus.
Retrograde
ejaculation: Frequently seen in men with diabetic complications
or neurologic injury. Low semen volume is noted because
most of the ejaculate refluxes into the bladder. Can be
treated with medication, isolation of sperm from urine and
subsequent intrauterine inseminations, or IVF.
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S
Salpingectomy: Removal of a fallopian tube. Almost always done laparoscopically.
Indicated for removal of fallopian tubes severely damaged by gonorrhea or chlamydia,
and in cases of ectopic pregnancies.
Salpingostomy:
Opening of a fallopian tube. Almost always done laparoscopically The most common
surgical procedure for removal of ectopic tubal pregnancies, which preserves the
fallopian tube.
Secondary infertility:
Lack of pregnancy after one year of unprotected intercourse, for a woman who has
been pregnant before.
Semen
analysis: Evaluation of the human ejaculate for volume,
count, motility and appearance (morphology). Specimen should
be produced after two to three days of abstinence and brought
to the laboratory within thirty minutes of production.
Speculum:
A small metal device used to visualize the vaginal walls
and cervix.
Sperm:
The mature male gamete.
Subcutaneous
injection: Injection into the fat with a small needle.
Subcutaneous injections are utilized for Lupron, recombinant
FSH, and Repronex.
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T
Teratazospermia:
Increased number of abnormally shaped sperm in the ejaculate.
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U
Ultrasound:
Radiographic method for measurement of ovarian follicle
growth and uterine lining thickness during ovulation induction
and in vitro fertilization. Follicles, which contain eggs,
are easily visualized. Ovulation is triggered when a follicle
measures between 16 and 20 mm. Transvaginal ultrasound is
also used to guide embryo transfer catheter for perfect
placement of embryos during IVF.
Unicornuate
uterus: An uncommon congenital uterine anomaly. Only
one uterine horn forms instead of two. Two ovaries are present.
Very good prognosis for carrying a successful pregnancy.
Increased risk of breech fetal presentation.
Uterine
anomaly: A birth defect resulting in abnormal uterine
shape. Includes septum, bicornuate, unicornuate, and others.
Uterine
receptivity: The ability of the uterus to allow for
an embryo to implant. Uterus is receptive only during the
window of implantation, from six to ten days after ovulation.
Markers of uterine receptivity, such as the b3 integrin,
have been extensively researched by Dr. Castelbaum and colleagues.
Uterine
septum: Congenital uterine abnormality associated with
recurrent pregnancy loss and breech pesentations. Septums
are easily resected using a hysteroscope, in an outpatient
surgery procedure.
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W
Window
of implantation: The time during the menstrual cycle
when the uterus will allow implantation of an embryo. The
uterus is only receptive from six to ten days after ovulation.
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Z
Zona pellucida:
The outer protein covering of an egg. Sperm binds to it prior to fertilization
of the egg. Embryologists can thin the zona pellucida just prior to embryo transfer
in IVF cycles (assisted hatching).
Zygote:
The fertilized egg.
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