Yesh Tikva’s “Insider’s Guide to Infertility” will help you learn what you need to know about infertility.
Infertility is defined as the inability to conceive after one year of trying for women under 35 or after six months for women over 35, or the inability to carry a pregnancy to live birth (recurrent pregnancy loss).
1 in 6 couples in the United States suffer from infertility (World Health Organization (WHO), April 2023).
About a third of infertility is attributed to the male partner, a third to the female partner, and third is attributed to factors in both partners or is diagnosed as “unexplained infertility.” Though many people think of infertility as a women’s problem men too are affected.
Many different treatment options exist, including drug therapy, surgical procedures, and reproductive technologies such as Intrauterine Insemination (IUI) and In Vitro Fertilization (IVF). Consult with a Reproductive Endocrinologist or Reproductive Immunologist for the best results.
Approximately 20% of all pregnancies will end in a miscarriage due to a non-recurrent cause. According to the American Society for Reproductive Medicine (ASRM) recurrent pregnancy loss is the loss of two or more consecutive pregnancies. A pregnancy loss is defined as a clinically recognized pregnancy ending before 20 weeks gestation.
Some of the causes for recurrent pregnancy loss include chromosomal abnormalities, blood clotting disorders, autoimmune disorders, uterine or cervical abnormalities, untreated infections including chlamydia and gonorrhea, advanced maternal or paternal age, as well as unexplained factors.
Many different treatment options exist, including drug therapy, immunotherapy, surgical procedures, and reproductive technologies including In Vitro Fertilization (IVF) with Preimplantation Genetic Diagnosis (PGD). Consult with a Reproductive Endocrinologist or Reproductive Immunologist for the best results.
According to the Society for Assisted Reproductive Technology (SART), IVF, the treatment with the highest chances of success, has the following live birth rates:
| Age of Woman | <35 | 35-37 | 38-40 | 41-42 | >42 |
| % of cycles resulting in live births | 40.1% | 31.4% | 21.2% | 11.2% | 4.5% |
The national average for an IUI is $3000. The national average for a fresh IVF cycle is $12,400 (ASRM), plus another $3,000-5,000 on medication (RESOLVE). Additional technologies, such as Preimplantation Genetic Diagnosis (PGD), which increase the chance of success of an IVF cycle, cost between $3,000-6,000.
Most reproductive technologies are not covered by insurance and must be paid “out-of-pocket.” Only eighteen states have either an insurance mandate to offer fertility coverage to employers or an insurance mandate to cover some level of infertility treatment. Even with insurance, many companies only cover some elements of a given reproductive treatment. Only eight of those states have an insurance mandate that requires qualified employers to include some form of fertility coverage in their plans offered to their employees: Arkansas, California, Connecticut, Delaware, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Hampshire, New Jersey, New York, Ohio, Rhode Island, Texas, Utah and West Virginia. (ASRM- more information available here.)
According to a study conducted at the New England Deaconess Hospital in Boston (Domar, A.D., Zuttermeister, P.C., & Friedman, R., 1993) patients with an infertility diagnosis suffered from depression and anxiety on levels equivalent to those with life threatening illnesses including cancer, heart disease, and hypertension.
An infertility diagnosis can create a significantly distressing life crises, especially as a member of a Jewish community where others are building and expanding their families and most rituals revolve around family and children. The inability to conceive and the loss of potential create significant feelings of loss, similar to the loss of pregnancy. Additionally, dealing (usually alone) with multiple medical decisions, lengthy waiting periods, uncertainties, and the loss of control, leads high levels of emotional distress and turmoil for many individuals and couples.
Egg freezing is the process of stimulating egg production (as done in the first phase of an IVF cycle) for retrieval and storage as a form of fertility preservation for future use in an IVF cycle. According to FertilityIQ it is estimated that this year 10,000 women in the US will freeze their eggs.
According to the American Society for Reproductive Medicine (ASRM) egg freezing is not a guarantee for achieving future pregnancy. The chance that one frozen egg will yield a baby in the future is around 2-12%. Therefore, when considering egg freezing it is important to consult with a doctor to ensure that enough eggs are retrieved and frozen for future use.
According to the ASRM, based on a comparison of IVF cycles using frozen eggs with IVF cycles using frozen embryos, the chances of achieving live birth ranged from 4-14% per egg frozen and 35-61% per embryo frozen.
The cost of an average egg freezing cycle with medication is approximately $16,000. The average clinic cost is $11,000 plus on average $5,000 for medication. Additionally, there are annual storage fees to keep eggs frozen and this on average costs $3000 a year, varying by clinic and state. (There are some third-party storage facilities and some are less expensive- though there are costs to transport the oocytes from the clinic to the facility and then again back to the clinic when ready for use.) Like other fertility treatments most insurance companies do not yet cover the costs.
Note: The following article is informational only and should not be construed as legal advice. If you would like legal advice, you are welcome to contact me for a consultation or a referral to a lawyer in your area.
After months – or maybe years – of trying to get pregnant, you find yourself in a doctor’s office considering IVF. The stress, the cost, the nerves – it all adds up, when all you’ve really wanted was a baby. And then, a medical staff person plunks down a pile of papers with small print. “Standard informed consent paperwork,” they tell you, and maybe they offer an opportunity for you to take it home and review it. Considering the urgency and longing you feel to get the process moving as quickly as possible, the impulse to check random boxes, sign the documents and shove them back under the nose of the person who handed them to you is only natural.
But, as your friendly neighborhood family formation lawyer, I’m here to beg you to take your time when filling out medical consent forms for IVF and keep your eyes open for a few key considerations. When people really want to get pregnant, it’s often hard to think about what may happen in the future, and no one likes to think about the possibility of death or divorce, but it’s my job to make sure that my clients work through these and other tough questions. Whether or not you decide to have a lawyer review the consent forms for you, DO NOT sign them until you feel comfortable that you understand what they say and what you are agreeing to.
Medical consent forms cover a lot of ground, including risk, medical procedures, and liability, but in this article, I am going to focus on the disposition of embryos for couples and individuals who have contributed their own gametes (sperm or egg) with the intention of becoming a parent. If you are using donor sperm or egg – whether from someone you know or an anonymous donor – you (hopefully) are already working with a lawyer for the donor agreement. Sometimes those agreements can conflict with what you sign in the doctor’s office or supersede the clinic forms entirely. Be sure to check in with your lawyer if you’re not sure how the forms will impact each other. But for couples who are using both their own sperm and egg, sometimes, a lawyer doesn’t end up in the picture…unless something goes wrong.
Here are a few pointers for couples to consider when signing clinic agreements related to embryos…to hopefully keep the lawyers away in the future:
As much as no one likes to think about it, splitting up is a reality for many, many couples. In some divorce proceedings, one spouse has wanted to keep and use remaining frozen embryos, while the other has wanted them thawed or donated to science or to another couple. Generally speaking, courts will not enforce a contract that “forces” one person to become a parent against their will. However, there have been special considerations and exceptions made when the person seeking to become a parent has no other option to have genetically related children in the future, for example, if they underwent chemo and no longer can produce any viable eggs. The final decision depends on state law, any contracts that have been signed, and the judge ruling on the case.
Have you talked to your spouse or significant other about what would happen to any remaining frozen embryos if you split up… …before getting pregnant? …during the pregnancy? …after having children?
How you feel now may change if your relationship dissolves. Is the moment when your relationship is breaking apart the time in which you want to be bound by a contract you signed when you were trusting your partner to raise a child with you? While courts may not find the contract enforceable, do you really want to have to fight in court over embryos when you’re already going through a divorce? Consider whether the contract has a mediation clause or another type of “escape valve.” Almost all contracts can be revoked and/or updated with the mutual written consent of the parties involved, so it’s often not too late to change your mind jointly.
Another topic that people don’t like to think about is death. Generally, surviving spouses will take responsibility for the remaining embryos and their future disposition, but what that means is a very personal decision. Additionally, there have been cases in which both spouses have died and the parents of one of the spouses sought to hire a surrogate to carry and give birth to their grandchildren whom they would raise. Clearly, this is a complicated scenario that may or may not be reflective of the choices you would make for your own family.
How would you feel about your spouse or significant other using the embryos that you created together in the event of your death? Would you want your spouse to go ahead and continue to try to have your children after you pass away or would you want the embryos disposed of in some other way? How about if your spouse was the one to pass away? If there are children born after your death, do you want them to inherit from your estate along with any children you had before your death?
What if (heaven forbid) both of you pass away in a car accident or some other disaster? Even if you clearly don’t want the embryos used in the event of both of your deaths, what do you want done with them? If you have wills, trusts, or other testamentary documents, consider updating them with explicit instructions on what to do with any of your frozen gametes. No one likes to have to make those decisions without knowing what you would have wanted. Consider it a gift to your future heirs. Additionally, some courts have ruled that without explicit written instructions from the person who passed away, no one has a right to use the genetic material at all, so make sure you’ve put your desires in clear writings.
Even if everything goes according to plan and you and your partner have as many babies as you’d hoped, and everyone is happy and healthy, many people still end up with leftover frozen embryos.
Have you discussed what you would want done with those?
Sometimes clinics charge fees for continuing to store embryos. At what point would you rather stop paying those fees and find a way to do something with them?
While some people are fine with thawing the embryos or donating them to science, for others, the choice of what to do with them is influenced by beliefs in terms of when human life begins. For some, those beliefs may shift throughout the family formation journey. Donating embryos to other couples seeking to have children may be a preferred option for some. And for others, a “compassionate transfer” is the best choice, in which the embryos are transferred at a time in the woman’s cycle and in a way in which a pregnancy would be highly unlikely.
Make sure that you have a serious conversation with your significant other about how you want your embryos treated in these different scenarios. And make certain that those choices are adequately and accurately reflected on the medical consent forms. If the forms don’t reflect what you both want, don’t be shy! Write what it is that you do want on the forms. At the end of the day, the most important thing is to show what your intent is, and if you sign the forms without reading them – or without thinking about these contingencies – it will be that much harder to figure out what to do if one of these situations comes up.
Two additional considerations may be important as you make these decisions:
1. Medical consent forms are often electronic now instead of on paper. Editing or modifying them to fit your needs may be more challenging than it was when you could literally take a pen to them and cross things out. Still, don’t let that prevent you from making the changes you need.
2. Despite best efforts, the medical consent forms are still just that – medical consent. And there is an argument to be made that medical consent can be withdrawn for any procedure at any time. If you want something that will be more likely to be upheld in court if there is a dispute, you may want to consider hiring a lawyer to write a direct contract between the two of you, rather than just signing off on the clinic forms.
With all of the medical research you do on this journey, don’t forget to protect yourself legally as well. As the saying goes – an ounce of prevention is worth a pound of cure! I wish you the best and hope that by getting you to think about these issues today, I’ve helped ensure that you won’t ever need to deal with them in the future.
Note: The following article is informational only and should not be construed as medical advice. If you would like medical advice, please contact a registered dietitian (RD or RDN), certified nutrition specialist (CNS) or your medical practitioner. You can read an in-depth analysis on different nutrition credentials here.
The journey to motherhood can be painful, exciting, and confusing. It seems like everyone who eats is a nutrition expert, dishing out advice to help you in your fertility struggle. As women who are also dietitians, we understand your confusion, as well as the problems it can cause. We want to help you overcome obstacles in your journey to motherhood while helping clear up the role of nutrition in fertility: where nutrition can help, where nutrition isn’t a factor, and where your nutrition information should come from.
A quick Google search of “fertility and nutrition” will bring up 113,000,000 results – and you may have tried 112,999,999 of those. We live in a culture which blames nutrition for everything while simultaneously looking toward nutrition to solve every health issue imaginable. We like to feel that we have some amount of control over our bodies, but when they seem to fail at the natural process of getting pregnant, we feel a profound lack of control. It is tempting to try to gain power over our bodies by following “the perfect diet”. This comes from the best of intentions, but unless indicated, nutritional changes can range from useless to harmful.
A woman who is considering nutrition modifications should discuss them with an educated and credentialed healthcare practitioner who can make recommendations based on the full picture of her health, taking into account her personal experience, her medical history, and her diagnosis. This is because making changes to food choices may have a profound impact on a woman’s health and fertility. Nutrition choices that benefit one diagnosis can actually worsen another. Additionally, changes to diet can result in increased stress and isolation as menu options become narrowed and social events are missed. Any changes made must be appropriate in the context of a woman’s unique situation.
An initial conversation with your healthcare team may present some clarity, but it doesn’t delve deep enough to warrant changes to your grocery list or menu choices. We seek emotional support from friends and family, and while loved ones (and strangers at the grocery checkout) mean well, the nature of medical and fertility needs means that meaningful nutrition information must come from a source who is well-versed in nutritional science as well as fertility.
By seeking out a registered dietitian (RD or RDN) or certified nutrition specialist (CNS), you can be confident that the information provided will be helpful in identifying nutrition-related conditions such as PCOS, thyroid issues, hypothalamic amenorrhea, or disordered eating. Having a solid diagnosis is the first step toward appropriate treatment. If you do not yet have a diagnosis, the first step is contacting your preferred reproductive endocrinologist for a workup. There is no nutrition plan that will help prior to diagnosis.
Many women embark on weight loss diets with the hope that doing so will improve their fertility. For a woman who feels she weighs too much, dieting may seem like a harmless first step; after all, dieting is so common nowadays that it sometimes feels hard to find someone who isn’t dieting. However, dieting and/or overexercise aren’t innocuous. It isn’t only the stereotypical girl with anorexia who suffers the health consequences of restriction. Rapid weight loss and/or consistent under eating can affect cycles in women of any size.
Functional hypothalamic amenorrhea (FHA), a condition in which a woman stops getting her period, is commonly caused by inadequate nutrition and over-exercising and does not only occur in very thin people. If a woman’s cycles have become irregular or go missing entirely, her eating and activity levels should be examined. She may have FHA or she may meet clinical criteria for an eating disorder. A woman with FHA will benefit from meeting with a dietitian who is experienced in treating this condition, typically a dietitian who specializes in eating disorders. The dietitian will help with modifying her diet and activity levels to restore menstrual function. Because it can be challenging to make these changes and deal with any associated shifts in body size or appearance, it may also be wise to see a psychotherapist. It’s important to recognize that FHA can almost always be resolved with the appropriate lifestyle modifications.
If a woman has an eating disorder, then she will need more intensive treatment, including a team of an eating disorder dietitian, therapist, physician, and sometimes others including a psychiatrist. Resolving an eating disorder may be challenging but full recovery is absolutely possible. A woman who begins the work of eating disorder treatment prior to pregnancy is better equipped for the postpartum stage as well as parenthood.
Polycystic ovarian Syndrome (PCOS) is one of the most widely-known diagnoses affecting fertility. The high circulating levels of hormones called insulin and androgens manifest in a variety of ways and mean that PCOS can affect fertility, metabolism, and overall health. This condition is also associated with chronic low-grade inflammation. PCOS can be improved with lifestyle modifications, which may include changes to diet, but do not require the extreme measures often promoted. Under eating and experiencing increased stress levels are things that can actually worsen PCOS, as well as contribute to rebound overeating. Consulting with a registered dietitian with experience treating PCOS can help a woman make healthy and appropriate changes. She should seek out a professional with a non-diet philosophy, an experienced professional who sees the number on the scale as one piece of data rather than meaningful or diagnostic information. She might also benefit from seeing a psychotherapist to help her with stress reduction and navigating the emotional challenges of having PCOS and experiencing infertility.
Even if a woman has unexplained infertility, or infertility that is not a result of a nutrition-related condition, she may still fall prey to the many fads that are a part of wellness culture. There is an abundance of products and protocols that claim to heal a wide spectrum of problems and conditions, including infertility. When a woman is desperate to have a baby, she may be vulnerable to making choices that seem promising in the moment but turn out to be less than wise in the long run. By receiving guidance from a qualified medical professional, a woman can avoid purchasing inappropriate supplements, pursuing restrictive diets that lead to nutrient depletion and/or rebound binge eating, and spending months and months down various dead-end roads.
Who should be advising you? We mentioned registered dietitians (RD or RDN) and certified nutrition specialists (CNS). What about nutritionists and health coaches? Neither is a defined term, meaning the professional in question may have a solid education, but may not. Health coaches are in a similar boat.
When evaluating a professional, you want to ask a few questions:
What is your level of formal education?
Where did you go to school?
What are your credentials?
Although it may be tempting to follow a strict set of food rules when pursuing pregnancy and feeling frustrated, your path will be smoother when following advice given by the appropriate healthcare practitioner and targeted to your individual diagnosis and life circumstances.
Progesterone in Oil*, or PIO, is a seemingly scary medication to administer based on the needle size alone. The reason for the needle being MUCH larger than the other medications you may take during the fertility process, is because these are INTRAMUSCULAR and need to get into the muscle.
Please note that these injections are not the only method available for progesterone administration. Other methods are vaginal suppositories and vaginal gels. Some women find progesterone injections to be quite painful (during the injection itself and/or as aftereffects on the body), thus if your doctor prescribes the injections, you should feel free to discuss with him or her if other methods are an option for you. Personally I had a better experience with injections, my body responded better to them in terms of maintaining appropriate hormone levels and I did not enjoy the messiness of suppositories (tip: be sure you wear a pad if using suppositories as they will leak during absorption).
Every woman is different- so don’t be afraid to speak up and talk to your doctor about what is right for you! Bottom line, if your situation calls for progesterone injections, we hope that these suggestions will reduce the difficulty and give you more control and power over the process.
Here is the regimen I followed to take my shots, and it is based on tips from friends on forums as well as my nurses:
Once I got this system down, there was NO PAIN. In fact, I got so good at it that when my husband went on an overnight work trip, I was able to administer it myself. I hope this routine give you encouragement to make it through these shots all the way through your first trimester.
Before you begin, even on the day or your transfer, ask your nurse to draw circles with a sharpie on your upper bum cheeks so that you, or your husband, know the areas where the injection should go.
Once you are home, and it is time to take your shot:
1. Fill a small cup with hot water.
2. Draw up the progesterone with the larger needle. (if your pharmacy gives you 2 needle sizes)
3. Tap it to make sure there are no air bubbles inside, and push the plunger up so a tiny bit comes out and there are no air bubbles inside.
4. Stick the syringe (with the top on it) into the hot water.PIO is VERY thick, so this will heat the oil and make it thinner and therefore easier to push the medication out of the syringe.
5. Take an ice pack to numb the location where the needle will go on your backside.
6. When ready, remove the syringe from the cup and replace the needle with the smaller one.
7. Which “upper bum cheek” should you choose?
– Rest all your weight on one leg, that leg’s muscle will be tight and will tighten the bum cheek as well.
– The other leg’s muscle will be loose and the injection should go on the loose leg’s bum cheek to minimize pain.
– (Reverse sides for the next night.)
8. Pick a spot for injection and place two fingers on the site and then pulling the skin tight by separating those two fingers into the shape of a “V”
9. Inject the needle into the spot between the two fingers where the skin is taught.
10. You should pull back a little on the plunger to make sure you have not hit a vein, and should not see blood. If you do see blood, remove the needle, toss it and begin again in a new location.
11. After the needle is out, massage the injection site with a hot towel to keep the medication heated and thin to get down into the muscle. This also prevents blistering.
12.Some also say to walk around after to get the circulation moving.
Once you have this guide, you will be in total control of what you need to do, and will even be able to administer it yourself in front of a mirror. Good Luck!!
Anti-cardiolipin Antibody
Adrenal Corticotropic Hormone
Aunt Flo, After Flo, (Period, or Menstrual Cycle)
Assisted Hatching
A procedure in which the outer covering of the embryo is partially opened to facilitate embryo implantation and pregnancy
Artificial/Assisted Insemination
Anti-nuclear Antibodies
Anti-phospholipid Antibodies
Activated Partial Thromboplastin Time
Assisted Reproductive Technology
An umbrella term for fertility treatments
Anti-sperm Antibody
American Society of Reproductive Medicine
Baby Aspirin
Basal Body Temperature
BBT is your body’s temperature when you are fully at rest
Tracking BBT can predict ovulation
Ovulation will raise your BBT
Birth Control Pills
Baby Dance, a reference to having intercourse during your most fertile days
Pregnancy test that measures HCG hormone levels
A test that measures the amount of HCG in the blood
HCG is Human Chorionic Gonadotropin and is produced by the placenta during pregnancy
A positive Beta HCG is 25 mIU/mL and indicates a pregnancy
An HCG level of less than 5 mIU/mL is considered negative for pregnancy
Big Fat Negative (Pregnancy Test)
Big Fat Positive (Pregnancy Test)
Bloodwork
Computer-assisted Semen Analysis
Cycle Buddy, someone who either started the cycle, ovulated, or is planning to take a pregnancy test around the same time as you.
Congenital Bilateral Absence of Vas Deferens
Clomiphene Citrate Challenge Test (Clomid Challenge Test)
This test is frequently used before IVF treatments begin to determine the likelihood for success
CCCT looks at the ovarian reserve and qualities of eggs remaining
Some doctors only prescribe this test if you are over a certain age, usually 37
Involves a blood draw around day 3 of your menstrual cycle to evaluate FSH (follicle stimulating hormone)
Followed by 5-6 days taking 100 mg of clomiphene citrate until day 10 of your cycle when FSH will be measured again
Cycle Day, a reference to the days of a treatment cycle or any menstrual cycle when trying to conceive
Cover Line, refers to a line drawn on a body basal temperature chart. Temperatures “above the cover line” occur after ovulation.
Cervical Mucus
Cytomegalovirus
Certified Nurse Midwife
Controlled Ovarian Hyperstimulation
A technique used to assist reproduction involving fertility medications which induce ovulation from multiple ovarian follicles
https://www.ccrmivf.com/services/ivf-fertilization/controlled-ovarian-hyperstimulation/
Cervical Position
Cycle Number, since TTC or since starting a treatment.
Chorionic Villus Sampling
Prenatal testing of the fetus for chromosomal or genetic disorders
A sample of chorionic villi is removed from the placenta for testing
Usually done between weeks 11 and 14 of pregnancy
Diminished Ovarian Reserve (DOR)
A woman’s ovarian reserve refers to her reproductive potential: the quality and quantity of her eggs
Diminished ovarian reserve means those factors are decreasing
Aging is the primary cause of DOR
Dilation & Curettage
Dilation & Evacuation
Donor Eggs
Diethylstillbestrol
Dihydroepiandrosterone
Donor Insemination, as you would have with IUI along with a sperm donor
Direct Intra-peritoneal Insemination
Diminished Ovarian Reserve
Days Post-Ovulation
Days Post-Retrieval
Days Post-Transfer
Days Post 3-Day Transfer
Days Post 5-Day Transfer
Estradiol
A type of estrogen secreted by the ovarian follicles
Helps trigger the rest of your reproductive cycle
Elevated levels tend to indicate issues with ovarian reserve and FSH
Endometrial BiopsyEstimated Due Date
A medical procedure which takes a sample of the lining of the uterus
Endometriosis
A condition in which tissue that normally lines the uterus grows in places outside of the uterus
Most commonly involves the ovaries, fallopian tubes and tissue lining the pelvic area
The tissue, although not lining the uterus, continues to respond to the reproductive cycle
It thickens and bleeds along with the menstrual cycle
Can be very painful especially during menstruation
Inflammation and irritation caused by endometriosis can impact fertility
Early Pregnancy Test
Egg Retrieval
Egg Transfer
Embryo Toxicity Assay
A test to detect embryo toxicity factor which in elevated amounts can be toxic to the embryo and cause loss of pregnancy during implantation or the first trimester
Embryo Toxicity Factor
A cytokine secreted by the immune system’s white blood cells in response to pregnancy
If too much ETF is present it may perceive the embryo as foreign and may attack it to maintain the body’s health
Egg White Cervical Mucus, or the most fertile kind of cervical mucus
Fasting Blood Glucose
Frozen Embryo
Frozen Embryo Transfer, referring to an IVF cycle using previously frozen embryos that have been thawed and then transferred
When previously frozen embryos are transferred into a woman’s uterus during the appropriate time of her menstrual cycle
Sometimes medication is taken prior to FET to ensure the endometrium is prepared for the transfer
Follicle-Stimulating Hormone (FSH)
A hormone that stimulates the growth of ovarian follicles in the ovary before they release an egg from one follicle at ovulation
Increases estradiol production
Can be used as a fertility medication to stimulate the ovarian follicles
Fasting Insulin
Fertility Friend, FertilityFriend.com
Fetal Heart Rate
Follicular Phase
Fertility Mucus or Fertility Monitor
First Morning Urine
Frozen Embryo
Follicle-Stimulating Hormone
Fertile Thoughts to All
Gestational Diabetes
Gastrointestinal
Gamete Intrafallopian Transfer
One of the methods of ART
Eggs are removed from a woman’s ovaries and are mixed with a man’s sperm inside a catheter and then placed in one of the fallopian tubes
Fertilization occurs within the fallopian tube
Not frequently done anymore
Gonadotropin-Releasing Hormone
Causes the pituitary gland to release luteinizing hormone and FSH → cause ovaries to make estrogen and progesterone
Triggers the ovaries to mature and ovulate eggs
Just before menstruation, GnRH pulses are more frequent
General Practitioner
Gestational Surrogate
Glucose Tolerance Test
Human Chorionic Gonadotropin
Proper consideration and effort has been made to find an adoptive family within the child’s country of origin.
A major goal of the Hague is to prevent the abduction, sale, and trafficking of children and to safeguard their best interests during the adoption process.
Higher Order Multiples (a pregnancy with three or more babies)
Hormone Replacement Therapy
Hysterosalpingogram
An HSG is an x-ray procedure used to assess whether the fallopian tubes are patent (open) and if the inside of the uterus is normal.
History
Immunobead Binding Test
Intra-cervical Insemination
Intra-cytoplasmic Sperm Injection
An IVF procedure in which a single sperm cell is directly injected into the cytoplasm of an egg
Embryo is then transferred into the uterus after evidence of fertilization
Infertility
Insulin and Glucose Tolerance Test
International Council on Infertility Information Dissemination
Intramuscular injections
Immature Oocyte Retrieval
Insulin Resistant
Intra-tubal Insemination
Intra-uterine Growth Restriction
Intra-uterine Insemination
Intra-vaginal Culture
In Vitro Fertilization and Embryo Transfer
A process when an egg retrieved from a woman is fertilized by sperm from a man in a petri dish in a lab and then the subsequent embryo is transferred into the woman’s uterus
In Vitro Fertilization/IVF with Donor Eggs
Intravenous Immunoglobulin
Leukocyte Antibody Detection Assay
Laparoscopy
Luteinizing Hormone
Hormone produced by gonadotropic cells in the pituitary gland
A sharp rise in LH triggers ovulation and development of the corpus luteum
Leukocyte Immunization Therapy
LIT is typically used after multiple failed IVF cycles and when immunologic reasons are suspect as the primary barrier
LIT is a procedure when the white blood cells from the man are injected into the woman to introduce the immune cells to prepare for pregnancy
LIT aims to prevent the mother’s immune system from attacking an embryo due to unfamiliarity with the father’s genes
https://www.cnyfertility.com/fertility-treatments/lit-therapy/
Last Menstrual Period (start date)
Luteal-Phase
Luteal-Phase Defect
Low Sperm Count
Luteinized Unruptured Follicle Syndrome
Miscarriage after Infertility
Miscarriage
Microsurgical Epididymal Sperm Aspiration
Typically performed in men who have vasal or epididymal obstructions
Sperm is extracted from the epididymal tubules
A large number of sperm can be retrieved
http://urology.ucla.edu/mens-clinic/microsurgical-sperm-retrieval
Male Factor
Non-stimulated Oocyte Retrieval In (office) Fertilization
Non-Surgical Sperm Aspiration
Procedure where a small needle is used to take sperm directly from the testis
Typically used if men do not have sperm in their ejaculate or cannot ejaculate
NSA is done in conjunction with ICSI because testicular sperm cannot enter eggs on their own
https://www.givf.com/fertility/maleinfertility.shtml
Ovulation
A condition that includes oligozoospermia, low sperm count, asthenozoospermia, poor sperm motility and teratozoospermia, abnormal sperm shape
Oral Contraceptives
Ovum Donor, Ovulatory Dysfunction
Ovarian Hyperstimulation Syndrome
Medical condition that can occur when a woman takes fertility medication to stimulate the development of eggs in the ovaries
Can be mild or severe
Symptoms often occur within 10 days after using injectable medications
Weight gain
Nausea
Vomiting
Diarrhea
Tender ovaries
Abdominal pain
Mild form of OHSS can go away after a week, if pregnancy occurs OHSS may worsen and last several days or weeks
https://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/syc-20354697
Ovulation Predictor Kit or Test
Over the Counter
Progesterone
Plasminogen Activator Inhibitor-1
Pregnancy After Infertility
Polycystic Ovaries
Hormonal disorder that causes enlarged ovaries and cause the development of cysts around the outer edges of the ovaries
Can impact the functionality of the ovaries
Women with PCOS may experience irregular or prolonged menstrual cycles or excess male hormone levels (androgen)
https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
Polycystic Ovarian Disease
Primary Care Physician
Post Coital Test
PCT assesses the quality of the cervical mucus and sperm survival following intercourse before ovulation
Not exceedingly accurate and somewhat controversial
This is not usually performed.
Percutaneous Epididymal Sperm Aspiration
When fluid is removed from the epididymis (may or may not include sperm) using a syringe
Typically done when there is an obstruction issue
More easily done by urologists
https://www.urologyhealth.org/urologic-conditions/sperm-retrieval
Pregnant
Pre-implantation Genetic Diagnosis
Primary Infertility
Pelvic Inflammatory Disease
An infection of the female reproductive organs
Occurs when sexually transmitted bacteria spread to the uterus, fallopian tubes or ovaries
Can be caused by untreated STDs
Can be treated if it is diagnosed early; can’t reverse any damage already done to the reproductive organs
https://www.cdc.gov/std/pid/stdfact-pid.htm
Progesterone In Oil
Paternal Leukocyte Immunization
Perinatal Mortality
Prenatal Vitamin
Pee On A Stick (home pregnancy test)
Products of Conception
Premature Ovarian Failure
Primary Ovarian Insufficiency
Loss of normal ovarian function before age 40
Ovaries fail and do not produce sufficient estrogen nor release eggs regularly
Periods are irregular; however, women can still become pregnant
Restoring estrogen levels in women with POF can help prevent some complications such as osteoporosis
https://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/syc-20354683
Premature Rupture of Membranes
Partial Zona Dissection
Society for Assisted Reproductive Technology
Stillborn
Stimulated Cycle Oocyte Retrieval
Sonohysterogram
Imaging study of the uterus
Special type of ultrasound
Fluid is put into the uterus via the cervix
Fluid helps show more detail than a normal ultrasound
Can detect abnormal uterine growths, scar tissue, abnormal uterine shape, problems with the uterine lining, and if the fallopian tubes are obstructed
Usually done post menstruation but before ovulation
Surrogate Mother
Sperm Count
Sperm Penetration Assay
Subsequent Pregnancy After a Loss Support
Sexually Transmitted Disease
Sub-zonal Insertion
Type 1 Diabetic – Juvenile Diabetes
Type 2 Diabetic – Insulin Resistant, Adult Onset
Thyroxine (Thyroid Hormone)
Testosterone-Estradiol Binding Globulin
Therapeutic Donor Insemination
Testicular Sperm Aspiration
Done with men who are getting sperm for IVF/ICSI
A needle is inserted into the testicle and tissue/sperm is aspirated
A sufficient amount of tissue/sperm isn’t always acquired
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sperm-retrieval-procedures
Testicular Sperm Extraction
A small incision is made in the testis and the tubules are examined for the presence of sperm
Typically sperm from this procedure will by cryopreserved for future IVF/ICSI
MicroTESE has replaced this as the optimal procedure for retrieval of sperm in men who do not have sperm in their ejaculate
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sperm-retrieval-procedures
Therapeutic Sperm Extraction
Tubal Embryo Transfer
Tubal Ligation
Toxoplasmosis, Other, Rubella, Cytomegalovirus & Herpes Test
Tubal Reversal
Thyroid Releasing Hormone
Thyroid Stimulating Hormone
Trying To Conceive/ Trying to Conceive After Reversal
Two Week Wait
Treatment
Within Normal Limits
Zygote Intra-fallopian Transfer

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