Key Terms for you to understand

Hormones:

AMH: Anti-Mullerian Hormone is produced by the growing follicles and is a direct marker of the number of follicles rather than egg quality. This test was developed to inform IVF treatment, but not natural fertility. Lower levels are indicative of poor ovarian reserve, and higher levels are associated with polycystic ovaries. Many women with low ovarian reserve will conceive without any problems, whilst others with a good ovarian reserve may take time and need fertility treatment. AMH does not vary through the cycle, so it can be measured at any time.

FSH: Follicle Stimulating Hormone. FSH is produced by the brain and travels through the bloodstream to the ovaries, where it stimulates the growth of follicles. Although AMH is a better marker of ovarian reserve than FSH, a raised FSH level is important as it does correlate with a poorer response to ovarian stimulation during IVF treatment. As FSH levels vary through the cycle, it must be measured in the first few days of menstruation (days 2-5 of the cycle).

Fertility investigations and treatment:

Egg freezing is a method of fertility preservation, which allows women to store eggs for later use when they are ready

Embryo freezing is a process that allows the storage of embryos created during IVF treatment for later use. We use a method called vitrification to rapidly freeze embryos to ensure the best preservation.

FET (frozen embryo transfer) is a cycle in which frozen embryos created during a previous “fresh” IVF cycle are warmed and transferred into the womb

Embryo transfer is a procedure in which a thin catheter is passed through the cervix to place one or two embryos, created during IVF treatment, into the womb.

Endometrial scratching is a procedure that is offered to women with recurrent implantation failure. It involves causing a slight injury to the lining of the womb. Some studies have suggested that this may improve the chances of an embryo implanting. The mechanism is not clearly understood, but it is thought that endometrial scratching results in inflammation and that the healing process that ensues makes the lining of the womb receptive to embryo implantation.

HyCoSY (hysterosalpingo-contrast-sonography) is a type of tubal testing which involves ultrasound to confirm that the fallopian tubes are patent (open) and to check for abnormalities of the uterus and ovaries.

Hysterosalpingogram (HSG) is a type of tubal testing which involves X-ray examination of the shape of the uterus to confirm that the fallopian tubes are open (patency).

Hysteroscopy is a procedure where a very thin telescope is used to view the inside of the womb. It is used to investigate and treat some uterine conditions (e.g., fibroids, polyps).

ICSI (intracytoplasmic sperm injection) is a fertilisation technique where an individual sperm cell is injected directly into the egg cell. It reduces the risk of failed fertilisation and improves the chance of success when sperm quality is reduced.

IUI is a fertility treatment that uses a catheter to put prepared sperm in the cavity of the womb around the time of ovulation to increase the chance of conceiving

IVF (in vitro fertilisation) is a type of fertility treatment which involves taking eggs from a patient’s ovaries, fertilising them with sperm to create embryos and then placing the embryos into the womb.

OR (egg retrieval) is a procedure performed during IVF treatment where eggs are collected with the help of a needle that is passed through the vagina into each ovary under ultrasound guidance.

SSR (surgical sperm recovery) is a procedure that involves collecting sperm directly from the testicle or epididymis. It is carried out as a day case under local anaesthetic.

PESA is a type of surgical sperm recovery. It is used where sperm production is normal, but there is a blockage that prevents the sperm from entering the ejaculate.

TESA is a type of surgical sperm recovery that can be used when sperm production by the testis is decreased. It involves aspiration of fluid and tissue from the testis using a thin needle attached to a syringe or a slightly larger needle to obtain a biopsy.

RIF (recurrent implantation failure) is defined as a failure to conceive after 2-3 cycles of IVF treatment, where a number of good-quality embryos have been transferred in a woman under 40 years of age with normal ovarian reserve.

Semen analysis is a baseline fertility investigation to check the number of sperm as well as the proportion of motile sperm and sperm that have a “normal” shape.

Sperm freezing or sperm cryopreservation is a term used to describe the freezing and storage of sperm for use in future treatment.

BMI (body mass index) is a measure of the weight compared to the height. It is used to determine if a person is overweight. ICBs (Integrated Care Boards) use BMI to determine eligibility for NHS-funded IVF treatment.

Common fertility problems

Azoospermia is a medical term used to describe the absence of sperm in the ejaculate. This can be due to the blockage (obstructive) or problems with sperm production in the testes (non-obstructive).

Endometriosis is a common condition where tissue similar to the lining of the womb (endometrium) is found in other places such as the fallopian tubes, ovaries, around the bladder or bowel. Endometriosis does not cause infertility, but there is an association with fertility problems, although the cause is not fully understood.

Low ovarian reserve means that the number of eggs is reduced. Although it is associated with reduced egg quality, the ultimate marker of egg quality is age. This means that many young women with low ovarian reserve may conceive without any problem. During IVF treatment, low ovarian reserve is associated with a poorer response to ovarian stimulation, a lower number of embryos and a higher rate of failed fertilisation.

Oligospermia is a term describing a low sperm count in the ejaculate. It is often associated with reduced motility and morphology (a number of sperm with normal shape).

Retrograde ejaculation is a medical term used to describe the absence of sperm in the ejaculate; the sperm is instead found in the urine. The bladder neck muscle does not tighten correctly, resulting in sperm entering the bladder instead of ejaculating out of the body through the penis.

Polycystic ovarian syndrome (PCOS) is a condition which causes a hormonal imbalance that affects the ability of the ovaries to release eggs. With treatment, most women with PCOS are able to get pregnant.

Tubal disease is a common cause of female subfertility, which occurs when fallopian tubes become blocked or damaged. The recommended treatment for tubal disease is IVF.

Unexplained subfertility means that no cause for difficulties in conceiving has been found on baseline fertility investigations. For couples with unexplained subfertility, NICE (The National Institute for Health and Care Excellence) recommends considering IVF after two years of trying.