IVF vocabulary

Artificial insemination is a technique used in treating infertility in both women and men. It involves bypassing any obstructions by inserting the sperm directly into the woman’s uterus, cervix or fallopian tubes. Artificial insemination makes it possible for a woman that could not conceive naturally to get pregnant. The most common type of artificial insemination is Intrauterine insemination (IUI). This method involves placing the sperm into the uterus. More advanced techniques than artificial insemination may have higher pregnancy rates but there are some advantages. First of all, it is simple and inexpensive. It also has very few side effects. That is why it is a good option for initial infertility treatment.

Artificial insemination is used for treating many different kinds of fertility issues. It is very often recommended to men which sperm count is low or their sperm is weaker and is not able to swim to the fallopian tubes through the cervix. Women are sometimes recommended for artificial insemination in cases of endometriosis or other disorders in their reproductive organs. It is also recommended to women with unreceptive cervical mucus. In this case, sperm cannot get into the uterus or the fallopian tubes because the mucus that surrounds the cervix is hostile to it. Using artificial insemination the cervical mucus is bypassed entirely letting the sperm get into the fallopian tubes. Often women with undiagnosed infertility are also recommended to have this procedure. When you decide to have artificial insemination the doctor will make sure that you are ovulating using ovulating kits, blood tests, or ultrasound so you can undergo the treatment.

If you are ovulating then your partner must provide the semen sample. The partner will probably be asked to not have sex for 2 to 5 days before the procedure to raise the sperm count. If the clinic is not far from your house he can collect the semen sample at home by masturbation. If not then your partner will be able to use a private room for that purpose and after that, the sperm must go to the laboratory within 1 hour from the ejaculation.
Then the sperm is “washed” which rises the chance of fertilization by removing chemicals from it that could interrupt a proper conception. Next, the most active sperm is separated and collected. The last step is inserting the sperm to the uterus through the vagina and the cervix. It is a simple, short and rather painless procedure. After this you will need to lay for about 30 minutes less or more and later you can go back to normal functioning. Sometimes fertility drugs are used before artificial insemination to achieve superovulation.

Factors like older age, poor egg or sperm quality, severe cases of endometriosis and damaged or blocked fallopian tubes can have a significant influence on the success rate of artificial insemination.

Assisted hatching is a technique used in the IVF laboratory. It is used to for improving embryo implantation in the uterus. It is done by making an opening with a microscopic cut so the embryonic cells are able to easily hatch out. There is no pregnancy without the hatching of the embryo. Just before the implantation occurs, the embryo has to hatch out from its outer shell. Some embryo shells are thicker than others which lowers their ability to hatch and that makes it a lot harder to properly implant. The reasons for the thicker shells of the embryos are unknown but it may have something to do with the woman’s age. The shell lets only one sperm enter and fertilize the egg. When it is fertilized the cleaving of the embryo into a two-cell begins, then there’s the four-cell and so forth. At the moment the early cleavage stage occurs then the assisted hatching on the embryo can be conducted.

Blastocyst transfer is a process when the embryos are cultured to the blastocyst stage in the laboratory’s incubator before they are implemented into the womb. Embryos are cultured for up to 6 days and then they become blastocysts and it is easier to choose the best quality embryos.
When the best embryos are chosen they are then implanted into the woman’s womb where they have to successfully attach so that the woman can become pregnant. So it is a process very similar to the standard embryo transfer but it is implanted after it is allowed to develop for 5 up to 6 days.

The blastocyst transfer is often recommended for single embryo transfers because statistics show that in such cases it improves the chance for pregnancy. It is a very effective technique for younger women who have a good prognosis for an IVF pregnancy. Furthermore, it is often recommended if a woman had an IVF treatment in the past and she produced quality eggs but they were not able to implant properly in the womb.
Like using embryo transfer also the blastocyst transfer has a risk of multiple births and your clinic will probably suggest you do a single blastocyst transfer.

Egg donation is the process of donating eggs by a woman for the purpose of assisted reproduction or research in the biomedical field. For the purpose of assisted reproduction, it is usually used for in vitro fertilization. The eggs are fertilized in a laboratory for IVF. Sometimes eggs are frozen and stored to be used in the future.

Very often when doing IVF the woman’s eggs are of poor quality and the chances of having a successful IVF are a lot smaller. In such cases, a woman can use the services of an egg donor which is most often a young woman with healthy and high-quality eggs. With those donated eggs the patient who wants to be a parent has higher chances of a successful IVF treatment.

Egg freezing also referred by scientists as the Oocyte Cryopreservation is a technique that lets women freeze their eggs and store them until they decide to use them for reproduction purposes. This process gives women the ability to stop the ticking of the family clock for some time and let them pursue other treatment (e.g cancer), education and careers putting aside worries about not being able to have kids in the future.

Egg freezing involves retrieving the eggs from a woman’s womb, then the eggs are frozen and stored. In the future when a woman decides she wants to have kids the eggs can be thawed, fertilized and transferred to the uterus as embryos.

Egg freezing is especially for women suffering from cancer and they did not undergone chemotherapy or radiotherapy yet and want to preserve the possibility of having kids in the future. It is also an option for people who are against freezing embryos because of religious or personal beliefs. This way they are able to create only the amount of embryos they want to use and not waste any. It is also a procedure aimed at women who want to pursue other goals in life like education or career and they want to postpone motherhood not letting their eggs lose quality with time. Also, women with a history of early menopause in the family can use egg freezing to make sure their eggs are safe.

The process of egg retrieval is similar to IVF in that it involves several weeks of hormone injections for stimulating the ovaries. When the oocytes become mature they are retrieved from the woman’s body using transvaginal oocyte retrieval. The eggs are being frozen immediately after this process.

Oocytes freezing is made using vitrification – which is safe and guarantees a very good survival rate after thawing – above 97%.

A procedure is usually done under sedation, so it is not painful and the patient should be “out” for the entire process. It involves a transvaginal ultrasound to visualize the follicles. A woman has inserted an aspiration needle through the vagina straight into the follicle to aspirate the fluid that contains the egg cell from the follicle. The whole procedure takes usually about 10 minutes or a bit more. After the procedure, the patient wakes up and is monitored for about an hour and then she can go home. There might be some cramps after the procedure for a couple of hours.

A process of obtaining semen samples from sexually mature males. Eletroejaculation is a process used for treating male ejaculatory disorders but it is also used as a breeding and research program for various species. It is usually done when the patient is under a general anaesthetic. The process involves an electric probe that is inserted into the rectum next to the prostate gland and it delivers about 12-24 volts of AC at the frequency of 60 Hz with about 500 mA. After about 2-3 minutes ejaculation occurs. Caution must be used during the procedure to not burn any of the delicate tissue.

Embryo biopsy is the process of retrieving a few cells from embryos for testing purposes. It’s usually done with a laser to make sure it’s safe for embryos. Usually, embryos are frozen as the testing process takes time. Most often the embryo biopsy for PGT-A/PGS testing is done on day 5 embryos at the blastocyst stage.

The embryo is suspended in a glass-like state with high amounts of cryo-protectants in liquid nitrogen. This way the ice-crystal formation is avoided and the embryos are cryopreserved more reliably and safely. Thanks to embryo cryopreservation the surplus of embryos from the IVF cycle can be frozen and stored to be used in the future. Vitrification can be used on embryos of different stages of development. The embryologist chooses the most suitable embryos to be frozen which are later put in a special culture media – cryoprotectant. This keeps them safe during freezing and storage. With this method, the embryos can stay frozen for many years.

It simply means monitoring the state of the embryo through all different stages of development. At almost all the stages embryo must be monitored so it can be observed if the embryo is developing in a healthy way. Thanks to the embryo monitoring it can be observed early if something is not going as planned and proper action can be taken to alter this development. It is also very important for research purposes so that the embryo’s development may be carried out in better circumstances. There are special types of equipment available e.g. Embryoscope, Time-Lapse, Gerri and others – helping embryologists monitor embryos in an easy and safe way.

Women usually produce a single egg cell in a follicle while being on a menstrual cycle. Every menstrual cycle has on average about 10 follicles that struggle with each other for domination. Only one follicle with the ovum is able to continue maturing and the rest, unfortunately, has to stop growing and die. Ovarian stimulation helps the follicle develop a kind of cooperation instead of fighting for dominance. To keep it short it means that ovarian stimulation helps those eggs which in a normal situation would die off in the struggle for domination.

To encourage mature follicles (which contain egg cells) production in the ovary, various hormonal medications and drugs have to be administered for a specific extent of time. The protocols of the treatment may be different depending upon whether intra-uterine-insemination or egg retrieval by follicle puncture is applied.

The hormonal therapy which is used most often during ovarian stimulation includes the hormones which occur in the human body naturally. They are mostly administered by injections.

IVF – in vitro fertilisation is a procedure of combining eggs and sperm outside the woman’s womb in an IVF laboratory – (this is the main difference between IVF and artificial insemination in which the sperm is transferred directly to the uterus and nature does the rest.) Later when the embryo or embryos developed they are transferred to the uterus. It may sound simple but 30 years ago it really was a complicated and expensive treatment, nowadays it is more of a standard procedure.

In vitro maturation is the process of removing the eggs from the ovaries at a time when they are still not mature. Next, the proper development to a mature state is done in a laboratory before fertilization. The difference between IVM and IVF is that in the first the eggs are immature at the stage of collection. This means that the treated woman does not need as much medication before the egg collection. You may be recommended to do IVM if you are susceptible to ovarian hyper-stimulation syndrome.

The procedure of IVM involves three steps which are:
1. Eggs are collected when they are still immature at an earlier stage – this way less medication is needed.
2. In the laboratory, eggs are put in a dish in an incubator where they stay for 1 to 2 days until they are mature.
3. Finally, the eggs are fertilized when they are finally matured using the sperm of your partner or the donor. Next, the embryos are cultured and transferred into the womb.

Intra-cytoplasmic sperm injection (ICSI) is a method used in IVF which involves selecting a single sperm that is then injected directly into the egg – oocyte. Therefore it is a great treatment in cases of male infertility when a man has a very low sperm count. However not only but it can also be used in cases of other problems with sperm like poor morphology or if the sperm has very slow movement. Furthermore, it is an option for men who had a vasectomy or extremely low sperm count then the sperm can be surgically collected directly from the testicles. It can also be recommended if in past IVFs fertilization failure occurred.

This is a relatively new way of preserving the fertility of women. Ovarian Tissue Freezing is a technique that was originally developed in order to preserve the fertility of younger women who were struggling with cancer using chemotherapy and radiation. Cancer treatments very often destroy the ovaries and with that woman’s ability to bear children. Patients in this situation can have their ovaries removed and their tissue is dissected using microsurgery, the tissue is then frozen and later transplanted surgically back into the woman after she conquers cancer.

Physiological Intra-cytoplasmic Sperm Injection (PICSI) is an additional technique that can be done with intra-cytoplasmic Sperm Injection (ICSI) procedure. PICSI is used to help the embryologist in selecting the right sperm. It is a process in which a single sperm is injected directly to the matured egg. PICSI is used for treating patients with severe cases of male infertility.

The PICSI procedure mimics the natural binding of the mature sperm with the oocyte complex. This way the sperm which has been selected in the process is the same which would have succeeded in the natural process of reproduction.

Pre-implantation genetic diagnosis (PGD) is a process that gives people with inheritable diseases in their families an option to avoid passing on the disease to their children. It is a procedure that involves screening the embryos created in the IVF laboratory.

It is a very useful tool in IVF treatments which is very helpful when previous pregnancies ended due to a genetic disorder or if the patient has already given birth to a child with a genetic disease.

Parents which carry inheritable genetic disorders can test the embryos by PGD and reduce the risk of passing these disorders onto the child.

Pre-implantation genetic screening (PGS) is the process of checking the embryos for chromosomal abnormalities. Those abnormalities are often a factor that makes the embryo fail the implantation and cause miscarriage. They are also the cause of Down’s syndrome. PGS may be recommended to you if you are older than 35 years and there is a risk of having a baby with chromosomal abnormalities and if you had miscarriages in the past. You should consider PGS if your family has a history of chromosomal problems.

It is able to aspire the sperm with a needle straight from the testicle or the structure next to the testicle which also contains sperm (vas deferens). Man is under sedation and the area of the procedure is numbed with local anaesthesia. Subsequently, a small needle is introduced to the testicle and sperm is aspirated. It may sound painful but no hard pain is associated with this procedure. The whole process takes about 30 minutes.

There are various techniques of aspiring and extracting sperm:
PESA: Percutaneous Epididymal Sperm Aspiration
TESA: Testicular Sperm Aspiration
TESE: Testicular Sperm Extraction

Both PESA and TESA can be done simply in the clinics office. However TESE involves a small incision and a bit of a tissue is snipped from inside of the testicle and so it often has to be done in a hospital.

It is simply a process of preserving sperm cells. Sperm can be successfully used after cryopreservation. The longest recorded time of successfully preserving sperm in storage was 21 years. Sperm freezing can be used in artificial insemination and other fertility treatments or it also can be donated.

The process of surrogacy is an arrangement between a couple or a single person and the surrogate who agrees on carrying the pregnancy for the intended parents or parent. Very often because of some medical complications a woman cannot carry the child in her own body and she uses a surrogate. Also, male homosexual couples sometimes use the services of a surrogate to have a child.
There are two types of surrogacy:
Gestational surrogacy:
Here the pregnancy is a result of transferring the embryo which was earlier created in an IVF process. As a result, the surrogate is not genetically related to the child.
Traditional surrogacy:
Here the pregnancy of the surrogate is natural or artificial and the child is genetically related to the surrogate.

It is a surgical procedure that is done to reconnect the reproductive tract after disconnecting it in the process of vasectomy. There are two ways of doing a vasectomy reversal:

Vasovasostomy – vas deferens to vas deferens connection
Vasoepididymostomy – epididymis to vas deferens connection

Vasectomy is known as contraception in a permanent form but modern microsurgery is able to make a reversal vasectomy restoring the reproductive capabilities of a male.

Vasectomy is a procedure very often used by fathers of bigger families who do not want to risk another child, sometimes the males want to have new families and they do the vasectomy reversal.