It seems so simple at first blush. Infertility means that a couple who wants to get pregnant just can’t. As soon as you start to dive a little deeper, though, the acronyms and jargon start flying. Secondary infertility. IVF. IUI. PCOS. TTC. Now you have to wade through both infertility and alphabet soup to have your baby.
In this post, I try to shed a little light on these terms, especially since you’ll see a lot of them here on How Do You Do It? over the next week.
Hop onto any (in)fertility-related message board, and you’ll see these acronyms in use:
- TTC: Trying to conceive. When a couple is TTC, the woman will often…
- POS: Pee on a stick. Take a generic pregnancy test. A lot of women do this many times before seeking help from a fertility specialist. And that brings me to…
- BFP: Big fat positive pregnancy test, whose less popular relative is the…
- BFN: Big fat negative pregnancy test.
- You might also wonder what secondary infertility is. I did. It’s an inability to get pregnant after delivering one or more kids without…
- ART: Assisted reproductive technologies. ART covers pretty much all methods of conception beyond sex without contraception.
Infertility, from a medical perspective, is defined as:
- An inability to get pregnant after 12 months of trying (regular unprotected sex), 6 months for women over 35 years old. OR
- Two consecutive miscarriages, or pregnancy loss in the first half (20 weeks) of the pregnancy. The death of a baby between 20 weeks and birth is called stillbirth.
12 ovulation cycles with no pregnancy to show for it can feel impossibly long, but that’s the official definition. Plenty of couples know there’s something wrong well before the 1-year mark, and kicking off the process of diagnosis doesn’t have to wait a full year of TTC. And the loss of one pregnancy can bring you to your knees, forget about two.
The first step in seeking out assisted reproductive technologies to overcome infertility is to get a diagnosis. This involves a lot of testing. The first step is to narrow down whether one or both partners is infertile. When the infertility diagnosis is the woman’s alone, this is called female infertility or female factor infertility. When the male is diagnosed, it’s male infertility or male factor infertility. Not infrequently in infertility testing, both partners are diagnosed with some reproductive problem. Unfortunately, even more frequent is unexplained infertility, where doctors can’t identify the source of the problem. The symptoms of unexplained infertility can be treated, but since the underlying cause isn’t understood, it can’t be specifically addressed.
Some of the tests include:
- A hysterosalpingogram (HSG) is an X-ray of the inside of a woman’s uterus and fallopian tubes.
- A hysteroscopy is a way to look at the lining of a woman’s uterus. The viewing tool is inserted through the vagina and up into the uterus.
- Laparoscopy is surgery that allows a doctor to insert a lighted tube into a woman’s pelvis through an incision to look around. This is commonly used to definitively diagnose endometriosis.
- Pelvic exams are standard, and most women are encouraged to have one every year. The doctor examines your vulva, vagina, cervix, uterus, fallopian tubes and ovaries visually and by feel.
- Semen analysis is the examination of a man’s semen for how many sperm there are and how they move.
- A sperm penetration assay (SPA) checks whether a man’s sperm can join with an egg.
- Transvaginal ultrasound allows a doctor to see a woman’s ovaries and uterus. The ultrasound wand is inserted in the vagina. This procedure is also common early in pregnancy when abdominal ultrasounds don’t provide a very good image.
A number of different medical specialists can participate in diagnosing and treating infertility
- An andrologist is a doctor who specializes in male fertility.
- You probably already know your obstetrician/gynecologist (ob/gyn), the doctor who specializes in women’s health, especially pregnancy, childbirth, and reproductive disorders.
- Reproductive endocrinologists (REs) are specialists in the hormones related to reproduction.
- A urologist, or genitourinary surgeon, is an expert in both male and female urinary tracts and male reproductive organs.
Common diagnoses for infertility include:
- Endometriosis is a condition in which a woman’s uterine lining tissue (endometrium) grows outside the uterus. This tissue can cause blockages. There can be huge variation in how and where the tissue grows and exactly how it contributes to infertility.
- In an ovulatory disorder, a woman’s ovaries do not consistently release eggs. Clomid is a common medication prescribed to encourage ovulation.
- PCOS (polycystic ovary syndrome) is a condition in which a woman grows small cysts in her ovaries and has hormonal problems. PCOS can have a wide array of health consequences in addition to infertility. A low estradiol or E2 level can indicate PCOS.
- A varicocele is an enlargement of a vein in a man’s scrotum, kind of like a varicose vein.
- Intrauterine insemination (IUI) is the placing a man’s sperm inside a woman’s uterus. This is a relatively straightforward and simple approach to tackle infertility.
- In-vitro fertilization (IVF) is the fertilization of a egg in a laboratory, followed by transfer into the mother’s uterus. Several steps are involved.
- Controlled ovarian hyperstimulation with follicle-stimulating hormones (FSH) encourages a woman’s ovaries to produce multiple eggs ready for fertilization. The trigger shot is the final dose of medication that sets ovulation in motion.
- Egg retrieval uses vaginal ultrasound to locate the eggs and aspiration to remove them from the woman’s body.
- Sperm retrieval usually takes one of two forms.
- Most often, the man provides his own sample through ejaculation. I don’t think I need to explain that here.
- Testicular Sperm Extraction (TESE) is a surgery to retrieve sperm directly from the testes.
- Sperm washing separates sperm cells from seminal fluid.
- The sperm are mixed with the eggs in the lab and allowed to fertilize them.
- Laboratory staff examine the fertilized eggs after they’ve divided a few times for embryo quality. Each embryo is given a grade between 1 and 4, where 4 is in the best shape to grow into a baby.
- In embryo transfer, promising embryos are placed in a woman’s uterus , in the hope that at least one will implant in the uterine wall and grow into a bouncing baby.
- Viable embryos that are not being immediately transferred can undergo embryo cryopreservation, being frozen for future use.
- Intracytoplasmic sperm injection (ICSI) involves the direct injection of a man’s sperm into a woman’s eggs. This is done in a laboratory in place of just mixing the eggs and sperm and letting them do their thing.
- Sometimes, the mother isn’t a good candidate for embryo transfer. In this case, the parents-to-be may opt to use a gestational surrogate, a woman who will accept the embryo transfer, go through the pregnancy of behalf of the mother, and give the baby to his/her parents after birth.
- Parents with frozen embryos in storage may decided that their family is complete or otherwise choose not to transfer their remaining embryos. In such a case, the couple can choose to participate in an embryo adoption, where they give their embryos to another parent to transfer, gestate and raise as her own.
After the Procedure
As you might expect, after working this hard to help an infertile couple become pregnant, doctors monitor the woman very closely to determine whether she has, in fact, become pregnant.
- Clinic pregnancy tests are far more sensitive than the home POS kind. Medical staff will draw the woman’s blood and measure her human chorionic gonadotropin (hCG) level. An hCG level of over 100 is considered to be positive test result. You may also see hCG test referred to as beta hCG or just beta.
- Multifetal reduction is the controversial practice of decreasing the number of fetuses in a woman’s womb to increase the chances of a healthy pregnancy for the remaining fetuses. This is usually considered in higher-order multiple pregnancies, of triplets or more, due to the high chance of premature delivery and related complications.
What other terms have you encountered in fertility clinics?
This post is part of Infertility Tales 2014, How Do You Do It?‘s series to raise awareness about infertility and its impact on families. Please take a moment to read through some of the personal stories of loss, pain, fertility treatments, and success.