Glossary

Adhesiolysis
Surgical removal of adhesions, usually during an out-patient Laparoscopy procedure. Adhesions are fibrous scar tissue that forms when tissue heals and cause adjacent organs to stick together. Adhesions in the abdomen may be painful when pulled or stretched, because fibrous tissue is not elastic. Adhesions found around reproductive organs can occur following a previous pelvic surgery, infections such as a ruptured appendix or pelvic inflammatory disease (PID) or pelvic injury.

Advanced Laparoscopy
An out-patient surgical procedure where a surgeon with advanced surgical skills and training in pelvic reconstruction (such as a board certified Reproductive Endocrinologist Infertility specialist) inserts a mini-telescope (endoscope) into the abdomen to view the pelvic organs. Surgical instruments can be inserted with the mini-telescope to perform surgical removal of adhesions, cysts, endometriosis and to reconstruct pelvic structures such as the fallopian tubes that have been damaged, infected or tied in the past. Generally, a pelvic Laparoscopy involves making two to three tiny incisions that require one or two sutures to close. One incision is generally at the bottom portion of the umbilicus (your belly button) and one or two in the pubic hair area either to the right or left or both.

Amenorrhea
The absence of menstruation. Causes include, Hypothalamic Hypogonadism, Polycystic Ovarian Disease, Hyperandrogenism, Hyperprolactinemia, Hyperthyroidism, Premature Ovarian Failure, and starvation (Anorexia Nervosa). Medical treatment can be prescribed for most cases except those with premature ovarian failure. An egg donor could be considered for women with premature ovarian failure.

Andrologist
A medical professional specializing in male fertility and assisted reproductive technology (ART). Houston Infertility Clinic's Andrologist, board certified Dr. Neil Stoddart is onsite, involved and overseeing all aspects of the Andrology lab performed.

Anovulation
The absence of ovulation. Failure to ovulate account for up to forty percent of women with infertility. It may present in a variety of clinical manifestations, including amenorrhea, irregular menses and hirsutism. Causes of Anovulation include, Hypothalamic Hypogonadism, Polycystic Ovarian Disease, Hyperandrogenism, Hyperprolactinemia, Hyperthyroidism, Luteal Phase Defect, and Premature Ovarian Failure. Medical treatment can be prescribed for most cases except those with premature ovarian failure. An egg donor could be considered for women with premature ovarian failure.

Artificial Insemination
Any of the various techniques whereby sperm is introduced to the female by means other than sexual intercourse, also referred to as Intrauterine Insemination (IUI). The insemination can occur with the husband's sperm or a donor sperm. For Intrauterine Insemination, the semen is collected, washed and processed to isolate the strongest sperm, concentrated and placed into a sterile medium. The concentrated sperm is then loaded into a syringe with a small thin catheter attached. The catheter is then inserted through the vagina, into the cervical opening where the sperm are placed high in the female reproductive tract (the uterus) to enhance the chance of successful fertilization.

Assisted Hatching
This technique is used to improve the probability of the embryo's implantation. Assisted Hatching involves the Embryologist opening a small hole in the outer membrane known as the zona pellucida of the embryo. This opening improves the ability of the embryo to leave its "shell" and implant into the uterine lining. Patients that may benefit from Assisted Hatching (AH) include those with previous In vitro Fertilization (IVF) failure, poor embryo growth rate, moderate to excessive cytoplasmic fragmentation and women with advanced maternal age.

Basal Body Temperature Test (BBT)
The temperature of a woman taken with a special thermometer every morning upon waking prior to any activity. A slight rise in temperature around mid-cycle (approximately day 14) would suggest ovulation and when in the cycle it occurred. The increase in temperature is due to the progesterone production by the corpus luteum that occurs after ovulation. Monthly BBT's will show a pattern for the patient and provide valuable information to the doctor about your menstrual cycle. Basal Body Thermometers may be purchased at any pharmacy and come with instructions and a chart to record the daily temperature.

Blastocyst Culture
In the past most embryos produced with IVF were transferred on day three of development, known as cleavage stage. When an embryo reaches five days of development it is called a blastocyst. Currently, with advances in understanding of the needs of developing embryos, the ability to produce blastocysts in the laboratory has increased. This extended culture time allows nature to help select those embryos with the highest capacity to produce a pregnancy. Culturing and transferring blastocysts on day five of development allows the transfer of fewer embryos while still maintaining a high pregnancy rate. Normally only two blastocyst stage embryos are transferred, thus reducing the risk of multiple gestations higher than twins.

Blocked Fallopian Tubes
Blocked or damaged fallopian tubes may interfere with the egg and sperm uniting. Blockages such as hydrosalpinx, may also negatively affect the embryo development and implantation in the uterus. Blocked/damaged fallopian tubes can be caused by a previous infection, such as an earlier episode of pelvic inflammatory disease (PID), history of ruptured appendix, or abdominal surgery. Often, there are no symptoms associated with blocked or damaged fallopian tubes. Treatment of tubal problems or pelvic scarring may require specialized surgery, depending on each woman's situation.

Cervical Mucus
Estrogen levels peak just prior to ovulation providing maximal stimulation of the cervical glands producing an outpouring of clear, watery mucus. This mucus produced by the cervix permits and encourages the passage of sperm into the uterus during ovulation.

Cervical Problems
When the body is not ovulating, cervical mucus helps prevent infection by killing bacteria. However, at the time of ovulation cervical mucus should change to encourage sperm survival. Cervical problems may be related to the consistency of the cervical mucus or cervical anatomy, which will not allow the sperm to enter the uterus. Abnormal cervical anatomy can be congenital or as a result of surgeries such as LEEP's or conizations done to treat abnormal pap smears.

Cetrotide
An injectable medication that is used during fertility treatment to prevent unwanted, early ovulation. A premature ovulation would result in the release of an immature egg that would have a decreased chance of fertilization.

Clomid
Clomid/Serophene/Clomiphene Citrate is a pill taken daily for approximately 5 to 6 days early in the cycle, usually day 2 thru 7. It works by stimulating the body to release more FSH and LH so that follicle development and ovulation can occur. Clomid/Serophene/Clomiphene has been found to induce ovulation in 82% -85% of women who were not ovulating before treatment and 40% of these women achieved pregnancy. Most pregnancies will result in single births, 10% or less will result in twins and less than 1% resulting in triplets or higher. The majority of patients who respond to Clomid/Serophene/Clomiphene citrate ovulate during the first month of therapy. Most pregnancies occur within 3 months of therapy. If pregnancy doesn't occur after 3 months of treatment, you should consider further evaluation so your doctor can determine additional treatment options.

Clomiphene Citrate
Clomid/Serophene/Clomiphene Citrate is a pill taken daily for approximately 5 to 6 days early in the cycle, usually day 2 thru 7. It works by stimulating the body to release more FSH and LH so that follicle development and ovulation can occur. Clomid/Serophene/Clomiphene has been found to induce ovulation in 82% -85% of women who were not ovulating before treatment and 40% of these women achieved pregnancy. Most pregnancies will result in single births, 10% or less will result in twins and less than 1% resulting in triplets or higher. The majority of patients who respond to Clomid/Serophene/Clomiphene citrate ovulate during the first month of therapy. Most pregnancies occur within 3 months of therapy. If pregnancy doesn't occur after 3 months of treatment, you should consider further evaluation so your doctor can determine additional treatment options.

Co-Culture of Embryos
The embryos of some couples have cytoplasmic fragmentation resulting in poor quality embryos. By culturing these embryos with cells similar to those that line the woman's fallopian tubes and uterus, the fragments can be reduced and the quality of the embryo improved.

Congenital Pelvic Abnormalities
Some patients may be born with structural birth defects of the vagina or uterus. Some of these defects can be easily corrected with minor surgery such as Hysteroscopy or Laparoscopy prior to achieving pregnancy.

Controlled Ovarian Hyperstimulation
Stimulation of the ovaries with various injectable hormonal medications such as Follistim, in order to develop as many follicles as possible as well as to control the timing of ovulation. This process is used with Intrauterine Insemination (IUI) and In vitro Fertilization (IVF).

Corpus Luteum
An ovarian follicle that has ruptured and released an egg. The Corpus Luteum produces Progesterone which is required to prepare the lining of the uterus for implantation.

Cryopreservation
A process used to freeze and preserve embryos (fertilized eggs) and gametes (sperm). Once embryos and gametes are frozen and stored, they remain viable for long periods of time. Cryopreservation (freezing) of embryos is utilized when the number of embryos produced during an IVF cycle exceeds the number of embryos placed in the uterus on day three or five embryo transfer. Once frozen, these embryos may be thawed and transferred in another cycle at a later time without hormonal ovarian stimulation and retrieval. Gamete cryopreservation (freezing) is used to freeze sperm so that it can be used at a later time. The process of freezing unfertilized eggs unfortunately has not shown to proven to be reliable at this time. Frozen embryos and gametes can be transferred from one IVF facility to another via a transportable cryo storage tank.

Dysmenorrhea
Painful cramping around the time of menstruation sometimes caused by endometriosis. Uterine lining tissue found outside the uterus, often inside the peritoneal cavity on the ovaries, fallopian tubes, uterus, bowels and bladder. It is a major cause of infertility. Treatments include laser surgery by Laparoscope, and medical management.

Ectopic Pregnancy
Development of an embryo outside the uterus, usually occurring in the fallopian tube. A delay in the transport of the fertilized egg results in implantation within the tube wall, which is too thin to sustain growth. The tube then ruptures and may hemorrhage, which can be a serious and potentially life threatening condition.

Egg
The female cell of reproduction. Each oocyte (egg) measures about 0.04 inch (0.1 mm) in diameter. There are about one million immature oocytes present in each ovary at birth; only about two hundred per ovary ever mature to be released at ovulation during a woman's fertile years. If fertilization occurs, the oocyte develops into an embryo.

Egg Donation
Eggs are donated for patients who have lost their ovaries, have premature ovarian failure or advanced maternal age. These donors are screened for genetic, psychological and health abnormalities, sexually transmitted diseases including HIV, smoking, drinking and recreational drug use. Physical characteristics are provided to help match various traits if desired. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

If you are interested in becoming an egg donor and are between the ages of 21 and 30, and a non-smoker, please call or email our patient advocate to see if you qualify. Compensation of $3,500.00 and up is paid to our egg donors.

Embryo
A fertilized egg. An embryo develops from an egg, fertilized by sperm. It is the cell produced when a sperm fertilizes an egg. It is referred to as an embryo until it reaches eight weeks of pregnancy, after that it is referred to as a fetus.

Embryo Biopsy
This procedure is used to detect certain types of genetic birth defects. Some couples who are at an unusually high risk for genetic abnormalities in their children based upon family or past reproductive history may choose to have a cell removed from the embryo for detection of the genetic abnormality. The biopsy is performed in the IVF laboratory a few days after fertilization. Embryos that do not demonstrate the genetic abnormality are then transferred back into the uterus or frozen for future use.

Embryo and Gamete Cryopreservation
A process used to freeze and preserve embryos (fertilized eggs) and gametes (sperm). Once embryos and gametes are frozen and stored, they remain viable for long periods of time. Cryopreservation (freezing) of embryos is utilized when the number of embryos produced during an IVF cycle exceeds the number of embryos placed in the uterus on day three or five embryo transfer. Once frozen, these embryos may be thawed and transferred in another cycle at a later time without hormonal ovarian stimulation and retrieval. Gamete cryopreservation (freezing) is used to freeze sperm so that it can be used at a later time. The process of freezing unfertilized eggs unfortunately has not shown to proven to be reliable at this time. Frozen embryos and gametes can be transferred from one IVF facility to another via a transportable cryo storage tank.

Embryologist
A medical professional specializing in embryo development and embryo micromanipulation. Houston Infertility Clinic's board certified Embryologist Dr. Stoddart is onsite and personally handles all embryo development and testing. His level of expertise is crucial in achieving the high success rates we have seen in our patient population.

Emotional Counseling
Infertility and the treatment can be very stressful at times. We offer emotional counseling with a Ph.D. who has many years experience with Infertility. Reducing stress may help increase your fertility.

Endometrial Biopsy
The removal of a sample of the lining of the uterus for microscopic examination. This usually done in an office setting with mild discomfort such as menstrual like cramps. A thin catheter is placed through the cervical opening, suctioning a thin strip of tissue from the endometrium.

Endometriosis
Fragments of the endometrium (the lining of the uterus) may travel from the uterus into the pelvic cavity via the fallopian tubes. They then implant on parts of the pelvic organs (such as the uterus, ovaries, fallopian tubes, vagina, cervix, bladder and rectum). The patches of endometrium continue to respond to the menstrual cycle and bleed each month, causing the formation of painful cysts. Endometriosis is most prevalent in women between the ages of twenty five and forty. It is a common cause in infertility. Ten to fifteen percent of infertility patients have endometriosis and thirty to forty percent of women who have endometriosis have infertility. Treatments include laser surgery by Laparoscope, and medical management.

Endometrium
The membrane that lines the inside of the uterine cavity. It increases in thickness during the menstrual cycle until ovulation occurs. The surface layers are shed during menstruation if conception does not take place.

Epididymis
A long, coiled tube connecting the vas efferentia (small tubes leading from the testicle) to the vas deferens (the sperm duct leading to the urethra). Sperm cells produced in the testicle pass slowly along the epididymis, maturing there until they are capable of fertilizing an egg. They are then stored in the seminal vesicles until ejaculation.

Estradial
The most important of the estrogen hormones (female sex hormones). They are essential for the healthy functioning of the reproductive system and for breast development. This hormone is produced by developing follicles in the ovaries. Measuring the level of estradiol during ovarian stimulation (ovulation induction) helps determine progressive growth of the follicle.

Estrogen
The female hormone produced mainly by the ovaries. Estrogen is essential for normal female sexual development and for the healthy functioning of the reproductive system.

Fallopian Tubes
The tube that extends from the uterus to the ovary. The fallopian tube transports eggs and sperm and is where fertilization takes place. The funnel shaped tube is about three inches long. The narrow end opens into the uterus and the free, the expanded end, divided into fimbria (fingerlike projections), lies close to the ovary. Its muscular wall is lined with cells with cilia (hairlike projections). The fimbria sweep up the egg after it is expelled from the ovary. The beating cilia and waves of muscular contractions propel the egg toward the uterus. After intercourse, sperm swim up the fallopian tube from the uterus. The lining of the fallopian tube and its secretions sustain the egg and sperm. They also encourage fertilization and nourish the egg until it reaches the uterus.

Fallopian Tube Reconstruction
A surgical procedure in which a damaged fallopian tube is repaired to treat infertility using microsurgery to unblock the delicate tubes. The fertility rate following surgery varies from five to fifty percent, depending on how badly the tube was damaged to start with and whether other causes of fertility exist. Ectopic pregnancy is more common in women who have had diseased tubes or tubal reconstruction than in those with healthy tubes. The most common form of damage is secondary to a previous tubal ligation.

Fertilization
The union of a sperm and an ovum. In natural fertilization, this occurs after sexual intercourse. Fertilization may also occur as a result of semen (sperm) being artificially introduced into the cervix (artificial insemination), or may take place in the laboratory (In vitro fertilization).

Fibroid
Benign tumor of the uterus. Fibroids consist of smooth muscle bundles and connective tissue that grow slowly within the uterine wall. As the fibroid enlarges, it may grow within the muscle so that the uterine cavity is distorted. Fibroids vary from the size of a pea to as large as a grapefruit, and several may develop simultaneously. The cause of fibroids in unknown, approximately 20% of women over age 30 have them. Pregnancy and hormone replacement therapy can cause fibroids to enlarge; decreased estrogen production after menopause usually causes them to shrink.

Fimbria
The finger-like extensions at the end of the fallopian tubes that lies close to the ovary. The fimbria help capture and sweep the released egg into the fallopian tube. Pelvic adhesions from previous pelvic surgeries, pelvic infections such as ruptured appendix, and pelvic inflammatory disease (PID) can adhere to the fimbria hampering its ability to sweep the egg into the fallopian tube.

Financial Counseling
Fertility treatment can be difficult to obtain with today's managed care. Our staff consultants are ready to assist you in securing financial coverage. Some insurance plans state no Infertility coverage when in fact they may cover some testing and treatment. Contact our office to discuss the financial options and care plans available to you.

Follicle
A structure in the ovary that nurtures and releases the developing egg and later produces the hormone Progesterone.

Follicle Scan
A vaginal ultrasound where the ovaries are evaluated, follicles are counted and measured. The thickness of the endometrial lining (the lining of the uterus) is also checked. This is done frequently to monitor the use of oral and injectable ovulation induction medications such as Clomid/Serophene or Follistim.

Follicle Stimulating Hormone (FSH)
A hormone produced by the pituitary gland that stimulates follicle growth in the female ovary and sperm production in the male testicle. FSH blood levels are usually drawn on day 2 or 3 of the menstrual cycle as part of the infertility work up.

Follicular Phase
Day one to about day thirteen of the monthly cycle. During this phase, the body releases a hormone known as follicle stimulating hormone (FSH). FSH stimulates the development of a follicle, which contains the maturing egg. The follicle also secretes estrogen, which produces midcycle changes in the cervical mucus. These changes help prepare the cervical mucus to receive and nourish sperm from the man.

Gamete Egg Donation
Eggs are donated for patients who have lost their ovaries, have premature ovarian failure or advanced maternal age. These donors are screened for genetic, psychological and health abnormalities, sexually transmitted diseases including HIV, smoking, drinking and recreational drug use. Physical characteristics are provided to help match various traits if desired. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

If you are interested in becoming an egg donor and are between the ages of 21 and 30, and a non-smoker, please call or email our patient advocate to see if you qualify. Compensation of $3,500.00 and up is paid to our egg donors.

Gestational Surrogacy
Women who may have the ability to produce eggs but are unable to use their uterus or don't have a uterus, may consider a gestational surrogate carrier. A donated egg may also be used with gestational surrogate in the event a woman can't produce her own eggs or her uterus is not intact or insufficient to carry a pregnancy. In either case, the husband's sperm may be used. Using an egg donor unrelated to the surrogate carrier eliminates any biological tie.

If you are interested in becoming a gestational surrogate and are between the ages of 21 and 35, and a non-smoker, please call or email our patient advocate to see if you qualify. Compensation of $15,000.00 is paid to our gestational surrogates.

Gonads
The sex glands, the testes in men and the ovaries in the women. The testes, situated in the scrotum, produce sperm and secrete the hormone testosterone. The ovaries, situated in the abdomen, release one ovum (egg) between them each month and secrete the hormones estrogen and progesterone. The activities of the gonads, both female and male, are regulated by gonadotropin hormones released by the pituitary gland.

Follistim
When Clomid/Serophene/Clomiphene citrate is not successful in producing a pregnancy after three attempts, the doctor may move on to a different form of hormone therapy. Follistim is a highly purified form of FSH that is injected just beneath the skin with a very small, thin needle. The doctor carefully monitors how the ovaries respond to the Follistim by frequent vaginal ultrasounds (follicle scans) and measures the estrogen levels in the blood.

Hirsutism
Women who experience excess hair production on their face, chest, abdomen, legs, and back may have abnormally high levels of male hormones. Conditions such as polycystic ovarian syndrome (PCOS) and congenital adrenal hyperplasia can result in hirsutism. Some excess hair growth is hereditary, particularly dark haired women and those of Hispanic or Indian extraction. Treatments include medical management.

Human Chorionic Gonadotropin (HCG)
A hormone medication like Ovidrel that is injected with a thin, small needle just underneath the skin, which works like luteinizing hormone (LH) to release the egg from the follicle. It is usually given the day after the last dose of Follistim and given at a specific time as instructed by the nurse. It is extremely important to adhere to the time the nurse states. The Intrauterine Insemination or In-Vitro Fertilization scheduled time is dependent to the proper dosing time of the Ovidrel.

Hydrosalpinx
An enlarged blocked fallopian tube that is filled with fluid, usually as a result of an pelvic infection or pelvic inflammatory disease (PID). This can occur in one or both fallopian tubes. Hydrosalpinx should be removed surgically prior to attempting pregnancy. Studies have shown higher pregnancy results with IVF procedures after the hydrosalpinx was removed. It thought that the infected tube possibly releases toxins into the uterus affecting implantation.

Hyperandrogenism
Excessive androgens, in females can cause increased facial and body hair, acne, and amenorrhea (absence of menstruation).

Hypogonadism
Underactivity of the gonads (testes or ovaries). Hypogonadism may be caused by disorders of the testis or ovary or by a pituitary gland disorder resulting in deficient production of Gonadotropin hormone. In affected males, Hypogonadism cause symptoms and signs of androgen hormone deficiency. In females, it causes the symptoms and signs of estrogen hormone deficiency.

Hypothalamus
A region of the brain, roughly the size of a cherry, situated behind the eyes and beneath another brain region called the thalamus. It has nerve connections to most other regions of the nervous system. The hypothalamus exerts overall control over the sympathetic nervous system (part of the autonomic nervous system, which controls the internal body organs). When we are suddenly alarmed, or excited, signals are sent from higher regions of the brain to the hypothalamus, which initiates sympathetic nervous system activity. This causes a faster heart beat, increased breathing and increased blood flow to muscles (known as the "fight or flight" response). Other groups of nerve cells in the hypothalamus are concerned with the control of body temperature. The Hypothalamus receives information from internal sense organs regarding the level of glucose in the blood and the body's water content; if they are too low they stimulate the appetite for food and water. The hypothalamus is also involved in regulating sleep and sexual behavior, and in determining mood and the experience of emotions. Another role of the hypothalamus is coordination of the function of the nervous and endocrine (hormonal) systems of the entire body. The hypothalamus connects with the pituitary gland through a short stalk of nerve fibers and controls hormonal secretions from this gland. It does this in two ways, through direct nerve connections and through specialized nerve cells, which secrete hormones called releasing factors into the blood to flow directly to the pituitary. In this way, the hypothalamus can convert nerve signals into hormonal signals. Thus, the hypothalamus indirectly controls many of the endocrine organs, including the pituitary, thyroid, adrenal cortex, and gonads.

Hysterosalpingogram (HSG)
An X-ray of the uterus and fallopian tubes. A small catheter is inserted in the cervical opening, allowing dye to flow inside the uterine cavity and fallopian tubes while x-rays are taken. The dye shows the shape of the inside portion of the uterus to rule out an abnormal shape, polyp, or fibroid and confirms the tubes are open allowing the free flow of dye. HSG are performed after the menstrual period but prior to ovulation, usually around day 9 or 10 of the cycle. This procedure is done at a diagnostic X-ray facility or hospital.

Hysteroscopy
An out-patient surgical procedure, where a surgeon places a mini telescope (endoscope) inside the uterine cavity to look for abnormalities such as a septum, fibroids, or polyps. Surgical instruments can also be inserted to surgically remove or correct abnormalities.

ICSI (Intracytoplasmic Sperm Injection)
ICSI has been one of the greatest advances in the treatment of male factor infertility. ICSI involves injecting a single sperm into a mature egg. This procedure involves an embryologist manipulating under a microscope a mature retrieved egg while injecting a micro needle loaded with a single sperm directly into the mature egg. This advancement in the hands of an experienced embryologist can increase the probability of fertilization to as much as eighty five percent. Indications for the ICSI procedure include couples with:

• Severely abnormal semen analysis, including low sperm counts below 20,000,000, poor motility, and abnormal morphology.
• Men requiring microsurgical epididymal sperm aspiration (MESA) or testicular sperm aspiration (TESA).
• Failed fertilization of embryos on prior IVF attempts.

Idiopathic Infertility
The medical term used when the cause of infertility cannot be explained. "Unexplained" infertility is the inability to achieve pregnancy, for no apparent reason, after one year or more of unprotected intercourse. For about eighty four percent of couples, experts can identify the male and female factors that reduce fertility. For the other sixteen percent of infertile couples, no explainable cause for the inability to conceive has been discovered. Treatment includes increasing the number of eggs and sperm and getting them closer to each other by either Clomid/Serophene (oral tablets) with intrauterine insemination (IUI) or Follistim (injectable FSH) with IUI. If pregnancy is not achieved, in vitro fertilization would be considered.

Implantation
Attachment of a fertilized ovum (egg) to the wall of the uterus. About six days after fertilization, the developing embryo comes into contact with the wall of the uterus and attaches to it. As the cells of the embryo divide, the outer cell layer grows into the lining of the uterus to obtain oxygen and nutrients from the mother's blood; later, this layer develops into the placenta. The embryo usually implants in the upper part of the uterus; if it implants low down by the cervix, placenta previa may develop. Rarely, the embryo does not reach the uterus and implants in a fallopian tube, resulting in an Ectopic pregnancy.

Houston Infertility Clinic
Sonja B. Kristiansen, MD, board certified Reproductive Endocrinologist Infertility specialist, founded Houston Infertility Clinic (HIC) January of 2002 and serves as the facility's Medical Director. HIC is a state-of-the-art laboratory that provides the latest Assisted Reproductive Technological (ART) procedures including, ICSI, PGD, Blastocyst Culture, Assisted Hatching, and Egg Donors. An onsite egg retrieval suite with anesthesia services provided by board certified Anesthesiologists eliminates a separate facility fee, reducing total in-vitro fertilization costs significantly. Full Andrology services are also provided at HIC by board certified Embryologist/Andrologist, Dr. Neil Stoddart who is onsite daily and is actively involved with all lab procedures performed.

HIC's first year of operation was a successful one. Having completed more than 175 IVF cycles with pregnancy rates that compare very well nationally, it is now utilized by several other Reproductive Endocrinologist in the Houston area. HIC is committed to providing women the most advanced infertility treatment available, in a compassionate private environment. Centrally located in Houston off I-10/Katy Freeway at the Campbell exit, between the 610 Loop and the Sam Houston Tollway/Beltway 8, free covered parking is available.

In-Vitro Fertilization (IVF)
IVF is a six step process. After controlled ovarian hyperstimulation, eggs are obtained from the ovaries by inserting an aspiration needle through the back of the vagina while under light anesthesia. The eggs are cleaned and husband or donor washed sperm is then added to the droplet containing the egg for fertilization. Micromanipulation of the egg and sperm, such as ICSI would be preformed at this stage, if indicated. The fertilized egg is called a zygote, zygotes develop into embryos. The embryos are incubated in the lab for three to five days. Prior to the embryo transfer the assisted hatching procedure is preformed to encourage implantation.

Step 1: Ovarian Stimulation - Injectable hormone medications such Follistim are given with a thin, small needle just underneath the skin for several days to stimulate the ovaries to produce multiple follicles. The development of these follicles is monitored by frequent vaginal ultrasounds and blood tests. Once the follicles have matured to the appropriate size, an injection of another hormone medication such as Ovidrel is given, which works like luteinizing hormone (LH) to release the egg. It is usually given the day after the last dose of Follistim and given at a specific time as instructed by the nurse. It is extremely important to adhere to the time the nurse states. The in-vitro fertilization (IVF) scheduled time is dependent to the proper dosing time of the Ovidrel.

Step 2: Semen Collection/Processing - Shortly before the egg retrieval, a semen sample will be collected and processed to isolate the strongest most active sperm. These sperm will be placed with each aspirated egg. We strongly encourage patients to consider freezing a semen specimen several weeks in advance of the egg retrieval date for several reasons. Coordinating work and surgery schedules can prove difficult and illness can occur unexpectedly. Also, the expectation of producing a sample on demand the day of the egg retrieval can be stressful.

Step 3: Egg Retrieval - Under light sedation given by a licensed Anesthesiologist, in a special air filtration egg retrieval suite, the doctor aspirates each mature follicle with a needle guided by ultrasound. This is usually done through the back of the vaginal wall but on rare occasions can be done through the abdomen. The aspirated eggs are then passed on to the Embryologist to identify and fertilize.

This is the stage where additional micromanipulation can occur if needed such as ICSI. ICSI involves an embryologist injecting a single sperm directly into a mature egg under a microscope. This procedure is done to increase probability of fertilization when there is a male factor problem such as low sperm count, poor motility/morphology, or when the sperm aspiration techniques TESA/MESA are used to obtain a sperm specimen. ICSI is also recommended if fertilization did not occur in previous IVF attempts.

Step 4: Fertilization Evaluation - 14 to 18 hours after the sperm and egg are placed together; they are evaluated by the Embryologist to confirm fertilization. If fertilization occurs, the zygotes (fertilized eggs) are cultured in preparation for embryo transfer. Continued observation will occur over the next few days by the Embryologist, who will determine the quality of the embryo. The quality of the embryo will determine when the embryo transfer will take place and the number of embryos to transfer. Depending on the number of fertilized eggs, some may be frozen for use in a later cycle.

Step 5: Assisted Hatching (AH) - This technique is used to improve the probability of the embryo's implantation. Assisted Hatching involves the Embryologist opening a small hole in the outer membrane known as the zona pellucida of the embryo. This opening improves the ability of the embryo to leave its "shell" and implant into the uterine lining. Patients that may benefit from Assisted Hatching (AH) include those with previous In vitro Fertilization (IVF) failure, poor embryo growth rate, moderate to excessive cytoplasmic fragmentation and women with advanced maternal age.

Step 6: Embryo Transfer - This brief, painless procedure involves the doctor placing a catheter that has been loaded with a selected number of embryos by the Embryologist, through the cervix and into the uterus to deposit the embryos. When possible Blastocyst transfers are done, which occur around day five of embryonic growth. Blastocyst transfers allow a more mature embryo to be transferred, allowing the Embryologist to select fewer embryos for transfer, achieving a high pregnancy rate with a lower risk of multiple gestations above twins. Occasionally, cleavage stage, day three of embryonic growth transfer are done at they recommendation of the Embryologist based on the quality of the embryo.

Intrauterine Insemination (IUI) using husband or donor sperm
For Intrauterine Insemination, the semen is collected, washed and processed to isolate the strongest sperm, concentrated and placed into a sterile medium. The concentrated sperm is then loaded into a syringe with a small thin catheter attached. The catheter is then inserted through the vagina, into the cervical opening where the sperm are placed high in the female reproductive tract (the uterus) to enhance the chance of successful fertilization.

Laparoscopy
An out-patient surgical procedure where a surgeon inserts a mini-telescope (endoscope) into the abdomen to view the pelvic organs. Surgical instruments can be inserted with the mini-telescope to perform surgical removal of adhesions, cysts, endometriosis and to reconstruct pelvic structures such as the fallopian tubes that have been damaged, infected or tied in the past. Generally, a pelvic Laparoscopy involves making two to three tiny incisions that require one or two sutures to close. One incision is generally at the bottom portion of the umbilicus (your belly button) and one or two in the pubic hair area either to the right or left or both. Board certified Reproductive Endocrinologist Infertility specialists have advanced training in Laparoscopic pelvic reconstruction and surgical procedures.

Lupron
An injectable medication that is used to suppress ovarian cysts prior to starting infertility medications.

Luteal Phase
Day fifteen to day twenty eight of the monthly cycle. After ovulation occurs, the luteal phase begins. During the luteal phase, the follicle that produced the egg becomes a functioning gland called the corpus luteum. The corpus luteum produces progesterone, which prepares the uterus with the rich lining needed for implantation of the fertilized egg (embryo).

Luteinizing Hormone (LH)
A naturally occurring hormone released by the hypothalamus in the brain. Luteinizing hormone-releasing hormone (LH-RH) stimulates the release of Gonadotropin hormones from the pituitary gland. Gonadotropin hormones, in turn, control the production of estrogen hormones and androgen hormones.

Menopause
The cessation of menstruation; the term is commonly used to describe the time in a woman's life when physical and psychological changes occur as a result of reduced production of estrogen hormones by the ovaries. Menopause usually occurs between the ages of forty five and fifty five. The follicles in the ovaries stop producing eggs and less estrogen is produced. An egg donor could be considered for women in menopause. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

Menstrual Disturbances
An abnormality of the monthly cycle of menstrual bleeding. Regular menstruation depends on development of a healthy endometrium (lining of the uterus) and regular cyclical production of estrogen hormones and progesterone hormones. This delicate balance is easily upset, making abnormal menstruation one of the most common disorders of women. Change in a woman's period can indicate a problem in the pelvic area, such as fibroids, endometriosis, polyps, and pelvic inflammatory disease. Hormonal imbalance, stress, travel, and starvation (Anorexia Nervosa) can also cause menstrual disturbances. For the first few years after menstruation starts, and for the few years before the menopause, cycles are often irregular and ovulation may not occur.

Menstruation
The periodic cyclical shedding of the endometrium (lining of the uterus), accompanied by bleeding, that occurs in a woman who has not become pregnant. Menstruation identifies the fertile years of a woman's life. Menstrual periods usually begin at puberty and continue until the menopause. The menstrual cycle, which is counted from the first day of bleeding to the last day before the next menstrual period, lasts between twenty four and thirty five days in ninety five percent of women, the average being twenty eight days. The length of bleeding also varies - usually lasting from one to eight days, with the average length being five days.

Microscopic Epididymal Sperm Aspiration (MESA)
Usually performed as an outpatient, this technique is used to aspirate sperm directly from the epididymis when the sperm can not move through the genital tract due to a blockage. Congenital absences of the vas deferens or seminal vesicles, failed vasovasostomy or epididymovasovasotomy are all conditions where MESA may be performed, whereby sperm can then be provided for in vitro fertilization. In vitro fertilization is used in conjunction with the ICSI procedure because epididymal cells are usually not fully motile and require micromanipulation to fertilize the egg.

Microsurgical Tubal Anastamosis
A surgical procedure in which a damaged fallopian tube is repaired to treat infertility using microsurgery to unblock the delicate tubes. The fertility rate following surgery varies from five to fifty percent, depending on how badly the tube was damaged to start with and whether other causes of fertility exist. Ectopic pregnancy is more common in women who have had diseased tubes or tubal reconstruction than in those with healthy tubes. The most common form of damage is secondary to a previous tubal ligation.

Miscarriage
Loss of a fetus before the twenty second week of pregnancy or before viability (the ability to survive outside the uterus without artificial support). The medical term for this is spontaneous abortion. The incidence of miscarriage is difficult to determine, since not all women who miscarry seek medical attention, or realize they are miscarrying. It is estimated that from ten to thirty percent of all pregnancies will end in miscarriage, with the majority occurring in the first ten weeks. A wide range of problems can cause miscarriage. Many miscarriages occur because of abnormalities of the fetus itself, such as chromosomal abnormalities or major developmental defects. Severe maternal illness or exposure to toxins may also cause miscarriage. Less common causes of miscarriages include abnormalities inadequate progesterone secretion or an autoimmune disorder of the pregnant woman. After the first three months, miscarriage is less common. Of the three to five percent of pregnancies that miscarry between twelve and twenty two weeks, problems include genetic defects, cervical incompetence (inability of the cervix to hold the pregnancy), a defect in the shape of the uterus such as septate (subdivided) uterus, and large uterine fibroid tumors.

Morphology
The description of the physical structure and configuration of a cell. In infertility this is used to describe the sperm cell, the shape and size. If the percentage of normal morphology is low, an in vitro fertilization cycle performed on the female, where the ovaries are stimulated, the eggs retrieved, can allow the intracytoplasmic sperm injection (ICSI) technique to be used. ICSI involves an Embryologist isolating a single normal sperm and injecting it directly into the retrieved egg. This procedure can improve fertilization by as much as ninety percent.

Motility
The description used to grade the movement of sperm. If the motility of sperm is abnormal, an in vitro fertilization cycle performed on the female, where the ovaries are stimulated, the eggs retrieved, can allow the intracytoplasmic sperm injection (ICSI) technique to be used. ICSI involves an Embryologist isolating a single normal sperm and injecting it directly into the retrieved egg. This procedure can improve fertilization by as much as ninety percent.

Nutritional Education
Proper diet and exercise are important for ideal reproductive functioning. Women who are significantly overweight or underweight may have difficulty getting pregnant. Recognizing that nutrition plays an important role in reproduction we offer nutritional counseling by a registered dietitian.

Oligo-Ovulation
Infrequent, irregular ovulation, often accompanied with irregular long menstrual cycles. Failure to ovulate accounts for up to forty percent of women with infertility. It may present in a variety of clinical manifestations, including amenorrhea, irregular menses and hirsutism. Causes of oligo-ovulation include, Hypothalamic Hypogonadism, Polycystic Ovarian Disease, Hyperandrogenism, Hyperprolactinemia, Hyperthyroidism, Luteal Phase Defect, and Premature Ovarian Failure. Medical treatment can be prescribed for most cases except those with premature ovarian failure. An egg donor could be considered for women with premature ovarian failure. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

Oligospermia
A deficiency in the number of sperm per unit volume of seminal fluid; there normally more than twenty million sperm per milliliter of semen. Oligospermia may be temporary or permanent. It is a major cause of infertility, especially when present with certain other disorders of the sperm. Oligospermia may be caused by a number of different disorders, including orchitis (inflammation of a testis), failure of a tests to descend into the scrotum, and a Varicocele (varicose vein of the testis). Stress, cigarette smoking, alcohol abuse and some drugs may cause temporary Oligospermia.

Oocyte
The egg cell (female cell) of reproduction. Each oocyte measures about 0.04 inch (0.1 mm) in diameter. There are about one million immature oocytes present in each ovary at birth; only about two hundred per ovary ever mature to be released at ovulation during a woman's fertile years. If fertilization occurs, the Oocyte develops into an embryo.

Ovarian Failure
The inability of the ovary to respond to any hormone. This is usually due to premature menopause. The term menopause is commonly used to describe the time in a woman's life when physical and psychological changes occur as a result of reduced production of estrogen hormones by the ovaries. Menopause usually occurs between the ages of forty five and fifty five but can occur earlier in five percent of women, in rare cases women in their early twenties or younger. The follicles in the ovaries stop producing eggs and less estrogen is produced. These women could consider using an egg donor. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

Ovarian Hyperstimulation Syndrome (OHSS)
Excessive stimulation of the ovaries is called ovarian hyperstimulation (OHSS), a painful and potentially serious condition. Medications used to stimulate the ovaries for follicular development such as Gonal F may cause side effects. These side effects can range from mild to severe. Treatment may include, removing some of the fluid in the office and/or a hospital stay in approximately one percent of the patients. Mild symptoms of ovarian hyperstimulation during the treatment cycle are common. Moderate and severe symptoms usually occur six to eight days after treatment ends. If menstruation occurs, you will likely begin to feel better. Pregnancy may prolong or exaggerate the side effects and may take up to ten weeks for the symptoms to resolve.

Ovary
One of a pair of almond-shape glands situated on either side of the uterus just below the opening of the fallopian tubes. Each ovary is about 1.25 inch (30 mm) long and .75 inch (20 mm) wide and contains numerous cavities called follicles in which egg cells develop. In addition to producing eggs, the ovaries also produce the female hormones estrogen and progesterone. Absence or failure of normal development of the ovaries is a rare disorder usually caused by a chromosomal abnormality.

Ovidrel
A medication that is injected with a thin, small needle just underneath the skin containing a hormone called human Chorionic Gonadotropin (hCG), which works like luteinizing hormone (LH) to release the egg from the follicle. It is usually given the day after the last dose of Follistim and given at a specific time as instructed by the nurse. It is extremely important to adhere to the time the nurse states. The Intrauterine Insemination or In-Vitro Fertilization scheduled time is dependent to the proper dosing time of the Ovidrel.

Ovulation Induction
Stimulation of the ovaries with various oral or injectable hormonal medications, such as Clomid/Serophene or Follistim, in order to develop and mature as many follicles as possible as well as to control the timing of ovulation.

Ovulation Test Kits
Several kits are available for home use that pinpoint when ovulation is occurring. They identify the natural surge in luteinizing hormone (LH) that precedes ovulation, which is detectable in urine. LH testing can be useful for planning intercourse around a woman's most fertile days and for scheduling other tests and procedures. LH testing usually begins about eleven days after the first day of a woman's period and is performed daily for about four or five days.

Ovulatory Dysfunction
Infrequent, irregular or no ovulation, often accompanied with irregular or no menstrual cycles. Ovulatory dysfunction accounts for up to forty percent of women with infertility. It may present in a variety of clinical manifestations, including amenorrhea, irregular menses and hirsutism. Causes of ovulatory dysfunction include, Hypothalamic Hypogonadism, Polycystic Ovarian Disease, Hyperandrogenism, Hyperprolactinemia, Hyperthyroidism, Luteal Phase Defect, and Premature Ovarian Failure. Medical treatment can be prescribed for most cases except those with premature ovarian failure. An egg donor could be considered for women with premature ovarian failure. Egg donated/IVF cycle success rates are generally very high because of the young age of the donated egg.

Ovulatory Phase
Occurs around day fourteen of a menstrual cycle. The ovulatory phase begins with a dramatic increase or surge in the LH hormone level which causes the follicle to break open and release its egg into the fallopian tube.

Ovum
The egg cell (female cell) of reproduction. Each oocyte measures about 0.04 inch (0.1 mm) in diameter. There are about one million immature oocytes present in each ovary at birth; only about two hundred per ovary ever mature to be released at ovulation during a woman's fertile years. If fertilization occurs, the oocyte develops into an embryo.

Pelvic Inflammatory Disease (PID)
An infection in the female reproductive system. Severe or recurrent pelvic infection is referred to as pelvic inflammatory disease (PID). The infection can result in damage to the fallopian tubes (adhesions, hydrosalpinx and scarring) and can cause female infertility. Chlamydia and gonorrhea can both cause pelvic inflammatory disease. Pelvic inflammatory disease may also occur after childbirth, miscarriage or abortion. Occasionally, nongynecological conditions affecting surrounding organs such as appendicitis and inflammatory bowel disease can cause damage to the female genital tract.

PCOS (Polycystic Ovarian Syndrome)
A condition, also known as Stein-Levanthal syndrome, characterized by oligomenorrhea or amenorrhea, infertility, Hirsutism, and obesity. Often, but not always, the ovaries contain multiple cysts. In most women with polycystic ovaries, menarche (the onset of menstruation) occurs at the normal age. After a year or two of regular menstruation, the periods become highly irregular, and then cease. Hirsutism, which often becomes evident around menarche, occurs in about fifty percent of cases, as does obesity. The condition is due to an imbalance between the pituitary gonadotropin hormones luteinizing hormone (LH) and follicle stimulating hormone (FSH); there is excessive stimulation of the ovaries by LH and a relative lack of deficiency of FSH. This results in lack of ovulation and in increased testosterone production by the ovaries. Treatment depends upon the desire for fertility and may include infertility drugs.

Pituitary Gland
Sometimes referred to as the master gland, the pituitary is the most important of the endocrine glands (glands that release hormones directly into the bloodstream). The pituitary regulates and controls the activities of other endocrine glands and many body processes. The pituitary is a pea size structure that hangs from the base of the brain just below the optic nerves, and lies in the cavity of the skull. It is attached by a short stalk of nerve fibers to the hypothalamus, a region of the brain that controls the function of the pituitary by nervous stimulation and by hormone-releasing factors. The pituitary consists of three parts - the anterior lobe, the intermediate lobe, and the posterior lobe. The different lobes of the pituitary produce a range of hormones. The anterior pituitary produces six hormones: growth hormone, which stimulates growth; prolactin, which stimulates the production of milk after giving birth; ACTH (adrenocorticotropic hormone), which stimulates hormone production in the adrenal glands; TSH (thyroid stimulating hormone), which stimulates hormone production by the thyroid gland; and the gonadotropins FSH (follicle stimulating hormone) and LH (luteinizing hormone), which stimulate the gonads (ovaries). The intermediate part of the pituitary secretes one hormone, MSH (melanocyte-stimulating hormone), which controls darkening of the skin. The posterior pituitary produces two hormones - ADH (antidiuretic hormone), which increases reabsorption of water into the blood by the kidneys and therefore decreases urine production; and oxytocin, which stimulates contractions of the uterus during labor and the ejection of milk during breast-feeding.

Polycystic Ovarian Syndrome (PCOS)
A condition, also known as Stein-Levanthal syndrome, characterized by oligomenorrhea or amenorrhea, infertility, Hirsutism, and obesity. Often, but not always, the ovaries contain multiple cysts. In most women with polycystic ovaries, menarche (the onset of menstruation) occurs at the normal age. After a year or two of regular menstruation, the periods become highly irregular, and then cease. Hirsutism, which often becomes evident around menarche, occurs in about fifty percent of cases, as does obesity. The condition is due to an imbalance between the pituitary gonadotropin hormones luteinizing hormone (LH) and follicle stimulating hormone (FSH); there is excessive stimulation of the ovaries by LH and a relative lack of deficiency of FSH. This results in lack of ovulation and in increased testosterone production by the ovaries. Treatment depends upon the desire for fertility and may include infertility drugs.

Post-Coital Test (PCT)
A test to determine whether the sperm can move properly through the cervical mucus. This is done around the time of ovulation about 4 to 12 hours after sexual intercourse. A sample of the cervical mucus is evaluated under a microscope.

Preimplantation Genetic Diagnosis (PGD)
Involves taking a single cell from a developing embryo and analyzing its genetic makeup. This is done to find chromosomal and genetic disorders early. PGD can be used for couples that are at risk for transmitting a genetic disease to their children such as Cystic Fibrosis. It can also screen for chromosomal abnormalities that can cause miscarriage or prevent pregnancy from occurring while also checking for certain genetic diseases, such as Down's syndrome.

Premenstrual Syndrome (PMS)
A combination of various physical and emotional symptoms that occurs in women the week or two before menstruation. Premenstrual syndrome (PMS) begins at or after ovulation and continues until the onset of menstruation. PMS affects more than ninety percent of fertile women at some time in their lives and in some women is so severe that work and social relationships are seriously disrupted. The most frequent emotional symptoms of PMS are irritability, tension, depression and, fatigue. Physical symptoms include breast tenderness, fluid retention, headache, backache, and lower abdominal pain. Medical management is the primary form of treatment in conjunction with exercise and dietary modifications such as decreasing salt and caffeine intake, while increasing calcium intake.

Progesterone
A female sex hormone essential for the healthy functioning of the female reproductive system. Progesterone is produced in the ovaries during the second half of the menstrual cycle and by the placenta during pregnancy. Small amounts of progesterone are produced in the adrenal glands and testes. Following ovulation, increased production of progesterone causes the endometrium (the lining of the uterus) to thicken in preparation for the implantation of a fertilized egg. If fertilization does not take place, the production of progesterone and of estrogen hormones falls, resulting in a shedding of the uterine lining and unfertilized egg in the monthly period.

Progesterone in Oil
A hormone medication that is given by injecting a thin needle into a muscle. This medication is given to patients who have gone through IVF until 12 weeks of pregnancy to give additional support to embryo growth.

Prolactin
Prolactin is the hormone produced by the anterior pituitary gland that stimulates production of breast milk in breast-feeding women. High levels of prolactin result in a condition known as hyperprolactinemia - a condition that can cause galactorrhea (breast milk production in non breast-feeding women, absence of menstrual periods and infertility in women. In men, it can cause impotence, infertility, feminization and galactorrhea. Blood tests to determine if this is the cause of an ovulatory problem are usually performed at the beginning of the menstrual cycle.

Prostate
A solid chestnut-shaped organ surrounding the first part of the urethra in the male. The prostate gland is situated immediately under the bladder and in front of the rectum. The prostate gland produces secretions that form part of the seminal fluid during ejaculation. The ejaculatory ducts from the seminal vesicles pass through the prostate gland to enter the urethra.

Recurrent Miscarriages
Any woman who miscarries three or more times consecutively is called an habitual aborter. Habitual aborter's miscarriages may be caused by genetic or hormonal abnormalities, chronic infection, autoimmune disease, or uterine abnormalities. Evaluation includes genetic studies, hormonal and infectious screening, as well as Hysterosalpingogram (HSG) to evaluate the uterus. The majority of women who miscarry can eventually carry a pregnancy to term. Current diagnostic and treatment measures have made the outlook better than ever.

Reproductive Endocrinologist Infertility Specialist (REI), Board Certified
Board certified Reproductive Endocrinologist Infertility specialists have completed: 1) Fours years of medical school, 2) Four year residency training in the OB/GYN specialty, 3) Two to three years off fellowship training in the Reproductive Endocrinology Infertility specialty, and 5) Passed the national Reproductive Endocrinologist Infertility written and oral test along with the OB/GYN specialty written and oral given by the American Board of Obstetrics and Gynecology. The additional two to three years of training beyond the OB/GYN specialty focuses on assisted reproductive techniques, advanced microsurgery of the pelvic organs, disorders of the anatomy which may affect fertility, and disorders of the sperm. This additional training beyond the OB/GYN specialty is invaluable and will increase your probability of conception. Some insurance plans will only reimburse fees for infertility services if the doctor is a board certified Reproductive Endocrinologist and Infertility specialist. The American Board of Obstetrics and Gynecology recommends patients seeking advanced infertility treatments see a board certified REI.

Scrotum
The pouch at the base of the penis that contains the testes. The scrotum consists of an outer layer of thin wrinkled skin over a layer of muscle-containing tissue. Internally it is divided by a membrane into two halves, each containing a testis.

Semen Analysis
A semen analysis measures the quantity and quality of the sperm. Several characteristics are examined, including the ability of sperm to move (motility), forward progression (the quality of movement), sperm count (the number of sperm), volume of semen (the total amount of ejaculate), as well as the size and shape of the sperm (morphology). The semen analysis must be collected within 1 hour prior to reaching the laboratory or be collected onsite. The laboratory should provide a sterile container and instructions on masturbation collection. The specimen must be processed immediately. Many laboratories do not have the ability to perform the semen analysis onsite and may ship the specimen to another city or state, thus not processing the specimen until several hours later or even the next day. This delay would severely impact the accuracy of the results. Complete Andrology Services including Semen Analysis are performed daily onsite at Houston Infertility Clinic.

Seminal Vesicle
The pair of pouch-like glands around the prostate that produce the milky fluid that mixes with the sperm prior to ejaculation.

Serophene
Clomid/Serophene/Clomiphene Citrate is a pill taken daily for approximately 5 to 6 days early in the cycle, usually day 2 thru 7. It works by stimulating the body to release more FSH and LH so that follicle development and ovulation can occur. Clomid/Serophene/Clomiphene has been found to induce ovulation in 82% -85% of women who were not ovulating before treatment and 40% of these women achieved pregnancy. Most pregnancies will result in single births, 10% or less will result in twins and less than 1% resulting in triplets or higher. The majority of patients who respond to Clomid/Serophene/Clomiphene Citrate ovulate during the first month of therapy. Most pregnancies occur within 3 months of therapy. If pregnancy doesn't occur after 3 months of treatment, you should consider further evaluation so your doctor can determine additional treatment options

Sperm (Spermatozoa)
Male reproductive sex cell, also known as spermatozoon (singular) spermatozoa (plural), responsible for fertilization of the female ovum (egg). Sperm are microscopically tiny, measuring 0.002 inch (0.05) in length. Sperm are produced within the seminiferous tubules of the testes by a process known as spermatogenesis. The production and development of sperm is dependant on the male sex hormone testosterone and on gonadotropin hormones produced by the pituitary gland. Sperm production commences at puberty. The original cell from which a sperm develops contains forty six chromosomes including the XY pair of male sex chromosomes. By a process of cell division, the number of chromosomes is halved to 23, including either the X or Y from the original pair of sex chromosomes. This X or Y is responsible for determining the sex of an embryo that develops after fertilization of the ovum by the sperm. The final stage of spermatogenesis takes place in the epididymis, where the sperm grow tails that will propel them through the woman's reproductive tract after ejaculation during sexual intercourse.

Spermatogenesis
Sperm are produced within the seminiferous tubules of the testes by a process known as spermatogenesis. The production and development of sperm is dependant on the male sex hormone testosterone and on gonadotropin hormones produced by the pituitary gland. Sperm production commences at puberty. The original cell from which a sperm develops contains forty six chromosomes including the XY pair of male sex chromosomes. By a process of cell division, the number of chromosomes is halved to 23, including either the X or Y from the original pair of sex chromosomes. This X or Y is responsible for determining the sex of an embryo that develops after fertilization of the ovum by the sperm. The final stage of spermatogenesis takes place in the epididymis, where the sperm grow tails that will propel them through the woman's reproductive tract after ejaculation during sexual intercourse.

Sperm Freezing and Storage
Cryopreservation a process used to freeze and preserve gametes (sperm). Once gametes are frozen and stored, they remain viable for long periods of time. Cryopreservation of gametes is recommended when an IVF cycle is scheduled. Sudden illness, travel and work schedule changes can occur. It also lessens the pressure of giving a sample on demand the day of the IVF procedure.

Sperm Function Testing
Several different tests are available to determine if the sperm is capable of fertilizing an egg. These studies vary from laboratory to laboratory and are not part of the routing semen analysis. Houston Infertility Clinic offers full Andrology testing of sperm.

Sperm Wash
This is a process to remove the sperm from the ejaculate and isolate the strongest, most viable sperm. This provides a highly concentrated amount of sperm that can then be introduced into the cervix or the uterus.

Testis
One of two male sex organs also called testicles that produce sperm and the male sex hormone testosterone. The testes are formed within the abdomen near the kidneys early in the growth of the make fetus. In response to hormones produced by the mother and to hormones produced in the testes themselves, the testes gradually descend through the inguinal canal (a tunnel in the groin). At birth, they have usually reached the surface of the body, where they hang in a pouch called the scrotum. Within each of the testes are the seminiferous tubules, delicate coiled tubes that produce sperm. The seminiferous tubules lead via the vas efferens (small ducts) to the epididymis, a structure lying behind the testis in which the newly formed sperm mature. Interstitial cells between the seminiferous tubules produce the male sex hormone testosterone, which passes in small blood vessels in the testis and then into the circulation. Each testis is protected by a tough fibrous capsule, the tunica albuginea and is attached by the spermatic cord, composed of the vas deferens (the tube that transports sperm from the epididymis to the urethra) and a number of blood vessels and nerves.

Testicular Biopsy
Is used to determine the ability of the sperm-producing cells to produce normal sperm. The biopsy allows direct inspection of a very small piece of testicular tissue that contains seminiferous tubules and interstitial tissues (cells between the tubules). In certain instances, a testicular biopsy is a very important part of the evaluation of the infertile male.

The testicular tissue is examined under a microscope for signs and patterns that suggest why sperm are abnormal. These findings may help the physician arrive at an accurate diagnosis and avoid unnecessary surgery and treatment. Some of the patterns physicians look for are described as follows:

Normal

The testicular tubules and sperm production both appear entirely normal. A decrease or absence of sperm in the ejaculate from an individual with this biopsy pattern suggests that sperm are being produced, but are not able to be ejaculated. An obstruction or absence of the ducts leading from the testicle to the prostate is suspected. An obstruction can often be treated by microsurgery.

Maturation Arrest Patterns

As sperm develop, they undergo a series of maturation steps. At any one of these steps, abnormalities may occur. Once the abnormality is diagnosed medical therapy may be used in an effort to help sperm fully mature. However, the prognosis is poor.

Hypospermatogenesis

In some patients, all of the elements of sperm production are present, but fewer sperm are produced. This will normally result in a lower number of sperm in the ejaculate. This condition can also coexist with a maturation abnormality. Although medical therapy can be used, results are unpredictable.

Germinal Cell Aplasia

Patients with this disorder do not have germ cells in their testes and, therefore are not able to produce sperm. No treatment exists for this disorder. Patients may choose to use donor sperm to achieve their dreams of parenthood.

Testosterone
The most important of the androgen hormones (male sex hormones). Testosterone stimulates bone and muscle growth and sexual development. It is produced by the testes and in very small amounts by the ovaries. Testosterone may be given to treat infertility in the male suffering from deficiency caused by disorders of the testes or pituitary gland.

Thyroid Stimulating Hormone (TSH)
Measurement of the level of Thyroid Stimulating Hormone produced by the pituitary gland provides a sensitive means of diagnosing a thyroid malfunction. Thyroid Stimulating Hormone directly controls the thyroid's secretions. Abnormal levels of thyroid secretions may interfere with ovulation.

Tubal Pregnancy
Development of an embryo outside the uterus, usually occurring in the fallopian tube. A delay in the transport of the fertilized egg results in implantation within the tube wall, which is too thin to sustain growth. The tube then ruptures and may hemorrhage, which can be a serious and potentially life threatening condition.

Uterus
The hollow, muscular organ of the female reproductive system in which the fertilized ovum (egg) normally becomes embedded and in which the developing embryo and fetus is nourished and grows. The uterus is situated in the pelvic cavity behind the bladder and in front of the bowel. The uterus in a nonpregnant woman measures three to four inches (7.5 to 10 cm) and weighs about two to three ounces (60 to 90 grams). In shape, it resembles an upside down pear. The lower, narrow part of the uterus opens into the vagina at the cervix (the neck of the uterus); the upper part opens into the fallopian tubes. In most women the uterus is anteverted (tilts forward) at an angle of ninety degrees to the vagina. In about twenty percent of women the uterus is retroverted (tilts backward). The uterus is lined with endometrium, which is a specialized tissue that undergoes changes during the menstrual cycle. The endometrium builds up under the influence of hormones from the ovary. When hormonal support is withdrawn at the end of each cycle, the blood supply to the endometrium is cut off and the tissue is shed.

Vagina
The muscular passage, forming part of the female reproductive system that connects the cervix (neck of the uterus) with the external genitalia. The vagina is two and a half to four inches (7 to 10 cm) in length, the back wall being slightly longer than the front. The vagina is H-shaped in cross section. The muscular walls have a ridged inner surface and are richly supplied with blood vessels. The walls are usually in contact with each other, except during sexual arousal and intercourse when they become engorged with blood. The vagina has three functions. It is a receptacle for the penis during sexual intercourse, bringing sperm closer to the ova (egg) for fertilization; it provides an outlet for blood shed at menstruation; and, during childbirth, it stretches to allow the baby through.

Varicocele
Varicose veins in the testicle that can cause sperm abnormalities. Varicoceles are one of the most common factors accounting for poor semen quality. Some nineteen to forty one percent of infertile males have varicoceles. Fortunately, this cause of male infertility is surgically correctable improving the semen quality in approximately fifty one to seventy eight percent of cases. The average pregnancy rate following varicocele repair is reported to be twenty four to fifty three percent.

Vas Deferens
A narrow tube that carries and stores sperm released from the testis and epididymis. At the base of the bladder, the vas deferens connects to a tube from the seminal vesicles to form the ejaculatory duct. The duct passes into the prostate and connects to the urethra. Sperm and seminal fluid are passed through this duct into the urethra during ejaculation. The vas deferens is about two feet (60 cm) long. Vasectomy involves blocking the vas deferens to prevent the passage of sperm.

Zygote
A fertilized egg. A zygote develops from an egg, fertilized by sperm. It is the cell produced when a sperm fertilizes an egg. It is referred to