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International Infertility Patients

Pahlajani Test Tube Baby Centre welcome the opportunity to provide a variety of fertility services to all international patients, and would be happy to assist you with any of your fertility concerns. In addition to our renowned infertility and in vitro fertilization services, we have the world's modern & leading infertility treatment procedure, highly successful and offer very popular egg donor and surrogacy options. We offer the immediate availability of both donors and surrogates for those in need. Unlike any similar programs, full Fertility service options under one roof.

Pahlajani Test Tube Baby Centre offers IVF ( In Vitro Fertilization ) treatment to infertile couples from all over the world. Like most infertile couples, you know that IVF can maximise your chances of getting pregnant. However, if you are worried that it is too expensive for you to be able to afford, we have good news for you.

At the Pahlajani Test Tube Baby Centre, Dr. Neeraj Pahlajani and Dr. Sameer Pahlajani provide state-of-the-art IVF treatment at affordable prices in a comfortable atmosphere. We offer all the newest reproductive techniques, including IVF, ICSI, laser assisted hatching, embryo freezing, egg donation, embryo biopsy, and blastocyst transfer.

If you have done IVF at another clinic, have you got upset that a different doctor attended your procedures each time? Are you forced to talk to a number of different nurses, with no real direction ? Are you having trouble getting the feedback or explanations you need ? At Pahlajani Test Tube Baby Centre, all the treatment ( including the consultation, all the ultrasound scans, egg collection and embryo transfers are done personally by either Dr. Neeraj Pahlajani and Dr. Sameer Pahlajani). The buck stops with us - and we don't delegate any part of your delicate and critical IVF treatment to anyone else !

We adopt a success-oriented approach towards infertility. This is very different from the traditional medical approach, so it needs to be described in detail.

Many infertile couples want to know - "What is the diagnosis, doctor? Why am I not getting pregnant?" Or "Why did the IVF cycle not work?" However, we feel this is the wrong question - and if you ask the wrong question, you get the wrong answer! Rather than focusing on what your problem is, you should focus on the solution - which is a baby! This means that the question you should be asking is "What can we do to maximise our chances of getting pregnant?"

Instead of spending time, money and energy on diagnostic testing, it makes more sense to select treatment options which maximise the chances of getting pregnant. You should concentrate on treatment paths and action plans - the next step forward, rather than worry about diagnostic labels. Fortunately, today with IVF technology, we are better at solving problems for infertile couples rather than diagnosing them. This often means that while we may not be able to explain why embryos did not successfully implant after IVF, the chances of success by repeating the treatment cycle remain excellent.

We strive to provide the best quality medical care, using the latest technology. Our equipment is state of the art and is sourced from all over the world. We help you to formulate an action-plan which is designed to resolve their problem as cost-effectively as possible, making the most efficient use of time, money and energy. We keep our unit efficient and patient-friendly. Thus, Dr Neeraj Pahlajani provide all the medical care you need personally - we do not employ junior doctors. Since we provide all our services at a single facility, you know you will always find us here at all times.

Coming to Pahlajani Test Tube Baby Centre for IVF treatment :
 
Coming to Raipur (capital of Chhattisgarh state) for IVF is extremely easy. Raipur is a Capital of Chhattisgarh State, and has international airport. You can book your tickets online, and find the best deals by asking Indian travel agents in your city. A return air ticket to India from the US costs about US $ 1000- 1500. Your husband can accompany you, or you can hand-carry his frozen sperm in a dry shipper ( which you will need to borrow from your local infertility clinic) or in a dry-ice box packed with dry ice. The clinic is in the heart of Raipur, and is an 25 minutes ride away from the airport. IVF treatment is done on a day-care basis, so you do not need hospitalisation at all. There are many hotelsnearby and we can help you arrange accommodation in close proximity to our clinic. You only need to make 4 - 6 visits to the clinic during the entire cycle, and after the embryo transfer, you can fly back home.

Over half our patients come to us from out of Raipur; and a quarter of all our patients come from overseas, so we are very experienced in meeting your special needs. To make the process as easy as possible for you, we have developed protocols that allow you to interact easily with us by email. You can have all your preliminary testing and care performed by your own doctor in your own town. This means that with well-planned scheduling, you only need to spend about 10 to 20 days at our clinic to complete an IVF cycle of treatment.

Traveling to do IVF may make it less stressful for you. Getting prepared for the cycle is more stressful (things to do to get ready for the trip, etc.), but the cycle itself may be less stressful. You can do a lot of sightseeing and you may obsess less about the cycle that way than you would have if you were home and working. Also, you have fewer responsibilities to worry about and can concentrate on your cycle.

Our patients have been surprised and pleased at the convenience that our system offers them . In fact, many feel that it is easier to be treated at Pahlajani Test Tube Baby Centre, than to take treatment in their own home city . A complete IVF cycle at our clinic costs only US $ 4000 - and this is all-inclusive of all medical procedures, including lab tests, scans, egg pickup and embryo transfer. The approximate total costs of all the medicines used for superovulation for one complete cycle is about US $ 1000 more. A complete cycle of donor egg IVF costs US $ 7500 only ( including payment for the egg donor). Embryo adoption costs US $ 5000 only.

We provide a package deal which includes all costs, rather than add on costs for individual services ( such as scans , facility fees and lab services ) which many other clinics do ! This helps patients to know what their total cost will be upfront. As an added service to our patients, we now accept payment at the clinic using international credit cards (Visa, MasterCard or American Express).

Travelling all the way to India for IVF treatment can be a difficult decision for many couples - especially those who have never been to India before.

Immunologic Infertility

What is Immunological infertility

A lymphocyte is a type of white blood cell.The three main types of lymphocyte are T lymphocyte, B lymphocytes and natural Killer cells (NK cells). The T cells produce substances known as cytokines. There are two types of T cells; Th1 (cytotoxic T cells) produce cytokines that attack cells infected by viruses and tumour cells. Th2 (helper T cells) produce cytokines that oppose the effect of ctyokines produced by Th1, it also release growth factors that regulate other immune cells. Th2 and Th1 are normally in balance. In normal pregnancy the balance is tilted toward excess Th2 while excess Th2 may result in pregnancy failure.

Natural killer cells are characterised by their expression of the cell surface antigens, CD56 and CD16. They play an important role in protecting the body from tumors and virus infection. They distinguish these from normal cells by recognizing a surface molecules known as MHC. When activated by cytokines (interferon) the NK cells release cytotoxic cytokines such as tumour necrosis factor (TNF) alpha which destroy cells infected by viruses. All NK cells originate from stem cells in the bone marrow and after maturation will either circulate in the blood or migrate and reside in tissues such as endometrium. Uterine NK cells are different from circulating (peripheral blood) NK cells.

Antibodies are substances produced by B lymphocytes in response to pathogens such as bacteria. The antibodies circulate into the blood and body tissues. Antibodies normally protect the body from invasion by foreign bodies such as bacteria and viruses. For unknown reasons the body may develop antibodies to its own cells.

At the time of implantation, a complex immunological interaction takes place between the embryo and immune cells of the endometrium “cross talk”. This is important for successful implantation and for continuation of the pregnancy. The interaction is done through exchange of cytokines. 

Immune system disorders may lead to reproductive failure at different stages of reproductive process: unexplained infertility, recurrent IVF or ICSI failures and recurrent miscarriage.

Anti-sperm antibodies can occur in both men and women. Antibodies are protein molecules that are attracted to a specific site on the sperm. Once attached, they may interfere with the sperm's activity in any of several ways. They may immobilize sperm, cause them to clump together, limit their ability to pass through the cervical mucus, or prevent them from binding to and penetrating the egg. Anti-sperm antibodies are frequently seen in men after vasectomy, testicular injury or infection. The cause of anti-sperm antibodies in the woman is unknown.
Researchers classify specific antibodies by type (IgA, IgG and IgM) as well as the point at which they attach to the sperm (head, midpiece, or tail). Studies indicate that IgG type antibodies are most common in men and that IgA type can be found in women's mucus and follicular fluid, but the significance of these findings is uncertain. Binding to the head is believed to interfere with attachment and penetration of the egg, while tail binding interferes with motility.

Unfortunately, testing and identification of type of antibody or the location does little to suggest who will or won't conceive. Attempts to treat the condition -- say, by lowering antibody levels with steroids or removing the antibodies from sperm -- have demonstrated limited benefit and have been fraught with disastrous complications. A trial of ovulation induction and insemination followed by in vitro fertilization with ICSI (a process that involves injecting a sperm directly into an egg) seems to be the best treatment available.

Between 20 and 25 percent of all repeated miscarriages are due to immunological problems. In some cases, the woman's immune system causes her body to reject the fetus as foreign tissue. This problem can often be solved by injecting white blood cells from the woman's partner into her body before conception, so that her body gets "used to" his cells and therefore "recognizes" the fetus later on as "friendly." Some clinics report about a 70 percent success rate using this method.

Other immunological causes involve women who produce antibodies that indirectly cause clotting in blood vessels leading to the developing fetus. The fetus is deprived of nutrients and dies in utero, which triggers an abortion. There are no definitive treatments, but some clinics are looking into combining acetylsalicylic acid (pain relievers), corticosteroids, or anticoagulants such as heparin.

Causes
Antisperm antibodies can be present in either or both partners. It can be present either in the blood or in the genital tract secretions such as cervical mucus and ejaculate. There are different types of antibodies e.g. IgG, IgA and IgM. Antisperm antibodies in the ejaculate will make the sperm ineffective by making them stick together and preventing them from being released. In the female, antisperm antibodies may interfere with the process of sperm transport and fertilization. Incidence 1-2%. The cause of antisperm antibodies is unknown, but there are associations with genital infection, trauma to the testicles, varicocele, vasectomy and after reversal of vasectomy.

DQ alpha matching in the couple: Each person inherits two DQ numbers from his or her prospective parents. A pregnancy is recognised as foreign because the fathers Human leukocyte antigen (HLA) antigen is different from that of the mother. The mother makes blocking antibodies that attach to and camouflage the placenta (protecting antibodies). If the father‘s HLA is too similar to that of the mother, the embryo will not be protected because it will not be able to differentiate itself from that of the mother, leading to lack of blocking antibodies to protect the fetus and the pregnancy may fail.

Antiphospholipids antibodies syndrome: Phospholipids are present on the cell membranes of all cells; they are glue molecules which play an important role in embryo implantation. Antiphospholipid antibodies (anticardiolipins and Lupus anticoagulant) cause the woman’s blood to clot quickly cutting off blood supply to the baby. Inherited thrombophilias (Factor V Leiden, prothrombin mutation, protein C, protein S, antithrombin deficiency etc) are associated with an increased risk of recurrent miscarriage and probably recurrent IVF failure . A mother may develop antibodies to her baby's DNA or DNA breakdown products such as ANA.

Excess or hyperactive Natural Killer cells and or CD 19 cells: Natural killer cells are good because they protect the body from developing cancer, infection etc. However excess or hyperactive NK cells can damage the cells which make the placenta and the endocrine system that produce hormones essential for pregnancy. Some laboratories define the presence of more than 12% of NK cells in blood of woman with recurrent failed IVF as abnormal.

Coital failure

Some infertile couples may experience difficulty in having a baby because of coital difficulty or inappropriate timing of sexual intercourse (infrequent intercourse or intercourse mainly at the beginnings and the ends of the womans menstrual cycle). Coital difficulty may also result after a sexually active couple has been labeled infertile. For some couples, sexual intercourse becomes a necessity rather than a natural love making experience. Infertility investigations itself can be very stressful to the couple.

Many men and women suffer for years without seeking advice and help. This is often because they are unaware that in most cases, treatment may help. Some do not know whom to turn to for advice and others are too embarrassed to seek help. Patient may not disclose the full extent of his or her sexual difficulties because of feeling of shame or fear of hurting his or her partner feelings.

The causes of the sexual difficulty could be physical or psychological. However, most cases will involve physical and psychological elements, although the balance may vary considerably from person to person.

Coital difficulty requires appropriate investigations and treatment. Unfortunately, talking about personal sexual matters including sexual disorders and difficulties, is often an uncomfortable experience for both doctors and patient. When the cause is predominantly psychological, normal sexual functions may be restored through psychosexual therapy. In many cases, nothing more than sex education of both partners is necessary. Some men are concerned about the size of their penis and their ability to father a child. The size of the penis is generally unimportant so long as penetration is achieved.

If the cause of coital failure is predominantly physical, normal sexual activities are unlikely to be restored without some form of medical or surgical treatment.

Incidence
2-3%

Causes : Psychological causes
Emotional and financial stress and anxiety from home or work
Marital disharmony
Worry about poor sexual performance, fear of failure, fear of pregnancy
Depression
Inadequate or absent sex education
Sexual problems in the partner
Psychological trauma such as sexual abuse, rape or traumatic childbirth.

Physical causes : Male
Damage to the special nerves which cause erection. This could have been the result of an injury such as spinal cord injury, surgery such as prostatectomy and surgery in the bladder neck, or diseases such as multiple sclerosis.
Deficient blood flow to the penis e.g. blocked arteries.
Chronic illnesses such as kidney or liver failure.
Side effects of prescribed drugs e.g. certain drugs for lowering high blood pressure.
Diabetes (30 % of diabetics suffer from some form of sexual dysfunction).
Hormonal e.g. hyperprolactinemia or low testosterone levels.
Heavy smoking
Alcoholism and drug abuse
Congenital penile abnormalities

Physical causes : Female
Painful scar (e.g. episiotomy)
Infection
Congenital abnormalities such as a rigid and tough hymen or unusually narrow entrance.
Endometriosis
Presentation
Frigidity
The absence of sexual desire "libido". The psyche is the seat of libido.

Premature ejaculation
The man arrives at orgasm and ejaculates before he wishes to do so.

Nonorgasm
The inability to achieve orgasm by means of masturbation or coitus. Although, it is not necessary for the woman to have an orgasm for conception to take place, unfulfilled sexual activity may create marital tension and stress.

Delayed (retarded) ejaculation
The inability to achieve an orgasm, even though the erection is satisfactory. At times retarded ejaculation is selective (a man is able to achieve an orgasm by masturbation but not during coitus).

Erectile dysfunction (ED)
Commonly referred to as impotence, it is the inability of the man to obtain or maintain an erection satisfactory for the purpose of sexual intercourse.

Dyspareunia
The pain experienced by the woman during intercourse. Dyspareunia could be superficial when the woman experiences pain in her vulva or vagina during penetration. Deep dyspareunia occurs when the woman experiences pain deep in her pelvis in the organs that surround the top of the vagina.

Vaginismus (vaginal spasm)
The inability of the woman to relax her vaginal muscles, preventing penetration by the male. Vaginismus is the commonest cause of dyspareunia. It can affect women who have never been pregnant before as well as women who have been pregnant before.

Hormonal Imbalances

What is Hormonal Imbalance?

Hormones play a vital role in every woman’s health and well-being. Very often when women are in a bad mood, you will find that they, or their partners, blame it on their hormones. When hormone levels fluctuate, this can affect your mood, sexual desire, fertility and ovulation. In other words, the imbalance of hormones may impact negatively on how your reproductive system responds.

Every month, the female hormones estrogen and progesterone are produced. When estrogen and progesterone levels do not balance, this may have a dramatic effect on your health. The gonadotrophin releasing hormone, also affects the functioning of the hypothalamus which in turn affects the pituitary gland, which then affects the ovaries, fallopian tubes and uterus.

The imbalance of estrogen hormones can also cause menopause and all the symptoms associated with it. These hormones are influenced by certain factors such as nutrition, diet, lifestyle, exercise, stress, emotions, age and ovulation.

Causes of hormone imbalance

The symptoms of hormonal imbalance can be caused by a multitude of factors. Mainly, the reasonis that there is fundamentally imbalanced relationship between progesterone and estrogen levels in a woman’s body.

These two hormones must co-exist peacefully in a perfect balance, because any variations and changes can have a dramatic effect on a woman’s health, thereby causing the onset of a host of unhealthy symptoms.

When there is no ovulation the production of progesterone from the ovaries does not occur. As a direct result, the healthy accepted levels of progesterone start to decline.

This means that ovaries may not produce the eggs that have to be fertilized every month, and as a natural consequence, the estrogen levels start to increase. This is one of the main causes of hormonal imbalance in a woman’s body.

Aside from this, there are other causes of hormonal imbalance as outlined below:

• Birth control pills.- Although declared safe by the FDA, the pill is made out of estrogen, causing many women to have abnormal reactions. The Pill can also cause low progesterone levels, leading to hormone imbalance.

• Hormone Replacement Therapy (HRT).- A combination of synthetic hormones, as well as estrogen, to alleviate menopause symptoms. If administered incorrectly, it can lead to hormonal imbalance.

• Poor Diet.- Low consumption of natural vitamins and nutrients also leads to hormonal imbalance.

• Environmental Reasons.- Stress or pollution from everyday life.

• Estrogen exposure. Consumption of non-organic or animal products with elevate estrogen levels can affect the body’s own levels.

• Cosmetics.- Some nail polish brands or hair products include estrogen in their chemical components.

Diagnosing Hormonal Imbalance

There are trained specialists such as obstetricians, gynecologists and reproductive endocrinologists who specialize in the diagnosis and treatment of hormonal imbalance and abnormalities.

Treatment options depend on the individual’s overall health, the type of hormonal imbalance and the severity of the fertility condition. For instance, a diet that is low in fat and high in fiber may be recommended. In addition, those who are suffering from Polycystic Ovary Syndrome (PCOS) may be treated with ovulation medications such as clomiphene (Clomid) while estrogen cream may be prescribed for cervical mucus irregularities.

Women of all ages may experience hormonal imbalances, often with symptoms becoming evident in their late twenties and throughout their forties. Many women also experience symptoms of hormonal changes during their premenstrual cycle.

Types of Hormonal Imbalance

More likely to occur during puberty and menopause, truth is that hormonal imbalances can arise at any age. There are quite a few serious medical conditions associated with hormonal imbalance including: polycystic ovarian syndrome (PCOS), endometriosis, breast disease, and menstrual abnormalities.

The following are the most common types of hormonal imbalances:

Adrenal Imbalance.- In females, the adrenal glands are the primary source of testosterone. If imbalanced, the adrenal system can cause irregularities in a woman nervous and immune systems, blood sugar and body composition.

Thyroid Function Imbalance.- Because thyroid hormones regulate the body’s metabolism, symptoms of their imbalance are wide-ranging and could involve various bodily functions.

Insulin Imbalance.- The conditions linked to insulin and glucose imbalances are chronic stress, polycystic ovarian syndrome (PCOS), coronary artery disease, high blood pressure, metabolic syndrome, and diabetes.

Adult Growth Hormone Deficiency.- Lack of this hormone has been related to poor muscle tone, weight gain, low energy levels, and cardiovascular changes.

Fortunately, there are different suitable treatment options to relieve symptoms of hormonal imbalance; however, before deciding what to do, it is important to get an adequate diagnose of the type of hormonal imbalance. Click on the following link to find out more about hormonal imbalance tests.

Symptoms of Hormonal Imbalance 
• Hot flashes
• Fatigue
• Insomnia
• Loss of libido
• Weight gain and bloating
• Depression
• Mood swings
• Headaches
• Joint pain
• Hair loss and facial hair growth
• Dry or oily skin
• Bone loss
• Decreased fertility
• Heavy or painful periods
• Tender or fibrocystic breasts
• Vaginal dryness

Hormonal Imbalance Treatments

Although the symptoms of hormone imbalance can be troubling at any age, the good news is that they can often be treated effectively in a healthy and natural way. A woman suffering from hormonal imbalance would probably be surprised by how quickly her symptoms improve after following the right advice.

While in the past it was common to prescribe hormone replacement therapy to treat hormonal imbalance, persistent links to breast and ovarian cancer, along with heart disease and blood clots, have caused most healthcare professionals to rethink this treatment option. Many now concur that the most effective approach is to combine a few changes in lifestyle with alternative treatment options.

Three levels of approaches can be considered for treating hormonal imbalance. These are categorized as: (1) Lifestyle Changes, (2) Alternative Medicine and (3) HRT.

It is recommended to start with the least risky option, lifestyle changes, before moving on to the next stage of treatment. According to most recent findings, HRT should really only be used only in extreme cases as prescribed by a medical professional.

Lifestyle changes

This primary level of treatment involves the least amount of risk, although conversely it requires the highest amount of self discipline. Many times some simple changes in lifestyle can reap huge benefits in fighting symptoms caused by hormonal imbalance and achieving a higher overall level of health. Techniques for stress reduction, such as yoga or meditation, combined with regular exercise and an improved diet can do a woman great service. Diet in particular is a key factor in alleviating problems associated with hormone imbalance.

Increasing the intake of foods rich in omega-3 and omega-6 fatty acids will help maintain a good hormonal balance. The omega-3 fatty acids can be found in flax seeds, pumpkin seeds and sunflower seeds. Omega-6 fatty acids can be found in eggs, nuts and poultry.

Making healthy lifestyle changes is easier said than done, especially if one is accustomed to a certain routine. In addition while these changes will help alleviate many symptoms they do not address the problem directly at the hormonal source and so further treatment may be necessary. Alternative medicine has proven to be excellent for treating hormonal imbalance in a safe and natural way.

Natural and Alternatives Treatments

Alternative approaches involve little to no risk and can be an extremely effective way to treat varying types of hormonal imbalance. This level of approach can involve several different therapies. Herbal remedies are the most prominent, though in addition women may turn to such techniques as acupuncture, biofeedback, massage, aromatherapy, or hypnosis. All of these can be valid and effective options, though most women find that herbal remedies are the easiest alternative treatment to follow, as the others require a greater time and monetary commitment. In addition herbal remedies are the only viable option to treat the hormonal imbalance directly at its source.

In the case of herbal remedies, there are two types of herbs that can be used for treating hormonal imbalance: phytoestrogenic and non-estrogenic herbs:

Phytoestrogenic herbs: They contain estrogenic components produced by plants. These herbs treat hormonal imbalance by introducing plant-based estrogens into the body. However, as a result of introducing outside hormones, a woman’s body may become less capable of producing estrogen on its own. This causes a further decrease of the body's own hormone levels.

Non-estrogenic herbs: As the name suggests, they don't contain any estrogen. These herbs stimulate a woman’s own hormone production by nourishing the pituitary and endocrine glands, causing them to more efficiently produce natural hormones. This ultimately results in balancing not only estrogen, but also progesterone and testosterone. Non-estrogenic herbs (e.g. Macafem) can be considered the safest way to treat the symptoms of hormonal imbalance naturally as the body creates its own hormones and doesn't require any outside assistance.

A combination of approaches is usually the most effective route to take. Lifestyle changes combined with alternative medicine will most likely be the best way to alleviate the symptoms of this hormonal imbalance. However, for some women, the symptoms will be so severe that a more drastic treatment is necessary. In taking the leap into pharmaceutical options, side effects are inevitable, yet sometimes they can be worth it if the benefits will outweigh the risks.

Drugs and HRT- Hormone replacement therapy

Interventions at the third level involve the highest risk and often the highest costs. The most common drug therapy for treating mood swings in the US is hormone replacement therapy (HRT). This may be a quick and strong way to combat the underlying hormonal imbalance; but, unfortunately, it entails serious side effects and increases the risk of different types of cancer among women, as the following study has proven. If symptoms are at the level of severity that a woman is still considering this final option it is wise to speak to a healthcare professional for guidance.

The three outlined levels of approaches are not mutually exclusive. A woman may use different approaches at different times or any combination of them, depending on the duration and severity of symptoms. Today more and more women find that dealing with the symptoms of hormonal imbalance is best accomplished via a combination of healthy lifestyle and alternative treatments.

Non-estrogenic herbs for treating hormonal imbalance, as seen in the second approach, are considered to be the most effective solution. Low cost and the non-existence of side effects are only some of the reasons why this treatment option is preferred.

Fallopian Tubal Blockage

Tubal blockage or tubal occlusion (the medical term) is the mechanism by which tubal ligation procedures prevent pregnancy. Tubal blockage prevents sperm from being able to reach an egg and also prevents eggs from being able to reach the uterus. When tubal sterilization is performed, tubal blockage is intentional. Tubal blockage also occurs due to disease conditions and results in involuntary infertility. Whether intentional or resulting from disease, tubal blockage can often be corrected with reconstructive tubal surgery.

Prevalence and Causes of Tubal Blockage

More than 10 million women in the US and 100 million worldwide have had a tubal sterilization. In the US alone, there are over 6 million infertile couples. Approximately 1 million of the cases of infertility are due to tubal disease. Most cases of tubal occlusion due to disease are caused by pelvic inflammatory disease (PID). PID is as an inflammatory condition of the fallopian tubes (salpingitis) and may also involve the ovaries (oophoritis), and pelvic peritoneum (peritonitis). In many, perhaps the majority of cases, PID is unrecognized or “silent”, and/or misdiagnosed. An authoritative medical text, Pelvic Inflammatory Disease has been published by Raven Press and edited by Dr. Gary S. Berger and Dr. Lars V. Westrom. Endometriosis is another condition that can cause tubal blockage and is sometimes confused clinicially with PID. Congenital abnormalities or malformations of the uterus and fallopian tubes may also result in tubal blockage. In these cases, the blockage is usually at the uterine, or proximal, end of the tube rather than at the fimbrial end as occurs with PID.

Treatments for Tubal Blockage

There are 2 basic approaches to treat infertility due to tubal blockage:
Tubal Surgery
In Vitro Fertilization (IVF)
Tubal surgery is best performed by gynecologic reproductive surgeons who have specialized training and experience in this area. In Vitro Fertilization (IVF) in essence replaces the functions of the fallopian tube with laboratory and minor surgical procedures that result in fertilization and transfer of fertilized eggs or embryos into the uterine cavity.Since the advent of in vitro fertilization (IVF), reconstructive tubal surgery is becoming a lost skill. IVF is more popular than tubal surgery among reproductive endocrinologists.

Tubal implantation is used to correct a proximal tubal occlusion or blockage at the junction of the fallopian tube and uterus. The blocked segment is bypassed by creating a new opening in the uterus and inserting the healthy portion of the fallopian tube into the uterine cavity. Tubal implantation is also called tubouterine implantation or uterotubal implantation.

Salpingostomy is creating a new opening in the fallopian tube. This operation, also called neosalpingostomy, is used to correct distal tubal occlusion at or near the fimbrial end of the tube caused by fimbriectomy, PID, or endometriosis.
Benefits and Risks of Tubal Surgery vs IVF

The primary benefit of tubal surgery to repair tubal blockage is that it is done once. After a tubal blockage is repaired, pregnancy can occur at any time after the surgical procedure. The primary risk of tubal surgery in an increased rate of tubal pregnancy.  IVF has the advantage that it avoids surgery, but it is more complicated and requires the use of extremely large doses of hormones to stimulate the ovaries. This is called "super-ovulation". The use of super-physiologic doses of ovarian stimulating hormones is associated with the risks of ovarian hyperstimulation and an increased rate of multiple pregnancies.

Tubal Blockage - How Can blocked Fallopian Tubes be treated?
There could be several reasons as to why a woman may be having problems conceiving. The most common reason of all could be that she has a tubal blockage that causes blocked fallopian tubes. In fact in the US today more than 6 million couples have problems when it comes to conceiving because one or both could be infertile. Then of these 6 million, about 1 million will be unable to have children because it has been discovered that the woman has suffered from some disease which has resulted in blocked fallopian tubes.

Most women who suffer from blocked fallopian tubes will find that they have suffered from PID (Pelvic Inflammatory Disease) at some stage in their lives. But there are in fact, ways of treating this particular condition and certainly most women will tend to undergo some form of tubal surgery which allows for the tubal blockage to be removed. There are three kinds of tubal surgery used today which removes these types of blockages and so increase the chances of the woman conceiving naturally.

Technique 1 - Tubal Anastomosis
This particular form of reconstructive tubal surgery is mostly used to reattach the blocked tubes after the tubal blockage is removed or for a reversal of a tubal ligation. A stent may be threaded through the fallopian tubes in order to ensure that the tubes are now open from both the fimbrial end and the uterine cavity. Once the new opening has been created, the tubes are drawn together using a suture. Only when the new ends of the fallopian tubes are together and the blockage has been removed will the stent be gently withdrawn. The two good ends of the fallopian tubes, no longer blocked, are then sutured together.

Technique 2 - Microsurgical Tubal Implantation
This form of reconstructive tubal surgery is carried out where only a distal portion of a woman's fallopian tubes are available as there is no proximal tubal opening into the uterus because of a tubal blockage at the end of the tube nearest the uterus. The surgeon will carry out this particular procedure in order that a new opening into the uterus can be created and then a tubal segment can be inserted into the uterine cavity making a complete path from ovary to uterus for the egg. 

Technique 3 - Fimbriectomy Reversal
Also known as microsurgical salpingostomy, this type of tubal surgery helps to create a new, although small, opening in the end of the blocked fallopian tubes. With this particular operation a microsurgical electrode needle will be used at the newly created openings in the fallopian tubes so that they can be enlarged and the ends can be folded back. However, with this particular surgical operation the actual fimbrial and infundibular portions of the woman's fallopian tubes next to the ovaries have to be removed which may be done due to scarring causing the tubal blockage in that area or as a result of a tubal ligation procedure. But although this needs to be carried out, the eggs that are released by the ovaries will still be able to be captured by the new tubal openings just as they would if the fimbrial ends where still in position.

Any woman who undergoes these surgical procedures after being diagnosed with blocked fallopian tubes will find that the chances of them conceiving naturally are greatly increased. In One tubal surgery study, with the last surgical technique we have discussed in this article, it has been found that around 40% of all women who have had it conceived in the first year after the surgery was completed. The other types of surgery to remove tubal blockage from the blocked fallopian tubes have an even better success rate dependent upon other factors.

What To Expect After Surgery

After open abdominal surgery, there usually is a 2- to 3-day hospital stay. Antibiotics may be given to prevent infection. A woman usually can return to work in 4 to 6 weeks, depending on the extent of surgery, the nature of her work, and her overall health and stamina.

After laparoscopic surgery, there is a brief hospital stay. A woman's return to daily activities can take a few days to a couple of weeks, depending on the type of procedure.

Why It Is Done

Fallopian tube surgery may be done if:

Hysterosalpingography shows blocked fallopian tubes.
A blocked fallopian tube has a buildup of fluid (hydrosalpinx).
You want to have a tubal ligation reversed.

How Well It Works

The success of a fallopian tube procedure depends in part on the location and extent of the blockage, as well as the presence or absence of other fertility problems.

Clearing a blockage in the part of the tube closest to the uterus (proximal occlusion) is more likely to be successful. These blockages often are functional (such as a mucus plug) rather than structural (such as scarring or other obstruction). Up to 60% of women with proximal occlusion have been reported to have successful pregnancies after tubal surgery.2
From 20% to 30% of women with a blockage near the end of the fallopian tube have had successful pregnancies after tubal surgery.2
The amount of fallopian tube that remains after surgery is critical to the function of the tube. If a large part of the tube must be removed to eliminate blockage, the likelihood of pregnancy after surgery is reduced.
The success of a sterilization reversal is influenced by the tubal ligation method used, by how recently the tubal ligation was performed, and by the woman's age-related fertility.

Additional conditions that affect the success of surgery include not only whether the woman has scar tissue (adhesions) in her pelvis and whether she has other diseases in the pelvic area but also the surgeon's level of skill and experience.

Risks
Risks of fallopian tube surgery include:

» Pelvic infection.
» Scar tissue (adhesions) forming on the reproductive organs, causing them to bind to the abdominal wall or to other organs.
» Increased risk of tubal (ectopic) pregnancy after surgery.

What To Think About
Some fallopian tube problems can be treated with more than one type of surgery or procedure. Ask your doctor for his or her success rates (birth of a healthy baby), as well as national success rates, for any procedure you are considering. Hysterosalpingography may be performed 3 to 6 months after surgery, to check whether the tubes have been opened. If you do not become pregnant within 12 to 18 months following surgery, your doctor may do a laparoscopy to check the condition of your fallopian tubes or may refer you for in vitro fertilization (IVF). When successful, a fallopian tube procedure can enable a woman to have more than one pregnancy without ongoing fertility treatment and repeated use of IVF

Infertility Glossary

»» Abortion: the medical term for miscarriage. The various types include
» Complete abortion:
A miscarriage in which all of the products of conception have been expelled and the cervix is closed.
» Habitual abortion:
A miscarriage occurring on two or more separate occasions.
» Incomplete abortion:
A miscarriage in which only a portion of the products of conception have been expelled. This usually requires dilatation and curettage.
» Induced abortion:
An intentional termination of pregnancy.
» Inevitable abortion:
A miscarriage that cannot be halted.
» Missed abortion:
A miscarriage in which a dead fetus and other products of conception remain in the uterus for four or more weeks.
» Selective abortion:
A term often used to refer to intentional termination of one or more gestational sacs within the uterus, usually in the case of a multiple pregnancy (triplets or more).
» Spontaneous abortion:
A miscarriage or the unintended termination of a pregnancy before the twentieth week.
» Therapeutic abortion:
An intentional termination of pregnancy for the purpose of preserving the life of the mother.
» Threatened abortion:
symptoms such as vaginal bleedings, with or without pain, which may end with a miscarriage or with continuation of a normal pregnancy.

» Adhesion:
An abnormal attachment of adjacent tissues by bands, scars or masses of fibrous tissue.
» Adrenal Glands:
Two glands near the kidneys that produce hormones, including some male sex hormones - the adrenal androgens.
» Agglutination of Sperm:
Sticking together of sperm.
» Amenorrhea:
The absence of menstruation.
» Ampulla:
The outer half of the fallopian tube, where fertilisation occurs. It opens into the abdominal cavity through the tubal ostium, which is lined by the fimbria.
» Androgens:
Male sex hormones. Testosterone is one example.
» Andrology:
The science of diseases peculiar to the male sex, particularly infertility, and sexual dysfunction.
» Anomaly:
A malformation or abnormality in any part of the body.
» Anovulation:
Total absence of ovulation. Note: This is not necessarily the same as "amenorrhea." Menses may still occur with anovulation.
» Anovulatory Bleeding:
The type of menstruation often associated with failure to ovulate. This menstruation may be scanty and of short duration; or abnormally heavy and irregular.
» Antibody:
A protective protein produced in the body that fights or otherwise interacts with a foreign substance in the body.
» Artificial Insemination by Donor (AID):
The injection of donor semen into a woman's reproductive tract for the purpose of conception.
» Artificial Insemination by Husband (AIH):
The injection of husband's semen into the wife's reproductive tract for the purpose of conception.
» Aspermia:
The absence of semen. This is not the same as azoospermia.
» Asthenospermia:
A condition in which the sperm do not move (swim) at all or move more slowly than normal.
» Azoospermia:
The absence of sperm in the ejaculate.

» » Basal Body Temperature (BBT):
The temperature of the woman, taken either orally or rectally, upon waking in the morning before any activity. Used to help determine ovulation.
» Bicornuate Uterus:
A congential malformation of the uterus in which it appears to have two "horns " (cornu).
» » Capacitation:
The process by which sperm are altered (usually during their passage through the female reproductive tract) that gives them the capacity to penetrate and fertilize the ovum.
» Cervix:
The lower section of the uterus which protrudes into the vagina.
» Child-free Living:
A resolution to infertility in which the couple opts for a life-style without parenting, either temporarily or permanently.
» Chlamydia:
A sexually transmitted disease that may cause impaired fertility.
» Chromosomes:
Rod-shaped bodies in a cell's nucleus which carry the genes that convey hereditary characteristics. Made up of DNA.
» Cilia:
Microscopic hair-like projections from the surface of a cell capable of beating in a coordinated fashion.
» Clitoris:
The small erectile sex organ of the female, located in front of the vagina and similar to the penis of the male.
» Clomiphene Citrate:
A synthetic drug used to stimulate the hypothalamus and pituitary gland to increase FSH and LH production. It is usually used to treat ovulatory failure due to hypothalamic pituitary dysfunction.
» Coitus:
Sexual intercourse.
» Conception:
The fertilization of a woman's egg by a man's sperm resulting in a new life.
» Congenital:
A characteristic or defect present at birth. It is acquired during pregnancy but is not necessarily hereditary.
» Corpus Luteum:
The special gland that forms in the ovary at the site of the released egg. This gland produces the hormone progesterone during the second half of the normal menstrual cycle.
» Cryobank:
A place where tissues (i.e., sperm, oocytes, embryos) are stored in the frozen state.
» Cryopreservation (freezing):
A procedure used to preserve (by freezing) and store embryos or gametes (sperm, oocytes).
» Cryptorchidism:
Undescended testicles.

» » Dilatation and curettage (D & C):
Dilatation of the cervix to allow scraping of the uterine lining with an instrument (curette). This also a means to induce abortion in the first trimester of pregnancy.
» Dysgenesis:
Faulty formation of any organ.
» Dysmenorrhea:
Painful menstruation.
» Dyspareunia:
Painful intercourse for either the woman or the man.

» » Ectopic pregnancy:
A pregnancy in which the fertilized egg implants anywhere but in the uterine cavity (usually in the fallopian tube, the ovary or the abdominal cavity).
» Egg (Oocyte) donation:
Surgical removal of an egg from one woman for transfer into the fallopian tube or uterus of another woman.
» Ejaculation:
The male orgasm during which approximately two to five milliters of semen (seminal fluid and sperm) are ejected from the penis.
» Embryo:
The term used to describe the early stages of fetal growth, from conception to the eighth week of pregnancy.
» Embryo transfer:
The introduction of an embryo into a woman's uterus after in vitro (or in vivo) fertilization.
» Endocrine system:
The system of glands including the pituitary, thyroid, adrenals, testicles or ovaries.
» Endocrinologist:
A doctor who specializes in diseases of the endocrine glands.
» Endometrial biopsy:
The extraction of a small sample of tissue from the uterus for examination. Usually done to show evidence of ovulation.
» Endometriosis:
The presence of endometrial tissue (the normal uterine lining) in abnormal locations such as the tubes, ovaries and peritoneal cavity, often causing painful menstruation and infertility.
» Endometrium:
The mucous membrane lining the uterus.
» Endosalpinx:
The tissue lining in the fallopian tube.
» Epididymis:
An elongated organ in the male lying above and behind the testicles. It contains a highly convoluted canal, four to six meters in length, where, after production, sperm are stored, nourished and ripened for a period of several months.
» Erection:
The enlarged, rigid state of the penis when sexually aroused.
» Estradiol (E2):
A hormone released by developing follicles in the ovary. Plasma estradiol levels are used to help determine progressive growth of the follicle during ovulation induction.
» Estrogen:
A class of female hormones, produced mainly by the ovaries from the onset of puberty until menopause which are also responsible for the development of secondary sexual characteristics in women.

» » Fallopian tubes:
A pair of narrow tubes that carry the ovum (egg) from the ovary to the body of the uterus.
» Fertilization:
The penetration of the egg by the sperm and fusion of genetic materials to result in the development of an embryo.
» Fetal death:
The term often used to include both miscarriage and still-birth.
» Fetus:
The developing baby from the ninth week of pregnancy until the moment of the birth.
» Fibroid tumor (leiomyoma):
A benign tumor of fibrous tissue that may occur in the uterine wall. Maybe totally without symptoms or may cause abnormal menstrual patterns or infertility.
» Fimbriae:
The fringed and flaring outer ends of the fallopian tubes which capture the egg after it released from the ovary.
» Follicle:
The structure in the ovary that has nurtured the ripening egg and from which the egg is released.
» Follicle stimulating hormone (FSH):
A hormone produced in the anterior pituitary that stimulates the ovary to ripen a follicle for ovulation.
» Follicular Phase:
The first half of the menstrual cycle when follicle development takes place in the ovary.
» Frigidity:
The inability to become sexually aroused. Not a known cause of infertility.

» » Gamete:
The male or female reproductive cells- the sperm or the ovum (egg).
» Gamete intra-fallopian transfer (GIFT):
Procedure in which the sperms and eggs are transferred by laparoscopy into the fallopian tubes where fertilization may then take place.
» Genes:
Substances that convey hereditary characteristics, consisting primarily of DNA and proteins and occurring at specific points on the chromosomes.
» Genetic:
Pertaining to hereditary characteristics.
» Genetic abnormality:
A disorder arising from an anomaly in the chromosomal structure which may or may not be hereditary.
» Genetic counseling:
Advice and information provided, usually by a team of experts, on the detection and risk of recurrence of genetic disorders.
» Gestation:
The period of fetal development in the uterus from conception to birth, usually considered to be 40 weeks in humans.
» Gland:
Hormone-producing organ.
» GnRH (gonadotropin releasing hormone; LHRH):
A hormone released from the hypothalamus that controls the synthesis and release of pituitary hormones FSH and LH.
» Gonadotropin:
A hormone capable of stimulating the gonads to produce hormones and / or gametes.
» Gonads:
The glands that make the gametes (the testicles in the male and the ovaries in the female).
» Gynecologist:
A doctor who specializes in the diseases of the female reproductive system.

» » Hamster Test (sperm penetration assay):
used to determine the ability of a man's sperm to penetrate a hamster egg. Thought to provide evidence of the sperm's fertilising ability.
» Hemorrhage:
Excessive bleeding.
» Hereditary:
Transmitted from one's ancestors by way of the genes within the chromosomes of the fertilizing sperm and egg.
» Hirsutism:
The presence of excessive body and facial hair, especially in women.
» Hormone:
A chemical, produced by an endocrine gland, which circulates in the blood and has widespread action throughout the body.
» Human chorionic gonadotropin (HCG):
A hormone secreted by the placenta during pregnancy that prolongs the life of the corpus luteum.
» Human menopausal gonadotropin (HMG):
A natural product containing both human FSH and LH. These hormones are extracted from the urine of postmenopausal women.
» Hydrocele:
A swelling in the scrotum containing fluid.
» Hydrosalpinx:
A large fluid-filled, club-shaped fallopian tube closed at the fimbriated end. It is a cause of infertility.
» Hydrotubation:
Lavage or "flushing" of the fallopian tubes with a sterile solution which sometimes contains medication such as antibiotics, enzymes, or steroids.
» Hymen:
A membrane that partially covers the virgin vagina.
» Hyperplasia:
An abnormal enlargement of an organ or tissue of the body.
» Hyperstimulation syndrome:
A syndrome which may include ovarian enlargement, abdominal distension and weight gain.
» Hypogonadism:
Inadequate gonadal function as manifested by deficiencies in sperm production in males or egg production in females and/or the secretion of gonadal hormones (estrogens and androgens, respectively).
» Hypospadias:
A malformation of the penis in which the urethral opening is found on the underside rather than at the tip of the penis.
» Hypothalamus:
A part of the base of the brain that controls the release of hormones from the pituitary.
» Hysterosalpingogram:
An X-ray study in which a contrast dye is injected into the uterus to show the delineation of the body of the uterus and the patency of the fallopian tubes. Also called a tubogram or uterotubogram.

» » Idiopathic (unknown or unexplained):
The term used when no reason can be found to explain the cause of a medical condition.
» Immunological response:
The production of antibodies in the woman or man.
» Implantation:
The embedding of the fertilized egg in the endometrium of the uterus.
» Impotence:
The inability of the male to achieve or maintain an erection for intercourse due to physical or emotional problems.
» Incompetent cervix:
A weakened cervix that is incapable of holding the fetus within the uterus for the full nine months. Can be a cause of late miscarriage.
» Infertility:
The inability of a couple to achieve a pregnancy after one year of regular unprotected sexual intercourse, or the inability of the woman to carry a pregnancy to live birth.
» Interstitial cells:
The cells between the seminiferous tubules of the testicles that produce the male hormone testosterone. Also called Leydig cells.
» In vitro (literally, in glass) fertilization (IVF):
A procedure in which a egg is removed from a ripe follicle and fertilized by a sperm cell outside the human body. Also called "test tube baby" and "test tube fertilization."
» In vivo fertilization:
The fertilization of an egg by a sperm within the woman's body.

» » Kallman's syndrome:
Hypogonadism with anosmia (loss of the sense of smell). Uncommon cause of male infertility.
» Karyotype:
A study of the chromosomes of the tissue. Used for genetic studies.
» Klinefelter's syndrome:
A congenital abnormality of the male wherein he receives an XXY chromosomal complement instead of XY. These men are infertile.

» » Labia:
Folds of skin on either side of the entrance of the vagina.
» Laparoscopy:
The direct visualization of the ovaries and the exterior of the fallopian tubes and uterus by means of inserting a surgical telescope through a small incision below the naval.
» Laparotomy:
Abdominal surgery.
» Leydig Cells:
See interstitial cells.
» LHRH:
Luteinizing hormone releasing hormone (see GnRH).
» Libido:
Sexual desire.
» Luteal Phase:
The days of the menstrual cycle following ovulation and ending with menses during which progesterone is produced by the corpus luteum.
» Luteal phase defect:
A shortened luteal phase or one with inadequate progesterone production.
» Luteinized unruptured follicle syndrome (LUF):
A condition in which the egg is not released during ovulation; the follicle does not rupture and the egg is trapped.
» Luteinizing hormone (LH):
A hormone secreted by the pituitary gland. Secretion of LH increases in the middle of the cycle to induce release of the egg.

» » Menarche:
The onset of menstruation in girls.
» Menopause:
The cessation of menstruation due to aging or failure of the ovaries. Most commonly occurs between the ages of 40 and 50.
» Menotropins (human menopausal gonadotropin or HMG):
Injections which containing FSH and LH. They are produced by extraction from the urine of menopausal women.
» Menstruation:
The shedding of the uterine lining by cyclic bleeding that normally occurs about once a month in the mature female.
» Miscarriage:
A spontaneous abortion of a fetus up to the age of viability.
» Mittelschmerz:
German for "middle pain," referring to the pain during ovulation that some women experience.
» Morphology of sperm:
The study of the shape of sperm cells. This evaluation is part of a semen analysis.
» Motility of sperm:
The ability of the sperm to move about.
» Mumps orchitis:
Inflammation of the testicle caused by mumps virus. Can lead to sterility if infection with the virus occurs after puberty.
» Myomectomy:
Surgical removal of a fibroid tumor (myoma) in the uterine muscular wall.

» » Necrospermia:
A condition in which sperm are produced and found in the semen but they are dead. These sperm cannot fertilize eggs.
» Nidation:
The implantation of the fertilized egg in the endometrium of the uterus.

» » Obstetrician:
A doctor who specializes in pregnancy and childbirth.
» Oligo-ovulation:
Infrequent ovulation, usually less than six ovulatory cycles per year.
» Oligospermia:
An abnormally low number of sperm in the ejaculate of the male.
» Oocyte:
The egg.
» Oocyte retrieval:
A surgical procedure to collect the eggs contained within the ovarian follicles.
Orchitis:
An inflammation of the testes.
» Ovarian failure:
The inability of the ovary to respond to any gonadotropic hormone stimulation, usually due to the absence of oocytes.
» Ovaries:
The sexual gland of the female which produces the hormones estrogen and progesterone, and in which the ova are developed.
» Oviduct:
Fallopian tube.
Ovulation:
The discharge of a mature egg, usually at about the midpoint of the menstrual cycle.
Ovulation induction:
The use of hormone therapy (clomiphene citrate, HMG,HCG) to stimulate development and release.
» Ovum:
The egg (reproductive) cell produced in the ovaries each month. (The plural of ovum is ova.)

» » Pelvic inflammatory disease (PID):
Inflammatory disease of the pelvis, often caused by infection.
» Penis:
The male organ of intercourse.
» Pituitary:
A gland located at the base of the human brain that secretes a number of important hormones related to normal growth and development and fertility.
» Polycystic ovarian syndrome (PCO):
Development of multiple cysts in the ovaries due to arrested follicular growth resulting in an imbalance in the amount of LH and FSH released.
» Polyp:
A nodule or small growth found frequently on mucous membranes, such as in the cervix or the uterus.
» Postcoital test (huhner test):
A diagnostic test for infertility in which vaginal and cervical secretions are obtained following intercourse and then analyzed under a microscope.
» Progesterone:
A hormone secreted by the corpus luteum of the ovary after ovulation has occurred. Also produced by the placenta during pregnancy.
» Prostate:
A gland in the male that surrounds the first portion of the urethra near the bladder. It secretes an alkaline liquid that neutralizes acid in the urethra and stimulates motility of the sperm.
» Pyospermia:
A condition in which the presence of white cells in the semen indicates possible infection.

» » Retrograde ejaculation:
Discharge of semen backward into the bladder rather than forward through the penis.
Retroverted uterus:
Uterus that is bent backward.
Rubin test:
Obsolete test in which a gas such as carbon dioxide is blown into the uterus under pressure to test if the fallopian tubes are open.

» » Salpingitis:
Inflammation of the fallopian tubes.
» Salpingolysis:
Surgery to clear the fallopian tubes of adhesions.
» Salpingoplasty:
Surgery to correct blocked fallopian tubes.
» Scrotum:
The bag of skin and thin muscle that holds the testicles.
» Secondary infertility:
The inability to conceive or carry a pregnancy after having successfully conceived and carried one or more pregnancies.
» Semen:
The sperm and seminal secretions ejaculated during orgasm.
» Semen analysis:
The study of a fresh ejaculate under the microscope.
» Seminal vesicle:
A pair of pouch-like glands above the prostate in the male that produce a thick, alkaline secretion that is passed in the semen during ejaculation.
» Seminiferous tubules:
The long tubes in the testicles in which sperm are formed.
» Septum:
An abnormality in organ structure present since birth in which a wall is present where one should not exist.
» Sperm (spermatozoa):
The male reproductive cell, that has measurable characteristics such as:
» Motility:
Refers to percent of sperm demonstrating any type of movement.
» Count (or Density):
Refers to the number of sperm present.
» Morphology:
Refers to form or shape of the sperm.
» » Viability:
Refers to whether or not the sperm are alive.

» » Sperm bank:
Place in which sperm (from donor or from husband) is stored frozen for future use in artificial insemination.
» Sperm washing:
A technique that separates the sperm from the seminal fluid.
» Spermatogenesis:
The production of sperm within the seminiferous tubules.
» Spinnbarkheit:
The stretchability of cervical mucus.
» Split ejaculate:
A method of collecting a semen specimen so that the first half of the ejaculate is caught in one container and the rest in a second container. The first half usually contains the majority of the sperm.
» Surrogate mother:
A woman who gestates an embryo and then turns over the child to the infertile couple, who may be its genetic parents.

» » Testicles:
The male sexual glands of which there are two. Contained in the scrotum, they produce the male hormone testosterone and produce the male reproductive cells, the sperm.
» Testicular biopsy:
Surgical excision of testicular tissue to determine the ability of the testes to produce normal sperm
» Testicular failure:
Occurs when the testes fail to produce sperm.
» Testosterone:
The most potent male sex hormone, produced in the testicles.
» Test-tube baby:
A child born through in vitro fertilization.
» Thyroid gland:
A gland located at the front base of the neck which secretes the hormone thyroid which is necessary for normal fertility.
» Tuboplasty:
Surgical repair of fallopian tubes.
» Turner's syndrome (ovarian dysgenesis):
A congenital abnormality of the female wherein she receives an XO instead of an XX genetic sex complement. Women with this condition are sterile.

» » Ultrasound (sonography):
A imaging technique for visualizing the growth of ovarian follicles during infertility therapy.
» Unexplained fertility:
See idiopathic infertility.
» Urethra:
The tube that carries urine from the bladder to the outside. In men it also carries semen from the prostate to the point of ejaculation during intercourse.
» Urologist:
A doctor who specializes in diseases of the urinary tract in men and women, and the genital organs in men.
» Uterotubogram:
See hysterosalpingogram.
» Uterus:
The hollow, muscular organ in the woman that holds and nourishes the fetus until the time of birth.

» » Vagina:
The birth canal opening in the woman extending from the vulva to the cervix of the uterus.
» Vaginismus:
A spasm of the muscles around the opening of the vagina, making penetration during sexual intercourse either impossible or very painful.
» Varicocele:
A varicose vein of the testicles, sometimes a cause of male infertility.
» Vas deferens:
A pair of thick-walled tubes about 45cm long in the male that lead from the epididymis to the ejaculatory duct in the prostate.
» Vasectomy:
Surgery to excise part of the vas deferens to sterilize a man.
» Vasogram:
X-ray of the sperm ducts.
» Venereal disease (VD):
Any infection pertaining to or transmitted by sexual intercourse. Also known as STD or sexually transmitted disease - most commonly gonorrhea, syphilis and chlamydia.
» Viscosity:
Thickness of the semen.
» Vulva:
The external genitalia of the female.
» » Zygote:
An embryo in early development stage.
» Zygote intra-fallopian transfer (ZIFT):
Transfer of a zygote into a fallopian tube (usually done by laparoscopy).