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The Lingo

We talk fast, sometimes too fast…way too fast! We also move fast and think fast—we can’t help it; we’re New Yorkers! But sometimes we need to slow down, not only how we talk but also how we move, both through our days and through our lives. And while it’s going to take work (#meditation) to slow things down, we can help those whom we frequently talk to (a.k.a. our patients) better understand the shorthand or lingo that we are using for medical terms. Think of the following as the Truly, MD, fertility language translator. We offer you the top 15 most frequently heard acronyms in the halls of a fertility clinic, in alphabetical order.

ART: Who doesn’t like to paint and color? And although we, too, like an adult coloring book (they’re now all over the place!), the ART we are referring to stands for Assisted Reproductive Technologies. Anything where fertilization occurs outside of the body (think IVF, egg donation, or surrogacy) is under the paintbrush of ART.

Azo: Despite the way it’s written, you’re not about to visit the zoo. Azo comes from the Greek word azoos, which means lifeless. In fertility medicine, azoo– is a prefix that, when placed before -spermia describes the lack of sperm found in the ejaculate. It can occur either when sperm is not being produced OR when sperm is being produced but its exit out of the testicles is blocked. In both cases, it requires an evaluation by a urologist.

CCS: Think of a girl named Elizabeth. Elizabeths can be Lizs, Beths, Lizzies, and even Elizas. Sometimes they drop the nickname thing completely and go by Elizabeth. Simply stated, there are many ways to refer to your friend named Elizabeth. Same goes for the names we use to describe the genetic testing of embryos. CCS, or comprehensive chromosomal screening, is a term used to describe the genetic testing procedure that checks to see how many chromosomes an embryo has (remember, 46 is the magic number!).

DOR: Women with low egg count and low egg quality are frequently diagnosed with diminished ovarian reserve. Simply stated, the “fuel tank” in the ovaries is running low. The ovaries have a finite number of eggs. Once we exhaust that supply, there is unfortunately no way to “refuel the tank.” To maximize what is remaining in the ovaries, fertility doctors will often recommend IVF.

hCG: Everyone’s favorite hormone. hCG is the hormone that is secreted by a pregnancy, so when it is positive or present in your blood or urine, it indicates that you’re pregnant. And while it can’t tell us if the pregnancy will be good, it tells us if something is there. On the flip side, it is also a shot we administer to achieve ovulation and egg maturation.

IC: Simply stated, IC = intercourse. Intercourse = sex. We, as fertility doctors, “prescribe” IC frequently. By using tools like your menstrual cycle, your ultrasound, and your blood work, we can predict when you will ovulate and when “having IC” will give you the best chance of “having a baby.”

ICSI: Staying with the egg-meets-sperm concept when ICSI is performed, this meeting takes place in a whole different spot in a whole different way. There is no swimming or mingling, but there is a whole lot of selection. During ICSI (intra-cytoplasmic sperm injection), an embryologist will select individual sperm and physically inject them into the egg to achiever fertilization. In most cases, the highest rates of fertilization are achieved following ICSI.

IUI: In the body, sperm has to swim—from the vagina, to the cervix, to the uterus, and to the tube to finally meet the egg. And while this journey is fairly short and fairly quick (most sperm reach the tube in less than two minutes), it can be taxing. IUI (also known as intrauterine insemination) is sort of like a way to bypass step A and step B, allowing them to get to step C much faster!

IVF: Fertility medicine has come a long way, baby! And while we have seen a lot on both the diagnostic and treatment side, the biggest leaps and bounds have come with in vitro fertilization (#IVF). In the most basic terms, when an egg meets a sperm outside of the body and fertilization occurs in the laboratory, that’s called IVF. The resultant embryo is either transferred back into the uterus three to five days later or frozen for future use.

Oligo: Going back to our Greek roots is where we will find the definition for the frequently used prefix in fertility medicine, oligo-. Simply stated, oligo means few, little, or scanty. We often put it in front of medical terms such as -spermia (a.k.a. sperm) or -menorrhea (a.k.a. period) to describe how many or how frequently something occurs.

OPK: OPKs have become a part of a reproductive age woman’s vernacular! They are so commonplace that we often forget they are somewhat new to the fertility scene. OPK stands for ovulation prediction kits, and they are an OTC (a.k.a. over the counter) means to know if you’re ovulating. While it does require urine, some diligence (you frequently need to take the test several days in a row), and anywhere between $20 and $100, it can provide helpful information regarding when and if you’re releasing an egg.

PGD: Although PGD and PGS are used interchangeably, they are not identical. PGD describes the genetic testing of embryos for single-gene disorders. PGS is looking to make sure that the embryo has the accurate number of chromosomes. To do PGD, you have to be looking for the presence or absence of a specific genetic condition, not for overall chromosome number. Picture this…if you and your partner are both carriers for Cystic Fibrosis, you would do PGD on the embryo to make sure that embryo will not inherit the disease. We can test for hundreds of genetic conditions as long as we know what the specific mutation is.

PGS: In many ways, PGS is the umbrella term for everything that “rains” genetics. Pre-genetic screening involves screening the embryos through a variety of techniques for chromosome number. It is probably the most frequently used term, by both physicians and patients, to describe embryo genetic testing.

TE Biopsy: We are taking you back to “Elizabeth” one last time…just with a bit of a twist. TE biopsy (a.k.a. trophectoderm biopsy) finds itself in the same family of terms used to describe genetic testing. However, TE biopsy actually describes the technique that we use to obtain the cells needed for the genetic testing. The trophectoderm is the part of the embryo that will become the placenta, months down the road. We take cells (biopsy) from the trophectoderm and send it to the genetics lab for analysis.

Although it’s fairly likely that we missed a few frequently used ph-rases (that’s what happens when you move fast!) this list captures most of the big ones. Use it as your cheat sheet when trying to decode the language you hear at a fertility clinic. And while you may never totally speak the same language as your fertility doctor, at least you will come pretty close to being fluent.

Can’t Stop, Won’t Stop: What to Do When Your First IVF Treatment Fails

Can’t stop, won’t stop; it’s not for nothing that this may be one of our favorite sayings. As overplayed as it might be and as trite as it might sound, it’s pretty much how we aim to live our lives, how we chose to tackle our challenges, and how we hope to make it to the end of a marathon. We push each other, we push ourselves, and we push ahead to get to OUR end.

But life is not a race, and there is no set finish line (except for the obvious one that we won’t harp on). How you end your day, how you end your career, and how you end any struggle in many ways is up to you. You set the start line, the halftime, and the finish line. Much can also be said for how many rounds of fertility treatment you decide to do and how long you continue to try for a baby.

Knowing when to call it quits can be nearly impossible. Whether professionally or personally, it’s hard to know when enough is enough. In terms of fertility treatment, specifically IVF cycles, how much is too much? How many is too many? When do you move on to something else?

A recent study from England published in a very prominent medical journal (JAMA) recently addressed this question. It got a whole lot of press and found its way into the New York Times, the Wall Street Journal, and all of the morning talk shows. It basically showed that women who hung in the game were more likely to get pregnant—quitting after a couple of failed IVF cycles was not the right move. Although they didn’t find a magic cutoff number after which patients should be told to exit stage left, they did find that nearly 70% of women under the age of 40 got pregnant after six IVF cycles. While about 30% of women got pregnant on the first cycle, many took longer to cross their finish line.

The results were less promising for women older than 40; while they also got pregnant at a higher rate after more IVF cycles, the total number did not exceed 30%. Bottom line, even though this study got as much press as a Kardashian wedding, it’s important not to misanalyze the data.

This study is NOT giving the green light to endless IVF and fertility treatments. This study is NOT saying that multiple IVF cycles are always the way to go. This study is NOT saying everyone who does multiple IVF cycles will get pregnant. This study is simply saying that, if you can emotionally, physically, and financially (unfortunately, finances come into play big time) swallow the treatment AND your doctor believes you are a good candidate, it’s okay to keep on keeping on.

Knowing when to bow out is nearly impossible. Unfortunately, there is no magic number. But here’s the CliffsNotes version from girls in the know… For starters, we use age, pregnancy history, and ovarian reserve testing to decide when enough is enough; these initial parameters can shed a lot of light about what’s to come.

Additionally, we use IVF response as a gauge of how much gas you have left in the tank—are you responding to medications, are you producing follicles, is your estrogen level rising?

Last, we use embryo development and, if available, embryo genetic testing results (PGS/CCS/TE biopsy, which tests for aneuploidy) to help patients decide whether further treatment is a go. For example, if patients have done several IVF cycles without any viable or normal embryos, we are hard pressed to recommend continued fertility treatments with your own eggs. And while no, history doesn’t always repeat itself, in these cases, it comes pretty close.

We are not dictators, czars, fortune tellers, or goddesses (although we wish we were)—and we are not afraid to admit that. We can’t tell you that more will be better; it may just cost more money, cause more physical discomfort, and evoke more emotional anguish. But quitting too early can be a real shame.

Just like in sports (from two women that love to pound the pavement!), there should always be a day for rest, always a moment to breathe, and always a time to stop. Without a break, you get injured. Without a day to sleep in, you get fatigued, and without days off from work, you get frustrated. In cases where there is no definable finish line for you or your partner, you may need your doctor to help you set it. When you collectively find that line in the sand, be careful not to step over it. Things will start to sink quickly on the other side.