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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.

Getting Your Timing Back: Preparing for Pregnancy

Nowadays, many of us prepare for getting pregnant in the same way we would train for a race or prepare for a big meeting at work. We carefully map out when we will stop our contraception, how we will tackle the trying thing, and how long we will let things go “naturally” before seeking out fertility advice. Infertility has gotten a lot of press (one in six couples will experience infertility), and therefore, many couples are thinking about what could go wrong before the process has even begun. But let us mitigate some of the madness about becoming a momma with a few morsels of advice about the “pre” period.

Most women who are not trying to conceive have a better idea about when their Amazon Prime package will arrive rather than when to expect their period. Tracking often applies only to packages, not periods! And the situation is even more confusing for women who are on the pill, the patch, or the ring or have an IUD. These forms of contraception can turn the system off all together (which is not a bad thing, we promise!), which makes knowing what’s up with your periods pretty problematic.

And while we certainly don’t recommend that you stop your hormonal contraception to focus on Aunt Flo’s arrival, we do suggest that you say goodbye to hormonal contraception a couple of months before you are ready to give things a go. During this time, you can get a good idea about the regularity (or irregularity) of your cycle—this information will be helpful when you are trying to track your ovulation and time intercourse. To protect yourself from pregnancy while you are getting your timing back, we suggest using a non-hormonal form of contraception (a.k.a. condom)—barrier methods only block pregnancy in that moment. They won’t have any impact on your menstrual cycle/ovulation.

Second, while we don’t want to turn the process into a science project from the start, we do suggest that you visit your OB before you get the pregnancy party started. During this visit, they will not only offer you good advice about timing/trying but also will make sure you have a clean bill of health. Medical problems that predate pregnancy can get worse with a baby on board; therefore, it’s important to make sure your body is prepared for what’s to come. A thorough medical history and physical exam can reveal a lot.

Additionally, during the pre-conception visit, most OBs will perform a genetic screening panel—this blood test is basically taking a magnifying glass to your genes to see what’s normal and what’s abnormal. And although we don’t have the ability to look at all 25,000 protein coding genes, we can look at a good number of them. In cases where you come up as a carrier for a genetic disorder, we will want you to chat with a genetics counselor and test your partner. Couples who are both carriers for the same genetic condition may elect to do PGD to screen embryos.

For anyone who has ever played tennis, golf, baseball, or squash, you know how important timing is. It can take a good number of practice sessions before you are making good contact with the ball. The same can be said for your menstrual cycle. Taking a few swings before game day can help. But remember, not everyone needs so much time on the practice field. Although infertility will affect many couples, you may not be one of them. Don’t let fear force you to start trying before you are ready for a baby. You will get your timing back, and if it doesn’t happen on your own, we can coach you through it!