Surgical removal of the fallopian tube (the Latin for which is salpinx).

Inflammation of the fallopian tubes, usually due to infection. Can be acute (e.g. gonorrhea, chlamydia and other infections) or chronic (e.g. persisting chlamydia, tuberculosis, various fungus infections). Leads to blockage of the tubes and peritubal adhesions if not treated promptly and effectively with antibiotics.

A nodular ('nodosa') thickening of the fallopian tube's isthmus ('isthmica'), probably due to previous salpingitis. Can cause localised obstruction of the tube and, if the obstruction is partial, an ectopic pregnancy can be caused. Overcomeable with microsurgery or tubal canalisation.

An x-ray of the fallopian tubes.

Microsurgery to remove peritubal adhesions or perifimbrial adhesions. Sometimes carried out at laparoscopy.

Looking inside the fallopian tube with a fiberoptic instrument through its relatively wide outer fimbrial end. Carried out at laparoscopy or laparotomy.

Microsurgery to make a permanent, new opening at the outer fimbrial end of the fallopian tube after it has become blocked from salpingitis or, uncommonly nowadays, from fimbriectomy. Sometimes attempted at laparoscopy, though mostly with a reduced chance of success.

An operation involving a temporary opening length-wise along (usually) the ampulla of the fallopian tube, usually for the treatment of a (tubal) ectopic pregnancy. Occasionally performed for a pyosalpinx. Can be carried out efficiently at laparoscopy.

The word is used medically in one of three ways: (1) part of a sequence, as in primary follicle, secondary follicle, tertiary follicle; (2) when a person has a precedent for a contrary state (e.g. secondary amenorrhea, when a woman has had at least one spontaneous menstrual period, but then menstruation stops; secondary dysmenorrhea means periods that have painful after having been not so -- or not-so-much; secondary infertility means having trouble getting pregnant despite having become pregnant successfully in the past); or (3) when the source of dysfunction lies elsewhere (e.g. secondary ovarian failure means ovaries that do not function because, in this example, the pituitary gland on which the ovaries depend is not functioning).

Absent periods (amenorrhea) when a woman has had at least one previous spontaneous menstrual period, but then menstruation stops.

The second stage of growth of the follicle, in which the egg (as a primary oocyte) is enclosed by a layer that's more than one cell thick of round-shaped, multiplying follicle cells. Virtually all secondary follicles will go on to become tertiary follicles.

Trouble getting pregnant (infertility) in someone who has previously had a successful or potentially successful pregnancy. Although the exact definition of secondary infertility can vary among gynecologists, for me the distinction between secondary infertility and primary infertility is most useful if the term secondary infertility is restricted to when there has been a prior induced abortion (which, the odds are, would otherwise have developed normally) or a successful pregnancy; a prior ectopic pregnancy or a prior miscarriage is, in my view, still the state of primary infertility.

The form of the oocyte, or egg, produced from the primary oocyte late in the life of the maturing follicle, just before ovulation. The egg stays at this stage until fertilisation by a sperm cell (spermatozoon).

Failure of ovulation along with low estrogen production from the ovaries because of insufficient signalling from the pituitary gland by its hormones, the gonadotropins.

The form of the sperm cell in the second stage of spermatogenesis (through which the sperm cells are formed in the testes), produced from primary spermatocytes in the first cell division of meiosis, and giving rise to spermatids, which have just half the normal cell's complement of chromosomes, through the second division of meiosis; enveloped by Sertoli cells in the testicular tubules.

The phase of development of the endometrium during which, after the proliferative phase, the endometrium stops growing but starts producing secretions (which nourish an implanting embryo) under the influence of progesterone, so it corresponds with the luteal phase in the ovarian cycle.

An x-ray-directed technique for placing fine catheters in veins of the body to sample the local production of hormones from a particular gland.

An x-ray like a hysterosalpingogram in which a catheter is passed through the cervix and uterus, and then wedged into the fallopian tube to fill it with fluid visible on x-ray. High pressure can be applied, so some tubes that seem blocked on hysterosalpingogram (or on passing dye at laparoscopy) can be shown in fact to be open.

Fluid produced by the male genital tract at ejaculation. Contains spermatozoa, as well as many other substances, including those that make the ejaculate coagulate (and then called a coagulum, which is given time to liquefy before a semen analysis is done on it). Sperm cells account for only about 1 percent of the volume of the ejaculate, so it's not possible to be confident about a man's sperm count just on the basis of the volume of the semen ejaculated.

Formal name for a sperm count.

A test for detecting sperm antibodies in semen.

Male sex organs that are joined to the vas deferens on each side as they enter the prostate gland to join the urethra; once thought to act as receptacles for storing sperm, they are now known to be more important for contributing constituents of semen.

Latin for a wall'.

One of a number of tests to detect previous or untreated syphilis, an important (though nowadays rare) cause of birth defects and recurrent miscarriages. The chance of detecting unsuspected syphilis might be very low, but the penalty for missing it is very high, so it's still a routine test in early pregnancy. Tests are done on serum and include the Venereal Disease Research Laboratory (VDRL) test and the Wasserman reaction (WR) test. Often tested as part of a screen for infectious disease before assisted conception, although there is no evidence that syphilis is transmitted through eggs or sperm (it is caught from contact between the lining of the vagina and the surface of the penis).

Clomiphene made by Serono.

The delicate, one-cell-thick outside lining of an organ in the body, particularly the organs of the peritoneal cavity. Unlike other body surfaces such as the skin and the lining of the stomach or intestines, an ulcer (or missing patch) of the peritoneal serosa always heals in 8 days, however big the ulcer, or defect, is.

Cells in the testis lining the testicular tubules that nurture the developing sperm cells; responsible in fetal life for the production of anti-Mullerian hormone, which stops the male fetus from developing fallopian tubes, a uterus and a vagina. A source of estradiol in men.

That part of blood that's left after it clots. Distinct from plasma, which is that part of unclotted blood that remains on top when blood is spun down in a centrifuge (which will still clot and leave serum unless an anticoagulant is added). Various serum tests (tests done on serum, also called blood tests), are described in this dictionary.

17-hydroxyprogesterone is formed from progesterone in the adrenal glands (mostly as an intermediary substance on the way to making the adrenal's main hormone, cortisol) and in the ovaries (on the way to making androgens and estrogens). A congenital lack of one or other of the enzymes needed to make cortisol in the adrenal causes androgens to be made instead, in turn causing hirsutism and oligomenorrhea in women, maybe with the polycystic ovary syndrome (in mild cases), or (in severe cases) causing intersex at birth. The adrenal glands enlarge in an attempt to maintain production of cortisol (hence congenital adrenal hyperplasia, CAH). An inappropriately high level of 17-hydroxyprogesterone in serum is diagnostic of CAH.

Measurement of alpha fetoprotein in blood serum. High levels can indicate a birth defect involving the brain or spinal cord, such as anencephaly or spina bifida (confirmed if amniocentesis shows high AFP levels in the amniotic fluid). Low levels can indicate an increased risk of Down syndrome (or trisomy 21), trisomy 18 and, occasionally, Klinefelter syndrome, signaling the need for a karyotype of the fetus's tissues by chorionic villus sampling (CVS) or amniocentesis.

A test done to investigate recurrent miscarriages.

Antibodies to gliadin, a component of dietary gluten, and present in wheat, barley, rice and oats, found in celiac disease, a defect of intestinal absorption caused by abnormal sensitivity to gluten.

Measurement of CA125 antigen in serum. A test done to investigate, particularly, adenomyosis and cancer of the ovary. Levels can also be increased with endometriosis (especially when there is a 'chocolate cyst' present), during normal menstruation and during normal early pregnancy.

A blood test to detect prior exposure to chlamydia. The antibodies commonly examined are not completely specific for the particular chlamydia organism that causes salpingitis and which is transmitted sexually: other chlamydia-like infections of the lungs and other regions of the body, and even some completely unrelated infections with non-chlamydial organisms can produce false positive tests; a negative test, that is an absence of detectable chlamydial antibodies, is however reassuring.

Done to screen for Wilson's disease, in which there is abnormal retention of copper in the body -- a rare cause of recurrent miscarriages.

Measurement of estradiol in blood serum. Used especially for monitoring the development of ovarian follicles in assisted conception, usually together with transvaginal ultrasound. The cycle might be a natural one or, more usually, when there is ovulation induction or superovulation. The result should be available within 4 hours of the test for this purpose.

The direct measurement of the small proportion of testosterone that is not bound in the blood to carrier proteins such as sex hormone binding globulin, and so is available directly to the tissues. A more sensitive and specific test than serum testosterone.

Measurement of follicle stimulating hormone in serum. Useful at the time of menstruation for indicating a significantly decreased number of eggs in the ovaries in the few years leading up to menopause (that is, indicative of depletion of eggs or primary ovarian failure); Continuously high in women after menopause, and then excreted in high amounts in the urine (from which, in turn human menopausal gonadotropin is derived).

Measurement of human chorionic gonadotropin in serum: essentially a pregnancy test, but carried out more precisely (quantitatively) than is the case with a yes or no test (which is qualitative). Often carried out serially, to determine if a pregnancy is: thriving (hCG levels double every two or three days in normal early pregnancy; languishing (levels rise more slowly, seen with an ectopic pregnancy and with an inevitable miscarriage); or resolving naturally (levels that are falling). Very high levels are seen with hydatidiform mole. Part of the triple screen used to screen for Down syndrome in early pregnancy.

A test for HIV, the virus that causes AIDS, and which comes in two strains, type 1 and type 2. They need separate tests, but mostly both are done as a routine. The test looks for the development of an immune reaction against the virus, it does not look for the virus itself, so it's possible, for a few weeks, to have been infected (and to be infective to others) with the test itself still a negative test, that is, apparently (but falsely) clear.

In women, when measured during menstruation, inversely related to the serum FSH (and probably provides no more information than the day 3 FSH level in predicting depletion of eggs); in men with azoospermia, levels predict the likelihood of being able to obtain sperm for ICSI at testicular sperm extraction.

Measurement of luteinising hormone in blood serum. Used in monitoring to judge the occurrence of the LH surge, if GnRH-analogs have not been employed. The result should be available within 4 hours of the test for this purpose.

Measurement of progesterone in serum. Often measured to check the occurrence of prior ovulation. Used to infer the onset of ovulation in ovulation induction or assisted conception programs, and attaches extra significance to an apparently raised serum LH in judging the onset of the LH surge during monitoring. The result should be available within 4 hours for these purposes. Abbr. serum P4.

Measurement of prolactin in serum. An increase is called hyperprolactinemia.

Estimation of sperm antibodies circulating in the blood. Generally not as useful as estimating semen sperm antibodies (for men) or cervical mucus sperm antibodies (for women), as these fluids have more immediate contact with sperm cells.

Measurement of testosterone, the chief male sex hormone (androgen) circulating in the blood serum. If increased in women with oligomenorrhea or amenorrhea, indicative of the polycystic ovary syndrome. The free androgen index and free testosterone are more sensitive tests.

Measurement of thyroid stimulating hormone in serum.

A test of kidney function. Sometimes measured when screening for a kidney (renal) cause of recurrent miscarriages.

Sexual intercourse (coitus or having sex) or, gender or relating to it (as in sex chromosome).

A chromosome that's either the X-chromosome (a pair confers femaleness in a normal diploid complement of chromosomes) or the Y-chromosome (just one confers maleness in a normal diploid complement of chromosomes); distinct from the non-sex chromosomes, or autosomes (which are numbered from 1 to 22); aneuploidies give rise to Turner syndrome, Klinefelter syndrome, triple-X syndrome, extra-Y-chromosome syndrome) etc; examined in a karyotype.

The main carrier protein in the blood for the hormone testosterone; measured in conjunction with the serum testosterone to derive the free androgen index.

Replication of a diploid organism after combination of haploid male and female gametes, each of which has been produced through the process of meiosis, thus assuring a reassortment of the alleles present among the two parents, in the form of a new, unique, individual genome. Preserved with in vitro fertilisation despite the absence of sexual intercourse. The opposite to cloning.

A treatment protocol for controlled stimulation of the ovaries using GnRH-agonists with injections of follicle stimulating hormone (FSH) for induction of superovulation in assisted conception programs involves starting the GnRH-agonist a day or two before the injections of FSH start. The advantage is one of cost: less FSH (and less GnRH-agonist) are used compared with the long protocol. The disadvantage is that luteinising hormone levels and progesterone levels can rise, possibly (in some cycles of treatment) spoiling optimal development of ovarian follicles. The GnRH-agonist is continued (in contrast to the ultrashort protocol) until follicles are mature and human chorionic gonadotropin is given to start the process of ovulation.

A brother or sister

The small intestine, leading out of the stomach; narrower but longer than the large intestine (or colon), to which it connects.

A general term used by obstetricians or pediatricians to refer to a fetus or newborn baby that seems smaller than it should be for the assumed duration of the pregnancy so far. The three main causes are a genetic abnormality of the fetus; insufficient nutrition for an otherwise normal fetus; and an incorrect calculation of the dates, maybe because ovulation and conception took place later than the usual two weeks after the last menstrual period. Recent research shows that women with infertility might be at higher risk of small-for-dates babies when they do get pregnant.

Any cell that forms the tissues and organs of the body that is not a germ cell. Derived from soma, the Greek for body.

(SCNT) Transfer of the nucleus of a somatic cell into a secondary oocyte or zygote from which the egg or zygote's chromosomes have been removed, in such a way that cleavage still occurs, in effect causing the cell's nucleus to 'bud', or reproduce without genetic recombination, and hence a form of asexual reproduction or cloning now commonly used for reproductive cloning in animals and, it is hoped, for therapeutic cloning to create embryonic stem cells for treatment of serious degenerative disease and cancers.

Common abbreviation for spermatozoon (or for the plural form, spermatozoa). Also used in the form sperm cell. Plural: sperm or spermatozoa.

The result of a reaction of the immune system against sperm cells (spermatozoa) and, by limiting the ability of sperm to show motility, a contributory (or occasionally the only) cause of infertility. Can be present in serum, in cervical mucus or in semen. Can be agglutinating (which make sperm stick in clumps), immobilising (which cripple sperm particularly effectively and kill them), or coating, which interfere with sperm attachment to the zona pellucida of the egg (the secondary oocyte), preventing fertilisation. The screening test for sperm antibodies involves immunobeads.

(SCSA) A measurement of the proportion of sperm cells that have damaged DNA. Fewer than 15% is consistent with normal fertility; 15%-30% can result in subfertility; and more than 30% may cause sterility or recurrent miscarriage.

A semen analysis, measuring the volume of the ejaculate, the density of spermatozoa ('sperm cells', or just 'sperm') in it (expressed as so many million sperm per milliliter), the proportion of sperm swimming normally (the motility), and the proportion with a normal shape. A normal sperm count consists of a volume of more than 1 ml; a density of more than 20 million per ml; a motility of more than 50 percent; and normal forms of more than 50 percent (casual examination) or more than 14 percent (critical examination by the strict criteria recently advocated by the World Health Organisation).

Either intracytoplasmic sperm insertion (ICSI) or subzonal insertion (SUZI, now obsolete). Abbreviated SMI, although no longer in common usage.

The product of the spermatocyte in the testis when it has completed meiosis (by which the number of chromosomes is halved, so it's in the haploid state), and also enclosed in the testicular tubules by the Sertoli cells. Early spermatids are round-shaped, whereas late spermatids closely resemble mature spermatozoa.

The sperm cell equivalent to the oocyte stage of the egg. Further development in the testicular tubules results in a spermatid.

Development of a sperm cell, in the tubules of the testes (the testicular tubules), from spermatogonium and spermatocyte to spermatozoon (the last part of this process, from spermatid to spermatozoon, is called spermiogenesis). The process of spermatogenesis takes 56 days. At any one location in a tubule there are cells at four different stages of maturity, so mature sperm are released from a particular location into the lumen of the testicular tubules every 14 days. A systematic interruption of spermatogenesis results in azoospermia and is called maturation arrest.

The replicating phase of the sperm cell in the testis, equivalent to the oogonium in the ovaries, but, unlike the oogonia, spermatogonia normally persist until old age. Located among the supporting cells (Sertoli cells) in the testicular tubules. Divides by the process of mitosis until it begins to undergo meiosis by changing into the primary spermatocyte, the first step in the process of sperm cell formation, or spermatogenesis. Plural: spermatogonia.

Plural of spermatozoon.

The final stage of development of the maturing sperm cell, as it leaves the tubules of the testis the testicular tubules, to mature in the epididymis. Composed of a head (including the acrosome), a midpiece loaded with mitochondria to provide energy, and a tail, or flagellum, for propulsion. Packed into the head of the spermatozoon is a haploid number of chromosomes (there are normally 23, including either an X-chromosome or a Y-chromosome).

The final part of the formation of a mature sperm cell, in which the round, early spermatid (already with a haploid number of chromosomes) loses its round shape to acquire the fea