Shane T. Russell, MD
Male Reproductive Medicine
Fertility from A to Z
Arimidex
Anastrozole. Non-steroidal aromatase inhibitor. An oral medication which can bring down elevated estradiol levels in men. Arimidex works by preventing the conversion of testosterone to estradiol by the enzyme aromatase. This medication is typically very well tolerated with minimal side effects (which can include rash, water retention, and hot flashes).
Azospermia
When no sperm at all are seen at the time of semen analysis testing.
Clomid
Clomiphene citrate. An oral medication which affects estrogen receptor function, and is commonly used in females to regulate or increase ovulation. In men, Clomid is effective in raising testosterone levels through increased production by the testicles. This medication is quite safe, with possible rare side effects including breast tenderness and enlargement, headaches, upset stomach, and water retention.
Ejaculate
The fluid released from the tip of the penis during ejaculation which normally contains large amounts of sperm. Typically, about 80% of the volume of fluid comes from the seminal vesicles, 15% from the prostate gland, and 5% from the testicles (which contains the sperm).
Ejaculatory Duct
The short channel which connects the end of the vas deferens to the urethra. The seminal vesicles also connect into the ejaculatory ducts. These ducts can occasionally become blocked, resulting in decreased ejaculate volume and sperm counts.
Epididymis
The structure which wraps around the back of the testicle. Sperm enter from the testicle into the epididymis where they undergo maturation and acquire improved motility. From the epididymis, mature sperm then enter into the vas deferens.
Estradiol
The female hormone. All men have a certain normal amount of female hormone, but if this level is too high, then it can cause problems with sperm production or quality.
FSH
Follicular stimulating hormone. A hormone made by the pituitary gland in the brain which signals the testicles to make sperm. A very low FSH can indicate a problem at the level of the pituitary gland. A very high FSH often indicates a problem with the testicle’s ability to make sperm (as the pituitary is making more FSH in an attempt to get the testicles to increase sperm production).
Gonadotropin Therapy
Gonadotropins are a group of hormones which include FSH and LH, and are used clinically in both men and women with fertility issues. In men who have pituitary/brain problems in which they produce low levels of FSH and/or LH, replacement of these hormones can profoundly increase sperm counts and fertility potential. In women, gonadotropin therapy is commonly used to induce their ovaries to make increased numbers of oocytes (eggs) in conjunction with IUI or IVF.
IUI (Intrauterine Insemination)
Also known as ‘Artificial Insemination’. This is the process where sperm from the male is processed (washed and concentrated) and placed through a slender tube into the woman’s uterus at the time of ovulation. This procedure is performed by reproductive endocrinologists. IUI is often combined with hormonal treatments for the female such as Clomid or gonadotropin therapy. Typically, IUI increases the chance of pregnancy per ovulatory cycle by 2-3 times over natural intercourse, with the chance of achieving pregnancy being about 10-20% for each attempt. At least 5 to 10 million total motile sperm are typically needed for a good chance at success with IUI.
IVF (In-Vitro Fertilization)
IVF is performed by reproductive endocrinologists who remove oocytes (‘eggs’) from the ovaries of the female and combine them with sperm from the male- this is called Standard IVF. A variant of this is called ICSI (Intracytoplasmic Sperm Injection) where a single sperm is injected into each egg, and therefore less sperm are required. Both procedures involve having the female produce a large amount of oocytes (typically between 5-20) by giving her gonadotropin therapy, after which her oocytes are removed under transvaginal ultrasound guidance. Fertilized oocytes become embryos, and between 1 to 3 embryos (depending on female factors such as age, embryo quality, etc.) are then transferred back into the female’s uterus. Remaining embryos can be frozen for later use. Typical success rates for pregnancy are about 40% per cycle, but this can vary with many different factors (such as the woman’s age, quality of the sperm, etc.).
LH
Luteinizing Hormone. A hormone made by the pituitary gland in the brain which signals to the testicles to make testosterone. A very low LH can indicate a problem at the level of the pituitary gland. A very high LH often indicates a problem with the testicle’s ability to make testosterone (as the pituitary is making more LH in an attempt to get the testicles to increase testosterone production).
Morphology
The shapes of sperm as defined on semen analysis testing. Grading is typically performed using one of the following criteria: the WHO criteria (where normal is 30% or greater normal shapes) and the Strict criteria (where is normal is 4% or greater normal shapes with most labs in the area). Lower rates of sperm with normal shapes can decrease chances of pregnancy, but does not imply a higher rate of birth defects in any children successfully conceived.
Motility
The number of sperm that are moving as measured by the semen analysis test. The typical cut-off for normal values is 50% or greater sperm with motility. Non-motile sperm could either be dead or they could be living but unable to move.
Oligospermia
When sperm counts on semen analysis testing are lower than normal (typically the cut-off is defined as <20million/mL).
Prolactin
A hormone made by the pituitary gland in the brain. If the prolactin is elevated, this can sometimes indicate a problem with the pituitary gland. Elevated prolactin levels also can significantly lower testosterone levels.
Prostate Gland
An organ typically about the size of a walnut which sits in front of the bladder. The urinary channel (urethra) runs through the prostate gland. The ejaculatory duct also travels through the prostate gland where it enters the urethra. The function of the prostate gland is to make certain fluids and enzymes for the ejaculate.
Reproductive Endocrinologists
Female infertility experts who are Ob/Gyn doctors who have completed specialized fellowship training in female infertility. They perform the IUI and IVF procedures, and work closely with their male infertility specialist counterparts to help couples achieve their reproductive goals.
Seminal Vesicles
Twin structures which sit behind the prostate gland and under the bladder. The seminal vesicles produce about 80% of the volume of the ejaculate fluid, which enters the urethra via the ejaculatory ducts during ejaculation. Typically there are very few sperm in the seminal vesicles of normal men. However, in the presence of ejaculatory duct blockage, the seminal vesicles may enlarge and contain large numbers of sperm.
Testosterone
The male hormone. Typically, levels above 300mg/dL on at least one reading during a work-up indicate an adequate hormonal environment for optimal sperm production.
Varicocele
Dilated veins in the scrotum (similar to varicose veins in the legs). They are present in about 15-20% of the male population and typically do not cause problems, especially if they are small. In some patients, however, they can cause increased temperatures in the scrotum, leading to testicular atrophy and decreased semen parameters. A small number of patients with varicoceles may also experience chronic dull scrotal discomfort which typically improves with lying down.
Vas Deferens
The tube which carries sperm from the epididymis to the ejaculatory duct before entering the urethra. During ejaculation, sperm enter the urethra where they are forcefully expelled out the tip of the penis. The vas deferens is the structure that is divided in the region of the upper scrotum during a vasectomy procedure.
Anastrozole. Non-steroidal aromatase inhibitor. An oral medication which can bring down elevated estradiol levels in men. Arimidex works by preventing the conversion of testosterone to estradiol by the enzyme aromatase. This medication is typically very well tolerated with minimal side effects (which can include rash, water retention, and hot flashes).
Azospermia
When no sperm at all are seen at the time of semen analysis testing.
Clomid
Clomiphene citrate. An oral medication which affects estrogen receptor function, and is commonly used in females to regulate or increase ovulation. In men, Clomid is effective in raising testosterone levels through increased production by the testicles. This medication is quite safe, with possible rare side effects including breast tenderness and enlargement, headaches, upset stomach, and water retention.
Ejaculate
The fluid released from the tip of the penis during ejaculation which normally contains large amounts of sperm. Typically, about 80% of the volume of fluid comes from the seminal vesicles, 15% from the prostate gland, and 5% from the testicles (which contains the sperm).
Ejaculatory Duct
The short channel which connects the end of the vas deferens to the urethra. The seminal vesicles also connect into the ejaculatory ducts. These ducts can occasionally become blocked, resulting in decreased ejaculate volume and sperm counts.
Epididymis
The structure which wraps around the back of the testicle. Sperm enter from the testicle into the epididymis where they undergo maturation and acquire improved motility. From the epididymis, mature sperm then enter into the vas deferens.
Estradiol
The female hormone. All men have a certain normal amount of female hormone, but if this level is too high, then it can cause problems with sperm production or quality.
FSH
Follicular stimulating hormone. A hormone made by the pituitary gland in the brain which signals the testicles to make sperm. A very low FSH can indicate a problem at the level of the pituitary gland. A very high FSH often indicates a problem with the testicle’s ability to make sperm (as the pituitary is making more FSH in an attempt to get the testicles to increase sperm production).
Gonadotropin Therapy
Gonadotropins are a group of hormones which include FSH and LH, and are used clinically in both men and women with fertility issues. In men who have pituitary/brain problems in which they produce low levels of FSH and/or LH, replacement of these hormones can profoundly increase sperm counts and fertility potential. In women, gonadotropin therapy is commonly used to induce their ovaries to make increased numbers of oocytes (eggs) in conjunction with IUI or IVF.
IUI (Intrauterine Insemination)
Also known as ‘Artificial Insemination’. This is the process where sperm from the male is processed (washed and concentrated) and placed through a slender tube into the woman’s uterus at the time of ovulation. This procedure is performed by reproductive endocrinologists. IUI is often combined with hormonal treatments for the female such as Clomid or gonadotropin therapy. Typically, IUI increases the chance of pregnancy per ovulatory cycle by 2-3 times over natural intercourse, with the chance of achieving pregnancy being about 10-20% for each attempt. At least 5 to 10 million total motile sperm are typically needed for a good chance at success with IUI.
IVF (In-Vitro Fertilization)
IVF is performed by reproductive endocrinologists who remove oocytes (‘eggs’) from the ovaries of the female and combine them with sperm from the male- this is called Standard IVF. A variant of this is called ICSI (Intracytoplasmic Sperm Injection) where a single sperm is injected into each egg, and therefore less sperm are required. Both procedures involve having the female produce a large amount of oocytes (typically between 5-20) by giving her gonadotropin therapy, after which her oocytes are removed under transvaginal ultrasound guidance. Fertilized oocytes become embryos, and between 1 to 3 embryos (depending on female factors such as age, embryo quality, etc.) are then transferred back into the female’s uterus. Remaining embryos can be frozen for later use. Typical success rates for pregnancy are about 40% per cycle, but this can vary with many different factors (such as the woman’s age, quality of the sperm, etc.).
LH
Luteinizing Hormone. A hormone made by the pituitary gland in the brain which signals to the testicles to make testosterone. A very low LH can indicate a problem at the level of the pituitary gland. A very high LH often indicates a problem with the testicle’s ability to make testosterone (as the pituitary is making more LH in an attempt to get the testicles to increase testosterone production).
Morphology
The shapes of sperm as defined on semen analysis testing. Grading is typically performed using one of the following criteria: the WHO criteria (where normal is 30% or greater normal shapes) and the Strict criteria (where is normal is 4% or greater normal shapes with most labs in the area). Lower rates of sperm with normal shapes can decrease chances of pregnancy, but does not imply a higher rate of birth defects in any children successfully conceived.
Motility
The number of sperm that are moving as measured by the semen analysis test. The typical cut-off for normal values is 50% or greater sperm with motility. Non-motile sperm could either be dead or they could be living but unable to move.
Oligospermia
When sperm counts on semen analysis testing are lower than normal (typically the cut-off is defined as <20million/mL).
Prolactin
A hormone made by the pituitary gland in the brain. If the prolactin is elevated, this can sometimes indicate a problem with the pituitary gland. Elevated prolactin levels also can significantly lower testosterone levels.
Prostate Gland
An organ typically about the size of a walnut which sits in front of the bladder. The urinary channel (urethra) runs through the prostate gland. The ejaculatory duct also travels through the prostate gland where it enters the urethra. The function of the prostate gland is to make certain fluids and enzymes for the ejaculate.
Reproductive Endocrinologists
Female infertility experts who are Ob/Gyn doctors who have completed specialized fellowship training in female infertility. They perform the IUI and IVF procedures, and work closely with their male infertility specialist counterparts to help couples achieve their reproductive goals.
Seminal Vesicles
Twin structures which sit behind the prostate gland and under the bladder. The seminal vesicles produce about 80% of the volume of the ejaculate fluid, which enters the urethra via the ejaculatory ducts during ejaculation. Typically there are very few sperm in the seminal vesicles of normal men. However, in the presence of ejaculatory duct blockage, the seminal vesicles may enlarge and contain large numbers of sperm.
Testosterone
The male hormone. Typically, levels above 300mg/dL on at least one reading during a work-up indicate an adequate hormonal environment for optimal sperm production.
Varicocele
Dilated veins in the scrotum (similar to varicose veins in the legs). They are present in about 15-20% of the male population and typically do not cause problems, especially if they are small. In some patients, however, they can cause increased temperatures in the scrotum, leading to testicular atrophy and decreased semen parameters. A small number of patients with varicoceles may also experience chronic dull scrotal discomfort which typically improves with lying down.
Vas Deferens
The tube which carries sperm from the epididymis to the ejaculatory duct before entering the urethra. During ejaculation, sperm enter the urethra where they are forcefully expelled out the tip of the penis. The vas deferens is the structure that is divided in the region of the upper scrotum during a vasectomy procedure.
A Glossary of Terminology
