Are you finding the world of fertility treatments filled with confusing acronyms? You’re not alone. In this post, we break down the jargon and provide a comprehensive guide to help you navigate the complex landscape of fertility acronyms, but feel free to check out the full video featuring Kerry Kavanaugh, a reporter and anchor at Boston 25, and Dr. Ann Korkidakis, a reproductive endocrinologist at Boston IVF, for a deeper dive into fertility acronyms.
Understanding the Basics: TTC and AF
Starting with the basics, TTC stands for “trying to conceive.” This phase refers to the early stage when couples begin timing intercourse with the goal of achieving pregnancy. AF, or “Aunt Flo,” denotes the menstrual period. In the fertility world we’re not excited when Aunt Flo comes to visit, but we do have to know when she’s coming to start our cycle.
Meet the Professionals: OBGYNs and REs
At the head of your fertility care team are medical professionals; OBGYNs are doctors who undergo obstetrics and gynecology residency after medical school to specialize in the female reproductive system, pregnancy, and childbirth. Reproductive Endocrinologists, or REs, are certified obstetricians and gynecologists who chose after residency to specialize further in infertility through a three-year clinical and research program.
Tests and Terminology: AMH, DOR, and more
Fertility treatment often starts with a host of tests to help discover what may be behind a difficulty getting pregnant. Anti-Müllerian Hormone (AMH) signifies ovarian reserve and egg quality. There are two qualities of eggs that need to be considered-there’s the actual quantity, the number of eggs in someone’s ovary, but there’s also the quality. Ovarian reserve really measures the quantity aspect: how many as a woman has left. Which tells us about a reproductive timeline and also tells us how they would respond to treatment.
Sometimes we see that in women with a low anti-müllerian hormone or something called low antral follicle count, which is a low number of follicles in the ovary, that they have more of a diminished ovarian reserve (DOR). Usually that’s approximately an AMH less than one, but there’s a lot of different criteria we look into.
In certain cases, including DOR or if IVF cycles using your own eggs were not successful, we consider donor eggs or DE. Those usually come from a donor egg bank and, because we think fertility is so closely tied to the egg age as opposed to the age of the uterus, when we use donor eggs we find that they have a high chance of success irrespective of age, about 50% per embryo transfer.
If you’re building your family with a partner, they have to be checked in this process as well and that brings us to SA or semen analysis. There are 4 different components that the lab looks closely at: one is the volume, then there’s the concentration, so how many millions sperm per milliliter, the motility, or how efficiently the sperm moves, and then finally the morphology, or size and shape of the sperm. Sometimes then the initial essay or the values are a little bit borderline and a SA is repeated because sperm parameters can definitely fluctuate over time.
If there are issues with any of those four components of a semen analysis, they can be overcome. Even with very, very low concentrations, we now have the technology through another acronym ICSI, intracytoplasmic sperm injection, to be able to take an individual’s sperm and inject it into the egg, helping to overcome even the more severe cases of male-factor infertility.
Another potential stumbling block can be syndrome known as PCOS. PCOS, or polycystic ovarian syndrome, is a really common cause of infertility. To meet that diagnosis you have to have 2 out of the 3 criteria called the Rotterdam criteria, the first of which is irregular menstrual cycles. The second is clinical or biochemical high levels of androgen, which sometimes present as excess hair growth, acne, and then the third criteria is polycystic appearing ovaries on ultrasound.
It is a diagnosis of exclusion, so we do have to do other testing to make sure there’s no other reason for irregular cycles, but it’s very common. Fortunately, it’s very treatable. There’s lots of oral medications to try to help restore normal cycles in the PCOS population. And once we are able to do that, their fertility rates are just the same as the general population.
A difficult acronym here, RPL. Recurrent pregnancy loss is one of the reasons that patients definitely seek the help of an RE. and RPL alludes to having at least 2 pregnancy losses. In the past you would actually have to have 3 to meet that requirement, but more and more research is suggesting that it’s worth doing some testing and potentially treatment after 2, because we do pick things up that we’re able to modify and improve the chances of a pregnancy sticking next time.
Exploring Treatment Options: IUI and IVF
Moving into treatment options, Intrauterine Insemination, or IUI involves the timed transfer of washed sperm into the uterus. This is often recommended for mild male factor issues or unexplained infertility. In Vitro Fertilization, more commonly referred to as IVF, on the other hand, includes retrieving eggs, fertilizing them with sperm in a lab, and transferring resulting embryos into the uterus.
Inside the IVF Cycle: ER, ET, and PGT-A
During an IVF cycle, procedures Egg Retrieval (ER), also sometimes referred to as a vaginal oocyte retrieval (VOR), take place. After stimulating the ovaries with various medications to create multiple eggs, we then go through a small surgical procedure to be able to retrieve those eggs. An ER/VOR consists of an ultrasound with a very fine needle that lets us drain follicles, follicles are sacks of fluid with eggs in it, that fluid is then processed in the lab, and eggs are retrieved. Once eggs are retrieved they are combined with sperm, sometimes using ICSI, and embryos begin to grow.
That then leads to ETs and FETs, or embryo transfers and frozen embryo transfers. In a fresh transfer, meaning at the end of the IVF cycle, typically 3 to 5 days after the egg retrieval, we do an embryo transfer. Another option is to freeze the embryos and do a frozen embryo transfer as part of a separate cycle. Frozen embryos function just as well, if not sometimes better than fresh embryos, which is pretty impressive.
During the time when you have an FET, you can do Pre-implantation Genetic Testing for Aneuploidy, or PGT-A, to assess embryo chromosome count before transfer. The acronym has changed over the years, but PGT-A is the one most commonly used at this current time.
During PGT-A embryos are tested usually at the blastocyst stage, which occurs about five, six, or seven days later after fertilization. At this point the embryos are hundreds of cells, there’s a cluster inside called the inner cell mass that becomes the fetus, and then the cells on the outside, the trophectoderm, becomes the placenta. We have the technology to be able to take about 5 to 7 cells of the trophectoderm and send it for genetic testing to see if this embryo likely has the correct number of chromosomes.
If it doesn’t have the correct number of chromosomes, it’s more common to encounter issues such as not implanting or sometimes an early miscarriage. It is a screening test, so definitely not perfect, there are some false positives and false negatives. It’s also not indicated in everyone, but in certain patient populations, it can be very helpful as part of the IVF cycle.
PIO, or progesterone in oil, can be a very important part of a frozen embryo transfer. We have many different protocols for frozen embryo transfers, but they can be divided essentially into 2 categories. One is a natural cycle, or modified natural cycle, frozen embryo transfer where we’re taking advantage of a woman’s normal menstrual cycle to thicken the lining where follicles develop, it’s making estrogen, it ovulates, and then that cyst that forms produces progesterone and we only supplement a little through vaginal progesterone.
The other option is a medicated or programmed frozen embryo transfer where we’re essentially overhauling the cycle, giving high doses of estrogen, and the body isn’t making progesterone on its own. That’s where progesterone in oil comes in. It’s an intramuscular injection usually given in the buttocks, it can be a little bit uncomfortable, but it is providing a high dose of progesterone and studies have shown that in these medicated, or programmed frozen embryo transfers, it actually improves the chance of having a pregnancy if you’re taking the PIO at least every 3 days. So oftentimes it’s incorporated into those protocols.
Navigating the 2WW and Beyond
The Two-Week Wait (2WW) refers to the time between embryo transfer and when you expect the first day of your next menstrual period, which is then the appropriate time to do a urine pregnancy test (UPT), sometimes also referred to as POAS for “pee-on-a-stick. During this often emotionally intense time, you may be referred to as PUPO, or “pregnant until proven otherwise” meaning individuals are advised to assume that they are pregnant and act accordingly in terms of avoiding alcohol, smoking, taking a prenatal vitamin, continuing with any prescribed luteal support, etc.
UPTs that you can buy at the drugstore and blood test that will be performed at the end of your 2WW at your RE’s office, look for a hormone called HCG or human chorionic gonadotropin, that is only produced during a pregnancy.
Usually the earliest you can detect it is usually approximately 14 days after ovulation or about 10 days after transfer so while it’s very natural to want to test early, there is a high chance of false readings prior to the end of the 2WW.
An acronym that sometimes comes up is PUL or a pregnancy of unknown location. Early pregnancy is such a hard period because when the pregnancy is very small and the HCG levels are on the lower side, it’s really hard to know if it is a pregnancy located in the uterus or is it a pregnancy outside of the uterus, potentially in the fallopian tubes, alluding to something called the ectopic pregnancy.
So in this early pregnancy period when you have a positive pregnancy test, HCG numbers are going up, but we can’t quite see anything on ultrasound just yet because it’s too early, we call it a pregnancy of unknown location. Usually over time it becomes very clear and a lot of these do continue on to be healthy pregnancies, but the early pregnancy period is really difficult to be able to navigate.
And lastly, two that are definitely not medical acronyms but definitely used in this space and community – BFN and BFP.
BFN is a “big fat negative” referring to a negative pregnancy test, although some may use a different F word in that acronym, but obviously an incredible disappointment. I think it is important to keep in mind that most of us have experienced a BFN before we’ve experienced a BFP, which is a “big fat positive,” or a positive pregnancy test.
What can we take away from this world of acronyms as we try to navigate this fertility treatment?
It can definitely be daunting entering this space when you’re not familiar with these acronyms, it can feel isolating, like everyone is speaking a different language, and infertility in itself is so isolating. But over time these acronyms become second nature.
And while acronyms streamline communication, it’s essential to understand their meanings and not solely rely on online forums or unverified sources. Relying on accurate information from healthcare providers and reputable sources like Resolve New England can be immensely helpful and make this journey less daunting.