Institutional ethics committee

A disease syndrome caused by abnormal sub-microscopic structure of cilia, which therefore do not function properly during embryonic life, childhood and adulthood. The consequences are situs inversus, in which the developing internal organs in the embryo rotate randomly (so that 50% of affected people have their heart on the right side of the chest and their liver on the left side of the abdomen), abnormal sinuses, a bad form of chronic bronchitis called bronchiectasis, because mucus is not cleared from lungs properly, and male infertility because the sperm tail (the flagellum) has the same sub-microscopic structure as the cilia and cannot propel the spermatozoon. Curiously, female fertility is often normal or adequate: it seems the cilia of the fallopian tube's fimbrial end still make useful contact with the cumulus mass at ovulation, stopping the egg from getting lost and giving the muscular contractions of the tube the chance to carry the egg down to the ampullary-isthmic junction. Also called Kartagener's syndrome, after the Swiss physician Manes Kartagener, who first described a triad of situs inversus, abnormal sinuses and bronchiectasis.

The body system devoted to resisting parasitic organisms (including viruses, bacteria, fungi and parasitic animals) and to identifying altered body cells (such as cancer) and destroying them. Includes nonspecific mechanisms ('innate immunity') as well as, particularly, the lymphoid system vertebrates have evolved to recognise antigens and, in response, to produce specific, neutralising antibodies. Excessive activity can lead to the immune system turning on normal tissues, or autoimmunity.

Tests that look for human antibodies attached to cells, especially (in our context) antibodies attached to sperm cells (see sperm antibodies). The test involves tiny plastic beads coated with antibodies to human antibodies: if they are seen to attach to sperm cells then the presence of antisperm antibodies on the sperm cells is inferred.

The process by which the embryo's trophoblast attaches to the mother's endometrium and penetrates it, establishing contact between the trophoblast's developing chorionic villi and the maternal blood. See also blastocyst. Signifies the commencement of gestation or pregnancy.

A small to moderate amount of vaginal bleeding at the time that implantation becomes established. Implantation bleeding can be confused with a menstrual period (particularly the last menstrual period) to give a false impression that pregnancy has not happened or, later, a false estimate of the duration of the pregnancy.

The proportion of transferred embryos in an in vitro fertilisation procedure that produce a gestational sac visible on transvaginal ultrasound. Unlike for the conception rate and the pregnancy rate, twins (with separate sacs) are counted separately. An important index of a clinic's success rate with IVF because it reflects embryo quality independently of the number of embryos transferred.

Inability to sustain an erection of the penis and hence to ejaculate. Occasional impotence is of no special psychological or medical importance. Although persistent impotence is most often due to psychological causes, medical tests are important.

Latin for 'in glass', meaning 'in the laboratory'. (In actual fact, these days, it's usually 'in plastic'!) See also in vitro fertilisation.

IVF, or fertilisation of the egg (the secondary oocyte) by a sperm (a spermatozoon) in vitro, i.e. in the laboratory. Necessary if the fallopian tubes are diseased or missing; useful if sperm fertilising capacity is doubtful, because evidence of fertilisation can be seen before the egg is transferred as an embryo.

Maturation in the laboratory of the egg (as a primary oocyte) obtained from an immature tertiary follicle until it becomes a secondary oocyte competent to be fertilised by sperm using in vitro fertilisation. The smaller the follicle, the lower the proportion of eggs that mature successfully. ICSI can be used to increase the proportion of eggs that will fertilise, but the embryos on average do no better, and so no advantage is conferred by ICSI in this situation.

One of several tests of the ability of sperm to penetrate cervical mucus at the time of ovulation or under the influence of estrogen.

(IMC) Any miscarriage before all miscarriage tissue has been expelled. Traditionally a uterine curettage was done after a miscarriage, in the belief (often accurate) that there would still be some immature pregnancy tissue left in the uterus that could cause more bleeding and get infected. Nowadays we can distinguish an incomplete from a complete miscarriage (and whether or not a curettage should be done) with a transvaginal ultrasound, which is able to reveal significant retained tissue. Management is similar to the management of an inevitable miscarriage (and both are abbreviated IMC).

(IMC) Traditionally any bleeding from the vagina during early pregnancy with, on vaginal examination, opening of the cervix. Today, the diagnosis can be made much sooner (and distinguished from a threatened miscarriage) by not detecting a normal embryo in a gestational sac on transvaginal ultrasound. Management is similar to the management of an incomplete miscarriage, often requiring curettage (and both are abbreviated IMC).

Not getting pregnant as quickly as expected.

An administrative and legal device by which approval to proceed based on known or predicted consequences is obtained and recorded from a patient or from a volunteer for medical research, and thus avoiding an accusation for what otherwise might be an assault. Just what 'informed' means can be the subject of much legal and ethical wrangling. One modern interpretation is that it means as much as the person giving the consent demonstrates that he or she wants to know (although most physicians, ethics committees, institutional review boards and courts underpin this with a minimum everyone should be told about the procedure being consented to).

A protein hormone produced in women by developing follicles as well as by the corpus luteum, and in men by the testis in the presence of spermatogenesis, and acting on the pituitary gland to inhibit the production of follicle stimulating hormone. In women, falling levels occur as the number of developing follicles reduces to low numbers leading up to menopause, thus causing the elevation of serum FSH and shortening of the follicular phase that characterises the premenopause. In men, appreciable levels of serum inhibin B, a subclass of the inhibin family, predicts the presence of at least a small amount of sperm production.

Group of cells that differentiates within (but to one side of) the developing embryo when it is a blastocyst and which will, if all goes well after implantation, form the embryo-proper, or fetus. Cells from the inner cell mass can be used to produce embryonic stem cells.

(IRB) The US equivalent of an institutional ethics committee, set up to govern the ethical conduct of medical research.

Proteins present on the surface of cells that are needed for cells stick to each other with the help of adhesion molecules. Important in implantation and in the proper construction of the placenta, so that abnormalities or mutations can result in infertility or recurrent miscarriage.

A systematic ethical goal that preserves the values of truth, accountability, equity and consistency.

Used for minimising adhesions in the peritoneal cavity after a surgical operation involving the fallopian tubes or ovaries. The material is woven from fibers of modified cellulose and, after being placed over abdominal surfaces the serosa of which is likely to have been damaged, dissolves in about a week or two into simple sugar molecules (which are then absorbed by the body and metabolised); in the meantime, the cloth keeps the covered surfaces apart while the serosa reforms. Controlled trials have shown Interceed to be effective in preventing or reducing adhesions, but an adhesion-free result is not guaranteed. In my experience Interceed is exceptionally useful when dense adhesions resulting from previous operations are being treated. Made by Johnson and Johnson.

A signalling molecule that inhibits the immune system, so preventing rejection of the fetus during pregnancy. It is thought that insufficient interleukin 10 is a cause of miscarriage.

(IMB) Bleeding between periods that are otherwise regular. If it happens while on the oral contraceptive pill it's called breakthrough bleeding; if it happens over a few days before a period starts properly it's premenstrual spotting; if it happens after sex it's postcoital bleeding. These forms of IMB have different, usually important, causes. The formal term for it is metrorrhagia.

A state of ambiguity regarding the assigning of sex or gender, usually because of ambiguity of the genital organs at birth. There is male intersex if the karyotype is 46,XY, female intersex if it's 46,XX. Incorporates hermaphrodism and pseudohermaphrodism, terms that are not much used outside the US.

An ectopic pregnancy located in the interstitial segment of the fallopian tube. An especially dangerous form of tubal pregnancy, because the surrounding myometrium of the uterus supports the pregnancy's growth for weeks without causing symptoms; when rupture eventually occurs it can be catastrophic, because a main branch of the main artery to the uterus is torn, with sudden (sometimes fatal) bleeding into the peritoneal cavity.

The innermost part of the fallopian tube, passing through the wall of the uterus (the myometrium) to join the isthmus to the endometrial cavity.

The space in the placenta in which the maternal blood flows. Washes around the chorionic villi, which contain blood capillaries from the fetus, so that oxygen and nutrition pass to the fetus, while carbon dioxide and waste pass to the mother. Formed from lacunae and lined by the syncytiotrophoblast.

Adhesions inside the endometrial cavity caused by prior infection (endometritis), especially if there has been a curettage during the period of infection, or if curettage is performed in conditions of low estrogen. The circumstances in which this combination is most common are treatment for a missed abortion and treatment of a postpartum hemorrhage (bleeding a few weeks after the birth of a baby). A cause of absent periods amenorrhea, light periods (hypomenorrhea) or recurrent miscarriages.

(IUI) A form of assisted conception involving assisted insemination into the uterus, either for donor insemination (DI) or with husband's semen (AIH). IUI can be carried out with a woman's natural cycles or with ovarian stimulation (superovulation) using clomiphene or follicle stimulating hormone, with ovarian monitoring.

A distressing dysfunction of the intestines, in which there's both overactivity of the involuntary contractions of the intestines' muscular wall and increased pain signals coming from those contractions. Treatment is based on decreasing the contractions (with a diet high in fibre, sometimes with antispasmodic drugs) and attempting to reduce the action of the pain-carrying nerves, both by sedating them (this means general sedation too, so it's often not very acceptable) and by re-educating them to be less sensitive. Treatment is time consuming and, ultimately, not always satisfactory. The symptoms of the irritable bowel syndrome are often confused with those of endometriosis; they are sometimes made worse with, and at the time of, premenstrual tension, or, in my experience of patients with it, by performance of a laparoscopy. Typically (but not always), there is an alternating tendency towards diarrhea or constipation; sometimes there is nausea with the spasms.

The narrow, inner part of the fallopian tube, about 3 to 4 cm long; lies between the ampulla and the interstitial segment.