A cell in the body (a bit like the one-celled animal called an ameba) that's able to: (1) wander about; (2) engulf and digest a huge range of foreign material and junk that gets into the body's tissues (including sperm cells). They are present in almost every tissue in the body, especially if there is inflammation. We see them as scavenging cells -- the cells that do the ultimate tidying up inside the body -- but they can be programmed to swallow very specific targets, sometimes committing suicide for the greater good! There are normally lots of macrophages in the peritoneal cavity.

An area of the genome where genes are found that determine your 'tissue type', important in determining whether, for example, you can accept or will reject an organ transplant from someone else. The genes in this area are tightly packed, show extreme polymorphism, and tend to be inherited together as a group.

Plural of medium.

(MPA) A progestogen of a type related to progesterone itself. Marketed as Provera (tablets) and Depo-Provera (injections) by Upjohn.

A process similar to mitosis in which two successive divisions of a diploid cell's nucleus result in four 'daughter' cells, each with a haploid number of chromosomes. Unlike mitosis, each chromosome therefore duplicates just once (before the beginning of meiosis). Meiosis in humans (and other higher animals) takes place only among the germ cells (oogonia and spermatogonia, which will have been multiplying by mitosis. By differentiating into, respectively, primary oocytes or primary spermatocytes, each with 92 chromatids, meiosis commences. With completion of the first meiotic division the products (including secondary oocytes and spermatocytes) each contain 46 chromosomes. With completion of the second meiotic division the haploid number (23) of chromosomes, suitable for fertilisation, is reached. In the testis, meiosis and the production of new sperm cells (spermatozoa) can continue throughout life, but in the ovary all egg cells that survive commence meiosis about 20 weeks before birth, spending the remaining time (up to 50 years or more) locked up in primordial follicles as primary oocytes. Whereas a primary spermatocyte gives rise to four haploid sperm cells, a primary oocyte produces just one secondary oocyte (the spare 46 chromosomes are dumped into the first polar body just before ovulation), and then one egg cell (the spare 23 chromosomes are dumped into the second polar body after fertilisation).

The amniotic membrane and the chorionic membrane attached to the placenta.

The first natural menstrual period (pronounced 'menarcky').

Highly purified human menopausal gonadotropin made by Ferring, and comparable to Metrodin HP. Called Repronex in the US. Not available in Australia.

The last natural menstrual period (so often a retrospective diagnosis); hence the adjective menopausal, the natural state a woman is in after the ovaries have stopped ovulating because of depletion of eggs. The normal age of menopause is between 40 and 55 years, with an average in Western societies of 50-51 years.

Traditional medical term for dysfunctional uterine bleeding, or, simply, heavy periods.

The ovarian cycle as it's expressed by the endometrium of the uterus. It consists of the menstrual phase, the proliferative phase and the secretory phase. Like the ovarian cycle itself, it's normally 24 to 35 days in length -- typically 28 days, but there are lots of normal exceptions.

For our purpose in the book, the loss of an early embryo at or before the expected time of a period. Not noticeable without specially measuring levels of serum human chorionic gonadotropin One form of so-called biochemical pregnancy.

The phase of the menstrual cycle in the endometrium during which there is menstruation, caused by withdrawal of progesterone at the end of the ovarian luteal phase as a new ovarian follicular phase starts; in anovulatory cycles or during treatment with estrogens, menstrual bleeding can occur from withdrawal, insufficiency or downward fluctuations of estrogen alone.

The third, or 'middle' layer of the developing tissues of the early embryo, forming between the ectoderm and the endoderm during the transformation of the embryo known as gastrulation; mesoderm gives rise to the body's muscles, bones and various connecting tissues.

A duct on each side of the developing embryo or fetus that leads from the embryo's mesonephros, or temporary kidney. In male fetuses the duct persists as the Wolffian duct to form the rete testis, the epididymis, the vas deferens and the seminal vesicle. In female fetuses it usually disappears completely (in favor of the paramesonephric duct, better known as the Mullerian duct), though portions of mesonephric duct can remain as harmless cysts, called Gartner's duct cysts.

The third stage (of four stages) of mitosis (or meiosis), at which the chromosomes, attached in a plate-like formation to a structure in the cell called a spindle, are easily distinguished with a microscope, and can be photographed to construct a karyotype.

The metamorphosis of a tissue to take on a different form, perhaps more characteristic of a tissue some distance away. One of the theories of the cause of endometriosis is based on metaplasia.

Oral anti-diabetic drug that improves many aspects of the polycystic ovary syndrome, including lowering of androgens, serum LH, insulin levels and weight, in combination with a low calorie diet; improves development of ovarian follicles and ovulation, as well as responsiveness to clomiphene or gonadotropins if ovulation induction or in vitro fertilisation is necessary.

A cytotoxic drug, originally developed for chemotherapy for certain cancers, used in the treatment of ectopic pregnancy, especially in the US; side effects can include bone marrow depression, gastrointestinal upset and mouth ulcers, and other effects.

Human menopausal gonadotropin (hMG) from which luteinising hormone (LH) has largely been removed, leaving follicle stimulating hormone (FSH) as the active substance. Metrodin HP (Fertinex in the US) is more purified, other urinary proteins having been extracted too, and (unlike Metrodin) has no LH activity at all. Made by Serono.

Called Fertinex in the US. Metrodin that has been highly purified by removing all contaminating urinary proteins and all luteinising hormone, and is thus similar in action to recombinant follicle stimulating hormone.

A plastic operation on the uterus to change the shape of its cavity, usually for a uterine septum or for a bicornuate uterus, if there have been a number of miscarriages.

Traditional medical term for intermenstrual bleeding.

A state in an embryo, fetus, animal or person in which a small number of cells occur that have a different genome. Arises naturally because cells (rarely, stem cells) can cross between a mother and her fetus, or experimentally by introducing foreign stem cells into an embryo, usually at the stage of blastocyst, when the introduced cells become part of the inner cell mass.

(MESA) Using microsurgery to dissect the epididymis or rete testis (or sometimes the tubules of the testis itself -- see also testicular sperm extraction) to find motile sperm cells suitable to be aspirated, isolated and prepared for an in vitro fertilisation procedure, usually involving sperm microinjection, especially intracytoplasmic sperm insertion.

Literally, operating on small organs and tissues under the magnification provided by an operating microscope; the magnification is typically in the range of 6-16x for infertility surgery. The term also implies keeping the tissues wet with physiological salt solution during the operation, using fine, non-reactive stitches or sutures, being meticulous about stopping bleeding from small blood vessels, and avoiding trauma to the serosa.

An instrument for carrying out laparoscopy that is just a few millimeters in diameter, making it possible to perform such operations in an ambulatory setting, without general anesthesia. The reliability of diagnoses made this way will need careful evaluation, especially if done to exclude endometriosis, which can be difficult to find even with conventional laparoscopy.

The delivery of (or the process of delivering) a conceptus before there is a viable fetus.

The percentage chance that a pregnancy will end as a miscarriage. The normal rate of clinically apparent miscarriage for young women is about 12 percent. The rate rises independently with age, the number of previous pregnancies, and especially the number of previous miscarriages experienced. The rate is also higher with many causes of infertility when conception occurs with or without treatment.

A miscarriage that should have happened but hasn't. As a result, the pregnancy tissue in the uterus gets tougher and more difficult to get out with a uterine curettage -- which is the only treatment for it, but risks producing intrauterine adhesions. The pregnancy test can stay positive for many weeks or even months.

Plural of mitochondrion.

A tiny structure inside the cell resembling a bacterium and responsible for burning food molecules with oxygen to produce carbon dioxide, and thus providing energy for the cell's use. Each cell has hundreds or thousands of mitochondria. If there's a single aspect of a cell that reveals the process of aging, it's the mitochondria, which get less efficient as a person (and specifically a tissue) gets older. Mitochondrial aging in egg cells could be the reason why eggs in women over the age of 40 so often seem unable to produce healthy embryos -- an intriguing area of current research.

Usual process by which a cell (more strictly the nucleus of a cell) divides into two. Each chromosome duplicates before the beginning of mitosis, and mitosis involves separation of the resulting duplicates so that one goes into each 'daughter' nucleus [adapted from The Penguin Dictionary of Biology, 6th edition, Penguin Books Australia Ltd, Ringwood, Victoria, 1973]. At the third stage (of four stages) of mitosis, called metaphase, the chromosomes are easily distinguished with a microscope, and can be photographed to construct a karyotype.

German for ovulation pain.

Repeated loss of pregnancies at different stages of development of the embryo or fetus, i.e. at different stages of pregnancy. Related to recurrent miscarriages.

An abnormal state of the chromosomes seen on a karyotype in which cells from an individual display two or more genetically different chromosome pattern. Can be the result of mosaicism or chimerism.

In our context, the frequent estimation of serum estradiol (or perhaps estimating the cervical score) and performance of transvaginal ultrasound to estimate how close a woman is to ovulation.

Identical or monozygotic twins in which the split has occurred after formation of the blastocyst, so that the twins share the same gestational sac (or amniotic cavity). There is a much higher risk of complications than in the more usual situation where twins do not share the same sac, because the fetuses or the umbilical cords can get tangled up.

An abnormality of the chromosome number due to a loss of one chromosome from a diploid set, resulting in 45 chromosomes instead of 46. The only mosomy compatible with fetal development and continued survival is that of Turner syndrome, the karyotype of which is 45,X (i.e. a monosomy of the sex chromosomes).

Twins formed from the splitting of a single fertilised egg, or zygote; identical twins;

American for the monthly chance of conception, or monthly fertility rate.

The monthly chance of conception, the technical term for which is fecundability.

A stage of the embryo that consists of a ball of cells, still enclosed by the zona pellucida, before the next stage of blastocyst. Formed from the fertilised egg, or zygote, by the processes of cleavage and compaction.

The condition when an individual shows two or more genetically different cell lines (generally with different karyotypes) that are derived from one zygote.

The quality of movement, especially forward propulsion, shown by sperm cells (spermatozoa) and caused by effective beating of their tail, or flagellum. Analyzed as part of the routine sperm count.

Magnetic resonance imaging is a special form of imaging the body's internal structures, taken with the person enveloped in a huge and powerful magnet; a picture is built up of any cross-section, or series of cross-sections, through the body, using a technique that detects and pictures structures by their different content of atoms with certain resonances to induced magnetic fields. Particularly useful for investigation of the anatomy of the pituitary gland and hypothalamus when a tumor is suspected. More expensive and less widely available than a CT scan, which gives adequate results in most cases.

Mitochondrial DNA. The small amount of DNA found in the mitochondria. mtDNA is the genetic code for 13 proteins involved in metabolism. Because mtDNA is much less stable than the DNA in the chromosomes (where the huge bulk of genetic code is stored), mutations accumulate with time at a greater rate than that for chromosomal DNA -- and eventually limit how well a particular cell or tissue can function with increasing age. Because all of the mtDNA you have you inherited from your mother (you derive your mitochondria from the egg you came from), we could have an explanation: (1) why all eggs are formed before birth (so the mitochondria don't have to keep on dividing too often and risking genetic errors); and (2) why miscarriages and infertility get commoner with age (as the egg's several thousand mitochondria begin to succumb to genetic errors).

A polymorphism affecting the metabolism of folic acid with a number of possible consequences avoidable by increasing dietary supplements to mega-doses (5 mg to 10 mg per day), including promotion of blood coagulation, or thrombophilia, abnormalities of the fetus (birth defects, especially neural tube defects such as spina bifida and anencephaly), recurrent miscarriage, an increased chance of heart disease and coronary thrombosis, and in men, possibly contributes to oligospermia and infertility.

Jelly-like secretion that is at once both sticky and slippery.

(pronounced 'mool-air-ian') Syn. paramesonephric duct. The internal female sex duct, which forms on each side of a female embryo to connect the peritoneal cavity with the outside of the embryo, starting at a point close to the ovary and forming first a fallopian tube then meeting its fellow from the other side to form the uterus, and then extending downwards to form the upper part of the vagina before finally connecting with a little dimple between the urethra (in front) and the anus (behind) to reach the exterior at the vulva. Passage of eggs from the ovaries (which ovulate into the peritoneal cavity of all vertebrate species) to the outside world through this duct is how animals, including humans, reproduce. In males the ducts do not develop because the Sertoli cells of the testes produce anti-Mullerian hormone.

An operation to remove a myoma, or fibroid. A myomectomy for a submucous fibroid is often possible at hysteroscopy; a myomectomy for an intramural fibroid (located within the wall of the uterus), usually requires an open operation, or laparotomy; a myomectomy for a subserous fibroid can be possible at laparoscopy.

The muscular wall of the uterus, surrounding the endometrium. The myometrium contracts (1) during menstruation perhaps causing dysmenorrhea, and (2) during miscarriage or labor to deliver the conceptus.