1. The International Glossary on Infertility and Fertility Care, 2017
Fertility and Sterility® Vol. 108, No. 3, September 2017
Why do definitions matter?

2. Dr. Paversan Archary Clinical Assistant:
African Network and Registry for Assisted Reproductive Technology
Reproductive Medicine Unit; Groote Schuur Hospital,
Cape Town, South Africa

3. Declarations The authors have not disclosed any external interests.
Slides used with permission: Fernando Zegers-Hochschild.

4. Why do definitions matter?
ART is practiced globally.
Specialized terms and concepts are unique to ART practice.
Terms may have different meanings depending on their context of use.
Standardization and comparison of interventions and outcomes becomes difficult.
Consensus definitions therefore form the cornerstone of ART practice.
ART is practiced across the globe, in various regions and among diverse populations.
Terms used in ART practice can have different meanings that are dependent upon the setting, their usage in research or clinical interventions, or among diverse populations.
This can result in difficulties in standardizing and comparing fertility care interventions and their outcomes.
The way some terms are defined can have an impact on their acceptance and understanding, not only by patients and their health care providers, but also by the public and their policy makers, potentially affecting the manner in which reproductive medicine is practiced and accepted at country level especially on a global level

5. ICMART Glossary
First international standardized definitions for reporting ART procedures published by ICMART in (53 terms)
Revised in 2009 by ICMART & WHO. Expanded to 87 terms.
Limitations of the glossary have since been identified in several areas.
andrology
epidemiology
social sciences
global public health
Updated 2017.

6. Result Consensus reached on 283 terms.
Updated glossary published September 2017, Fertility & Sterility.

7. Infertility
A disease characterized by the failure to establish a clinical pregnancy after 12 months of regular, unprotected sexual intercourse.
Or due to an impairment of a person’s capacity to reproduce either as an individual or with his/her partner.
Fertility interventions may be initiated in less than one year based on clinical findings.
Infertility is a disease, which generates disability as an impairment of function.

8. Medically Assisted Reproduction (MAR)
Reproduction brought about through various interventions, procedures, surgeries and technologies to treat different forms of fertility impairment and infertility.
These include ovulation induction, ovarian stimulation, ovulation triggering, all ART procedures, uterine transplantation and intrauterine, intracervical and intravaginal insemination with semen of husband/partner or donor.

9. Assisted Reproductive Technology (ART)
Interventions that include the in-vitro handling of both human oocytes and sperm or of embryos for the purpose of reproduction.
This includes but is not limited to IVF and embryo transfer; ICSI; gamete and embryo cryopreservation; semen, oocyte and embryo donation; and gestational carrier cycles.
Thus, ART does not include insemination using sperm from either a woman's partner or a sperm donor. (See broader term, medically assisted reproduction (MAR).
IVF and embryo transfer ET,
intracytoplasmic sperm injection ICSI,
embryo biopsy, preimplantation genetic testing PGT,
assisted hatching,
gamete intrafallopian transfer GIFT, zygote intrafallopian transfer,
gamete and embryo cryopreservation, semen, oocyte and embryo donation, and gestational carrier cycles

10. Pregnancy Pregnancy: Biochemical pregnancy: Clinical pregnancy:
A state of reproduction beginning with implantation of an embryo in a woman.
Biochemical pregnancy:
A pregnancy diagnosed only by the detection of beta hCG in serum or urine.
Clinical pregnancy:
A pregnancy diagnosed by ultrasound visualization of one or more gestational sacs or definitive clinical signs of pregnancy.
In addition to intra-uterine pregnancy, it includes a clinically documented ectopic pregnancy.
Pregnancy A state of reproduction beginning with implantation of an embryo in a woman
ImplantationThe attachment and subsequent penetration by a zona-free blastocyst into the endometrium

11. Gestational Timeline Fetal Loss: Death of a fetus.
Pregnancy
Implantation 8
weeks
Embryo loss 22
Early fetal loss
Abortion 28
Late fetal loss
Stillbirth
Delivery
Birth
Perinatal Mortality
Early neonatal death 7
days
Fetal Loss: Death of a fetus.
Early fetal loss when death takes place between 10 and 22 wks;
Late fetal loss when death takes place between 22 and 28 wks;
Stillbirth when death takes place after 28 wks gestational age.

12. Pregnancy Loss
The outcome of any pregnancy that does not result in at least one live birth.
When reporting pregnancy loss, the estimated gestational age at the end of pregnancy should be recorded.

13. Births & Deliveries Birth Delivery
The complete expulsion or extraction from a woman of a fetus after 22 completed weeks of gestation.
If gestational age is unknown, a birth weight more than 500 grams.
Delivery
The complete expulsion or extraction from a woman of one or more fetuses, after at least 22 completed weeks of gestation.
A delivery of either a single or multiple newborn is considered as one delivery.
BIRTHS: A single birth refers to an individual newborn; and a delivery of multiple births, such as a twin delivery, would be registered as two births.
DELIVERIES:If more than one newborn is delivered, it is recognized as a single delivery with multiple births.

14. Conclusion
The glossary revision provides a consensus and evidence-driven set of terms and definitions.
Can be implemented globally to provide quality care and ensure consistency of ART practice.
Use will result in accurate reporting and comparison of outcomes in research, media as well as data registries.
This glossary revision provides the medical and scientific communities, the lay public and policy-makers with a consensus and evidence-driven set of terms and definitions that can be used globally to provide quality care and ensure consistency in registering specific fertility care interventions plus more accurate reporting of their outcomes on national, regional and international registries, and in social media or results from research.