Fertility and Infertility Practice Questions

Q: In which case homologous artificial insemination is used in females?

Cervical factor. **Explanation:** **Artificial Insemination Homologous (AIH)** involves the deliberate introduction of the husband’s processed semen into the female reproductive tract (usually intrauterine). The primary goal of AIH is to bypass barriers that prevent sperm from reaching the fallopian tubes naturally. **Why Cervical Factor is Correct:** In patients with **cervical factor infertility**, the cervical mucus may be hostile (due to antisperm antibodies) or insufficient (due to prior surgery like conization). By performing Intrauterine Insemination (IUI), the "cervical barrier" is bypassed, depositing highly motile sperm directly into the uterine cavity, significantly increasing the chances of fertilization. **Why Other Options are Incorrect:** * **Tubal Block:** This is a major contraindication for AIH/IUI. For insemination to work, at least one fallopian tube must be patent to allow the sperm and egg to meet. Patients with bilateral tubal blocks require **IVF (In Vitro Fertilization)**. * **Hormonal Disturbance:** While hormonal issues (like PCOS or anovulation) cause infertility, the primary treatment is **ovulation induction** (e.g., Clomiphene or Letrozole). AIH is only an adjunct if there is an associated male or cervical factor; it does not treat the underlying hormonal pathology. **High-Yield NEET-PG Pearls:** * **Indications for AIH:** Unexplained infertility, cervical factor, mild endometriosis, and male factors (mild oligospermia or hypospadias). * **Prerequisite:** At least one patent fallopian tube (confirmed via HSG or Laparoscopy) is mandatory. * **Semen Processing:** AIH requires "washing" the semen to remove prostaglandins, which can cause severe uterine cramping if injected directly. * **Success Rate:** Approximately 10–15% per cycle.

Q: Decreased motility of the fallopian tube is seen in which condition?

Kartagener syndrome. **Explanation:** **Kartagener syndrome** is a subset of **Primary Ciliary Dyskinesia (PCD)**, an autosomal recessive disorder characterized by a structural defect in the **dynein arms** of cilia. Cilia are essential for movement in various parts of the body, including the respiratory tract and the fallopian tubes. In the fallopian tubes, ciliary action is responsible for the transport of the ovum toward the uterus. Dysfunction or decreased motility of these cilia leads to impaired tubal transport, significantly increasing the risk of **ectopic pregnancy** and **infertility**. **Analysis of Options:** * **Kartagener syndrome (Correct):** Defined by the triad of **situs inversus, bronchiectasis, and chronic sinusitis**. The underlying ciliary immotility directly causes decreased fallopian tube motility. * **Churg-Strauss syndrome:** Now known as Eosinophilic Granulomatosis with Polyangiitis (EGPA), this is a small-vessel necrotizing vasculitis associated with asthma and eosinophilia; it does not affect ciliary function. * **Noonan syndrome:** A genetic condition characterized by short stature, heart defects (pulmonary stenosis), and distinct facial features. It is often called "Pseudo-Turner" but does not involve tubal motility. * **Turner syndrome (45, XO):** Characterized by **streak ovaries** and primary amenorrhea due to accelerated oocyte atresia. While it causes infertility, the mechanism is ovarian failure, not tubal dysmotility. **High-Yield NEET-PG Pearls:** * **PCD Triad:** Bronchiectasis, Sinusitis, and Infertility (due to immotile sperm in males and ciliary dyskinesia in females). * **Kartagener Triad:** PCD + Situs Inversus. * **Diagnosis:** Screening via nasal nitric oxide levels; definitive diagnosis via electron microscopy (showing absent dynein arms) or genetic testing.

Q: Preimplantation genetic diagnosis is used for which of the following?

Single gene mutation analysis. **Explanation:** **Preimplantation Genetic Testing (PGT)** is a technique used to identify genetic defects in embryos created through In-Vitro Fertilization (IVF) before pregnancy is established. **Why Option B is correct:** The primary clinical indication for PGT-M (formerly known as PGD) is the detection of **Single Gene Mutations** (monogenic disorders). It is used for couples who are known carriers of specific inherited conditions such as Cystic Fibrosis, Thalassemia, Sickle Cell Anemia, or Huntington’s disease. By testing a biopsy from the trophectoderm (blastocyst stage), clinicians can select and transfer only those embryos that are unaffected by the specific mutation. **Analysis of Incorrect Options:** * **A. Fetal gender determination:** While technically possible, using PGT solely for social sex selection is ethically controversial and legally prohibited in many regions (including India under the PCPNDT Act). * **C. HLA typing:** While PGT can be used for HLA matching (to create a "savior sibling"), it is a specialized application and not the primary diagnostic use of the technology compared to mutation analysis. * **D. Karyotyping:** Traditional karyotyping requires a large number of dividing cells (metaphase). For embryos, we use **PGT-A** (Aneuploidy screening) via NGS (Next-Generation Sequencing) or FISH, rather than standard karyotyping, to detect chromosomal imbalances. **High-Yield Clinical Pearls for NEET-PG:** * **Timing of Biopsy:** Usually performed at the **Blastocyst stage (Day 5)** by sampling the trophectoderm (5-10 cells), which is safer for the embryo than the cleavage stage (Day 3) biopsy. * **PGT-A:** Screens for aneuploidy (e.g., Down Syndrome); recommended for advanced maternal age. * **PGT-SR:** Screens for structural rearrangements (e.g., balanced translocations). * **Legal Note:** In India, PGT is governed by the ART (Regulation) Act, 2021.

Q: A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?

Anti-Müllerian hormone (AMH). ***Anti-Müllerian hormone (AMH)***- **AMH** is currently considered the single **best test** for assessing ovarian reserve because it is produced by **granulosa cells** of pre-antral and small antral follicles, directly correlating with the size of the **remaining follicle pool**.- It can be measured reliably at **any time** during the menstrual cycle or even while using oral contraceptives, providing a highly stable and convenient assessment compared to cycle-dependent hormones.*Follicle-stimulating hormone (FSH) on day 3*- While commonly used, day 3 **FSH levels** are less sensitive than AMH because they reflect the degree of **luteal-follicular axis feedback** rather than the absolute number of follicles.- FSH levels are subject to significant **cycle-to-cycle variability**, and elevated readings often represent an already **advanced stage** of ovarian decline.*Estradiol on day 3*- Day 3 **Estradiol** is primarily measured to exclude premature follicle recruitment (which could suppress FSH), but it is a **poor independent predictor** of ovarian reserve.- Estradiol levels fluctuate greatly and high levels can **falsely mask** elevated FSH readings, limiting its utility as a primary diagnostic tool.*Serum inhibin levels on day 5*- **Inhibin B** is produced by developing follicles and reflects ovarian reserve, but it exhibits significant **menstrual cycle variability**, making interpretation challenging.- It is considered a **secondary marker**; it is less standardized and has lower predictive accuracy for future fertility compared to **AMH**.

Q: Ovarian drilling is done in which of the following conditions?

Polycystic ovarian syndrome. ***Polycystic ovarian syndrome (PCOS)*** - **Ovarian drilling (laparoscopic ovarian diathermy)** is a surgical treatment specifically indicated for **clomiphene-resistant PCOS** - The procedure involves creating multiple small perforations in the ovarian capsule using diathermy or laser - **Mechanism:** Destroys androgen-producing ovarian stroma, reduces serum LH and androgens, restores ovulation in 50-70% of cases - **Indications:** Failed medical management with clomiphene citrate, as an alternative to gonadotropin therapy - Advantages include lower multiple pregnancy risk compared to gonadotropins *Incorrect: Endometriosis* - Treated with laparoscopic excision/ablation of endometriotic deposits, not ovarian drilling - May involve ovarian cystectomy for endometriomas *Incorrect: Ovarian tumor* - Requires surgical excision (cystectomy or oophorectomy) based on pathology - Drilling would be inadequate and inappropriate for tumor management *Incorrect: Ovarian hyperstimulation syndrome (OHSS)* - Iatrogenic complication of ovulation induction with gonadotropins or IVF - Managed conservatively with fluid management, monitoring, and supportive care - Not a surgical condition requiring ovarian drilling

Q: Which of the following is seen in the HSG given below?

Hydrosalpinx. ***Hydrosalpinx*** - The image shows a **dilated, fluid-filled fallopian tube** with a characteristic coiled or "sausage-shaped" appearance on the left side, which is indicative of a hydrosalpinx. - The contrast material has filled the dilated tube but there is no spill into the peritoneal cavity, suggesting distal tubal occlusion, a hallmark of hydrosalpinx. *Bicornuate uterus* - A bicornuate uterus would appear as a **heart-shaped uterus** with two distinct uterine horns, but the image depicts a normal uterine cavity. - While there might be some variation in uterine shape due to contrast filling, the overall morphology does not suggest a septate or bicornuate uterus. *Asherman syndrome* - Asherman syndrome is characterized by **intrauterine adhesions** (scarring) within the uterine cavity, often leading to irregular filling defects within the uterus. - The uterine cavity in the image appears smooth and well-filled without evidence of synechiae (adhesions). *Septate uterus* - A septate uterus is a congenital anomaly where the **uterine cavity is divided by a septum**, which would appear as a filling defect or division in the middle of the uterine cavity. - The uterine cavity in the image is uniform and triangular, without any internal division or septum.

Q: Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct? I. Tubal patency assessment following tuboplasty operation II. Diagnosis of uterine synechiae III. Detection of IUD IV. Diagnosis of subserosal fibroid Select the answer using the code given below :

I, II and III. ***I, II and III*** Hysterosalpingography (HSG) is a radiological procedure that uses contrast material injected into the uterus to visualize the **uterine cavity** and **fallopian tubes** under fluoroscopy. It is specifically useful for: **Statement I - Tubal patency assessment following tuboplasty operation** ✓ - HSG is the standard procedure to evaluate whether fallopian tubes remain patent after reconstructive tubal surgery **Statement II - Diagnosis of uterine synechiae** ✓ - HSG excellently demonstrates intrauterine adhesions (Asherman's syndrome) as filling defects in the uterine cavity **Statement III - Detection of IUD** ✓ - Radiopaque IUDs are easily visualized on HSG, and the procedure can confirm proper IUD position within the uterine cavity **Statement IV - Diagnosis of subserosal fibroid** ✗ - **Subserosal fibroids** project outward from the uterine serosa into the peritoneal cavity - HSG only outlines the **endometrial cavity** and **tubal lumen**, not external uterine surfaces - These fibroids do not impinge on the uterine cavity and therefore cannot be visualized by HSG - Better diagnosed by **ultrasound** or **MRI** *I, II and IV* - While HSG is excellent for assessing tubal patency and diagnosing uterine synechiae (I and II), it cannot diagnose **subserosal fibroids** which are located on the outer surface of the uterus and do not affect the uterine cavity outline. *II, III and IV* - This option correctly identifies HSG's utility in diagnosing **uterine synechiae** and detecting **IUDs**, but incorrectly includes **subserosal fibroids** which cannot be visualized by this procedure. *I, III and IV* - This option accurately includes HSG's role in assessing **tubal patency** and detecting **IUDs**, but mistakenly includes diagnosis of **subserosal fibroids** which require imaging modalities that visualize the external uterine surface.

Question 1

A married patient for 3 years is unable to conceive despite having regular menstrual cycles. Her husband's semen analysis and hormonal profile are normal. What is the optimal timing in the menstrual cycle to perform an endometrial biopsy for infertility evaluation?

Accepted Answer

Days 20-22

Answer

Days 12-14

Answer

Days 17-19

Answer

Days 3-5

Question 2

Which of the following is NOT an essential criterion according to WHO for normal semen analysis?

Accepted Answer

Volume > 1.5 ml

Answer

Sperm count > 20 million/ml

Answer

Sperm with normal morphology (strict criteria) > 15%

Answer

Motility > 25% with rapidly progressive motility

Question 3

In which case homologous artificial insemination is used in females?

Accepted Answer

Cervical factor

Answer

Hormonal disturbance

Answer

Tubal block

Answer

All of the above

Question 4

Decreased motility of the fallopian tube is seen in which condition?

Accepted Answer

Kartagener syndrome

Answer

Churg-Strauss syndrome

Answer

Noonan syndrome

Answer

Turner syndrome

Question 5

Preimplantation genetic diagnosis is used for which of the following?

Accepted Answer

Single gene mutation analysis

Answer

Fetal gender determination

Answer

HLA typing

Answer

Karyotyping

Question 6

Infertility issues associated with leiomyoma can be addressed by which of the following?

Accepted Answer

GnRH agonist

Answer

Combined oral contraceptive pills

Answer

DMPA

Answer

Ulipristal

Question 7

A 35-year-old female patient presents to the clinic for evaluation of her fertility status. She has been trying to conceive for over a year without success. Which of the following is the single best test for assessing her ovarian reserve?

Accepted Answer

Anti-Müllerian hormone (AMH)

Answer

Serum inhibin levels on day 5

Answer

Estradiol on day 3

Answer

Follicle-stimulating hormone (FSH) on day 3

Question 8

Ovarian drilling is done in which of the following conditions?

Accepted Answer

Polycystic ovarian syndrome

Answer

Endometriosis

Answer

Ovarian tumor

Answer

Ovarian hyperstimulation syndrome

Question 9

Which of the following is seen in the HSG given below?

Accepted Answer

Hydrosalpinx

Answer

Bicornuate uterus

Answer

Asherman syndrome

Answer

Septate uterus

Question 10

Which of the following statements about hysterosalpingography, as a diagnostic procedure, are correct?
I. Tubal patency assessment following tuboplasty operation
II. Diagnosis of uterine synechiae
III. Detection of IUD
IV. Diagnosis of subserosal fibroid

Select the answer using the code given below :

Accepted Answer

I, II and III

Answer

I, II and IV

Answer

II, III and IV

Answer

I, III and IV

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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