Fertility and Infertility Practice Questions

Q: A hysteroscopy image is shown. What will be the Hysteroscopic finding?

Hydrosalpinx. ***Hydrosalpinx*** - A **hysteroscopy** can reveal the presence of a **hydrosalpinx** if the fluid from the dilated fallopian tube refluxes into the **uterine cavity**. - This refluxed fluid may be visible as a clear or yellowish discharge coming from the **tubal ostium** during hysteroscopic examination. *Cornual block* - A **cornual block** refers to an obstruction at the junction of the **fallopian tube** and the **uterus**. - While it can be identified by **hysteroscopy** if the ostium appears occluded, it is a *cause* for infertility, not a direct hysteroscopic *finding* itself regarding the fluid accumulation. *Normal findings* - **Normal hysteroscopic findings** would include a healthy **endometrium**, patent **tubal ostia** without reflux, and no signs of intrauterine abnormalities or fluid collection. - This option is incorrect because the presence of refluxed fluid from a hydrosalpinx would not constitute a normal finding. *Bicornuate uterus* - A **bicornuate uterus** is a **congenital uterine anomaly** where the uterus has two horns due to incomplete fusion of the **Müllerian ducts**. - While a **bicornuate uterus** can be diagnosed via hysteroscopy (observing two hemi-cavities), it is a structural anomaly and not related to the presence of a **hydrosalpinx** or its associated fluid reflux.

Q: An infertile woman has bilateral tubal block at cornua diagnosed on hysterosalpingography. Next treatment of choice is?

IVF. ***IVF*** - For **bilateral cornual tubal block**, In Vitro Fertilization (IVF) is the most effective and often preferred treatment. It bypasses the blocked tubes entirely by fertilizing the egg outside the body. - This approach offers the highest success rates when tubal patency cannot be restored or in cases of severe tubal damage. *Laparoscopy and hysteroscopy* - While these procedures diagnose and treat various infertility causes, they are less effective for **bilateral cornual block**. - **Hysteroscopy** might be used to confirm the block or perform canalization, but the success rate for achieving pregnancy with this method is low. *Tuboplasty* - **Tuboplasty** refers to surgical repair of the fallopian tubes, which is generally not recommended for **cornual block**. - Success rates for achieving live birth after tuboplasty for cornual occlusion are very low, and it carries risks such as ectopic pregnancy. *Hydrotubation* - This procedure involves flushing the fallopian tubes with fluid and is primarily used for **mild distal tubal block** or as a diagnostic step with contrast medium to confirm patency. - It is unlikely to effectively resolve a **significant bilateral cornual block**, which requires more definitive intervention.

Q: Abstinence period before semen analysis is?

3-5 days. ***3-5 days*** - An abstinence period of **3-5 days** is recommended before semen analysis to ensure optimal sperm concentration and motility for accurate results, as per World Health Organization (WHO) guidelines. - This period allows for the accumulation of a sufficient number of mature sperm while avoiding the negative effects of prolonged abstinence on sperm quality. *1-2 days* - An abstinence period of **1-2 days** is generally too short and may result in a falsely low sperm concentration. - This duration does not allow for adequate replenishment of sperm in the epididymis. *5-7 days* - While a longer period might increase sperm count, **abstinence exceeding 5 days** can negatively impact sperm motility and morphology due to increased exposure to reactive oxygen species and cellular degradation. - This can lead to a suboptimal sample for evaluation. *7-9 days* - An abstinence period of **7-9 days** is generally considered too long, leading to a significant decrease in sperm quality, particularly **motility** and **viability**. - Prolonged abstinence can result in an abnormal semen analysis due to the accumulation of older, less viable sperm.

Q: In a case of recurrent spontaneous abortion, which of the following investigations is least indicated?

Testing for TORCH infections. ***Testing for TORCH infections*** - While TORCH infections (Toxoplasmosis, Other [syphilis, parvovirus B19, varicella-zoster], Rubella, Cytomegalovirus, Herpes simplex virus) can cause **spontaneous abortion**, they are **rarely a cause of recurrent spontaneous abortion**. - Recurrent infections are uncommon, making chronic or repeated TORCH infections an unlikely primary driver for multiple losses. *Hysteroscopy* - **Hysteroscopy** is often indicated to evaluate for **intrauterine structural abnormalities** such as septa, polyps, fibroids, or Asherman's syndrome, which can contribute to recurrent pregnancy loss. - These structural issues can interfere with implantation and uterine blood supply, leading to repeated abortions. *Thyroid function tests* - Both **hypothyroidism and hyperthyroidism** are associated with an increased risk of recurrent spontaneous abortion. - **Thyroid hormone imbalances** can disrupt ovulation, implantation, and early fetal development. *Testing for antiphospholipid antibodies* - **Antiphospholipid syndrome (APS)** is a significant and treatable cause of recurrent spontaneous abortion due to **thrombotic events** in the placental circulation. - Testing for lupus anticoagulant, anti-cardiolipin antibodies, and anti-beta-2 glycoprotein I antibodies is a **standard part of the workup** for recurrent pregnancy loss.

Q: Azoospermic patient can be a father of a child, by which of the following?

ICSI. ***ICSI*** - **Intracytoplasmic sperm injection (ICSI)** involves injecting a single sperm directly into an egg, making it the procedure of choice for men with **severe male factor infertility**, including azoospermia. - Even with **azoospermia** (absence of sperm in ejaculate), sperm can be surgically retrieved from the **epididymis (PESA/MESA)** or **testes (TESA/TESE)** and used for ICSI. - This allows biological fatherhood even in cases of **obstructive** or **non-obstructive azoospermia**. *IUI* - **Intrauterine insemination (IUI)** involves placing washed sperm directly into the uterus. - Requires a sufficient number of **motile sperm** in the ejaculate. - **Not effective for azoospermia** as there is no sperm in the ejaculate to be inseminated. *ZIFT* - **Zygote intrafallopian transfer (ZIFT)** involves fertilizing eggs in vitro and transferring the resulting zygotes into the fallopian tube. - Requires viable sperm for fertilization, making it unsuitable as a primary option for azoospermic patients. - If sperm retrieval is performed, ICSI would be the fertilization method used, not traditional ZIFT. *Not possible & counsel regarding adoption* - While adoption is a valid option, advances in reproductive technology, particularly **ICSI with sperm retrieval techniques (TESE/PESA)**, offer a chance for biological parenthood even in cases of azoospermia. - This statement represents an **outdated approach** and is incorrect given current ART capabilities.

Q: Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?

Day 21-23. ***Day 21-23*** - An **endometrial biopsy** performed around **day 21-23** of a typical 28-day cycle coincides with the **luteal phase**, when progesterone levels are high after ovulation. - This timing allows for the examination of **secretory changes** in the endometrium, which are indicative of successful ovulation and progesterone influence. *Day 8-9* - This period is during the **late follicular phase**, prior to ovulation. - The endometrium would still be in the **proliferative phase**, showing no signs of progesterone-induced secretory changes. *Day 13-15* - This timeframe is typically around the expected time of **ovulation** itself. - An endometrial biopsy during this period would likely show a **transitional or early secretory phase**, making it difficult to definitively confirm post-ovulatory changes. *Day 3-5* - This is the **menstrual phase**, when the uterine lining is being shed. - An endometrial biopsy at this time would primarily show **shedding and regenerative changes**, not features indicative of the secretory phase following ovulation.

Q: What is the procedure used in preimplantation genetic diagnosis (PGD) to obtain cells from an embryo for genetic analysis before transferring it to the uterus during IVF?

Embryo cell biopsy. ***Embryo cell biopsy*** - **Embryo cell biopsy** is the procedure used to remove one or more cells from an early embryo (typically at the cleavage stage on day 3 or blastocyst stage on day 5) for genetic analysis in PGD. - The biopsied cells are then tested for **genetic abnormalities** using techniques like FISH (Fluorescence In Situ Hybridization), PCR (Polymerase Chain Reaction), or Next Generation Sequencing (NGS). - This allows selection of chromosomally normal or unaffected embryos for transfer during IVF, preventing transmission of genetic disorders. *CVS* - **Chorionic Villus Sampling (CVS)** is a prenatal diagnostic procedure performed during an established pregnancy, typically between 10 and 13 weeks of gestation. - CVS involves obtaining placental tissue to test for genetic abnormalities in the fetus, but occurs **after implantation**, not before embryo transfer. *ICSI* - **Intracytoplasmic Sperm Injection (ICSI)** is an assisted reproductive technique where a single sperm is directly injected into an oocyte to facilitate fertilization. - ICSI is a fertilization method, not a diagnostic procedure for detecting **genetic abnormalities** in embryos. *None of the options* - This option is incorrect because **Embryo cell biopsy** is the established procedure used in PGD to obtain embryonic cells for subsequent genetic testing.

Q: In IVF, during cleavage stage embryo transfer, embryos are typically transferred back to uterine cavity at which cell stage?

4-8. ***4-8*** - **Cleavage stage embryo transfer** typically occurs on **day 3** after fertilization, when the embryo has divided into approximately **6-8 cells** (within the 4-8 cell range). - This stage is the **most common timing** for cleavage stage transfers in conventional IVF, chosen for transfer into the **uterine cavity** as it allows for adequate embryo assessment while mimicking natural progression toward implantation. - Day 3 transfers at this stage are preferred when blastocyst culture is not planned or available. *2* - An embryo with only 2 cells is at the **very early cleavage stage**, typically observed on **day 1** (approximately 24 hours) after fertilization. - Transferring at this early stage is **rarely done** in modern IVF practice as it provides insufficient time for embryo quality assessment and viability evaluation. *2-4* - A 2-4 cell stage embryo is typically seen on **day 2** after fertilization (approximately 48 hours). - While day 2 transfers can be performed, **day 3 transfers** (4-8 cell stage) are generally preferred for cleavage stage embryo transfer as they allow better morphological assessment and selection of viable embryos. *8-16* - An 8-16 cell embryo is typically seen on **day 4** and represents the **morula stage**, characterized by compaction of cells. - This stage is **beyond the typical cleavage stage transfer window** - embryos at this point would usually be cultured further to **blastocyst stage** (day 5-6) rather than transferred at the morula stage.

Q: Chlamydia trachomatis infection commonly causes: March 2004

Infertility. ***Infertility*** - **Chlamydia trachomatis** is the **leading cause of preventable infertility** worldwide. - It commonly causes **pelvic inflammatory disease (PID)**, which leads to **tubal scarring and blockage** of the fallopian tubes. - **Tubal damage** from PID is a major cause of female infertility and significantly increases the risk of **ectopic pregnancy**. - This is the **most common long-term complication** of chlamydial infection. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) is not a direct or common complication of **Chlamydia trachomatis** infection. - Chlamydia causes **local reproductive tract inflammation**, not hormonal disruption leading to amenorrhea. *Malignancy* - **Chlamydia trachomatis** is not linked to cervical or reproductive organ cancers. - **Human Papillomavirus (HPV)** is the primary infectious agent associated with cervical malignancy, not Chlamydia. *Post coital bleeding* - While **Chlamydia can cause cervicitis** with a friable cervix that may result in post-coital bleeding, this is **not the most common or significant complication**. - **Infertility** is far more common as a long-term consequence of untreated chlamydial infection, making it the best answer to what Chlamydia "commonly causes."

Question 1

A hysteroscopy image is shown. What will be the Hysteroscopic finding?

Accepted Answer

Hydrosalpinx

Answer

Cornual block

Answer

Normal findings

Answer

Bicornuate uterus

Question 2

An infertile woman has bilateral tubal block at cornua diagnosed on hysterosalpingography. Next treatment of choice is?

Accepted Answer

IVF

Answer

Tuboplasty

Answer

Hydrotubation

Answer

Laparoscopy and hysteroscopy

Question 3

Abstinence period before semen analysis is?

Accepted Answer

3-5 days

Answer

1-2 days

Answer

5-7 days

Answer

7-9 days

Question 4

In a case of recurrent spontaneous abortion, which of the following investigations is least indicated?

Accepted Answer

Testing for TORCH infections

Answer

Thyroid function tests

Answer

Hysteroscopy

Answer

Testing for antiphospholipid antibodies

Question 5

What is the best indicator for ovarian reserve?

Accepted Answer

Anti-Müllerian Hormone (AMH) - Reflects antral follicle count

Answer

Follicle Stimulating Hormone (FSH) - Day 2-3 cycle marker

Answer

Estradiol (E2) - Fluctuates during cycle

Answer

LH/FSH ratio - Relevant in PCOS diagnosis

Question 6

Azoospermic patient can be a father of a child, by which of the following?

Accepted Answer

ICSI

Answer

IUI

Answer

ZIFT

Answer

Not possible & counsel regarding adoption

Question 7

Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?

Accepted Answer

Day 21-23

Answer

Day 8-9

Answer

Day 13-15

Answer

Day 3-5

Question 8

What is the procedure used in preimplantation genetic diagnosis (PGD) to obtain cells from an embryo for genetic analysis before transferring it to the uterus during IVF?

Accepted Answer

Embryo cell biopsy

Answer

CVS

Answer

ICSI

Answer

None of the options

Question 9

In IVF, during cleavage stage embryo transfer, embryos are typically transferred back to uterine cavity at which cell stage?

Accepted Answer

4-8

Answer

2

Answer

2-4

Answer

8-16

Question 10

Chlamydia trachomatis infection commonly causes: March 2004

Accepted Answer

Infertility

Answer

Malignancy

Answer

Amenorrhoea

Answer

Post coital bleeding

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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