Fertility and Infertility Practice Questions

Q: Aspiration of sperms from testes is done in which procedure?

TESA. **Explanation:** The correct answer is **TESA (Testicular Sperm Aspiration)**. This procedure involves the direct aspiration of sperm from the **testicular parenchyma** using a fine needle. It is primarily indicated for patients with obstructive azoospermia or non-obstructive azoospermia where mature sperm are not found in the ejaculate. **Analysis of Options:** * **TESA (Correct):** As the name implies, sperm is aspirated directly from the **Testes**. It is a minimally invasive technique used to retrieve immature sperm for use in ICSI (Intracytoplasmic Sperm Injection). * **MESA (Microsurgical Epididymal Sperm Aspiration):** This involves collecting sperm from the **Epididymis**, not the testes. It is performed under a microscope and typically yields a higher concentration of mature, motile sperm compared to testicular extraction. * **ZIFT (Zygote Intra-Fallopian Transfer):** This is an assisted reproductive technique where a **fertilized egg (zygote)** is transferred into the fallopian tube. It is not a sperm retrieval method. * **GIFT (Gamete Intra-Fallopian Transfer):** This involves transferring **unfertilized eggs and washed sperm** into the fallopian tube so fertilization can occur *in vivo*. **High-Yield Clinical Pearls for NEET-PG:** * **PESA (Percutaneous Epididymal Sperm Aspiration):** Similar to MESA but done blindly without a microscope. * **TESE (Testicular Sperm Extraction):** Involves a **biopsy/tissue sample** of the testes rather than simple needle aspiration. * **ICSI Requirement:** Since sperm retrieved via TESA/MESA are often immature or have poor motility, they **must** be used in conjunction with **ICSI**, as they cannot fertilize an egg via standard IVF. * **Indication:** These procedures are the gold standard for **Obstructive Azoospermia** (e.g., Congenital Bilateral Absence of Vas Deferens).

Q: According to WHO criteria for semen analysis, which of the following statements is true?

Sperm count >39 million. The World Health Organization (WHO) updated its criteria for semen analysis in the **6th Edition (2021)** manual. Understanding these lower reference limits is crucial for diagnosing male factor infertility. ### **Explanation of the Correct Answer** **Option D (Sperm count >39 million)** is correct because it represents the **Total Sperm Number** per ejaculate. It is calculated by multiplying the sperm concentration by the total volume. According to the WHO 6th edition, the lower reference limit for total sperm number is **39 million per ejaculate**. ### **Analysis of Incorrect Options** * **Option A (Progressive motility >15%):** This is incorrect. The lower reference limit for **progressive motility** (PR) is **32%**. The total motility (Progressive + Non-progressive) should be at least 40%. * **Option B (Normal morphology >25%):** This is incorrect. Using Tygerberg’s strict criteria, the lower reference limit for **normal morphology** is only **4%**. A value of 25% is significantly higher than the minimum requirement. * **Option C (Volume of 2-5ml):** While 2-5ml is a common average, the WHO lower reference limit for **semen volume** is **1.4 ml** (updated from 1.5 ml in the 5th edition). ### **High-Yield Clinical Pearls for NEET-PG** * **Sperm Concentration:** The lower limit is **16 million/ml** (previously 15 million/ml). * **Vitality:** At least **54%** of sperms should be alive (dye exclusion test). * **Azoospermia vs. Oligozoospermia:** Azoospermia is the total absence of sperm; Oligozoospermia is 1 million WBCs/ml, indicating infection.

Q: Antisperm antibody testing is not needed if the sperm are to be used for what procedure?

Intracytoplasmic sperm injection (ICSI). **Explanation:** The presence of **Antisperm Antibodies (ASA)**—whether on the sperm surface or in the cervical mucus—interferes with fertility by causing sperm agglutination, inhibiting motility, or preventing the sperm from binding to and penetrating the *zona pellucida* of the oocyte. **Why ICSI is the Correct Answer:** Intracytoplasmic Sperm Injection (ICSI) is a specialized form of micromanipulation where a single sperm is directly injected into the cytoplasm of the oocyte. Because this process **bypasses all natural barriers** to fertilization (such as cervical mucus, the cumulus oophorus, and the zona pellucida), the presence of antibodies on the sperm head or tail becomes irrelevant. The mechanical injection ensures fertilization regardless of the sperm's immunological status. **Why Other Options are Incorrect:** * **IVF (In Vitro Fertilization):** In conventional IVF, sperm and eggs are placed in a dish, and the sperm must still bind to and penetrate the egg naturally. High titers of ASA can significantly reduce fertilization rates in IVF. * **GIFT & ZIFT:** These are older assisted reproductive techniques where gametes (GIFT) or zygotes (ZIFT) are placed into the fallopian tubes. Since GIFT requires the sperm to fertilize the egg naturally within the tube, ASA would still hinder the process. **High-Yield Clinical Pearls for NEET-PG:** * **Screening Test:** The **Immunobead test** and **Mixed Antiglobulin Reaction (MAR) test** are the gold standards for detecting ASA. * **Indications for ICSI:** Apart from ASA, ICSI is the treatment of choice for severe male factor infertility (oligozoospermia, asthenozoospermia) and prior IVF failure. * **ASA in Men:** Often occurs due to a breach in the **blood-testis barrier** (e.g., post-vasectomy, testicular trauma, or infection).

Q: Pituitary down-regulation is done in IVF for all the following reasons except?

To cause oocyte maturation and ovulation. **Explanation:** In In Vitro Fertilization (IVF), pituitary down-regulation is achieved using **GnRH agonists or antagonists**. The primary goal is to suppress the patient's endogenous hormonal control to allow the clinician to take full command of the follicular cycle. **Why Option D is the Correct Answer:** Pituitary down-regulation **does not** cause oocyte maturation or ovulation. In fact, it suppresses the natural LH surge required for these processes. Oocyte maturation and "triggering" of ovulation are achieved by administering an external bolus of **hCG (Human Chorionic Gonadotropin)** or a GnRH agonist (if an antagonist protocol was used), which mimics the natural LH surge. **Analysis of Other Options:** * **Option B & C:** These are the primary goals of down-regulation. By suppressing the pituitary, we prevent a **premature LH surge**. Without this, the follicles might rupture (premature ovulation) before they can be surgically retrieved, leading to a cancelled cycle. * **Option A:** Down-regulation (specifically using GnRH antagonists) allows for the use of a GnRH agonist trigger instead of hCG. This significantly reduces the risk of **Ovarian Hyperstimulation Syndrome (OHSS)**, making it a protective strategy. **High-Yield Clinical Pearls for NEET-PG:** * **Long Protocol:** Starts GnRH agonist in the mid-luteal phase (Day 21) of the previous cycle. * **Short/Antagonist Protocol:** Preferred in PCOS patients to minimize OHSS risk. * **The "Trigger":** hCG is the gold standard for final oocyte maturation because its alpha subunit is identical to LH, but it has a much longer half-life. * **Down-regulation** ensures synchronous follicular growth, allowing multiple eggs to be harvested simultaneously.

Q: Your patient on infertility treatment comes to you for consultation. She feels that the uterine myoma may be responsible for her decreased fertility. Which of the following is NOT a mechanism for decreased fertility in patients with uterine myoma?

Increased vascularity. **Explanation:** The relationship between uterine myomas (fibroids) and infertility is primarily mechanical and biochemical. The correct answer is **D (Increased vascularity)** because, in the context of myomas, the pathological change is actually **impaired or disordered vascularity** (venous stasis and congestion) rather than a simple increase that supports fertility. In fact, myomas often cause focal endometrial inflammation and abnormal vascular patterns that interfere with embryo implantation. **Why the other options are incorrect (Mechanisms of Infertility in Myoma):** * **A. Impaired tubal motility:** Large or cornual myomas can physically compress the fallopian tubes or distort their anatomy, hindering the transport of the ovum and sperm. * **B. Distorted uterine cavity:** Submucosal and large intramural myomas alter the shape of the cavity, increasing the distance sperm must travel and interfering with the "niche" required for successful implantation. * **C. Displacement of cervix:** Massive fibroids can shift the entire uterus, pulling the cervix away from the posterior vaginal fornix (the seminal pool), thereby reducing the chance of sperm entering the cervical canal. **High-Yield NEET-PG Pearls:** * **Most common fibroid causing infertility:** Submucosal fibroids (FIGO Type 0, 1, 2) have the highest impact on implantation rates. * **Management:** Myomectomy is indicated if the fibroid distorts the cavity (submucosal) or is >4 cm in size in an asymptomatic infertile patient. * **Other mechanisms:** Myomas also cause increased uterine contractility and local release of cytokines/prostaglandins, both of which are detrimental to pregnancy.

Question 1

Which of the following drugs is used for ovulation induction in PCOD with infertility?

Accepted Answer

Spironolactone

Answer

Tamoxifen

Answer

Clomiphene

Answer

Testosterone

Question 2

PESA/MESA is helpful in which of the following conditions?

Accepted Answer

Post-testicular azoospermia

Answer

Pre-testicular azoospermia

Answer

Testicular azoospermia

Answer

Asthenospermia

Question 3

Testicular sperm aspiration is performed for azoospermic men. Which of the following procedures can be performed in an Assisted Reproductive Technology Lab to help such couples achieve successful embryo formation?

Accepted Answer

Intracytoplasmic Sperm Injection

Answer

In Vitro Fertilization

Answer

Intrauterine Insemination

Answer

Intravaginal insemination of the aspirated sperms

Question 4

Aspiration of sperms from testes is done in which procedure?

Accepted Answer

TESA

Answer

MESA

Answer

ZIFT

Answer

GIFT

Question 5

According to WHO criteria for semen analysis, which of the following statements is true?

Accepted Answer

Sperm count >39 million

Answer

Progressive motility >15%

Answer

Normal morphology >25%

Answer

Volume of 2-5ml

Question 6

Antisperm antibody testing is not needed if the sperm are to be used for what procedure?

Accepted Answer

Intracytoplasmic sperm injection (ICSI)

Answer

Gamete intrafallopian transfer (GIFT)

Answer

Zygote intrafallopian transfer (ZIFT)

Answer

In vitro fertilization (IVF)

Question 7

Pituitary down-regulation is done in IVF for all the following reasons except?

Accepted Answer

To cause oocyte maturation and ovulation

Answer

To prevent ovarian hyperstimulation syndrome

Answer

To prevent endogenous LH surges

Answer

To prevent premature ovulation

Question 8

A patient with infertility, treated with ovulation induction and HCG injection for ovulation, presents to the OPD 5 days later with complaints of abdominal distension with pain, nausea, and vomiting. Ultrasound reveals subclinical ascites. What is the next step in management?

Accepted Answer

Outpatient management with limited activity, daily weight record, and fluid balance monitoring.

Answer

Hospitalization, input-output charting, and IV fluid administration.

Answer

Hospitalization, albumin infusion, and input-output charting.

Answer

Paracentesis.

Question 9

A 26-year-old female patient with PCOS, treated with ovulation induction using clomiphene citrate, presents with sudden onset of abdominal pain, distension, and ascites 20 days after starting treatment. What is the probable cause?

Accepted Answer

Ovarian hyperstimulation syndrome

Answer

Uterine rupture

Answer

Ectopic pregnancy rupture

Answer

Multifetal pregnancy causing uterine distention

Question 10

Your patient on infertility treatment comes to you for consultation. She feels that the uterine myoma may be responsible for her decreased fertility. Which of the following is NOT a mechanism for decreased fertility in patients with uterine myoma?

Accepted Answer

Increased vascularity

Answer

Impaired tubal motility

Answer

Distorted uterine cavity

Answer

Displacement of cervix from vaginal pool of semen

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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