Fertility and Infertility Practice Questions

Q: Which of the following is not considered a marker of ovarian reserve?

Inhibin A. ***Inhibin A*** - **Inhibin A** levels primarily rise during the mid to late luteal phase and are involved in regulating FSH, but they are not a reliable or commonly used marker for **ovarian reserve**. - Its fluctuations are more indicative of the presence of a **corpus luteum** and short-term ovarian function rather than the total follicular pool. *Inhibin B* - **Inhibin B** is produced by granulosa cells of small antral follicles and is an important marker of **ovarian reserve**. - It inversely correlates with **FSH** levels in the early follicular phase, reflecting the number of developing follicles. *Ovarian volume* - **Ovarian volume**, particularly when measured by ultrasound, can be an indicator of **ovarian reserve**. - Smaller ovarian volume is generally associated with a reduced number of **antral follicles** and lower ovarian reserve. *Anti-Müllerian Hormone (AMH)* - **AMH** is a well-established and highly reliable marker of **ovarian reserve**, produced by the granulosa cells of preantral and small antral follicles. - Its levels correlate directly with the total number of remaining **primordial follicles** and are relatively stable throughout the menstrual cycle.

Q: On which day LH & FSH should be measured?

1-3rd day. ***1-3rd day*** - Measuring **LH** (Luteinizing Hormone) and **FSH** (Follicle-Stimulating Hormone) on cycle days 1-3 provides a baseline assessment of **ovarian reserve** and pituitary function. - At this early follicular phase, hormone levels are relatively stable and reflect the intrinsic **gonadal feedback** mechanisms before significant follicular development begins. *7th day* - By day 7, **follicular development** is usually well underway, and FSH levels might be decreasing as a dominant follicle is selected. - Measuring hormones on this day would not provide an accurate baseline assessment, as the levels are already influenced by **follicular growth**. *14th day* - Day 14 is often associated with the **LH surge** that triggers ovulation, making it unsuitable for a baseline assessment of ovarian reserve. - FSH levels would also be significantly different from the early follicular phase due to the ongoing **ovarian cycle events**. *10th day* - On day 10, **estrogen levels** are typically rising, which would already be providing negative feedback to the pituitary, affecting FSH and LH levels. - This timing would not be ideal for assessing baseline hormone levels for **fertility evaluations**.

Q: For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?

Just before menstruation. ***Just before menstruation*** - An endometrial biopsy is typically performed in the **late secretory phase (just before menstruation)**. This timing is crucial for evaluating the endometrial response to progesterone and for detecting abnormalities that may be evident during this phase. - This timing allows for the assessment of the **full development of the secretory glands** and stroma, which can reveal issues like **inadequate luteal phase** or **endometrial hyperplasia** more clearly. *10-12 days after menstruation* - This time point corresponds to the mid-proliferative phase, where the endometrium is still growing under **estrogen influence**. - While suitable for evaluating proliferative changes, it might **miss subtle secretory phase abnormalities** or early signs of hyperplasia that are more evident later. *Just after menstruation* - This period is the early proliferative phase, where the endometrium is **thin and regenerating**. - Biopsying at this time might yield insufficient tissue for comprehensive evaluation and would be too early to assess **hormonal responses** that occur later in the cycle. *At the time of ovulation* - Ovulation marks the transition from the proliferative to the secretory phase, influenced by a surge in **luteinizing hormone (LH)**. - An endometrial biopsy at this phase would primarily show a proliferative endometrium and would not provide adequate information about the **key features of the secretory phase**, which are important for diagnostic purposes related to fertility or abnormal bleeding.

Q: What is the most common presenting symptom of TB endometritis?

Infertility. ***Infertility*** - **Infertility** is the most common presenting symptom of **tuberculosis (TB) endometritis**, particularly secondary infertility. - The infection leads to inflammation and scarring of the endometrium and fallopian tubes, impairing implantation and ovum transport. *Abdominal pain* - While **abdominal pain** can occur in TB endometritis, it is typically a less frequent or prominent presenting symptom compared to infertility. - Pain often arises from pelvic inflammation or adhesions but is not the cardinal complaint that prompts diagnosis. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) can be a symptom, especially in advanced cases where there is significant destruction of the endometrium. - It is, however, less common than infertility as the initial presenting symptom. *Vaginal discharge* - **Vaginal discharge** is an uncommon symptom of TB endometritis. - When present, it is often non-specific and not characteristic enough to suggest TB as the underlying cause.

Q: What does teratozoospermia refer to?

Morphologically defective sperm. ***Morphologically defective sperm*** - **Teratozoospermia** specifically refers to the presence of an unusually high percentage of **abnormally shaped sperm** in an ejaculate. - These malformations can affect the **head, midpiece, or tail** of the sperm, potentially impairing its ability to fertilize an egg. *Low sperm count* - This condition is known as **oligozoospermia**, which refers to a sperm concentration below the normal range. - While low sperm count can affect fertility, it is distinct from issues with sperm morphology. *Sperm with abnormal motility* - This condition is called **asthenozoospermia**, characterized by reduced or absent sperm movement. - Poor motility impacts the sperm's ability to reach and penetrate the egg, but it is not directly related to sperm shape. *Absence of sperm in semen* - The complete absence of sperm in the ejaculate is known as **azoospermia**. - This is a severe form of male infertility, different from having sperm with structural defects.

Q: Ovarian reserve is best indicated by

Anti-Müllerian Hormone (AMH). ***Anti-Müllerian Hormone (AMH)*** - **AMH is currently considered the best single biochemical marker** for assessing ovarian reserve - Produced by **granulosa cells of preantral and small antral follicles**, directly reflecting the size of the primordial follicle pool - **Cycle-independent** - can be measured at any time during the menstrual cycle - **More sensitive and specific** than FSH for detecting diminished ovarian reserve - **Minimal inter-cycle and intra-cycle variability**, providing consistent and reliable results - Widely used in **fertility assessment, IVF protocols**, and predicting ovarian response to stimulation *Follicle-stimulating hormone (FSH)* - Elevated **early follicular phase FSH** (measured on day 3) indicates diminished ovarian reserve - Historically the most commonly used marker, but **less sensitive than AMH** - **Cycle-dependent** - must be measured on specific days (day 2-4 of cycle) - A **late marker** - rises only when ovarian reserve is already significantly diminished - Still clinically useful and widely available, but not the "best" indicator *Luteinizing hormone (LH)* - **LH** primarily triggers ovulation and does not directly reflect ovarian reserve - Elevated in conditions like **PCOS** but does not assess the quantity or quality of remaining follicles - Not a reliable indicator of overall ovarian reserve *LH/FSH ratio* - An elevated **LH/FSH ratio** (>2:1 or >3:1) is associated with **Polycystic Ovary Syndrome (PCOS)** - Reflects anovulation and hormonal imbalance, not the number or viability of ovarian follicles - Does not assess ovarian reserve capacity

Q: Most common site of ectopic pregnancy is -

Tubal. ***Tubal*** - The **fallopian tubes** are the most common site for ectopic pregnancies, accounting for over **95%** of all cases. - This is because the fertilized ovum typically implants in the tube rather than reaching the uterus. *Abdominal* - **Abdominal ectopic pregnancies** are rare, occurring when the fertilized egg implants in the abdominal cavity. - They account for about **1%** of all ectopic pregnancies and often result in significant maternal complications. *Ovarian* - **Ovarian ectopic pregnancies** are very rare, occurring when the ovum is fertilized within the ovary itself. - They represent less than **1%** of all ectopic cases and can be difficult to diagnose. *Cervical* - **Cervical ectopic pregnancies** involve implantation within the cervical canal. - These are also very rare (less than **1%** of ectopic pregnancies) and are associated with a high risk of severe hemorrhage.

Q: Human sperm remains fertile for how many hours in a female genital tract ?

Up to 5 days (120 hrs). ***Up to 5 days (120 hrs)*** - **Sperm viability** within the female reproductive tract can extend up to **5 days (120 hours)** under optimal conditions. - This extended viability is crucial for fertility, as it allows for fertilization even if ovulation occurs several days after intercourse. *6-8 hrs* - This timeframe is significantly **too short** for typical human sperm viability in the female genital tract. - While some sperm may lose motility or viability relatively quickly, a substantial portion remains viable for much longer. *12-24 hrs* - This represents the average **lifespan of an ovum** (egg) after ovulation, not the typical viability of sperm. - Sperm generally survive longer than an unfertilized egg. *24-48 hrs* - This duration underestimates the maximum potential survival time of human sperm in the female reproductive tract. - While many sperm may be viable within this period, it does not represent the full potential for fertilization.

Q: The thickness of the endometrium at the time of implantation is:

7 - 10 mm. ***7 - 10 mm*** - At the time of **implantation** (day 6-10 post-fertilization, around day 20-24 of the menstrual cycle), the endometrium is in the **mid-secretory phase** and measures **7-10 mm** in thickness. - This is the **optimal thickness** for successful embryo implantation, characterized by a receptive endometrium with **decidualization**, **spiral artery development**, and **glycogen-rich glandular secretions**. - Endometrial thickness <7 mm is associated with **poor implantation rates** and reduced pregnancy success. *3 - 4 mm* - An endometrial thickness of 3-4 mm is **too thin** for successful implantation. - This thickness is typically seen in the **early proliferative phase** (immediately after menstruation), not during the implantation window. - Thin endometrium (<7 mm) is associated with **poor receptivity** and lower pregnancy rates in both natural conception and assisted reproduction. *20 - 30 mm* - An endometrial thickness of 20-30 mm is **abnormally thick** and not conducive to normal implantation. - Such thickness may indicate **endometrial hyperplasia**, **polyps**, or other pathological conditions requiring investigation. *30 - 40 mm* - An endometrial thickness of 30-40 mm is **severely abnormal** and would likely prevent successful implantation. - This extreme thickness suggests significant pathology such as **endometrial hyperplasia** or **malignancy** and requires urgent evaluation.

Q: What are the primary indications for in vitro fertilization (IVF)?

Tubal blocks. ***Tubal blocks*** - **Tubal blockages**, whether bilateral or severe unilateral, prevent the natural meeting of sperm and egg, making IVF an essential treatment to bypass this anatomical obstruction. - This is the **primary and classic indication** for IVF, as it allows fertilization to occur externally before embryo transfer to the uterus. - Tubal factor infertility was the original indication for which IVF was developed. *Uterine factor* - **Severe uterine factors**, such as significant structural abnormalities or severe intrauterine adhesions, are generally considered contraindications or make IVF less successful. - While IVF can bypass some reproductive challenges, it cannot overcome significant issues with the uterine environment needed for implantation and pregnancy maintenance. *None of the options* - This option is incorrect because **tubal blocks** are a well-recognized and primary indication for IVF. - IVF effectively addresses reproductive challenges linked to tubal patency issues. *Male factor (sperm count 12 million/ml)* - A sperm count of 12 million/mL represents **oligozoospermia** (normal >15 million/mL per WHO criteria). - While male factor infertility is an indication for assisted reproduction, **ICSI (Intracytoplasmic Sperm Injection)** rather than conventional IVF is typically the preferred treatment for significant male factor. - Treatment choice depends on comprehensive semen analysis including motility, morphology, and overall fertility assessment of both partners.

Question 1

Which of the following is not considered a marker of ovarian reserve?

Accepted Answer

Inhibin A

Answer

Ovarian volume

Answer

Inhibin B

Answer

Anti-Müllerian Hormone (AMH)

Question 2

On which day LH & FSH should be measured?

Accepted Answer

1-3rd day

Answer

7th day

Answer

14th day

Answer

10th day

Question 3

For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?

Accepted Answer

Just before menstruation

Answer

10-12 days after menstruation

Answer

Just after menstruation

Answer

At the time of ovulation

Question 4

What is the most common presenting symptom of TB endometritis?

Accepted Answer

Infertility

Answer

Amenorrhoea

Answer

Vaginal discharge

Answer

Abdominal pain

Question 5

What does teratozoospermia refer to?

Accepted Answer

Morphologically defective sperm

Answer

Low sperm count

Answer

Sperm with abnormal motility

Answer

Absence of sperm in semen

Question 6

Ovarian reserve is best indicated by

Accepted Answer

Anti-Müllerian Hormone (AMH)

Answer

Follicle-stimulating hormone (FSH)

Answer

Luteinizing hormone (LH)

Answer

LH/FSH ratio

Question 7

Most common site of ectopic pregnancy is -

Accepted Answer

Tubal

Answer

Cervical

Answer

Abdominal

Answer

Ovarian

Question 8

Human sperm remains fertile for how many hours in a female genital tract ?

Accepted Answer

Up to 5 days (120 hrs)

Answer

6-8 hrs

Answer

12-24 hrs

Answer

24-48 hrs

Question 9

The thickness of the endometrium at the time of implantation is:

Accepted Answer

7 - 10 mm

Answer

20 - 30 mm

Answer

30 - 40 mm

Answer

3 - 4 mm

Question 10

What are the primary indications for in vitro fertilization (IVF)?

Accepted Answer

Tubal blocks

Answer

Uterine factor

Answer

None of the options

Answer

Male factor (sperm count 12 million/ml)

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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