Fertility and Infertility — MCQs

Fertility and Infertility Indian Medical PG Practice Questions and MCQs

Question 261: A 30-year-old woman presents with primary infertility. Which of the following tests is typically performed to evaluate male factor infertility?

A. Hysterosalpingography
B. Laparoscopy
C. Semen analysis (Correct Answer)
D. Endometrial biopsy

Explanation: ***Semen analysis*** - **Semen analysis** is the cornerstone test for evaluating male factor infertility, assessing sperm count, motility, and morphology. - It is a non-invasive and highly informative initial step to identify potential male reproductive issues. *Hysterosalpingography* - This procedure evaluates the **patency of fallopian tubes** and the shape of the uterine cavity in women. - It is a diagnostic tool for female infertility, not male factor infertility. *Laparoscopy* - **Laparoscopy** is a surgical procedure used to visualize pelvic organs, often to diagnose conditions like **endometriosis** or **pelvic adhesions** in women. - It is an invasive procedure and is not used to directly evaluate male fertility. *Endometrial biopsy* - An **endometrial biopsy** involves taking a tissue sample from the uterine lining to assess for conditions like **endometrial hyperplasia** or **receptivity issues** in women. - This test is specific to female reproductive health and not for male factor infertility evaluation.

Question 262: A 35-year-old woman presents with a history of recurrent miscarriages and is found to have a septate uterus. What is the most appropriate management?

A. Hysteroscopic resection of the septum (Correct Answer)
B. Cerclage placement
C. Progesterone therapy
D. In vitro fertilization

Explanation: ***Hysteroscopic resection of the septum*** - A **septate uterus** is a congenital uterine anomaly strongly associated with **recurrent miscarriages** due to inadequate vascularization and implantation failure. - **Hysteroscopic resection (metroplasty)** is the gold standard treatment, as it is minimally invasive and effectively restores a normal uterine cavity, significantly improving pregnancy outcomes. *Cerclage placement* - **Cerclage** is used to treat **cervical insufficiency**, where the cervix prematurely dilates during pregnancy, leading to miscarriage or preterm birth. - This patient's miscarriages are attributed to a uterine anomaly, not cervical incompetence; therefore, cerclage would not address the underlying problem. *Progesterone therapy* - **Progesterone therapy** is sometimes used for threatened miscarriage or in cases of luteal phase defect, which is a hormonal imbalance. - While it might support early pregnancy, it does not correct structural abnormalities like a **septate uterus**, which is the primary cause of recurrent miscarriages in this scenario. *In vitro fertilization* - **In vitro fertilization (IVF)** is primarily used for **infertility** in cases like blocked fallopian tubes, male factor infertility, or unexplained infertility. - While it helps achieve pregnancy, it does not correct the **septate uterus** and thus would not prevent miscarriages caused by the uterine anomaly itself.

Question 263: What is the primary risk associated with the use of clomiphene citrate for ovulation induction in women with polycystic ovary syndrome (PCOS)?

A. Multiple gestations (Correct Answer)
B. Ovarian hyperstimulation syndrome
C. Uterine fibroids
D. Endometrial cancer

Explanation: ***Multiple gestations*** - **Clomiphene citrate** stimulates the release of multiple eggs, increasing the chance of **more than one embryo** implanting, leading to twin or higher-order pregnancies. - This increased risk is due to its mechanism of action, which involves blocking estrogen receptors in the hypothalamus and pituitary, leading to increased **gonadotropin release**. *Ovarian hyperstimulation syndrome (OHSS)* - While a risk with ovarian stimulation, **OHSS** is more commonly associated with injectable gonadotropins, not typically the primary risk with oral **clomiphene citrate** at standard doses. - OHSS presents with enlarged ovaries, ascites, and electrolyte imbalances, which are less frequent or severe with clomiphene compared to more potent fertility drugs. *Uterine fibroids* - **Clomiphene citrate** has no direct causal link to the development or exacerbation of **uterine fibroids**, which are benign smooth muscle tumors of the uterus. - Fibroids are influenced by estrogen, and clomiphene's anti-estrogenic effects are localized and generally do not promote fibroid growth. *Endometrial cancer* - Short-term use of **clomiphene citrate** for ovulation induction is not associated with an increased risk of **endometrial cancer**. - While prolonged unopposed estrogen can increase this risk, clomiphene's anti-estrogenic effects on the endometrium mitigate this concern during treatment cycles.

Question 264: In evaluating a woman for infertility, which test is essential for assessing ovulatory function?

A. Serum progesterone (Correct Answer)
B. Pelvic ultrasound
C. Hysterosalpingogram
D. Laparoscopy

Explanation: ***Serum progesterone*** - A **mid-luteal phase serum progesterone level** (typically measured 7 days before the expected next menses, around day 21 of a 28-day cycle) is the primary biochemical indicator of **ovulation and corpus luteum function**. - A level of **greater than 3 ng/mL (or 10 nmol/L)** indicates that ovulation has occurred, as the corpus luteum produces progesterone after ovulation. *Pelvic ultrasound* - A **pelvic ultrasound** can monitor follicular development and detect the presence of a corpus luteum, which provides indirect evidence of ovulation, but it does not directly confirm the hormonal event of ovulation. - It is crucial for assessing **uterine and ovarian morphology** and can identify conditions like polycystic ovaries or fibroids, but it's not the definitive test for ovulatory function itself. *Hysterosalpingogram* - A **hysterosalpingogram (HSG)** is an imaging test used to evaluate the patency of the **fallopian tubes** and the shape of the **uterine cavity**. - It is essential for assessing tubal factor infertility and uterine anomalies, but it provides no information about ovulatory function. *Laparoscopy* - **Laparoscopy** is a minimally invasive surgical procedure used to directly visualize the pelvic organs and identify conditions such as **endometriosis, adhesions, or pelvic inflammatory disease**. - While it can diagnose structural causes of infertility, it is an invasive procedure and does not directly assess ovulatory function; rather, it identifies anatomical issues that might prevent conception even with normal ovulation.

Question 265: Identify the most common risk factor for ectopic pregnancy.

A. Previous ectopic pregnancy
B. History of pelvic inflammatory disease (Correct Answer)
C. Use of intrauterine devices
D. Advanced maternal age

Explanation: ***History of pelvic inflammatory disease*** - **Pelvic inflammatory disease (PID)** is the *most common risk factor* for ectopic pregnancy as it can cause *inflammation* and *scarring* of the fallopian tubes, impairing ovum transport. - The resulting tubal damage, such as *adhesions* and *strictures*, creates a hostile environment for the fertilized egg, making it more likely to implant outside the uterus. *Previous ectopic pregnancy* - While a *significant risk factor*, a history of **ectopic pregnancy** is not the most common risk factor overall, as its prevalence is lower than that of PID. - Women who have had one ectopic pregnancy have a *10-15% chance* of having another, but this is a *recurrent risk* rather than a primary cause in the general population. *Use of intrauterine devices* - **Intrauterine devices (IUDs)**, particularly *progestin-releasing IUDs*, do not cause ectopic pregnancies but instead prevent intrauterine pregnancies. - If a pregnancy does occur with an IUD in place, there is a *higher chance* that it will be ectopic due to the successful prevention of uterine implantation. *Advanced maternal age* - Although **advanced maternal age** (typically defined as over 35 years) is associated with an *increased risk of infertility* and other pregnancy complications, it is not the leading risk factor for ectopic pregnancy. - The association is often due to the *cumulative exposure to other risk factors* over time, such as PID, rather than age itself directly causing ectopic implantation.

Question 266: What is the best indicator for ovarian reserve?

A. Follicle Stimulating Hormone (FSH) - Day 2-3 cycle marker
B. Estradiol (E2) - Fluctuates during cycle
C. Anti-Müllerian Hormone (AMH) - Reflects antral follicle count (Correct Answer)
D. LH/FSH ratio - Relevant in PCOS diagnosis

Explanation: ***Anti-Müllerian Hormone (AMH) - Reflects antral follicle count*** - **AMH** is produced by **granulosa cells** of small antral and pre-antral follicles and directly correlates with the size of the **primordial follicle pool**. - Its levels are stable throughout the menstrual cycle and are not affected by oral contraceptives, making it a reliable indicator of **ovarian reserve**. *Follicle Stimulating Hormone (FSH) - Day 2-3 cycle marker* - While **FSH** on cycle days 2-3 can be used as an indicator of ovarian reserve, its levels fluctuate and are inversely related to **inhibin B**, making them less stable than AMH. - An elevated basal FSH level indicates a diminished ovarian reserve, but it is not as sensitive or specific as AMH. *Estradiol (E2) - Fluctuates during cycle* - **Estradiol** levels fluctuate significantly throughout the menstrual cycle and are only meaningful when measured in conjunction with FSH on **cycle day 2-3**. - High basal estradiol can suppress FSH, masking a true elevation in FSH, making it a less direct and reliable marker for ovarian reserve on its own. *LH/FSH ratio - Relevant in PCOS diagnosis* - The **LH/FSH ratio** is primarily used in the diagnosis of **Polycystic Ovary Syndrome (PCOS)**, where a ratio of >2:1 or >3:1 suggests the condition. - It does not directly represent the quantity or quality of the remaining ovarian follicles, hence it is not an indicator of **ovarian reserve**.

Question 267: Abstinence period before semen analysis is?

A. 1-2 days
B. 3-5 days (Correct Answer)
C. 5-7 days
D. 7-9 days

Explanation: ***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.

Question 268: What is the drug of choice (DOC) for medical management of ectopic pregnancy?

A. Actinomycin D
B. Methotrexate (Intramuscular) (Correct Answer)
C. Prostaglandin F2 alpha
D. Mifepristone

Explanation: ***Methotrexate (Intramuscular)*** - **Methotrexate** is the **drug of choice** for the medical management of **ectopic pregnancy** that meets specific criteria (e.g., hemodynamically stable, small unruptured ectopic mass, and absence of fetal cardiac activity). - It works by inhibiting **dihydrofolate reductase**, thereby interfering with **DNA synthesis** and cell proliferation of the rapidly dividing trophoblastic tissue. *Actinomycin D* - **Actinomycin D** is an **antineoplastic antibiotic** that is used in the treatment of various cancers, such as Wilms' tumor and gestational trophoblastic disease. - While it has anti-proliferative effects, it is not the standard first-line treatment for **ectopic pregnancy** given the effectiveness and established safety profile of methotrexate. *Prostaglandin F2 alpha* - **Prostaglandin F2 alpha** (e.g., dinoprost) is primarily used for **induction of labor**, **abortion**, or management of **postpartum hemorrhage** due to its myometrial contraction stimulation properties. - It does not specifically target the trophoblastic tissue of an ectopic pregnancy and is not indicated for its medical management. *Mifepristone* - **Mifepristone** is an **anti-progestin** used to induce medical abortion, often in combination with misoprostol. - While it terminates intrauterine pregnancies by blocking progesterone receptors, it is not effective as a standalone treatment for **ectopic pregnancy**, as it does not directly target the ectopic trophoblastic tissue.

Question 269: Which of the following is NOT a risk factor for ectopic pregnancy?

A. Past history
B. Tubal ligation failure
C. IVF
D. LNG IUCD (Correct Answer)

Explanation: ***LNG IUCD*** - A **levonorgestrel-releasing intrauterine contraceptive device (LNG IUCD)** significantly reduces the risk of **both intrauterine and ectopic pregnancies**. - While it doesn't completely eliminate the risk of ectopic pregnancy, the overall absolute risk is very low, making it a protective factor against pregnancy in general. *Past history* - A **history of ectopic pregnancy** is a significant risk factor for future ectopic pregnancies due to **pre-existing tubal damage**. - A previous ectopic pregnancy increases the recurrence risk from 10% to 25%. *Tubal ligation failure* - If a **tubal ligation** fails, there is a higher chance of the subsequent pregnancy being **ectopic** because the fallopian tube may have been damaged or partially obstructed during the procedure. - This damage creates an environment conducive to implantation outside the uterus. *IVF* - **In vitro fertilization (IVF)** is a known risk factor for ectopic pregnancy, even though embryos are placed directly into the uterus. - Embryo transfer can sometimes lead to **retrograde migration of the embryo** into the fallopian tubes, or there may be underlying tubal issues in women undergoing IVF.

Question 270: In IVF, during cleavage stage embryo transfer, embryos are typically transferred back to uterine cavity at which cell stage?

A. 2
B. 2-4
C. 4-8 (Correct Answer)
D. 8-16

Explanation: ***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.

Practice by Chapter

Reproductive Physiology

Practice Questions

Evaluation of the Infertile Couple

Practice Questions

Male Factor Infertility

Practice Questions

Female Factor Infertility

Practice Questions

Ovulatory Disorders

Practice Questions

Tubal and Peritoneal Factors

Practice Questions

Uterine Factors

Practice Questions

Unexplained Infertility

Practice Questions

Assisted Reproductive Technologies

Practice Questions

Psychological Aspects of Infertility

Practice Questions

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