Fertility and Infertility — MCQs

Fertility and Infertility Indian Medical PG Practice Questions and MCQs

Question 271: 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?

A. Embryo cell biopsy (Correct Answer)
B. CVS
C. ICSI
D. None of the options

Explanation: ***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.

Question 272: Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?

A. Day 8-9
B. Day 13-15
C. Day 21-23 (Correct Answer)
D. Day 3-5

Explanation: ***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.

Question 273: Azoospermic patient can be a father of a child, by which of the following?

A. IUI
B. ZIFT
C. ICSI (Correct Answer)
D. Not possible & counsel regarding adoption

Explanation: ***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.

Question 274: An infertile woman has bilateral tubal block at cornua diagnosed on hysterosalpingography. Next treatment of choice is?

A. Tuboplasty
B. Hydrotubation
C. Laparoscopy and hysteroscopy
D. IVF (Correct Answer)

Explanation: ***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.

Question 275: In a case of recurrent spontaneous abortion, which of the following investigations is least indicated?

A. Thyroid function tests
B. Testing for TORCH infections (Correct Answer)
C. Hysteroscopy
D. Testing for antiphospholipid antibodies

Explanation: ***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.

Question 276: Chlamydia trachomatis infection commonly causes: March 2004

A. Infertility (Correct Answer)
B. Malignancy
C. Amenorrhoea
D. Post coital bleeding

Explanation: ***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 277: Most common cause of early abortion?

A. Genetic (Correct Answer)
B. Maternal
C. Immunologic
D. Anatomic abnormalities

Explanation: ***Correct: Genetic*** - **Chromosomal abnormalities**, such as aneuploidy, are the most frequent cause of **spontaneous abortions**, especially early in pregnancy (accounting for **50-60% of first-trimester losses**). - These genetic errors often lead to **non-viable embryos**, resulting in early pregnancy loss. - Most common abnormalities include **trisomies** (especially trisomy 16), **monosomy X**, and **triploidy**. *Incorrect: Maternal* - While maternal factors like **diabetes** or **thyroid dysfunction** can contribute to abortion, they are less common causes of early abortion compared to genetic issues. - Systemic maternal health problems usually account for a smaller percentage of all miscarriages. *Incorrect: Immunologic* - **Autoimmune disorders** like **antiphospholipid syndrome** can cause recurrent pregnancy loss, but they are not the primary cause of the majority of early, sporadic abortions. - These are typically considered in cases of **recurrent miscarriages**, not usually the first or early spontaneous abortion. *Incorrect: Anatomic abnormalities* - **Uterine anomalies** (e.g., septate uterus) or **cervical incompetence** can lead to recurrent pregnancy loss, particularly in the later first or second trimester. - However, they are less frequently the cause of very early, isolated miscarriages compared to genetic factors.

Question 278: Which of the following is NOT an indication for hysterosalpingography?

A. Evaluate fallopian tube patency in infertility
B. Study uterine anomalies
C. Detect uterine synechiae
D. Detect endometriosis (Correct Answer)

Explanation: ***Detect endometriosis*** - Hysterosalpingography (HSG) primarily visualizes the **uterine cavity** and **fallopian tubes**; it cannot directly detect endometrial implants outside the uterus. - **Laparoscopy** is the gold standard for diagnosing endometriosis, allowing direct visualization and biopsy of lesions. *Study uterine anomalies* - HSG is effective in outlining the shape and structure of the **uterine cavity**, making it useful for identifying congenital abnormalities like **septate** or **bicornuate uteri**. - It helps distinguish between different types of anomalies that can impact fertility or pregnancy outcomes. *Detect uterine synechiae* - **Intrauterine adhesions**, or synechiae (Asherman's syndrome), appear as filling defects or irregular contours within the endometrial cavity on an HSG. - The contrast medium outlines these adhesions, indicating areas where the uterine walls are abnormally fused. *Evaluate fallopian tube patency in infertility* - HSG is a standard diagnostic tool to assess whether the **fallopian tubes are open** (patent) or blocked, which is a common cause of infertility. - The spill of contrast medium into the peritoneal cavity indicates tubal patency, while absence of spill suggests **tubal obstruction**.

Question 279: Which of the following is not a risk factor for ectopic pregnancy?

A. PID
B. Previous ectopic pregnancy
C. Barrier methods of contraception (e.g., condoms) (Correct Answer)
D. OCP (in cases of contraceptive failure)

Explanation: ***Barrier methods of contraception (e.g., condoms)*** - **Barrier methods** like condoms prevent fertilization entirely by blocking sperm-egg interaction - They do not alter tubal anatomy, tubal motility, or hormonal environment - Therefore, they are **NOT a risk factor** for ectopic pregnancy and represent the correct answer to this negation question *OCP (in cases of contraceptive failure)* - Oral contraceptive pills (OCPs) **dramatically reduce the overall risk of all pregnancies**, including ectopic pregnancies - If contraceptive failure occurs, OCPs do not increase ectopic risk—they do not cause tubal damage or dysfunction - The parenthetical qualifier "(in cases of contraceptive failure)" in the option is medically imprecise; **OCPs themselves are NOT a risk factor for ectopic pregnancy** - Note: Some epidemiological studies show a higher **proportion** of ectopic among the rare pregnancies that occur on OCPs, but this is a statistical artifact, not a causal relationship *PID* - **Pelvic inflammatory disease (PID)** is a **major established risk factor** for ectopic pregnancy - It causes inflammation, scarring, and adhesions of the **fallopian tubes** - This tubal damage impedes normal transport of the fertilized ovum to the uterus, leading to ectopic implantation - PID increases ectopic risk by 6-10 fold *Previous ectopic pregnancy* - A history of **previous ectopic pregnancy** is one of the **strongest risk factors** for recurrence - It indicates underlying tubal pathology (damage, dysfunction, or anatomical abnormality) - Recurrence risk is approximately **10-25%** in subsequent pregnancies - This reflects persistent tubal factors that predispose to abnormal implantation

Question 280: Clomiphene citrate is primarily used for treating which condition in women?

A. Anovulation in women (Correct Answer)
B. Menorrhagia during puberty
C. Hormonal therapy for menopause
D. Infertility due to endometriosis

Explanation: ***Anovulation in women*** - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) that blocks estrogen receptors in the hypothalamus, leading to increased **GnRH** pulsatility and subsequently increased **FSH** and **LH** release. - This surge in **gonadotropins** stimulates follicular development and ovulation, making it a primary treatment for **anovulatory infertility**. *Menorrhagia during puberty* - **Menorrhagia** (heavy menstrual bleeding) during puberty is often related to an **immature hypothalamic-pituitary-ovarian axis**, leading to anovulatory cycles. - While clomiphene induces ovulation, it is not the primary treatment for managing **menorrhagia** in adolescents; hormonal therapies like oral contraceptives or progestins are typically used. *Hormonal therapy for menopause* - **Menopause** is characterized by ovarian failure and a significant decline in estrogen production. - **Clomiphene** is used to stimulate ovulation, not to replace hormones or manage menopausal symptoms, which are typically treated with **hormone replacement therapy (HRT)**. *Infertility due to endometriosis* - **Endometriosis** causes infertility through various mechanisms including anatomical distortion, inflammation, and altered peritoneal fluid, which clomiphene does not directly address. - Treatment for **endometriosis-related infertility** often involves surgical removal of endometrial implants, assisted reproductive technologies, or hormonal suppression therapy.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free