Fertility and Infertility Practice Questions

Q: All of the following are techniques used for preimplantation genetic testing except?

Morula biopsy. **Explanation:** Preimplantation Genetic Testing (PGT) involves analyzing the genetic material of an embryo before transfer to the uterus. The correct answer is **Morula biopsy** because it is not a standard clinical technique for PGT. **Why Morula Biopsy is the exception:** The morula stage (Day 4, 16–32 cells) is characterized by **compaction**, where cells begin to adhere tightly to one another. Attempting a biopsy at this stage is technically difficult, risks significant damage to the embryo, and provides no clinical advantage over other methods. **Analysis of other options:** * **Polar body analysis:** Performed on the 1st and 2nd polar bodies of the oocyte/zygote. It only provides information on maternal genetic contribution and does not reflect paternal DNA or mitotic errors. * **Blastomere biopsy:** Performed on **Day 3** (6–8 cell stage). One or two cells (blastomeres) are removed. While common in the past, it is associated with higher rates of embryo mosaicism and potential reduction in implantation rates. * **Trophectoderm biopsy:** The current **gold standard**, performed on **Day 5/6 (Blastocyst stage)**. Multiple cells are taken from the outer layer (future placenta), leaving the inner cell mass (future fetus) intact. It provides more DNA and is less traumatic to the embryo. **High-Yield Clinical Pearls for NEET-PG:** * **PGT-A:** Screens for Aneuploidy (most common). * **PGT-M:** Screens for Monogenic/single-gene disorders (e.g., Thalassemia). * **PGT-SR:** Screens for Structural Rearrangements (e.g., translocations). * **Blastocyst stage** is preferred for biopsy because it offers the highest diagnostic accuracy and lowest risk of embryo injury.

Q: What does a hysterosalpingography (HSG) report typically show in cases of tubal patency issues?

Hydro-salpinx. ### Explanation **Hysterosalpingography (HSG)** is the gold standard initial investigation for evaluating the uterine cavity and fallopian tube patency in cases of infertility. **1. Why Hydrosalpinx is Correct:** Hydrosalpinx refers to a fallopian tube that is distended and filled with fluid, usually due to distal tubal occlusion (often from pelvic inflammatory disease). On HSG, tubal patency is confirmed by the **free spill** of contrast into the peritoneal cavity. In hydrosalpinx, the contrast enters the tube but fails to spill, instead collecting in a dilated, club-shaped ampullary portion. This directly indicates a **tubal patency issue**. **2. Why Other Options are Incorrect:** * **Uterus Didelphys:** This is a congenital Müllerian duct anomaly resulting in a double uterus and double cervix. While HSG can diagnose this, it is a structural uterine anomaly, not a primary "tubal patency" issue. * **Adenomyosis:** This is the presence of endometrial tissue within the myometrium. It is best diagnosed via MRI or Transvaginal Ultrasound (TVUS). HSG may show non-specific findings like "diverticula" extending into the myometrium, but it is not a test for tubal patency. * **Endometriosis:** While endometriosis can cause tubal adhesions, the disease itself is a clinical/laparoscopic diagnosis. HSG cannot visualize endometrial implants on the ovaries or peritoneum. **Clinical Pearls for NEET-PG:** * **Best time for HSG:** Proliferative phase (Day 7 to Day 10 of the menstrual cycle) to ensure the endometrium is thin and the patient is not pregnant. * **Beaded appearance of tubes:** Highly suggestive of **Genital Tuberculosis**. * **Intravasation of contrast:** If contrast enters the uterine venous/lymphatic plexus, it may indicate high injection pressure or recent uterine trauma. * **Therapeutic effect:** HSG can sometimes clear minor tubal blockages (mucus plugs), slightly increasing pregnancy rates immediately following the procedure.

Q: What is the most common cause of bilateral cornual block observed on hysterosalpingography?

Physiological spasm. **Explanation:** The correct answer is **Physiological Spasm**. **1. Why Physiological Spasm is the correct answer:** Hysterosalpingography (HSG) involves the injection of radio-opaque contrast into the uterine cavity. The cornua (the junction of the fallopian tube and uterus) is the narrowest part of the tube and is surrounded by smooth muscle. The irritation caused by the contrast medium or the pressure of the injection often triggers a **transient physiological spasm** of these muscles. This prevents the contrast from entering the tubes, mimicking a bilateral block. It is the most frequent cause of "apparent" cornual obstruction seen on an initial HSG. **2. Why other options are incorrect:** * **Tuberculosis (A):** While Genital TB is a major cause of tubal infertility in developing countries, it typically presents with features like "beaded tubes," "tobacco pouch" appearance, or distal hydrosalpinx. It causes organic (permanent) blocks rather than the more common transient functional blocks. * **Endometriosis (B):** This usually causes peritubal adhesions and distal tubal distortion rather than isolated bilateral cornual occlusion. * **Pelvic Inflammatory Disease (D):** PID is a leading cause of organic tubal blockage, but it most commonly results in distal tubal occlusion (fimbrial block) and hydrosalpinx. **3. Clinical Pearls for NEET-PG:** * **Management of Spasm:** If a cornual block is suspected on HSG, antispasmodics (like Glucagon or Buscopan) or selective tubal cannulation under fluoroscopy can be used to differentiate spasm from a true organic block. * **Gold Standard:** Laparoscopy with chromopertubation remains the gold standard to confirm tubal patency and rule out false positives caused by HSG spasms. * **Water-soluble vs. Oil-based contrast:** Water-soluble contrast is preferred for HSG as it provides better mucosal detail and carries a lower risk of embolism.

Q: In which assisted reproductive technique does fertilization occur outside the body?

Gamete intrafallopian tube transfer. **Explanation** The core concept in this question is distinguishing between **In-Vitro Fertilization (IVF)**, where fertilization occurs in a laboratory dish, and **In-Vivo Fertilization**, where fertilization occurs naturally inside the woman's body. **Why Option C is Correct:** In **Gamete Intrafallopian Transfer (GIFT)**, unfertilized oocytes and washed sperm are collected and immediately placed into the fallopian tubes via laparoscopy. Because the gametes are placed together inside the tube, **fertilization occurs naturally (in-vivo)**. This technique requires at least one functional, healthy fallopian tube. **Analysis of Incorrect Options:** * **A. Zygote Intrafallopian Transfer (ZIFT):** Fertilization occurs **outside** the body (IVF). The resulting zygote is then transferred into the fallopian tube. * **B. Intracytoplasmic Sperm Injection (ICSI):** This is a specialized form of IVF where a single sperm is injected directly into an egg. Fertilization occurs **outside** the body in a lab setting. * **D. In Vitro Fertilization (IVF):** By definition, "In Vitro" means "in glass." Fertilization occurs **outside** the body, and the resulting embryos are later transferred to the uterus. **NEET-PG High-Yield Pearls:** * **GIFT vs. IVF:** GIFT is often preferred by patients with religious or ethical objections to IVF, as fertilization happens inside the body. * **Prerequisite for GIFT:** Unlike IVF, GIFT **cannot** be performed in cases of bilateral tubal blockage. * **Success Rates:** Currently, IVF/ICSI are more commonly used than GIFT/ZIFT due to higher success rates and less invasive procedures (no laparoscopy required for transfer). * **Site of Fertilization:** In a normal pregnancy and GIFT, the site of fertilization is the **Ampulla** of the fallopian tube.

Q: A 29-year-old married woman, unable to conceive after 3 years of marriage, presents with regular menstrual cycles and mild dysmenorrhea. Her pelvic scan reveals a 3 cm intramural fibroid and a follicular ovarian cyst. Hysterosalpingography (HSG) shows normal fallopian tubes. Her husband's semen analysis and hormonal profile are normal. What is the most likely cause of her infertility?

Endometriosis. ### Explanation The correct answer is **Endometriosis**. **Why Endometriosis is the most likely cause:** In a patient with primary infertility, regular menstrual cycles, and a normal semen analysis, the diagnosis is often narrowed down to pelvic factors. The presence of **mild dysmenorrhea** is a classic clinical pointer toward endometriosis. Even in the absence of large endometriomas, "minimal to mild" endometriosis can cause infertility by creating a pro-inflammatory peritoneal environment that impairs sperm motility, oocyte quality, and fertilization. While the scan shows a follicular cyst (physiological) and a small fibroid, these do not typically cause infertility in the presence of regular cycles and patent tubes. **Why the other options are incorrect:** * **Polycystic Ovarian Disease (PCOD):** This is characterized by irregular cycles (oligomenorrhea) and anovulation. The patient in the question has regular menstrual cycles, making PCOD unlikely. * **Fibroid Uterus:** Small (3 cm) **intramural** fibroids that do not distort the endometrial cavity generally do not cause infertility. Submucosal fibroids are the ones primarily associated with implantation failure. * **Tubal Factor:** This is ruled out by the **normal Hysterosalpingography (HSG)**, which confirmed bilateral tubal patency. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Laparoscopy is the gold standard for diagnosing endometriosis (visualizing "powder-burn" lesions). * **Infertility Paradox:** There is a poor correlation between the stage of endometriosis and the degree of pain or infertility. * **Sampson’s Theory:** Retrograde menstruation is the most widely accepted theory for the pathogenesis of endometriosis. * **Management:** For infertility associated with minimal endometriosis, the treatment of choice is often Laparoscopic ablation followed by IUI or IVF, rather than medical management (which suppresses ovulation).

Q: Decreasing AMH (anti-Mullerian hormone) is a sign of which of the following?

Decreased ovarian reserve. **Explanation:** **Anti-Mullerian Hormone (AMH)** is a glycoprotein secreted by the **granulosa cells of pre-antral and small antral follicles** (less than 8mm). Because it is produced directly by the growing follicle pool, it serves as a biochemical marker of the **ovarian reserve**—the total quantity of remaining oocytes. * **Why Option D is correct:** As a woman ages or undergoes premature ovarian insufficiency, the number of primordial follicles decreases. Consequently, the number of small antral follicles recruited also drops, leading to a **decrease in serum AMH levels**. Unlike FSH, AMH levels remain relatively stable throughout the menstrual cycle, making it a superior and more convenient marker for assessing ovarian reserve. **Analysis of Incorrect Options:** * **Option A:** AMH production is **independent** of the hypothalamic-pituitary-ovarian axis. It is not regulated by FSH or LH, which is why it can be tested on any day of the cycle. * **Option B:** AMH indicates the *quantity* of follicles, not whether ovulation has occurred. The gold standard for confirming ovulation is a **Mid-luteal Progesterone** test. * **Option C:** While AMH is often *elevated* in PCOS (where androgens are high), a *decrease* in AMH specifically signifies follicular depletion, not androgenic activity. **High-Yield Clinical Pearls for NEET-PG:** * **Best Marker for Ovarian Reserve:** AMH (Biochemical) and Antral Follicle Count (AFC via Ultrasound). * **PCOS:** AMH levels are characteristically **increased** (2-3 times normal) due to the high number of small antral follicles. * **Stability:** AMH does not fluctuate with the menstrual cycle, pregnancy, or use of oral contraceptives. * **Cut-off:** An AMH level **< 1 ng/mL** typically indicates a diminished ovarian reserve and a poor response to controlled ovarian stimulation.

Question 1

All of the following are techniques used for preimplantation genetic testing except?

Accepted Answer

Morula biopsy

Answer

Polar body analysis

Answer

Blastomere biopsy

Answer

Trophectoderm biopsy

Question 2

Varicoceles appear to cause male infertility by which mechanism?

Accepted Answer

Increasing the likelihood of sperm antibody formation

Answer

Interfering with sperm production

Answer

Blocking epididymal sperm motility activation

Answer

Interfering with sperm movement through cervical mucus

Question 3

Which of the following is true for patients treated with clomiphene?

Accepted Answer

Increased risk of ovarian hyperstimulation and polycystic ovaries

Answer

Decreased risk of ovarian carcinoma

Answer

Causes decreased sexuality if given in males

Answer

Risk of ectopic pregnancy

Question 4

What does a hysterosalpingography (HSG) report typically show in cases of tubal patency issues?

Accepted Answer

Hydro-salpinx

Answer

Uterus didelphys

Answer

Adenomyosis

Answer

Endometriosis

Question 5

A semen analysis of a male partner in an infertile couple shows low volume with azoospermia and absent fructose. Serum FSH levels are normal. What is the most probable diagnosis?

Accepted Answer

Block in the efferent duct system

Answer

Prostatic infection

Answer

Mumps orchitis

Answer

Hypothalamic dysfunction

Question 6

What is the most common cause of bilateral cornual block observed on hysterosalpingography?

Accepted Answer

Physiological spasm

Answer

Tuberculosis

Answer

Endometriosis

Answer

Pelvic inflammatory disease

Question 7

Tubal patency can be checked by all EXCEPT:

Accepted Answer

Post coital test

Answer

Hysterosalpingography

Answer

Laparoscopic chromotubation

Answer

Sonosalpingography

Question 8

In which assisted reproductive technique does fertilization occur outside the body?

Accepted Answer

Gamete intrafallopian tube transfer

Answer

Zygote intrafallopian tube transfer

Answer

Intracytoplasmic sperm injection

Answer

In vitro fertilization

Question 9

A 29-year-old married woman, unable to conceive after 3 years of marriage, presents with regular menstrual cycles and mild dysmenorrhea. Her pelvic scan reveals a 3 cm intramural fibroid and a follicular ovarian cyst. Hysterosalpingography (HSG) shows normal fallopian tubes. Her husband's semen analysis and hormonal profile are normal. What is the most likely cause of her infertility?

Accepted Answer

Endometriosis

Answer

Polycystic ovarian disease

Answer

Fibroid uterus

Answer

Tubal factor

Question 10

Decreasing AMH (anti-Mullerian hormone) is a sign of which of the following?

Accepted Answer

Decreased ovarian reserve

Answer

Disruption of ovarian-hypothalamic-pituitary axis

Answer

Test of ovulation

Answer

Increased androgen production from ovaries

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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