Fertility and Infertility Practice Questions

Q: In semen banks, at what temperature is semen preserved?

Liquid nitrogen. **Explanation:** **Correct Answer: C. Liquid nitrogen** The standard method for long-term preservation of semen (cryopreservation) is storage in **liquid nitrogen at -196°C**. At this ultra-low temperature, all metabolic activities of the spermatozoa are suspended, effectively "stopping the clock" on cellular aging and preventing biochemical reactions that would lead to cell death. This process typically involves the use of cryoprotectants (like glycerol) to prevent the formation of intracellular ice crystals, which would otherwise rupture the sperm cell membrane. **Why other options are incorrect:** * **Dry Ice (Solid CO₂):** Maintains a temperature of approximately **-78.5°C**. While cold, this is insufficient for long-term stability; metabolic processes are not completely halted, leading to rapid deterioration of sperm quality. * **Deep Freeze:** Standard medical deep freezers reach **-20°C to -80°C**. These temperatures are used for short-term storage of certain reagents or vaccines but are inadequate for preserving the structural integrity of gametes over months or years. * **Liquid Air:** While it can reach temperatures around -190°C, it is highly unstable and poses a significant **fire/explosion hazard** because the liquid oxygen component can react violently with organic materials. **High-Yield Clinical Pearls for NEET-PG:** * **Quarantine Period:** Semen samples are typically frozen and quarantined for **6 months** before use to re-test the donor for HIV, Hepatitis B, and Hepatitis C (due to the window period of these infections). * **Cryoprotectant:** **Glycerol** is the most commonly used agent to protect sperm from cold shock. * **Post-thaw Motility:** Usually, 50% or more of the initial motility is lost during the freezing and thawing process. * **Vitrification:** A "flash-freezing" technique used more commonly for oocytes and embryos to avoid ice crystal formation.

Q: Absolute contraindications for hysterosalpingography (HSG) include all except:

Mullerian anomalies. **Explanation:** Hysterosalpingography (HSG) is a fluoroscopic procedure used primarily to evaluate tubal patency and the uterine cavity. Understanding its contraindications is crucial for NEET-PG. **Why Mullerian Anomalies is the Correct Answer:** Mullerian anomalies (such as a septate, bicornuate, or unicornuate uterus) are actually an **indication** for performing an HSG, not a contraindication. HSG is a primary diagnostic tool used to delineate the internal architecture of the uterus to identify these structural malformations. **Analysis of Incorrect Options (Absolute Contraindications):** * **Pregnancy (A):** Performing an HSG during pregnancy is strictly contraindicated as the procedure involves ionizing radiation and the injection of contrast medium, which can lead to fetal harm or miscarriage. * **Pelvic Inflammatory Disease (B):** HSG is contraindicated in the presence of acute pelvic infection. The procedure involves injecting contrast under pressure, which can cause the retrograde spread of bacteria into the peritoneal cavity, potentially leading to peritonitis or sepsis. * **Genital Tuberculosis (D):** Active genital TB is considered a contraindication because the procedure can cause a flare-up or hematogenous spread of the infection. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** HSG should be performed during the **proliferative phase** (Day 7 to Day 10 of the menstrual cycle) to ensure the endometrium is thin (better visualization) and to avoid an early undiagnosed pregnancy. * **Water-soluble vs. Oil-based contrast:** Water-soluble contrast (e.g., Iohexol) is preferred today due to faster absorption and lower risk of granuloma formation. * **Therapeutic Effect:** HSG can sometimes have a "flushing" effect, slightly increasing conception rates in the months following the procedure.

Q: Which of the following methods for assessment of female infertility during a menstrual cycle can best predict the timing of ovulation?

Hormonal Study. **Explanation:** The assessment of ovulation is a cornerstone of infertility evaluation. Among the options provided, **Hormonal Study** is the most reliable and precise method for predicting and confirming the timing of ovulation. **1. Why Hormonal Study is Correct:** The "Gold Standard" for predicting ovulation is the detection of the **LH (Luteinizing Hormone) surge**. Monitoring serum or urinary LH levels can predict ovulation approximately **24–36 hours** before it occurs. Additionally, a mid-luteal phase (Day 21) serum progesterone level >3 ng/mL confirms that ovulation has taken place. These hormonal markers provide objective, quantifiable data compared to physical signs. **2. Why Other Options are Incorrect:** * **Basal Body Temperature (BBT):** BBT rises (0.5–1.0°F) due to the thermogenic effect of progesterone. However, this rise occurs **after** ovulation has already happened. It is a retrospective tool and is easily influenced by fever, stress, or irregular sleep, making it poor for precise prediction. * **Fern Test & Spinnbarkeit Phenomenon:** These reflect high estrogen levels (pre-ovulatory phase) which cause the cervical mucus to become thin, stretchy, and exhibit a ferning pattern on microscopy. While they indicate the *approach* of ovulation, they are subjective, can be affected by infections, and do not pinpoint the exact timing as accurately as an LH surge. **Clinical Pearls for NEET-PG:** * **Most accurate method to *predict* ovulation:** LH Surge (Urinary kits). * **Most accurate method to *confirm* ovulation:** Mid-luteal Progesterone or Serial Transvaginal Ultrasound (showing follicle disappearance/collapse). * **Spinnbarkeit:** Refers to the "stretchability" of mucus; maximum stretch (10-12 cm) occurs just before ovulation. * **Mittelschmerz:** Mid-cycle pelvic pain associated with ovulation.

Q: Which of the following is used as a surrogate for the endogenous LH surge in IVF?

HCG. **Explanation:** In the final stages of Controlled Ovarian Hyperstimulation (COH) for IVF, the **endogenous LH surge** must be simulated to induce final oocyte maturation and trigger ovulation. **Why HCG is the Correct Answer:** Human Chorionic Gonadotropin (HCG) is the most commonly used surrogate for LH because it shares a common **alpha-subunit** with LH and has a **beta-subunit** that is structurally similar. Crucially, HCG binds to the same **LH/hCG receptor** on the granulosa cells. Due to its longer half-life (>24 hours compared to 60 minutes for LH), a single bolus of HCG effectively mimics the mid-cycle LH surge, leading to the resumption of meiosis in the oocyte and luteinization of the follicle. **Analysis of Incorrect Options:** * **IGF (Insulin-like Growth Factor):** This is a growth factor that modulates the action of FSH on granulosa cells but does not trigger ovulation. * **GnRH (Gonadotropin-Releasing Hormone):** While GnRH *agonists* can be used to trigger an endogenous LH surge (the "GnRH trigger"), GnRH itself is a hypothalamic hormone, not a surrogate for the surge. * **HMG (Human Menopausal Gonadotropin):** This contains both FSH and LH activity and is used for **follicular recruitment and growth**, not for the final trigger. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Oocyte retrieval is typically performed **34–36 hours** after the HCG "trigger" shot. * **Dose:** Standard dose is 5,000–10,000 IU of urinary HCG or 250 mcg of recombinant HCG (Ovidrel). * **Complication:** HCG is the primary driver of **Ovarian Hyperstimulation Syndrome (OHSS)**. In high-risk patients, a GnRH agonist trigger is preferred to reduce this risk.

Q: Sonosalpingography is done for what purpose?

Testing tubal patency. **Explanation:** **Sonosalpingography (SSG)**, also known as saline infusion sonography, is a diagnostic procedure used primarily to **test tubal patency**. It involves the instillation of sterile saline (or a specialized contrast medium) into the uterine cavity via a catheter while performing real-time transvaginal ultrasonography. If the fallopian tubes are patent, the fluid can be seen spilling from the fimbrial ends into the Pouch of Douglas (POD). **Analysis of Options:** * **Option C (Correct):** SSG is a safe, radiation-free alternative to Hysterosalpingography (HSG) for evaluating the fallopian tubes and the uterine cavity in infertile patients. * **Option A:** Basal body temperature (BBT) is measured daily by the patient at home to retrospectively confirm ovulation, not via ultrasound procedures. * **Option B:** Pregnancy is detected via urine/serum beta-hCG levels or direct visualization of a gestational sac on routine ultrasonography. * **Option D:** Anovulatory cycles are typically diagnosed using mid-luteal progesterone levels or serial follicular monitoring (folliculometry). **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Laparoscopy with **Chromopertubation** (using Methylene blue dye) remains the gold standard for assessing tubal patency. * **First-line Investigation:** Hysterosalpingography (HSG) is the most common initial screening test for tubal factors. * **Timing:** SSG/HSG should be performed during the **pre-ovulatory phase** (Day 7 to Day 10 of the menstrual cycle) to avoid disrupting an early pregnancy and to ensure the endometrium is thin. * **Advantage of SSG:** Unlike HSG, SSG avoids exposure to ionizing radiation and iodine-based contrast agents.

Q: What is considered the best test for evaluating tubal function?

Laparoscopy. **Explanation:** The evaluation of tubal patency and function is a critical step in the infertility workup. While several tests exist, **Laparoscopy with Chromopertubation** is considered the **Gold Standard** (best test) for evaluating tubal function. **Why Laparoscopy is the Correct Answer:** Laparoscopy allows for direct visualization of the pelvic anatomy. By injecting a dye (like Methylene blue) through the cervix and observing its spill from the fimbrial ends, clinicians can confirm patency. More importantly, it is the only test that can evaluate **extratubal factors** such as peritubal adhesions, endometriosis, and fimbrial morphology, which significantly impact tubal motility and ovum pickup—functions that cannot be assessed by imaging alone. **Analysis of Incorrect Options:** * **Hysterosalpingography (HSG):** This is the **first-line screening test** for tubal patency. While excellent for viewing the internal architecture of the uterus and tube (e.g., salpingitis isthmica nodosa), it has a high false-positive rate due to tubal spasms and cannot detect pelvic adhesions. * **Rubin’s Test:** An obsolete test involving insufflation of $CO_2$ into the fallopian tubes. It is no longer used due to high failure rates, risk of air embolism, and lack of anatomical detail. * **X-ray Pelvis:** A plain X-ray has no role in evaluating tubal function as soft tissue structures like the fallopian tubes are not visible without contrast. **NEET-PG High-Yield Pearls:** * **Gold Standard for Tubal Patency:** Laparoscopy + Chromopertubation. * **First-line/Screening Test:** HSG (performed in the pre-ovulatory phase, Day 7–10). * **Best test for Uterine Cavity:** Hysteroscopy. * **Maitland’s Sign:** Presence of "oil droplets" on X-ray after HSG using oil-based contrast (historical significance).

Q: What is the most common parental chromosomal abnormality associated with recurrent abortion?

Robertsonian translocations. **Explanation:** Recurrent Pregnancy Loss (RPL) is defined as two or more consecutive pregnancy losses. While the most common cause of *sporadic* miscarriage is fetal aneuploidy (Trisomy), the most common **parental** chromosomal abnormality identified in couples with RPL is a balanced translocation. **1. Why Robertsonian Translocation is Correct:** Among parental chromosomal rearrangements, **Balanced Translocations** are the most frequent. These are divided into Reciprocal and Robertsonian translocations. While some textbooks debate which is more frequent, **Robertsonian translocations** (involving acrocentric chromosomes like 13, 14, 15, 21, and 22) are a classic high-yield answer for parental causes. In these cases, the parent is phenotypically normal but produces unbalanced gametes, leading to embryos with lethal monosomies or trisomies, resulting in miscarriage. **2. Why Other Options are Incorrect:** * **Trisomy:** This is the most common chromosomal cause of **sporadic** (isolated) spontaneous abortion (specifically Trisomy 16), but it is a fetal error, not a parental structural abnormality. * **Microdeletions:** These are usually associated with specific genetic syndromes (e.g., DiGeorge) rather than being the primary "most common" cause of recurrent early pregnancy loss. * **Mosaicism:** While parental mosaicism can occur, it is significantly less common than balanced structural translocations in the context of RPL. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of sporadic abortion:** Fetal Aneuploidy (Trisomy 16 is the most common specific trisomy). * **Most common parental factor in RPL:** Balanced Translocations (found in 2-5% of couples). * **Investigation of choice:** Peripheral blood **Karyotyping** of both parents. * **Management:** Genetic counseling and Preimplantation Genetic Testing (PGT) if necessary.

Q: A 24-year-old female is unable to conceive after 15 months of trying. She has a history of recurrent pelvic inflammatory disease, but has normal menses and normal vaginal and cervical examinations. What is the next line investigation?

Hysterosalpingography (HSG). ### Explanation **Correct Answer: A. Hysterosalpingography (HSG)** **Why HSG is the correct choice:** The patient is a young woman (24 years old) with primary infertility (trying for >12 months) and a significant history of **recurrent Pelvic Inflammatory Disease (PID)**. In cases of PID, the most common cause of infertility is **tubal factor infertility** due to pelvic adhesions or tubal occlusion (salpingitis). Since her menstrual cycles are normal (suggesting regular ovulation) and physical exams are unremarkable, the next logical step is to assess **tubal patency**. HSG is the gold-standard screening test for evaluating the uterine cavity and tubal patency in an outpatient setting. **Why other options are incorrect:** * **B. Anti-Müllerian Hormone (AMH):** AMH is a marker of ovarian reserve. While useful in older patients or those with suspected Premature Ovarian Insufficiency, it is not the priority here as her menses are normal and her history strongly points toward a structural (tubal) issue. * **C. Hysteroscopy:** This allows direct visualization of the uterine cavity. While it can detect intrauterine pathology (like polyps or synechiae), it cannot evaluate the patency of the fallopian tubes. * **D. CA-125 level:** This is a non-specific marker for ovarian cancer and endometriosis. It has no routine role in the initial workup of infertility. **Clinical Pearls for NEET-PG:** * **Gold Standard for Tubal Patency:** Laparoscopy with Chromopertubation (but HSG is the initial screening test). * **Timing of HSG:** Performed in the **proliferative phase** (Day 6 to Day 10 of the cycle) to ensure the endometrium is thin and the patient is not pregnant. * **Therapeutic effect:** HSG can sometimes be therapeutic, as the flushing of dye may clear minor tubal debris or mucus plugs. * **Most common cause of Tubal Factor Infertility:** Chlamydia trachomatis infection (often silent PID).

Q: Which one of the following is a hereditary disease that may be associated with infertility?

Immotile cilia syndrome. **Explanation:** **Immotile Cilia Syndrome (Kartagener’s Syndrome)** is the correct answer because it is an autosomal recessive hereditary disorder characterized by a structural defect in the dynein arms of cilia and flagella. * **Mechanism of Infertility:** In males, the flagella of spermatozoa are structurally defective, leading to **asthenozoospermia** (total lack of motility). In females, the cilia lining the fallopian tubes are dysfunctional, which impairs the transport of the ovum toward the uterus, significantly increasing the risk of primary infertility and ectopic pregnancy. **Analysis of Incorrect Options:** * **A. Polycystic Ovaries (PCOS):** While PCOS has a strong genetic predisposition and is a leading cause of infertility due to anovulation, it is considered a **multifactorial** metabolic disorder rather than a classic hereditary (monogenic) disease. * **B. Bullous Pemphigoid:** This is an **acquired autoimmune** blistering skin disease. It is not hereditary and has no direct clinical association with infertility. * **C. Uterine Fibroids:** These are benign monoclonal tumors of the myometrium. While they may show familial clustering, they are primarily considered **hormone-dependent** (estrogen/progesterone) growths rather than a hereditary disease. **High-Yield Clinical Pearls for NEET-PG:** * **Kartagener’s Triad:** Situs inversus, chronic sinusitis, and bronchiectasis. * **Diagnosis:** The gold standard for diagnosing Immotile Cilia Syndrome is **Electron Microscopy** to visualize the absence of dynein arms. * **Management:** For males with this condition, **ICSI (Intracytoplasmic Sperm Injection)** is the treatment of choice for achieving pregnancy, as sperm viability is usually preserved despite the lack of motility.

Question 1

In Vitro Fertilization (IVF) is indicated for which type of infertility?

Accepted Answer

Azoospermia

Answer

Tubal infertility

Answer

Infertility due to Pelvic Inflammatory Disease (PID)

Answer

Uterine agenesis

Question 2

In semen banks, at what temperature is semen preserved?

Accepted Answer

Liquid nitrogen

Answer

Dry ice

Answer

Deep freeze

Answer

Liquid air

Question 3

Absolute contraindications for hysterosalpingography (HSG) include all except:

Accepted Answer

Mullerian anomalies

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Answer

Genital tuberculosis

Question 4

Which of the following methods for assessment of female infertility during a menstrual cycle can best predict the timing of ovulation?

Accepted Answer

Hormonal Study

Answer

Basal Body Temperature (BBT)

Answer

Fern Test

Answer

Spinnbarkeit Phenomenon

Question 5

Which of the following is used as a surrogate for the endogenous LH surge in IVF?

Accepted Answer

HCG

Answer

IGF

Answer

GnRH

Answer

HMG

Question 6

Sonosalpingography is done for what purpose?

Accepted Answer

Testing tubal patency

Answer

Measuring basal body temperature

Answer

Detecting pregnancy

Answer

Determining anovulatory cycles

Question 7

What is considered the best test for evaluating tubal function?

Accepted Answer

Laparoscopy

Answer

Hysterosalpingography

Answer

Rubin's test

Answer

X-ray pelvis

Question 8

What is the most common parental chromosomal abnormality associated with recurrent abortion?

Accepted Answer

Robertsonian translocations

Answer

Trisomy

Answer

Microdeletions

Answer

Mosaicism

Question 9

A 24-year-old female is unable to conceive after 15 months of trying. She has a history of recurrent pelvic inflammatory disease, but has normal menses and normal vaginal and cervical examinations. What is the next line investigation?

Accepted Answer

Hysterosalpingography (HSG)

Answer

Anti-Müllerian Hormone (AMH) level

Answer

Hysteroscopy

Answer

CA-125 level

Question 10

Which one of the following is a hereditary disease that may be associated with infertility?

Accepted Answer

Immotile cilia syndrome

Answer

Polycystic ovaries

Answer

Bullous pemphigoid

Answer

Uterine fibroid

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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