Fertility and Infertility Practice Questions

Q: A 28-year-old woman presents to the clinic for evaluation of infertility. Her menstrual cycles have been regular every 28 days. She reports using basal body temperature charting, which shows a biphasic pattern with temperature elevation occurring around day 14. Serum progesterone is measured on day 21 of her cycle and is found to be 18 ng/mL (normal luteal phase >10 ng/mL). Based on this information, what is the most likely status of her ovulatory function?

Normal ovulation with adequate luteal phase. ***Normal ovulation with adequate luteal phase*** - A **serum progesterone level >10 ng/mL** on day 21 and a **biphasic basal body temperature** are definitive markers of successful ovulation. - **Regular 28-day cycles** and a temperature shift around day 14 further confirm the presence of a functional **corpus luteum** and adequate luteal phase duration. *Anovulatory cycles with inadequate corpus luteum function* - **Anovulatory cycles** would lack the **biphasic temperature pattern** and typically present with irregular, unpredictable menstrual bleeding. - Inadequate luteal function would result in **progesterone levels <10 ng/mL** during the mid-luteal phase, which is not the case here. *Luteinized unruptured follicle syndrome* - While this condition involves **luteinization** of a follicle without egg release, it is a rare cause of infertility and hard to diagnose with simple labs. - Since the patient has all clinical indicators of **normal ovulatory physiology**, this specific pathology is less likely than a normal status. *Premature ovarian insufficiency* - This condition is characterized by **amenorrhea** or oligomenorrhea and elevated **FSH levels**, not regular 28-day cycles. - Patients would typically show **low progesterone** and low estrogen due to follicular depletion, which contradicts the mid-luteal progesterone of 18 ng/mL. *Polycystic ovary syndrome with irregular ovulation* - **PCOS** usually presents with **oligomenorrhea** or amenorrhea and clinical or biochemical signs of **hyperandrogenism**. - The patient’s highly **regular menstrual cycles** and confirmed mid-luteal progesterone elevation effectively rule out the chronic anovulation seen in PCOS.

Q: Clomiphene citrate challenge test (CCCT) is used for what purpose?

Assessing the ovarian reserve of a woman. **Explanation:** The **Clomiphene Citrate Challenge Test (CCCT)** is a provocative screening test used to assess **ovarian reserve**. It is more sensitive than a baseline (Day 3) FSH level because it evaluates the ovary's ability to respond to gonadotropin stimulation. **Mechanism:** 1. **Day 3:** Serum FSH and Estradiol levels are measured. 2. **Days 5–9:** 100 mg of Clomiphene Citrate is administered daily. Clomiphene blocks estrogen receptors in the hypothalamus, tricking the brain into sensing low estrogen, which triggers an increase in FSH. 3. **Day 10:** Serum FSH is measured again. In a woman with good ovarian reserve, the developing follicles produce enough **Inhibin-B** and **Estradiol** to provide negative feedback, bringing the FSH level back down by Day 10. **An elevated FSH on Day 3 or Day 10 indicates diminished ovarian reserve.** **Analysis of Incorrect Options:** * **A & B:** LH surge and PCOS are typically monitored via urinary LH kits, serial ultrasonography (folliculometry), or specific Rotterdam criteria (hyperandrogenism, ovulatory dysfunction, and polycystic morphology). CCCT is not a diagnostic tool for these. * **C:** Luteal phase defect is traditionally assessed via mid-luteal progesterone levels or endometrial biopsy, not by provocative FSH testing. **High-Yield Clinical Pearls for NEET-PG:** * **Best marker for Ovarian Reserve:** Anti-Müllerian Hormone (**AMH**) is now considered the most reliable marker as it is cycle-independent. * **Best Ultrasound marker:** Antral Follicle Count (**AFC**). * **CCCT Significance:** An abnormal CCCT is highly predictive of poor response to ovulation induction and low pregnancy rates in IVF.

Question 1

A 22-year-old woman presents at 14 weeks of gestation with excessive nausea, uterine size larger than dates, and a serum beta-hCG of 450,000 mIU/mL. Ultrasound shows a 'snowstorm' appearance. Suction evacuation is performed and the specimen is sent for histopathological examination. The histopathology is shown in Image 1. Which of the following best describes the karyotype and mechanism of origin of this condition?

Accepted Answer

A. 46,XX or 46,XY arising from fertilization of an empty (anucleate) ovum by a single haploid sperm with subsequent duplication (monospermic), or by two spermatozoa (dispermic)

Answer

B. 69,XXX or 69,XXY arising from fertilization of a normal ovum by two spermatozoa

Answer

C. 46,XY arising from fertilization of a normal ovum by a single diploid sperm without duplication

Answer

D. 45,X arising from meiotic non-disjunction in the maternal gamete

Question 2

A 27-year-old woman with Kallmann syndrome (congenital GnRH deficiency) desires pregnancy. She has been on estrogen-progesterone replacement for bone health. Her physician plans to switch her to pulsatile GnRH therapy. After 6 weeks of treatment, labs show: LH 4 mIU/mL, FSH 5 mIU/mL, estradiol 120 pg/mL. Ultrasound shows a 16mm dominant follicle. Evaluate and synthesize the physiologic response to determine the appropriate next intervention for ovulation induction.

Accepted Answer

Administer exogenous hCG to trigger ovulation and time intercourse

Answer

Switch to gonadotropin therapy with recombinant FSH and LH

Answer

Increase GnRH pulse frequency to stimulate endogenous LH surge

Answer

Add clomiphene citrate to augment endogenous gonadotropin release

Answer

Continue current GnRH dosing and monitor for spontaneous LH surge

Question 3

A 28-year-old woman presents to the clinic for evaluation of infertility. Her menstrual cycles have been regular every 28 days. She reports using basal body temperature charting, which shows a biphasic pattern with temperature elevation occurring around day 14. Serum progesterone is measured on day 21 of her cycle and is found to be 18 ng/mL (normal luteal phase >10 ng/mL). Based on this information, what is the most likely status of her ovulatory function?

Accepted Answer

Normal ovulation with adequate luteal phase

Answer

Anovulatory cycles with inadequate corpus luteum function

Answer

Luteinized unruptured follicle syndrome

Answer

Premature ovarian insufficiency

Answer

Polycystic ovary syndrome with irregular ovulation

Question 4

Clomiphene citrate challenge test (CCCT) is used for what purpose?

Accepted Answer

Assessing the ovarian reserve of a woman

Answer

Assessing LH rise prior to ovulation

Answer

Accurate diagnosis of PCOS

Answer

Estimating the luteal phase defect

Question 5

In Polycystic Ovary Disease (PCOD), which of the following drugs is NOT used for infertility management?

Accepted Answer

Spironolactone

Answer

Clomiphene

Answer

Tamoxifen

Answer

Testosterone

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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