Assisted Reproductive Technologies — MCQs
Which of the following is the least invasive assisted reproductive technique?
Embryo gets implanted at what stage of development?
The contraceptive which is contraindicated in DVT is?
A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?
A 30-year-old woman presents with primary infertility for 2 years. Her menstrual cycles are irregular (35-45 days). Investigations reveal FSH 15 IU/L, AMH 0.5 ng/mL. Semen analysis is normal and HSG shows patent tubes. What is the most appropriate first-line treatment?
A 34-year-old with recurrent miscarriages and history of septate uterus presents for counseling. Which intervention is most suitable to prevent future pregnancy losses?
What is the incorrect statement?
Which of the following can be considered as grounds of divorce under matrimonial law?
A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?
Which of the following structures has the function of capacitation?
Assisted Reproductive Technologies Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is the least invasive assisted reproductive technique?
- A. GIFT
- B. ZIFT
- C. IVF
- D. Intra-Uterine Insemination (Correct Answer)
Explanation: ***Intra-Uterine Insemination (IUI)*** - **IUI** involves directly placing **sperm** into the **uterus**, bypassing the cervix after sperm washing, making it the least invasive method among the options. - It is often used for mild male factor infertility, unexplained infertility, or when a woman has cervical mucus issues. *GIFT (Gamete Intra-Fallopian Transfer)* - **GIFT** is more invasive as it requires a **laparoscopic procedure** to place both **sperm** and **eggs** directly into the fallopian tube. - While fertilization occurs *in vivo* (in the body), the surgical aspect makes it more invasive than IUI. *ZIFT (Zygote Intra-Fallopian Transfer)* - **ZIFT** involves **IVF** to fertilize eggs in the lab, but then requires a **laparoscopic procedure** to place the resulting **zygotes** (early embryos) into the fallopian tube. - The combination of *in vitro* fertilization and surgical placement makes it more invasive than IUI. *IVF (In Vitro Fertilization)* - **IVF** involves **oocyte retrieval** (a transvaginal ultrasound-guided procedure) and **fertilization in vitro** (in the lab), followed by **embryo transfer** into the uterus. - While embryo transfer is less invasive than laparoscopic procedures, the initial oocyte retrieval makes IVF generally more invasive than IUI.
Question 2: Embryo gets implanted at what stage of development?
- A. Two cell stage
- B. Four cell stage
- C. Morula
- D. Blastocyst (Correct Answer)
Explanation: Blastocyst - Implantation into the uterine wall occurs when the embryo has developed into a blastocyst, typically around day 6 post-fertilization [1]. - The blastocyst consists of an inner cell mass (which forms the embryo) and an outer layer called the trophoblast (which contributes to the placenta) [1]. Two cell stage - This stage occurs very early in development, usually within the first 24-30 hours after fertilization [1]. - At this point, the embryo is still in the fallopian tube and has not yet reached the uterus for implantation [1]. Four cell stage - The four-cell stage is also an early cleavage stage, occurring around 2 days post-fertilization [1]. - Like the two-cell stage, the embryo is still in transport through the fallopian tube and is not ready for implantation [1]. Morula - The morula is a solid ball of cells formed by cleavage, typically around day 3-4 post-fertilization [1]. - While it has moved closer to the uterus, it has not yet formed the distinct inner cell mass and trophoblast necessary for successful implantation [1].
Question 3: The contraceptive which is contraindicated in DVT is?
- A. Barrier method
- B. Non hormonal IUCD
- C. Billing's method
- D. OCP (Correct Answer)
Explanation: ***OCP*** - **Oral contraceptive pills (OCPs)**, especially those containing estrogen, increase the risk of **venous thromboembolism (VTE)**, including deep vein thrombosis (DVT). - Estrogen promotes a **hypercoagulable state** by increasing clotting factors and decreasing natural anticoagulants. *Barrier method* - **Barrier methods** like condoms or diaphragms are non-hormonal and act physically to prevent sperm from reaching the egg. - They have **no systemic effects** on coagulation and are safe for individuals with DVT. *Non hormonal IUCD* - **Non-hormonal intrauterine contraceptive devices (IUCDs)**, such as copper IUCDs, prevent conception primarily by causing a local inflammatory reaction in the uterus. - They do not release hormones and therefore **do not affect coagulation** or increase DVT risk. *Billing's method* - The **Billing's ovulation method** (cervical mucus method) is a natural family planning technique based on observing changes in cervical mucus. - It involves no medications or devices and thus has **no impact on DVT risk**.
Question 4: A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?
- A. Hysterolaparoscopy
- B. Diagnostic hysteroscopy
- C. Reassure and review the couple after 6 months (Correct Answer)
- D. Semen analysis for husband
Explanation: ***Reassure and review the couple after 6 months*** - Infertility is defined as the inability to conceive after **12 months** of regular, unprotected intercourse in women under 35 years old. For women aged 35 or older, this period is 6 months. - Since the patient is 23 years old and has been trying for only 6 months, she does not yet meet the diagnostic criteria for infertility. The appropriate action is to advise them to continue trying and to return for evaluation if conception does not occur after a full year. *Semen analysis for husband* - While a semen analysis is a crucial initial step in an infertility workup, it is premature at this stage given the duration of attempted conception. - It would be appropriate to order this test after the couple has met the criteria for infertility (12 months for women under 35). *Hysterolaparoscopy* - This is an invasive procedure typically reserved for more advanced stages of an infertility workup, especially when suspected pathologies like endometriosis or tubal factor infertility are present. - It is not indicated as an initial step for a couple who has only been trying to conceive for 6 months and does not yet meet the definition of infertility. *Diagnostic hysteroscopy* - A diagnostic hysteroscopy is used to visualize the inside of the uterus to identify intrauterine pathologies that could contribute to infertility. - Like hysterolaparoscopy, it is an invasive diagnostic tool and should only be considered after initial, less invasive investigations have been performed and the couple meets the criteria for infertility.
Question 5: A 30-year-old woman presents with primary infertility for 2 years. Her menstrual cycles are irregular (35-45 days). Investigations reveal FSH 15 IU/L, AMH 0.5 ng/mL. Semen analysis is normal and HSG shows patent tubes. What is the most appropriate first-line treatment?
- A. Letrozole (Correct Answer)
- B. IVF with donor eggs
- C. Clomiphene citrate
- D. Gonadotropins
Explanation: ***Letrozole*** - This patient has **diminished ovarian reserve (DOR)** evidenced by **FSH 15 IU/L** (borderline elevated) and **AMH 0.5 ng/mL** (significantly low), along with **irregular cycles suggesting anovulation**. - **Letrozole**, an aromatase inhibitor, is the **preferred first-line ovulation induction agent** in patients with DOR who are anovulatory. It works by reducing estrogen production, leading to increased FSH release and follicular development. - **Advantages over clomiphene:** Letrozole has fewer anti-estrogenic effects on the endometrium and cervical mucus, making it superior in DOR patients where endometrial receptivity is crucial. - Given her young age (30 years) and evidence of some ovarian reserve (AMH 0.5, not undetectable), a trial of **2-3 cycles of ovulation induction** before proceeding to IVF is reasonable and cost-effective. *IVF with donor eggs* - This is **premature as first-line therapy**. While the patient has DOR, she still has detectable AMH (0.5 ng/mL), indicating some ovarian function remains. - The **first step** would be attempting conception with her own eggs through ovulation induction, and if that fails, **IVF with autologous (own) eggs** should be tried before considering donor eggs. - Donor egg IVF is typically reserved for patients with **premature ovarian failure**, very advanced age, or after repeated failed IVF cycles with own eggs. *Clomiphene citrate* - While clomiphene is an effective **ovulation induction agent**, it has significant **anti-estrogenic effects** on the endometrium (causing thinning) and cervical mucus (reducing quality). - In patients with **DOR**, where pregnancy rates are already compromised, these anti-estrogenic effects can further reduce success rates. - **Letrozole has been shown to have better pregnancy outcomes** in various populations, including those with DOR, making it the preferred first-line agent. *Gonadotropins* - Injectable gonadotropins (FSH/LH) directly stimulate follicular development and are more potent than oral agents. - However, they carry **higher risks**: multiple gestations (20-30%), ovarian hyperstimulation syndrome (OHSS), and significantly higher cost. - They are typically reserved as **second-line therapy** after failed response to oral ovulation induction agents, or as part of IVF protocols. - Starting with less aggressive, safer oral agents like letrozole is the **standard stepwise approach** in infertility management.
Question 6: A 34-year-old with recurrent miscarriages and history of septate uterus presents for counseling. Which intervention is most suitable to prevent future pregnancy losses?
- A. Hysteroscopic resection
- B. IVF with PGD
- C. Cervical cerclage
- D. Strassman's metroplasty (Correct Answer)
Explanation: ***Strassman's metroplasty*** - **Strassman's metroplasty** is a surgical procedure specifically designed to correct a **septate uterus** by removing or unifying the uterine septum to create a single functional cavity. This improves uterine shape and capacity, addressing the primary anatomical defect causing recurrent miscarriages. - By correcting the **septate uterus**, this intervention directly targets the underlying structural cause of the patient's **recurrent pregnancy losses**, making it the most suitable treatment among the options provided. - While **hysteroscopic septum resection** is now the preferred modern approach for septate uterus, Strassman's metroplasty (abdominal approach) remains a valid surgical option, particularly in cases where hysteroscopic approach is not feasible. *Hysteroscopic resection* - **Hysteroscopic resection** is indeed used for removing an **intrauterine septum** and is currently the **preferred minimally invasive approach** for septate uterus. - However, in the context of this question, Strassman's metroplasty represents the classical **abdominal surgical approach** for the same condition, and both can be effective, though hysteroscopic resection has largely replaced open surgery due to lower morbidity. *IVF with PGD* - **IVF with preimplantation genetic diagnosis (PGD)** is used to screen embryos for genetic abnormalities before implantation, which is not the cause of miscarriages in cases of **septate uterus**. - This intervention does not address the **structural abnormality** of the uterus, which is the primary problem in this patient. *Cervical cerclage* - **Cervical cerclage** is used to treat **cervical insufficiency**, where the cervix dilates prematurely, leading to late-trimester pregnancy loss. - While recurrent miscarriages can sometimes be linked to cervical issues, the history of a **septate uterus** points to a uterine structural anomaly as the primary cause, making cerclage a secondary or irrelevant intervention in this context.
Question 7: What is the incorrect statement?
- A. MIS inhibits the formation of Mullerian duct
- B. WD form male internal genitalia
- C. Zygote is Bipotential at 8 weeks (Correct Answer)
- D. DHT is necessary for the development of external genitals
Explanation: ***Zygote is Bipotential at 8 weeks*** - A **zygote** is formed at conception and is the single-cell diploid organism, not bipotential at 8 weeks. - The **bipotential gonad** can develop into either testes or ovaries, and this stage of sexual differentiation occurs earlier in gestation, typically around the 6th to 7th week, before differentiating into male or female gonads, not at 8 weeks as an entire zygote. *MIS inhibits the formation of Mullerian duct* - **Müllerian Inhibiting Substance (MIS)**, also known as **Anti-Müllerian Hormone (AMH)**, is produced by the Sertoli cells of the developing testes [1]. - Its primary function is to cause the **regression of the Müllerian ducts**, which would otherwise develop into female internal reproductive structures (fallopian tubes, uterus, and upper vagina) [1]. *WD form male internal genitalia* - The **Wolffian ducts (WD)**, also known as mesonephric ducts, are precursors to male internal genitalia in the presence of testosterone [1]. - stimulated by **testosterone** produced by the Leydig cells of the fetal testes, they develop into the **epididymis, vas deferens, and seminal vesicles** [1]. *DHT is necessary for the development of external genitals* - **Dihydrotestosterone (DHT)**, a more potent form of testosterone, is crucial for the development of male external genitalia [1]. - The enzyme **5α-reductase** converts testosterone to DHT in target tissues, leading to the formation of the **penis, scrotum, and prostate** [1].
Question 8: Which of the following can be considered as grounds of divorce under matrimonial law?
- A. Sterility
- B. Frigidity
- C. Impotence developing after the marriage (Correct Answer)
- D. Temporary Mental illness
Explanation: ***Impotence developing after the marriage*** - **Impotence** (inability to consummate the marriage) can constitute a ground for **nullity** if it existed **at the time of marriage** and was not disclosed. - However, **impotence developing after marriage** may be considered under certain legal frameworks as inability to fulfill marital obligations, though its status varies by jurisdiction. - In the context of medical jurisprudence, **sexual incapacity** affecting the continuation of marriage is recognized as a potential ground in matrimonial disputes. - This is the **most appropriate answer** among the given options as it relates to inability to fulfill a fundamental aspect of marriage. *Sterility* - **Sterility** (inability to conceive children) is generally **not considered a ground for divorce** under most matrimonial laws. - It does not prevent consummation of marriage or fulfillment of other marital duties. - While it may cause personal distress, legal systems distinguish between inability to conceive and inability to engage in sexual relations. *Frigidity* - **Frigidity** (lack of sexual desire or responsiveness) is typically **not a sufficient ground for divorce** on its own. - If the spouse is physically capable of consummating the marriage, lack of desire alone does not constitute legal grounds. - It may overlap with other marital issues but has weaker legal standing compared to actual physical incapacity. *Temporary Mental illness* - **Temporary mental illness** is generally **not a ground for divorce** because it implies a recoverable condition. - For mental disorder to constitute grounds for divorce under Indian matrimonial law (Hindu Marriage Act Section 13), it must be: - **Incurable** or of such nature that cohabitation becomes unreasonable - **Continuous or intermittent** mental disorder of sufficient severity - A **temporary** condition that can be cured does not meet these criteria.
Question 9: A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?
- A. Tompkins procedure
- B. Hysteroscopic surgery (Correct Answer)
- C. Jones procedure
- D. Strassman procedure
Explanation: ***Hysteroscopic surgery*** - This minimally invasive procedure involves resecting the **septum** using a hysteroscope, which is associated with excellent reproductive outcomes, often achieving **term pregnancy rates of 70-80%**. - It is preferred because it avoids hysterotomy (incision into the uterus), preserving uterine integrity and reducing the risk of future complications during pregnancy and delivery. *Tompkins procedure* - This procedure involves a **laparotomy and longitudinal incision** into the uterus to excise the septum, followed by closure. - While effective, it is a more invasive open surgical approach, leading to a **longer recovery time** and potentially compromising uterine integrity, increasing the risk of future uterine rupture. *Jones procedure* - The Jones procedure is also an **abdominal metroplasty** that involves excising a wedge of tissue from the fundus of the uterus, typically used for **bicornuate uteri**. - It is **highly invasive** and not the preferred method for a septate uterus due to its extensive nature and associated risks. *Strassman procedure* - The Strassman procedure is primarily used for the surgical correction of a **bicornuate uterus** or **uterus didelphys**, involving unification of the two uterine horns. - This procedure is also an **open abdominal surgery** with significant recovery time and risks, and is not applicable for a septate uterus, where the issue is a fibrous or muscular wall within a single uterine cavity.
Question 10: Which of the following structures has the function of capacitation?
- A. Male reproductive tract
- B. Vas deferens
- C. Female reproductive tract (Correct Answer)
- D. Capillary
Explanation: ***Female reproductive tract*** - **Capacitation** is a biochemical process that occurs in the **female reproductive tract** (primarily the fallopian tubes and uterus), enabling sperm to gain the ability to fertilize an egg. - This process involves the removal of **cholesterol and glycoproteins** from the sperm head membrane, which modifies its motility and prepares it for the **acrosome reaction**. - Capacitation typically takes **5-6 hours** and is essential for successful fertilization. *Male reproductive tract* - The male reproductive tract produces and stores sperm, but it is **not the site where capacitation occurs**. - Sperm are immature and unable to fertilize an egg when they leave the male reproductive tract. - Sperm only gain fertilizing capacity after exposure to the female reproductive tract environment. *Vas deferens* - The vas deferens is a tube that transports sperm from the epididymis to the ejaculatory duct. - It is a part of the male reproductive tract and does **not contribute to capacitation**. *Capillary* - Capillaries are tiny blood vessels involved in nutrient and waste exchange, entirely unrelated to sperm function or capacitation. - This option is biologically implausible in the context of reproduction.
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