Fertility and Infertility Practice Questions

Q: A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Vas obstruction. ### Explanation The clinical presentation of **azoospermia** (absence of sperm in the ejaculate) combined with **normal testicular size** and **normal hormonal profiles** (FSH, LH, and Testosterone) is the classic hallmark of **Obstructive Azoospermia**. **Why "Vas obstruction" is correct:** In obstructive azoospermia, the hypothalamic-pituitary-gonadal axis is intact, and spermatogenesis within the testes is functioning normally. Because the germinal epithelium is healthy, **FSH levels remain normal** (as Inhibin B production is not compromised). Since the Leydig cells are unaffected, **Testosterone** and testicular volume are also normal. The "blockage" is purely mechanical, occurring in the epididymis, vas deferens, or ejaculatory ducts. **Why the other options are incorrect:** * **Maldescended testis:** Usually leads to testicular atrophy and damage to the seminiferous tubules due to higher intra-abdominal temperatures, often resulting in elevated FSH and reduced testicular size. * **Klinefelter’s Syndrome (47,XXY):** This is a form of primary hypergonadotropic hypogonadism. It presents with **small, firm testes**, **elevated FSH/LH**, and low testosterone. * **Kallmann’s Syndrome:** This is hypogonadotropic hypogonadism. It presents with **low FSH/LH**, low testosterone, and prepubertal testicular volume (micropenis/small testes), often accompanied by anosmia. **High-Yield Clinical Pearls for NEET-PG:** * **FSH is the best marker for spermatogenesis:** Elevated FSH almost always indicates primary testicular failure (Non-obstructive azoospermia). * **Most common cause of Obstructive Azoospermia:** Post-inflammatory (e.g., post-gonorrheal) or Congenital Bilateral Absence of Vas Deferens (CBAVD), which is strongly associated with **Cystic Fibrosis (CFTR gene mutations)**. * **Management:** In obstructive cases, sperm can be retrieved directly from the testes/epididymis (TESA/MESA) for use in ICSI.

Q: In which case homologous artificial insemination is used in females?

Cervical factor. **Explanation:** **Artificial Insemination Homologous (AIH)** involves the deliberate introduction of the husband’s processed semen into the female reproductive tract (usually intrauterine). The primary goal of AIH is to bypass barriers that prevent sperm from reaching the fallopian tubes naturally. **Why Cervical Factor is Correct:** In patients with **cervical factor infertility**, the cervical mucus may be hostile (due to antisperm antibodies) or insufficient (due to prior surgery like conization). By performing Intrauterine Insemination (IUI), the "cervical barrier" is bypassed, depositing highly motile sperm directly into the uterine cavity, significantly increasing the chances of fertilization. **Why Other Options are Incorrect:** * **Tubal Block:** This is a major contraindication for AIH/IUI. For insemination to work, at least one fallopian tube must be patent to allow the sperm and egg to meet. Patients with bilateral tubal blocks require **IVF (In Vitro Fertilization)**. * **Hormonal Disturbance:** While hormonal issues (like PCOS or anovulation) cause infertility, the primary treatment is **ovulation induction** (e.g., Clomiphene or Letrozole). AIH is only an adjunct if there is an associated male or cervical factor; it does not treat the underlying hormonal pathology. **High-Yield NEET-PG Pearls:** * **Indications for AIH:** Unexplained infertility, cervical factor, mild endometriosis, and male factors (mild oligospermia or hypospadias). * **Prerequisite:** At least one patent fallopian tube (confirmed via HSG or Laparoscopy) is mandatory. * **Semen Processing:** AIH requires "washing" the semen to remove prostaglandins, which can cause severe uterine cramping if injected directly. * **Success Rate:** Approximately 10–15% per cycle.

Q: All of the following are tubal patency tests EXCEPT?

Fern test. **Explanation:** The **Fern test** is the correct answer because it is a test used to evaluate **ovulation and cervical mucus quality**, not tubal patency. Under the influence of high estrogen levels (just before ovulation), cervical mucus becomes thin and watery. When dried on a glass slide, it crystallizes into a "fern-like" pattern due to high sodium chloride content. Post-ovulation, progesterone inhibits this pattern. **Evaluation of Incorrect Options:** * **Tubal CO2 Insufflation (Rubin’s Test):** An older method where CO2 is introduced into the uterus. If tubes are patent, gas enters the peritoneal cavity, causing referred shoulder pain or a characteristic "hissing" sound on auscultation. * **Laparoscopy (Chromopertubation):** Considered the **Gold Standard** for assessing tubal patency. Methylene blue dye is injected through the cervix, and its spill from the fimbrial ends is directly visualized via laparoscope. * **HSG (Hysterosalpingography):** The **first-line investigation** for tubal factors. It involves injecting radiopaque dye and taking X-rays to visualize the uterine contour and tubal spill. **NEET-PG High-Yield Pearls:** * **Gold Standard for Tubal Patency:** Laparoscopy and Chromopertubation. * **First-line Screening for Tubal Patency:** HSG (usually done in the proliferative phase, Day 7–10). * **Spinnbarkeit Test:** Another cervical mucus test (measures "stretchability") used to predict the ovulatory period. * **Sonohysterosalpingography (SSG):** Uses saline and ultrasound; it is safer (no radiation) but less accurate for distal tubal blocks compared to HSG.

Q: According to the WHO definition, what is considered a normal sperm count?

20 million/ml. **Explanation:** The correct answer is **20 million/ml**. This value is based on the **WHO 4th Edition (1999) criteria**, which is frequently tested in NEET-PG as the standard benchmark for "normal sperm count." According to these guidelines, a concentration below 20 million/ml is defined as **Oligozoospermia**. **Analysis of Options:** * **A (10 million/ml):** This is considered subnormal (Oligozoospermia). While pregnancy can still occur, the statistical probability of natural conception is significantly reduced. * **B (20 million/ml):** This is the traditional WHO threshold for a normal sperm concentration. (Note: The newer WHO 5th and 6th editions have lowered this to 15 million/ml, but 20 million/ml remains the classic "high-yield" answer in many Indian competitive exams unless specified otherwise). * **C & D (40-50 million/ml):** These values are well within the normal range but do not represent the *minimum* threshold defined by the WHO for a "normal" count. **High-Yield Clinical Pearls for NEET-PG:** 1. **Definitions:** * **Azoospermia:** Total absence of sperm in semen. * **Aspermia:** Absence of semen (ejaculate). * **Asthenozoospermia:** Reduced sperm motility ( 50% (Grade a+b) or >25% (Grade a) * Morphology: >30% normal forms (Strict criteria: >14%)

Question 1

Which of the following is NOT a side effect of clomiphene citrate?

Accepted Answer

Teratogenic effects on offspring

Answer

Multiple pregnancy

Answer

Increased risk of ovarian cancer

Answer

Multiple polycystic ovaries

Question 2

A male patient presents with azoospermia. On examination, testicular size is normal, FSH is normal, and testosterone levels are normal. What is the most probable cause?

Accepted Answer

Vas obstruction

Answer

Maldescended testis

Answer

Klinefelter's syndrome

Answer

Kallmann's syndrome

Question 3

A married patient for 3 years is unable to conceive despite having regular menstrual cycles. Her husband's semen analysis and hormonal profile are normal. What is the optimal timing in the menstrual cycle to perform an endometrial biopsy for infertility evaluation?

Accepted Answer

Days 20-22

Answer

Days 12-14

Answer

Days 17-19

Answer

Days 3-5

Question 4

According to the 2010 WHO criteria, what are the characteristics of normal semen analysis?

Accepted Answer

Volume 1.5 mL, sperm count 15 million/mL, morphology 4%, progressive motility 32%

Answer

Volume 2.0 mL, sperm count 20 million/mL, morphology 4%, progressive motility 32%

Answer

Volume 2.0 mL, sperm count 15 million/mL, morphology 40%, progressive motility 32%

Answer

Volume 1.5 mL, sperm count 20 million/mL, morphology 4%, progressive motility 32%

Question 5

Which of the following is NOT an essential criterion according to WHO for normal semen analysis?

Accepted Answer

Volume > 1.5 ml

Answer

Sperm count > 20 million/ml

Answer

Sperm with normal morphology (strict criteria) > 15%

Answer

Motility > 25% with rapidly progressive motility

Question 6

In which case homologous artificial insemination is used in females?

Accepted Answer

Cervical factor

Answer

Hormonal disturbance

Answer

Tubal block

Answer

All of the above

Question 7

All of the following are tubal patency tests EXCEPT?

Accepted Answer

Fern test

Answer

Tubal CO2 insufflation test

Answer

Laparoscopy

Answer

HSG

Question 8

What is the most common cause of male infertility?

Accepted Answer

Varicocele

Answer

Smoking

Answer

Epididymitis

Answer

Idiopathic

Question 9

A 35-year-old woman presents with delayed menstrual cycles and a history of primary infertility. Laparoscopic examination reveals a normal uterus, bilateral enlarged ovaries, and normal fallopian tubes. Chromotubation shows blue dye spillage. What is the most probable cause?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

Endometriosis

Answer

Ovarian cyst

Answer

Tubo-ovarian mass

Question 10

According to the WHO definition, what is considered a normal sperm count?

Accepted Answer

20 million/ml

Answer

10 million/ml

Answer

40 million/ml

Answer

50 million/ml

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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