Fertility and Infertility — MCQs
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Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?
A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:
The phenomenon of conception of a woman due to deposition of semen on vulva without vaginal penetration is called as
When should semen analysis be done?
Ring of fire on USG signifies-
Which of the following structures has the function of capacitation?
What is the cause of a twin pregnancy resulting from two different men?
WHO guidelines for minimal sperm count is:
Medical treatment of ectopic pregnancy is :
Which of the following is an indication for medical management in ectopic pregnancy?
Fertility and Infertility Indian Medical PG Practice Questions and MCQs
Question 231: Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?
- A. Tuboplasty
- B. Laparoscopy and hysteroscopy (Correct Answer)
- C. USG
- D. IVF
Explanation: ***Laparoscopy and hysteroscopy*** - A **laparoscopy** allows for direct visualization of the fallopian tubes to confirm the tubal obstruction and assess for other pelvic pathology like **endometriosis** or **adhesions**. - A **hysteroscopy** can be performed concurrently to inspect the uterine cavity and the tubal ostia for any intracavitary abnormalities or to attempt **canalization of the cornual block**. *Tuboplasty* - **Tuboplasty** is a corrective surgical procedure for tubal obstruction, but it is typically considered *after* a definitive diagnosis and assessment of the block's extent have been made via diagnostic procedures. - Its success rate varies depending on the location and nature of the block, and it is not the immediate next step for diagnosis. *USG* - **Transvaginal ultrasonography (USG)** is a useful tool for evaluating uterine and ovarian morphology but is generally *not definitive* for diagnosing tubal patency or specific locations of tubal blockage. - While it can identify some pathologies, it cannot visualize the fallopian tubes with sufficient clarity to determine cornual obstruction. *IVF* - **In vitro fertilization (IVF)** is an *assisted reproductive technology* used to bypass tubal factor infertility, but it is a treatment option, not a diagnostic step. - It would be considered *after* a full diagnostic workup has confirmed the tubal blockage and other fertility factors, and after counseling regarding prognosis and success rates.
Question 232: A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:
- A. Adenomyosis
- B. Endometriosis (Correct Answer)
- C. Cervicitis
- D. Myomas
Explanation: ***Endometriosis*** - The classic triad of symptoms in this 29-year-old female—**dysmenorrhea**, **dyspareunia**, and **infertility**—is highly suggestive of endometriosis. - **Ectopic endometrial tissue** can cause chronic abdominal pain, menorrhagia, and inflammation, contributing to infertility. *Adenomyosis* - This condition involves the presence of **endometrial tissue within the myometrium**, leading to a thickened uterine wall. - While it can cause dysmenorrhea and menorrhagia, **infertility** is not its primary presentation, and it is less commonly associated with severe dyspareunia compared to endometriosis. *Cervicitis* - **Inflammation of the cervix** typically presents with vaginal discharge, post-coital bleeding, or pelvic pain. - It is not a common cause of primary infertility, severe dysmenorrhea, or dyspareunia as described. *Myomas* - Uterine **fibroids (leiomyomas)** are benign tumors that can cause heavy menstrual bleeding (menorrhagia), pelvic pressure, and sometimes infertility. - However, they are less commonly associated with the triad of severe dysmenorrhea and dyspareunia as prominently as seen in endometriosis.
Question 233: The phenomenon of conception of a woman due to deposition of semen on vulva without vaginal penetration is called as
- A. Fecundation ab extra (Correct Answer)
- B. Vaginismus
- C. Superfoetation
- D. Superfecundation
Explanation: ***Fecundation ab extra*** - This term precisely describes conception from semen deposited on the **vulva** or external genitalia without actual **vaginal penetration**. - It means "fertilization from outside" and implies that **sperm** can travel from the *vulva* to the uterus and fertilize an egg. *Vaginismus* - This is a condition characterized by involuntary **spasms** of the muscles surrounding the vagina, leading to painful or impossible penetration. - It is a sexual dysfunction and does not relate to the mechanism of conception itself. *Superfoetation* - This refers to the rare phenomenon where a pregnant woman conceives again, resulting in two fetuses of different **gestational ages** in the uterus. - It involves a new conception during an existing pregnancy, not external fertilization. *Superfecundation* - This occurs when two or more ova from the same ovulatory cycle are fertilized by sperm from **different acts of intercourse**, potentially from different partners. - It involves fertilization within the vagina or uterus from distinct sexual encounters, not external fertilization on the vulva.
Question 234: When should semen analysis be done?
- A. After 30-60 mins irrespective of liquefaction
- B. As early as possible
- C. After liquefaction with thorough mixing (Correct Answer)
- D. After 15-30 mins irrespective of liquefaction
Explanation: ***After liquefaction with thorough mixing*** - Semen analysis should be performed **after complete liquefaction** (typically within 20-30 minutes, maximum 60 minutes) followed by **thorough mixing**. - According to **WHO guidelines (2010, 2021)**, the sample must first liquefy completely at room temperature, then be mixed well before microscopic examination. - This ensures accurate assessment of **sperm concentration, motility, and morphology** without artifacts from viscous semen. - The standard practice is to examine within **60 minutes of collection** but only after liquefaction is complete. *After 30-60 mins irrespective of liquefaction* - The phrase "irrespective of liquefaction" is **incorrect** as analysis before complete liquefaction leads to inaccurate results. - Performing analysis on a non-liquefied sample can cause **underestimation of sperm motility** and difficulty in proper microscopic assessment. - Liquefaction status must be assessed before proceeding with analysis. *As early as possible* - Analyzing too early before **liquefaction** (which typically takes 20-30 minutes) will yield inaccurate results. - A viscous, non-liquefied sample impairs proper **sperm movement assessment** and mixing. *After 15-30 mins irrespective of liquefaction* - While 30 minutes may be sufficient for many samples to liquefy, the phrase "irrespective of liquefaction" makes this incorrect. - Some samples may require up to **60 minutes** to liquefy completely, and analysis should not proceed until liquefaction is confirmed.
Question 235: Ring of fire on USG signifies-
- A. H. mole
- B. Aneuploidy
- C. PCOD
- D. Ectopic pregnancy (Correct Answer)
Explanation: ***Ectopic pregnancy*** - The \"ring of fire\" sign on ultrasound indicates increased vascularity around an **extrauterine gestational sac** or mass due to the surrounding trophoblastic tissue. - This Doppler finding is characteristic of an **ectopic pregnancy**, where a fertilized egg implants outside the uterus. *H. mole* - A **hydatidiform mole** (H. mole) typically presents with a \"snowstorm\" or \"grape-like cluster\" appearance on ultrasound, representing swollen chorionic villi. - While it involves abnormal trophoblastic proliferation, the classic **ring of fire** is not its defining ultrasound feature. *Aneuploidy* - **Aneuploidy** refers to an abnormal number of chromosomes and is detected through genetic testing or indicated by specific fetal anomalies on ultrasound. - It does not directly manifest as a \"ring of fire\" on ultrasound; this is a sign of abnormal gestational tissue vascularity. *PCOD* - **Polycystic Ovary Disease (PCOD)** is characterized by numerous small cysts in the ovaries (\"string of pearls\" appearance) and hormonal imbalances. - The \"ring of fire\" sign is not associated with PCOD; it is an indicator of vascular flow in a gestational sac.
Question 236: 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.
Question 237: What is the cause of a twin pregnancy resulting from two different men?
- A. Superfetation
- B. Both superfetation and superfecundation
- C. Not a real possibility
- D. Superfecundation (Correct Answer)
Explanation: ***Superfecundation*** - **Superfecundation** is the fertilization of two or more ova from the same ovulatory cycle by sperm from **different acts of coitus**, potentially involving different partners. - This is the **correct answer** because it specifically explains how fraternal twins can have different biological fathers when a woman has sexual intercourse with two different men within a short time frame during the same ovulatory cycle. - **Heteropaternal superfecundation** (twins with different fathers) is rare but well-documented, and can be confirmed through DNA paternity testing. *Superfetation* - **Superfetation** involves the fertilization of an ovum during a **separate ovulatory cycle** that occurs after an initial pregnancy has already been established. - This results in two fetuses of **different gestational ages** in the uterus simultaneously, which is an extremely rare phenomenon. - This does not explain twins from different fathers in the **same gestational period**. *Both superfetation and superfecundation* - This is incorrect because only **superfecundation** explains the specific scenario of twins with different fathers conceived during the same ovulatory cycle. - Superfetation refers to a different phenomenon involving separate pregnancies at different developmental stages. *Not a real possibility* - This is incorrect; heteropaternal superfecundation is a **documented biological phenomenon**, though rare. - Cases have been confirmed through **DNA paternity testing**, proving that twins can indeed have different biological fathers.
Question 238: WHO guidelines for minimal sperm count is:
- A. 50 million/ ml
- B. 10 million/ ml
- C. 15 million/ml (Correct Answer)
- D. 20 million/ml
Explanation: ***15 million/ml*** - According to **WHO 2010 guidelines** (reaffirmed in WHO 2021), the lower reference limit for sperm concentration is **15 million/ml**. - This represents the **5th percentile** of fertile men and is the current standard for defining normal sperm count. - Values below 15 million/ml indicate **oligospermia** and may be associated with reduced fertility. *20 million/ml* - This was the threshold in the **older WHO 1999 guidelines**. - While this indicates good fertility, it is **not the current minimal threshold** according to modern WHO criteria. - Current WHO guidelines have revised this downward to 15 million/ml based on updated reference populations. *10 million/ml* - A sperm count of 10 million/ml is considered **oligospermia** (low sperm count). - This concentration is **below the normal range** and indicates potential **male factor infertility**. - Further evaluation and possible treatment would be recommended. *50 million/ml* - While 50 million/ml indicates excellent fertility, it is **not the minimal threshold**. - This count is well above the lower reference limit and represents optimal sperm concentration. - This is not relevant when defining the minimum normal value.
Question 239: Medical treatment of ectopic pregnancy is :
- A. Oestrogen
- B. Adriamycin
- C. Progesterone
- D. Methotrexate (Correct Answer)
Explanation: ***Methotrexate*** - **Methotrexate** is the primary medical treatment for **unruptured ectopic pregnancies** in stable patients. - It works by inhibiting **folate reductase**, stopping rapidly dividing cells, which leads to the dissolution of the ectopic gestational tissue. *Oestrogen* - **Oestrogen** (estrogen) is a female sex hormone primarily involved in the development and regulation of the female reproductive system and secondary sex characteristics. - It is not used to treat ectopic pregnancies and may even promote growth of uterine tissue, which is not desired in this context. *Adriamycin* - **Adriamycin** (doxorubicin) is an **anthracycline chemotherapy agent** used primarily in the treatment of various cancers. - It has significant side effects and is not indicated for the treatment of ectopic pregnancy. *Progesterone* - **Progesterone** is a hormone essential for maintaining pregnancy and is often used to support early pregnancies, especially in cases of threatened miscarriage. - It would work against the goal of terminating an ectopic pregnancy and is therefore contraindicated.
Question 240: Which of the following is an indication for medical management in ectopic pregnancy?
- A. Presence of fetal heart activity
- B. Size <4 cm (Correct Answer)
- C. Gestation <6 weeks
- D. β-hCG>1500
Explanation: ***Correct: Size <4 cm*** - An **ectopic pregnancy** with a maximum diameter of **less than 3.5-4 cm** without fetal cardiac activity is a suitable candidate for medical management with **methotrexate**. - This criterion indicates a smaller, less advanced ectopic pregnancy, making medical intervention more likely to be successful and reducing the risk of complications like **rupture**. - Larger masses (>4 cm) have higher failure rates with medical management. *Incorrect: Presence of fetal heart activity* - The presence of **fetal heart activity** is a **contraindication** for medical management with methotrexate. - **Absence of fetal cardiac activity** is required for medical management eligibility. - When cardiac activity is present, surgical intervention is preferred due to **lower success rates** of methotrexate and increased risk of **persistent ectopic pregnancy** or **rupture**. *Incorrect: Gestation <6 weeks* - While early gestational age may correlate with smaller ectopic masses, **gestational age alone is not a primary criterion** for medical management. - The **size of the ectopic mass**, **absence of fetal cardiac activity**, and **β-hCG levels** are more critical factors. - Many ectopic pregnancies are diagnosed before reliable gestational age determination. *Incorrect: β-hCG>1500* - For medical management eligibility, **β-hCG should be <5000 mIU/mL** (some protocols accept <10,000 mIU/mL). - **Lower β-hCG levels** are associated with **higher success rates** for methotrexate therapy. - A β-hCG >1500 mIU/mL doesn't define suitability; rather, levels **>5000 mIU/mL** are associated with decreased efficacy and increased failure rates.
Practice by Chapter
Reproductive Physiology
Practice Questions
Evaluation of the Infertile Couple
Practice Questions
Male Factor Infertility
Practice Questions
Female Factor Infertility
Practice Questions
Ovulatory Disorders
Practice Questions
Tubal and Peritoneal Factors
Practice Questions
Uterine Factors
Practice Questions
Unexplained Infertility
Practice Questions
Assisted Reproductive Technologies
Practice Questions
Psychological Aspects of Infertility
Practice Questions
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