Fertility and Infertility Practice Questions

Q: Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?

Laparoscopy and hysteroscopy. ***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.

Q: A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Endometriosis. ***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.

Q: The phenomenon of conception of a woman due to deposition of semen on vulva without vaginal penetration is called as

Fecundation ab extra. ***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.

Q: When should semen analysis be done?

After liquefaction with thorough mixing. ***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.

Q: Ring of fire on USG signifies-

Ectopic pregnancy. ***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.

Q: Which of the following structures has the function of capacitation?

Female reproductive tract. ***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.

Q: What is the cause of a twin pregnancy resulting from two different men?

Superfecundation. ***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.

Q: WHO guidelines for minimal sperm count is:

15 million/ml. ***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.

Q: Medical treatment of ectopic pregnancy is :

Methotrexate. ***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.

Q: Which of the following is an indication for medical management in ectopic pregnancy?

Size <4 cm. ***Correct: Size 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 1500* - For medical management eligibility, **β-hCG should be 1500 mIU/mL doesn't define suitability; rather, levels **>5000 mIU/mL** are associated with decreased efficacy and increased failure rates.

Question 1

Lady presents with infertility and diagnosed with bilateral cornual block on hysterosalpingography. What is the next step?

Accepted Answer

Laparoscopy and hysteroscopy

Answer

Tuboplasty

Answer

USG

Answer

IVF

Question 2

A 29 year old female presented with infertility. There is history of abdominal pain, dyspareunia, dysmenorrhea, menorrhagia. Most likely cause:

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Cervicitis

Answer

Myomas

Question 3

The phenomenon of conception of a woman due to deposition of semen on vulva without vaginal penetration is called as

Accepted Answer

Fecundation ab extra

Answer

Vaginismus

Answer

Superfoetation

Answer

Superfecundation

Question 4

When should semen analysis be done?

Accepted Answer

After liquefaction with thorough mixing

Answer

After 30-60 mins irrespective of liquefaction

Answer

As early as possible

Answer

After 15-30 mins irrespective of liquefaction

Question 5

Ring of fire on USG signifies-

Accepted Answer

Ectopic pregnancy

Answer

H. mole

Answer

Aneuploidy

Answer

PCOD

Question 6

Which of the following structures has the function of capacitation?

Accepted Answer

Female reproductive tract

Answer

Male reproductive tract

Answer

Vas deferens

Answer

Capillary

Question 7

What is the cause of a twin pregnancy resulting from two different men?

Accepted Answer

Superfecundation

Answer

Superfetation

Answer

Both superfetation and superfecundation

Answer

Not a real possibility

Question 8

WHO guidelines for minimal sperm count is:

Accepted Answer

15 million/ml

Answer

50 million/ ml

Answer

10 million/ ml

Answer

20 million/ml

Question 9

Medical treatment of ectopic pregnancy is :

Accepted Answer

Methotrexate

Answer

Oestrogen

Answer

Adriamycin

Answer

Progesterone

Question 10

Which of the following is an indication for medical management in ectopic pregnancy?

Accepted Answer

Size <4 cm

Answer

Presence of fetal heart activity

Answer

Gestation <6 weeks

Answer

β-hCG>1500

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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