Fertility and Infertility Practice Questions

Q: Which of the following is NOT a risk factor for ectopic pregnancy?

LNG IUCD. ***LNG IUCD*** - A **levonorgestrel-releasing intrauterine contraceptive device (LNG IUCD)** significantly reduces the risk of **both intrauterine and ectopic pregnancies**. - While it doesn't completely eliminate the risk of ectopic pregnancy, the overall absolute risk is very low, making it a protective factor against pregnancy in general. *Past history* - A **history of ectopic pregnancy** is a significant risk factor for future ectopic pregnancies due to **pre-existing tubal damage**. - A previous ectopic pregnancy increases the recurrence risk from 10% to 25%. *Tubal ligation failure* - If a **tubal ligation** fails, there is a higher chance of the subsequent pregnancy being **ectopic** because the fallopian tube may have been damaged or partially obstructed during the procedure. - This damage creates an environment conducive to implantation outside the uterus. *IVF* - **In vitro fertilization (IVF)** is a known risk factor for ectopic pregnancy, even though embryos are placed directly into the uterus. - Embryo transfer can sometimes lead to **retrograde migration of the embryo** into the fallopian tubes, or there may be underlying tubal issues in women undergoing IVF.

Q: Abstinence period before semen analysis is?

3-5 days. ***3-5 days*** - An abstinence period of **3-5 days** is recommended before semen analysis to ensure optimal sperm concentration and motility for accurate results, as per World Health Organization (WHO) guidelines. - This period allows for the accumulation of a sufficient number of mature sperm while avoiding the negative effects of prolonged abstinence on sperm quality. *1-2 days* - An abstinence period of **1-2 days** is generally too short and may result in a falsely low sperm concentration. - This duration does not allow for adequate replenishment of sperm in the epididymis. *5-7 days* - While a longer period might increase sperm count, **abstinence exceeding 5 days** can negatively impact sperm motility and morphology due to increased exposure to reactive oxygen species and cellular degradation. - This can lead to a suboptimal sample for evaluation. *7-9 days* - An abstinence period of **7-9 days** is generally considered too long, leading to a significant decrease in sperm quality, particularly **motility** and **viability**. - Prolonged abstinence can result in an abnormal semen analysis due to the accumulation of older, less viable sperm.

Q: What is the procedure used in preimplantation genetic diagnosis (PGD) to obtain cells from an embryo for genetic analysis before transferring it to the uterus during IVF?

Embryo cell biopsy. ***Embryo cell biopsy*** - **Embryo cell biopsy** is the procedure used to remove one or more cells from an early embryo (typically at the cleavage stage on day 3 or blastocyst stage on day 5) for genetic analysis in PGD. - The biopsied cells are then tested for **genetic abnormalities** using techniques like FISH (Fluorescence In Situ Hybridization), PCR (Polymerase Chain Reaction), or Next Generation Sequencing (NGS). - This allows selection of chromosomally normal or unaffected embryos for transfer during IVF, preventing transmission of genetic disorders. *CVS* - **Chorionic Villus Sampling (CVS)** is a prenatal diagnostic procedure performed during an established pregnancy, typically between 10 and 13 weeks of gestation. - CVS involves obtaining placental tissue to test for genetic abnormalities in the fetus, but occurs **after implantation**, not before embryo transfer. *ICSI* - **Intracytoplasmic Sperm Injection (ICSI)** is an assisted reproductive technique where a single sperm is directly injected into an oocyte to facilitate fertilization. - ICSI is a fertilization method, not a diagnostic procedure for detecting **genetic abnormalities** in embryos. *None of the options* - This option is incorrect because **Embryo cell biopsy** is the established procedure used in PGD to obtain embryonic cells for subsequent genetic testing.

Q: Azoospermic patient can be a father of a child, by which of the following?

ICSI. ***ICSI*** - **Intracytoplasmic sperm injection (ICSI)** involves injecting a single sperm directly into an egg, making it the procedure of choice for men with **severe male factor infertility**, including azoospermia. - Even with **azoospermia** (absence of sperm in ejaculate), sperm can be surgically retrieved from the **epididymis (PESA/MESA)** or **testes (TESA/TESE)** and used for ICSI. - This allows biological fatherhood even in cases of **obstructive** or **non-obstructive azoospermia**. *IUI* - **Intrauterine insemination (IUI)** involves placing washed sperm directly into the uterus. - Requires a sufficient number of **motile sperm** in the ejaculate. - **Not effective for azoospermia** as there is no sperm in the ejaculate to be inseminated. *ZIFT* - **Zygote intrafallopian transfer (ZIFT)** involves fertilizing eggs in vitro and transferring the resulting zygotes into the fallopian tube. - Requires viable sperm for fertilization, making it unsuitable as a primary option for azoospermic patients. - If sperm retrieval is performed, ICSI would be the fertilization method used, not traditional ZIFT. *Not possible & counsel regarding adoption* - While adoption is a valid option, advances in reproductive technology, particularly **ICSI with sperm retrieval techniques (TESE/PESA)**, offer a chance for biological parenthood even in cases of azoospermia. - This statement represents an **outdated approach** and is incorrect given current ART capabilities.

Q: Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?

Day 21-23. ***Day 21-23*** - An **endometrial biopsy** performed around **day 21-23** of a typical 28-day cycle coincides with the **luteal phase**, when progesterone levels are high after ovulation. - This timing allows for the examination of **secretory changes** in the endometrium, which are indicative of successful ovulation and progesterone influence. *Day 8-9* - This period is during the **late follicular phase**, prior to ovulation. - The endometrium would still be in the **proliferative phase**, showing no signs of progesterone-induced secretory changes. *Day 13-15* - This timeframe is typically around the expected time of **ovulation** itself. - An endometrial biopsy during this period would likely show a **transitional or early secretory phase**, making it difficult to definitively confirm post-ovulatory changes. *Day 3-5* - This is the **menstrual phase**, when the uterine lining is being shed. - An endometrial biopsy at this time would primarily show **shedding and regenerative changes**, not features indicative of the secretory phase following ovulation.

Q: Chlamydia trachomatis infection commonly causes: March 2004

Infertility. ***Infertility*** - **Chlamydia trachomatis** is the **leading cause of preventable infertility** worldwide. - It commonly causes **pelvic inflammatory disease (PID)**, which leads to **tubal scarring and blockage** of the fallopian tubes. - **Tubal damage** from PID is a major cause of female infertility and significantly increases the risk of **ectopic pregnancy**. - This is the **most common long-term complication** of chlamydial infection. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) is not a direct or common complication of **Chlamydia trachomatis** infection. - Chlamydia causes **local reproductive tract inflammation**, not hormonal disruption leading to amenorrhea. *Malignancy* - **Chlamydia trachomatis** is not linked to cervical or reproductive organ cancers. - **Human Papillomavirus (HPV)** is the primary infectious agent associated with cervical malignancy, not Chlamydia. *Post coital bleeding* - While **Chlamydia can cause cervicitis** with a friable cervix that may result in post-coital bleeding, this is **not the most common or significant complication**. - **Infertility** is far more common as a long-term consequence of untreated chlamydial infection, making it the best answer to what Chlamydia "commonly causes."

Q: Clomiphene citrate is primarily used for treating which condition in women?

Anovulation in women. ***Anovulation in women*** - **Clomiphene citrate** is a selective estrogen receptor modulator (SERM) that blocks estrogen receptors in the hypothalamus, leading to increased **GnRH** pulsatility and subsequently increased **FSH** and **LH** release. - This surge in **gonadotropins** stimulates follicular development and ovulation, making it a primary treatment for **anovulatory infertility**. *Menorrhagia during puberty* - **Menorrhagia** (heavy menstrual bleeding) during puberty is often related to an **immature hypothalamic-pituitary-ovarian axis**, leading to anovulatory cycles. - While clomiphene induces ovulation, it is not the primary treatment for managing **menorrhagia** in adolescents; hormonal therapies like oral contraceptives or progestins are typically used. *Hormonal therapy for menopause* - **Menopause** is characterized by ovarian failure and a significant decline in estrogen production. - **Clomiphene** is used to stimulate ovulation, not to replace hormones or manage menopausal symptoms, which are typically treated with **hormone replacement therapy (HRT)**. *Infertility due to endometriosis* - **Endometriosis** causes infertility through various mechanisms including anatomical distortion, inflammation, and altered peritoneal fluid, which clomiphene does not directly address. - Treatment for **endometriosis-related infertility** often involves surgical removal of endometrial implants, assisted reproductive technologies, or hormonal suppression therapy.

Q: Which of the following is a risk factor for ectopic pregnancy?

All of the options. ***All of the options*** - **Intrauterine contraceptive devices (IUCDs)**, a history of **infertility**, and **tubal endometriosis** are all recognized risk factors for ectopic pregnancy. - These factors either interfere with normal tubal function and ovum transport or create an environment conducive to implantation outside the uterus. *IUCD* - While IUCDs are highly effective at preventing intrauterine pregnancies, they do not prevent ectopic pregnancies with the same efficacy, thus slightly *increasing the relative risk* of an ectopic pregnancy if a pregnancy does occur. - The presence of an IUCD can also induce a mild inflammatory reaction in the fallopian tubes, potentially impairing normal ciliary function and ovum transport. *History of infertility* - Many causes of infertility, such as **pelvic inflammatory disease (PID)**, **endometriosis**, or previous **tubal surgery**, can damage the fallopian tubes and impair their ability to transport a fertilized egg to the uterus. - Infertility treatments, particularly those involving **assisted reproductive technologies (ART)**, can also increase the risk of ectopic pregnancy due to manipulation of gametes and embryos. *Tubal endometriosis* - **Endometriotic implants** within the fallopian tubes can cause structural damage, inflammation, scarring, and alterations in the tubal motility. - These changes can obstruct or slow the passage of a fertilized egg, leading to its implantation within the tube rather than the uterus.

Q: Most common cause of early abortion?

Genetic. ***Correct: Genetic*** - **Chromosomal abnormalities**, such as aneuploidy, are the most frequent cause of **spontaneous abortions**, especially early in pregnancy (accounting for **50-60% of first-trimester losses**). - These genetic errors often lead to **non-viable embryos**, resulting in early pregnancy loss. - Most common abnormalities include **trisomies** (especially trisomy 16), **monosomy X**, and **triploidy**. *Incorrect: Maternal* - While maternal factors like **diabetes** or **thyroid dysfunction** can contribute to abortion, they are less common causes of early abortion compared to genetic issues. - Systemic maternal health problems usually account for a smaller percentage of all miscarriages. *Incorrect: Immunologic* - **Autoimmune disorders** like **antiphospholipid syndrome** can cause recurrent pregnancy loss, but they are not the primary cause of the majority of early, sporadic abortions. - These are typically considered in cases of **recurrent miscarriages**, not usually the first or early spontaneous abortion. *Incorrect: Anatomic abnormalities* - **Uterine anomalies** (e.g., septate uterus) or **cervical incompetence** can lead to recurrent pregnancy loss, particularly in the later first or second trimester. - However, they are less frequently the cause of very early, isolated miscarriages compared to genetic factors.

Q: Which of the following is not a risk factor for ectopic pregnancy?

Barrier methods of contraception (e.g., condoms). ***Barrier methods of contraception (e.g., condoms)*** - **Barrier methods** like condoms prevent fertilization entirely by blocking sperm-egg interaction - They do not alter tubal anatomy, tubal motility, or hormonal environment - Therefore, they are **NOT a risk factor** for ectopic pregnancy and represent the correct answer to this negation question *OCP (in cases of contraceptive failure)* - Oral contraceptive pills (OCPs) **dramatically reduce the overall risk of all pregnancies**, including ectopic pregnancies - If contraceptive failure occurs, OCPs do not increase ectopic risk—they do not cause tubal damage or dysfunction - The parenthetical qualifier "(in cases of contraceptive failure)" in the option is medically imprecise; **OCPs themselves are NOT a risk factor for ectopic pregnancy** - Note: Some epidemiological studies show a higher **proportion** of ectopic among the rare pregnancies that occur on OCPs, but this is a statistical artifact, not a causal relationship *PID* - **Pelvic inflammatory disease (PID)** is a **major established risk factor** for ectopic pregnancy - It causes inflammation, scarring, and adhesions of the **fallopian tubes** - This tubal damage impedes normal transport of the fertilized ovum to the uterus, leading to ectopic implantation - PID increases ectopic risk by 6-10 fold *Previous ectopic pregnancy* - A history of **previous ectopic pregnancy** is one of the **strongest risk factors** for recurrence - It indicates underlying tubal pathology (damage, dysfunction, or anatomical abnormality) - Recurrence risk is approximately **10-25%** in subsequent pregnancies - This reflects persistent tubal factors that predispose to abnormal implantation

Question 1

Which of the following is NOT a risk factor for ectopic pregnancy?

Accepted Answer

LNG IUCD

Answer

Past history

Answer

Tubal ligation failure

Answer

IVF

Question 2

Abstinence period before semen analysis is?

Accepted Answer

3-5 days

Answer

1-2 days

Answer

5-7 days

Answer

7-9 days

Question 3

What is the procedure used in preimplantation genetic diagnosis (PGD) to obtain cells from an embryo for genetic analysis before transferring it to the uterus during IVF?

Accepted Answer

Embryo cell biopsy

Answer

CVS

Answer

ICSI

Answer

None of the options

Question 4

Azoospermic patient can be a father of a child, by which of the following?

Accepted Answer

ICSI

Answer

IUI

Answer

ZIFT

Answer

Not possible & counsel regarding adoption

Question 5

Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?

Accepted Answer

Day 21-23

Answer

Day 8-9

Answer

Day 13-15

Answer

Day 3-5

Question 6

Chlamydia trachomatis infection commonly causes: March 2004

Accepted Answer

Infertility

Answer

Malignancy

Answer

Amenorrhoea

Answer

Post coital bleeding

Question 7

Clomiphene citrate is primarily used for treating which condition in women?

Accepted Answer

Anovulation in women

Answer

Menorrhagia during puberty

Answer

Hormonal therapy for menopause

Answer

Infertility due to endometriosis

Question 8

Which of the following is a risk factor for ectopic pregnancy?

Accepted Answer

All of the options

Answer

History of infertility

Answer

IUCD

Answer

Tubal endometriosis

Question 9

Most common cause of early abortion?

Accepted Answer

Genetic

Answer

Maternal

Answer

Immunologic

Answer

Anatomic abnormalities

Question 10

Which of the following is not a risk factor for ectopic pregnancy?

Accepted Answer

Barrier methods of contraception (e.g., condoms)

Answer

PID

Answer

Previous ectopic pregnancy

Answer

OCP (in cases of contraceptive failure)

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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