Fertility and Infertility — MCQs
On this page
Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?
Azoospermic patient can be a father of a child, by which of the following?
What is the best indicator for ovarian reserve?
In a case of recurrent spontaneous abortion, which of the following investigations is least indicated?
Abstinence period before semen analysis is?
Chlamydia trachomatis infection commonly causes: March 2004
Which of the following is not a risk factor for ectopic pregnancy?
Clomiphene citrate is primarily used for treating which condition in women?
Which of the following is a risk factor for ectopic pregnancy?
Most common cause of early abortion?
Fertility and Infertility Indian Medical PG Practice Questions and MCQs
Question 271: Endometrial biopsy to detect ovulation is done on which day of the menstrual cycle?
- A. Day 8-9
- B. Day 13-15
- C. Day 21-23 (Correct Answer)
- D. Day 3-5
Explanation: ***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.
Question 272: Azoospermic patient can be a father of a child, by which of the following?
- A. IUI
- B. ZIFT
- C. ICSI (Correct Answer)
- D. Not possible & counsel regarding adoption
Explanation: ***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.
Question 273: What is the best indicator for ovarian reserve?
- A. Follicle Stimulating Hormone (FSH) - Day 2-3 cycle marker
- B. Estradiol (E2) - Fluctuates during cycle
- C. Anti-Müllerian Hormone (AMH) - Reflects antral follicle count (Correct Answer)
- D. LH/FSH ratio - Relevant in PCOS diagnosis
Explanation: ***Anti-Müllerian Hormone (AMH) - Reflects antral follicle count*** - **AMH** is produced by **granulosa cells** of small antral and pre-antral follicles and directly correlates with the size of the **primordial follicle pool**. - Its levels are stable throughout the menstrual cycle and are not affected by oral contraceptives, making it a reliable indicator of **ovarian reserve**. *Follicle Stimulating Hormone (FSH) - Day 2-3 cycle marker* - While **FSH** on cycle days 2-3 can be used as an indicator of ovarian reserve, its levels fluctuate and are inversely related to **inhibin B**, making them less stable than AMH. - An elevated basal FSH level indicates a diminished ovarian reserve, but it is not as sensitive or specific as AMH. *Estradiol (E2) - Fluctuates during cycle* - **Estradiol** levels fluctuate significantly throughout the menstrual cycle and are only meaningful when measured in conjunction with FSH on **cycle day 2-3**. - High basal estradiol can suppress FSH, masking a true elevation in FSH, making it a less direct and reliable marker for ovarian reserve on its own. *LH/FSH ratio - Relevant in PCOS diagnosis* - The **LH/FSH ratio** is primarily used in the diagnosis of **Polycystic Ovary Syndrome (PCOS)**, where a ratio of >2:1 or >3:1 suggests the condition. - It does not directly represent the quantity or quality of the remaining ovarian follicles, hence it is not an indicator of **ovarian reserve**.
Question 274: In a case of recurrent spontaneous abortion, which of the following investigations is least indicated?
- A. Thyroid function tests
- B. Testing for TORCH infections (Correct Answer)
- C. Hysteroscopy
- D. Testing for antiphospholipid antibodies
Explanation: ***Testing for TORCH infections*** - While TORCH infections (Toxoplasmosis, Other [syphilis, parvovirus B19, varicella-zoster], Rubella, Cytomegalovirus, Herpes simplex virus) can cause **spontaneous abortion**, they are **rarely a cause of recurrent spontaneous abortion**. - Recurrent infections are uncommon, making chronic or repeated TORCH infections an unlikely primary driver for multiple losses. *Hysteroscopy* - **Hysteroscopy** is often indicated to evaluate for **intrauterine structural abnormalities** such as septa, polyps, fibroids, or Asherman's syndrome, which can contribute to recurrent pregnancy loss. - These structural issues can interfere with implantation and uterine blood supply, leading to repeated abortions. *Thyroid function tests* - Both **hypothyroidism and hyperthyroidism** are associated with an increased risk of recurrent spontaneous abortion. - **Thyroid hormone imbalances** can disrupt ovulation, implantation, and early fetal development. *Testing for antiphospholipid antibodies* - **Antiphospholipid syndrome (APS)** is a significant and treatable cause of recurrent spontaneous abortion due to **thrombotic events** in the placental circulation. - Testing for lupus anticoagulant, anti-cardiolipin antibodies, and anti-beta-2 glycoprotein I antibodies is a **standard part of the workup** for recurrent pregnancy loss.
Question 275: Abstinence period before semen analysis is?
- A. 1-2 days
- B. 3-5 days (Correct Answer)
- C. 5-7 days
- D. 7-9 days
Explanation: ***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.
Question 276: Chlamydia trachomatis infection commonly causes: March 2004
- A. Infertility (Correct Answer)
- B. Malignancy
- C. Amenorrhoea
- D. Post coital bleeding
Explanation: ***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."
Question 277: Which of the following is not a risk factor for ectopic pregnancy?
- A. PID
- B. Previous ectopic pregnancy
- C. Barrier methods of contraception (e.g., condoms) (Correct Answer)
- D. OCP (in cases of contraceptive failure)
Explanation: ***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 278: Clomiphene citrate is primarily used for treating which condition in women?
- A. Anovulation in women (Correct Answer)
- B. Menorrhagia during puberty
- C. Hormonal therapy for menopause
- D. Infertility due to endometriosis
Explanation: ***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.
Question 279: Which of the following is a risk factor for ectopic pregnancy?
- A. History of infertility
- B. All of the options (Correct Answer)
- C. IUCD
- D. Tubal endometriosis
Explanation: ***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.
Question 280: Most common cause of early abortion?
- A. Genetic (Correct Answer)
- B. Maternal
- C. Immunologic
- D. Anatomic abnormalities
Explanation: ***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.
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
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free