Fertility and Infertility Practice Questions

Q: What will be the Hysterosalpingogram (HSG) finding?

Hydrosalpinx. ***Hydrosalpinx*** - The image, likely a hysterosalpingogram (HSG), shows a **dilated and fluid-filled fallopian tube** with no spillage of contrast into the peritoneal cavity, which is characteristic of hydrosalpinx. - The **contrast media fills the tubal lumen** but is unable to egress, indicating distal tubal obstruction and fluid accumulation. *Cornual block* - A cornual block would present as **obstruction at the uterine ostium** of the fallopian tube, preventing contrast from entering the tubal lumen. - In this image, contrast has clearly entered and dilated the fallopian tube, ruling out a cornual block. *Normal findings* - Normal HSG findings would show **patent fallopian tubes** with free spill of contrast into the peritoneal cavity. - The visible **dilation** and **lack of spill** in the image are distinctly abnormal. *Bicornuate uterus* - A bicornuate uterus is a **congenital uterine anomaly** characterized by two separate uterine horns. - While the uterus appears somewhat irregular, the dominant feature is the dilated fallopian tube, which is not a hallmark of a bicornuate uterus.

Q: Most common site for fertilization?

Ampulla. ***Ampulla*** - The **ampulla** of the **fallopian tube** is the widest and longest section, providing an ideal environment for the sperm and ovum to meet. - Fertilization most commonly occurs here, as it allows sufficient time for sperm capacitation and interaction with the egg. *Isthmus* - The **isthmus** is a narrow, thick-walled section of the fallopian tube, closer to the uterus. - While sperm may pass through here, it is not the primary site for fertilization. *Intramural* - The **intramural** (or interstitial) part is the segment of the fallopian tube that passes through the muscular wall of the uterus. - This narrowest part is not conducive to fertilization. *Fimbriae* - The **fimbriae** are finger-like projections at the end of the fallopian tube that capture the ovum after ovulation. - Their role is to direct the egg into the tube, not to be the site of fertilization.

Q: The window of implantation occurs at which of the following time periods after fertilization?

6-10 days. ***6-10 days*** - The uterus is most receptive to implantation during the **"window of implantation,"** which occurs roughly **6 to 10 days post-fertilization**, coinciding with the mid-luteal phase. - During this period, the **endometrial lining** undergoes specific changes, guided by hormonal signals from **progesterone**, making it optimal for the blastocyst to attach. *12 days* - While implantation can still occur, the **peak receptivity window** is generally considered to be narrower, between 6 and 10 days. - By day 12, changes in the **endometrial environment** may start to reduce the likelihood of successful implantation. *12 weeks* - **12 weeks** refer to the end of the first trimester of pregnancy and is far too late for the initial implantation event. - Implantation must have occurred much earlier for a viable pregnancy at this stage. *6 weeks* - **6 weeks** refers to an established pregnancy, at which point implantation would have occurred several weeks prior. - The process of implantation is completed within the first two weeks post-fertilization.

Q: Which of the following is not considered a marker of ovarian reserve?

Inhibin A. ***Inhibin A*** - **Inhibin A** levels primarily rise during the mid to late luteal phase and are involved in regulating FSH, but they are not a reliable or commonly used marker for **ovarian reserve**. - Its fluctuations are more indicative of the presence of a **corpus luteum** and short-term ovarian function rather than the total follicular pool. *Inhibin B* - **Inhibin B** is produced by granulosa cells of small antral follicles and is an important marker of **ovarian reserve**. - It inversely correlates with **FSH** levels in the early follicular phase, reflecting the number of developing follicles. *Ovarian volume* - **Ovarian volume**, particularly when measured by ultrasound, can be an indicator of **ovarian reserve**. - Smaller ovarian volume is generally associated with a reduced number of **antral follicles** and lower ovarian reserve. *Anti-Müllerian Hormone (AMH)* - **AMH** is a well-established and highly reliable marker of **ovarian reserve**, produced by the granulosa cells of preantral and small antral follicles. - Its levels correlate directly with the total number of remaining **primordial follicles** and are relatively stable throughout the menstrual cycle.

Q: Ovarian reserve is best indicated by

Anti-Müllerian Hormone (AMH). ***Anti-Müllerian Hormone (AMH)*** - **AMH is currently considered the best single biochemical marker** for assessing ovarian reserve - Produced by **granulosa cells of preantral and small antral follicles**, directly reflecting the size of the primordial follicle pool - **Cycle-independent** - can be measured at any time during the menstrual cycle - **More sensitive and specific** than FSH for detecting diminished ovarian reserve - **Minimal inter-cycle and intra-cycle variability**, providing consistent and reliable results - Widely used in **fertility assessment, IVF protocols**, and predicting ovarian response to stimulation *Follicle-stimulating hormone (FSH)* - Elevated **early follicular phase FSH** (measured on day 3) indicates diminished ovarian reserve - Historically the most commonly used marker, but **less sensitive than AMH** - **Cycle-dependent** - must be measured on specific days (day 2-4 of cycle) - A **late marker** - rises only when ovarian reserve is already significantly diminished - Still clinically useful and widely available, but not the "best" indicator *Luteinizing hormone (LH)* - **LH** primarily triggers ovulation and does not directly reflect ovarian reserve - Elevated in conditions like **PCOS** but does not assess the quantity or quality of remaining follicles - Not a reliable indicator of overall ovarian reserve *LH/FSH ratio* - An elevated **LH/FSH ratio** (>2:1 or >3:1) is associated with **Polycystic Ovary Syndrome (PCOS)** - Reflects anovulation and hormonal imbalance, not the number or viability of ovarian follicles - Does not assess ovarian reserve capacity

Q: What is the most common presenting symptom of TB endometritis?

Infertility. ***Infertility*** - **Infertility** is the most common presenting symptom of **tuberculosis (TB) endometritis**, particularly secondary infertility. - The infection leads to inflammation and scarring of the endometrium and fallopian tubes, impairing implantation and ovum transport. *Abdominal pain* - While **abdominal pain** can occur in TB endometritis, it is typically a less frequent or prominent presenting symptom compared to infertility. - Pain often arises from pelvic inflammation or adhesions but is not the cardinal complaint that prompts diagnosis. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) can be a symptom, especially in advanced cases where there is significant destruction of the endometrium. - It is, however, less common than infertility as the initial presenting symptom. *Vaginal discharge* - **Vaginal discharge** is an uncommon symptom of TB endometritis. - When present, it is often non-specific and not characteristic enough to suggest TB as the underlying cause.

Q: Most common site of ectopic pregnancy is -

Tubal. ***Tubal*** - The **fallopian tubes** are the most common site for ectopic pregnancies, accounting for over **95%** of all cases. - This is because the fertilized ovum typically implants in the tube rather than reaching the uterus. *Abdominal* - **Abdominal ectopic pregnancies** are rare, occurring when the fertilized egg implants in the abdominal cavity. - They account for about **1%** of all ectopic pregnancies and often result in significant maternal complications. *Ovarian* - **Ovarian ectopic pregnancies** are very rare, occurring when the ovum is fertilized within the ovary itself. - They represent less than **1%** of all ectopic cases and can be difficult to diagnose. *Cervical* - **Cervical ectopic pregnancies** involve implantation within the cervical canal. - These are also very rare (less than **1%** of ectopic pregnancies) and are associated with a high risk of severe hemorrhage.

Question 1

What will be the Hysterosalpingogram (HSG) finding?

Accepted Answer

Hydrosalpinx

Answer

Cornual block

Answer

Normal findings

Answer

Bicornuate uterus

Question 2

A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. The ultrasound image is shown below. What is the most likely diagnosis?

Accepted Answer

OHSS

Answer

PCOS

Answer

Theca lutein cyst

Answer

Mucinous cystadenomas

Question 3

Most common site for fertilization?

Accepted Answer

Ampulla

Answer

Isthmus

Answer

Intramural

Answer

Fimbriae

Question 4

What is meant by Superfecundation?

Accepted Answer

Fertilization of two or more ova in different intercourses in same menstrual cycle

Answer

Fertilization of ova and then its division

Answer

Fertilization of two or more ova in one intercourse

Answer

Fertilization of second ovum after first one is already implanted

Question 5

The window of implantation occurs at which of the following time periods after fertilization?

Accepted Answer

6-10 days

Answer

12 days

Answer

12 weeks

Answer

6 weeks

Question 6

Which of the following is not considered a marker of ovarian reserve?

Accepted Answer

Inhibin A

Answer

Ovarian volume

Answer

Inhibin B

Answer

Anti-Müllerian Hormone (AMH)

Question 7

What is the most appropriate management for a 28-year-old hemodynamically stable patient with mild abdominal pain and an unruptured tubal ectopic pregnancy measuring 2.5 x 3 cm, with β-hCG level of 8500 mIU/mL, visible fetal cardiac activity, and who desires future fertility?

Accepted Answer

Laparoscopic salpingostomy

Answer

Methotrexate therapy

Answer

Laparoscopic salpingectomy

Answer

Expectant management

Question 8

Ovarian reserve is best indicated by

Accepted Answer

Anti-Müllerian Hormone (AMH)

Answer

Follicle-stimulating hormone (FSH)

Answer

Luteinizing hormone (LH)

Answer

LH/FSH ratio

Question 9

What is the most common presenting symptom of TB endometritis?

Accepted Answer

Infertility

Answer

Amenorrhoea

Answer

Vaginal discharge

Answer

Abdominal pain

Question 10

Most common site of ectopic pregnancy is -

Accepted Answer

Tubal

Answer

Cervical

Answer

Abdominal

Answer

Ovarian

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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