Fertility and Infertility Practice Questions

Q: On which day LH & FSH should be measured?

1-3rd day. ***1-3rd day*** - Measuring **LH** (Luteinizing Hormone) and **FSH** (Follicle-Stimulating Hormone) on cycle days 1-3 provides a baseline assessment of **ovarian reserve** and pituitary function. - At this early follicular phase, hormone levels are relatively stable and reflect the intrinsic **gonadal feedback** mechanisms before significant follicular development begins. *7th day* - By day 7, **follicular development** is usually well underway, and FSH levels might be decreasing as a dominant follicle is selected. - Measuring hormones on this day would not provide an accurate baseline assessment, as the levels are already influenced by **follicular growth**. *14th day* - Day 14 is often associated with the **LH surge** that triggers ovulation, making it unsuitable for a baseline assessment of ovarian reserve. - FSH levels would also be significantly different from the early follicular phase due to the ongoing **ovarian cycle events**. *10th day* - On day 10, **estrogen levels** are typically rising, which would already be providing negative feedback to the pituitary, affecting FSH and LH levels. - This timing would not be ideal for assessing baseline hormone levels for **fertility evaluations**.

Q: Which drug is commonly used in the medical management of ectopic pregnancy?

Methotrexate. ***Correct: Methotrexate*** - **Methotrexate** is a **folic acid antagonist** that inhibits DNA synthesis and cell proliferation, making it effective in terminating early ectopic pregnancies by targeting rapidly dividing trophoblastic cells. - It is typically considered for **hemodynamically stable** patients with unruptured ectopic pregnancies, a beta-hCG level below a certain threshold (e.g., <5,000 mIU/mL), and no cardiac activity in the ectopic mass. - This is the **gold standard** for medical management of ectopic pregnancy meeting specific criteria. *Incorrect: Mifepristone* - **Mifepristone** is an **antiprogestin** primarily used for medical abortion of intrauterine pregnancies, causing detachment of the gestational sac and cervical ripening. - While it can be used in combination with misoprostol for medical abortion, it is **not the primary drug** for managing ectopic pregnancies. *Incorrect: Leuprolide* - **Leuprolide** is a **GnRH agonist** mainly used for conditions like endometriosis, uterine fibroids, and prostate cancer by suppressing ovarian or testicular hormone production. - It is **not used** in the direct medical management of ectopic pregnancy. *Incorrect: Carboprost* - **Carboprost** is a **prostaglandin F2-alpha analog** primarily used to treat **postpartum hemorrhage** by inducing strong uterine contractions. - It is **not indicated** for the treatment of ectopic pregnancy.

Q: What does teratozoospermia refer to?

Morphologically defective sperm. ***Morphologically defective sperm*** - **Teratozoospermia** specifically refers to the presence of an unusually high percentage of **abnormally shaped sperm** in an ejaculate. - These malformations can affect the **head, midpiece, or tail** of the sperm, potentially impairing its ability to fertilize an egg. *Low sperm count* - This condition is known as **oligozoospermia**, which refers to a sperm concentration below the normal range. - While low sperm count can affect fertility, it is distinct from issues with sperm morphology. *Sperm with abnormal motility* - This condition is called **asthenozoospermia**, characterized by reduced or absent sperm movement. - Poor motility impacts the sperm's ability to reach and penetrate the egg, but it is not directly related to sperm shape. *Absence of sperm in semen* - The complete absence of sperm in the ejaculate is known as **azoospermia**. - This is a severe form of male infertility, different from having sperm with structural defects.

Q: Human sperm remains fertile for how many hours in a female genital tract ?

Up to 5 days (120 hrs). ***Up to 5 days (120 hrs)*** - **Sperm viability** within the female reproductive tract can extend up to **5 days (120 hours)** under optimal conditions. - This extended viability is crucial for fertility, as it allows for fertilization even if ovulation occurs several days after intercourse. *6-8 hrs* - This timeframe is significantly **too short** for typical human sperm viability in the female genital tract. - While some sperm may lose motility or viability relatively quickly, a substantial portion remains viable for much longer. *12-24 hrs* - This represents the average **lifespan of an ovum** (egg) after ovulation, not the typical viability of sperm. - Sperm generally survive longer than an unfertilized egg. *24-48 hrs* - This duration underestimates the maximum potential survival time of human sperm in the female reproductive tract. - While many sperm may be viable within this period, it does not represent the full potential for fertilization.

Q: What is the most common site for ectopic pregnancies?

Ampulla. ***Ampulla*** - The **ampulla** of the fallopian tube is the most common site for ectopic pregnancies, accounting for about **70-80% of all cases**. - Its **wider lumen** and **tortuous path** can delay the ovum's transit, increasing the likelihood of implantation there. *Isthmus* - The **isthmus** is the second most common site for ectopic pregnancies, accounting for about **12% of cases**. - Pregnancies in this narrow, muscular part of the tube are more prone to **early rupture** due to limited distensibility. *Fimbriae* - **Fimbrial** ectopic pregnancies are rare, accounting for approximately **5% of cases**. - These occur when the fertilized egg implants on the **finger-like projections** at the end of the fallopian tube. *Interstitial/Cornual* - **Interstitial** or **cornual** pregnancies are uncommon but serious, making up about **2-4% of ectopic pregnancies**. - They occur in the portion of the fallopian tube that passes through the **muscular wall of the uterus** and carry a higher risk of hemorrhage due to rich vascularity.

Q: The thickness of the endometrium at the time of implantation is:

7 - 10 mm. ***7 - 10 mm*** - At the time of **implantation** (day 6-10 post-fertilization, around day 20-24 of the menstrual cycle), the endometrium is in the **mid-secretory phase** and measures **7-10 mm** in thickness. - This is the **optimal thickness** for successful embryo implantation, characterized by a receptive endometrium with **decidualization**, **spiral artery development**, and **glycogen-rich glandular secretions**. - Endometrial thickness <7 mm is associated with **poor implantation rates** and reduced pregnancy success. *3 - 4 mm* - An endometrial thickness of 3-4 mm is **too thin** for successful implantation. - This thickness is typically seen in the **early proliferative phase** (immediately after menstruation), not during the implantation window. - Thin endometrium (<7 mm) is associated with **poor receptivity** and lower pregnancy rates in both natural conception and assisted reproduction. *20 - 30 mm* - An endometrial thickness of 20-30 mm is **abnormally thick** and not conducive to normal implantation. - Such thickness may indicate **endometrial hyperplasia**, **polyps**, or other pathological conditions requiring investigation. *30 - 40 mm* - An endometrial thickness of 30-40 mm is **severely abnormal** and would likely prevent successful implantation. - This extreme thickness suggests significant pathology such as **endometrial hyperplasia** or **malignancy** and requires urgent evaluation.

Q: Blastocyst makes contact with endometrium on ?

5 - 7 days. ***5-7 days*** - The **blastocyst makes initial contact** (apposition) with the **endometrium** around **day 5-6 after fertilization**. - **Implantation**, which includes adhesion and invasion, typically begins around day 6 and is complete by day 10. - This timeframe allows the blastocyst to travel from the fallopian tube to the uterus and for the uterine lining to be optimally prepared. *< 3 days* - Within the first few days after fertilization, the zygote is still undergoing **cleavage** and development into a **morula**, then a young blastocyst, while traveling down the fallopian tube. - It has not yet reached the uterus or developed sufficiently to interact with the endometrium. *8-11 days* - By 8-11 days, the process of implantation is usually **well underway or completed**, with the blastocyst already invading the endometrial wall. - Initial contact and attachment occur prior to this period. *15-16 days* - This timeframe is well beyond the typical window for initial blastocyst contact and implantation. - By 15-16 days post-fertilization, the embryo would be undergoing **gastrulation** and early organogenesis, assuming successful implantation.

Q: Which of the following is the least invasive assisted reproductive technique?

Intra-Uterine Insemination. ***Intra-Uterine Insemination (IUI)*** - **IUI** involves directly placing **sperm** into the **uterus**, bypassing the cervix after sperm washing, making it the least invasive method among the options. - It is often used for mild male factor infertility, unexplained infertility, or when a woman has cervical mucus issues. *GIFT (Gamete Intra-Fallopian Transfer)* - **GIFT** is more invasive as it requires a **laparoscopic procedure** to place both **sperm** and **eggs** directly into the fallopian tube. - While fertilization occurs *in vivo* (in the body), the surgical aspect makes it more invasive than IUI. *ZIFT (Zygote Intra-Fallopian Transfer)* - **ZIFT** involves **IVF** to fertilize eggs in the lab, but then requires a **laparoscopic procedure** to place the resulting **zygotes** (early embryos) into the fallopian tube. - The combination of *in vitro* fertilization and surgical placement makes it more invasive than IUI. *IVF (In Vitro Fertilization)* - **IVF** involves **oocyte retrieval** (a transvaginal ultrasound-guided procedure) and **fertilization in vitro** (in the lab), followed by **embryo transfer** into the uterus. - While embryo transfer is less invasive than laparoscopic procedures, the initial oocyte retrieval makes IVF generally more invasive than IUI.

Q: What are the primary indications for in vitro fertilization (IVF)?

Tubal blocks. ***Tubal blocks*** - **Tubal blockages**, whether bilateral or severe unilateral, prevent the natural meeting of sperm and egg, making IVF an essential treatment to bypass this anatomical obstruction. - This is the **primary and classic indication** for IVF, as it allows fertilization to occur externally before embryo transfer to the uterus. - Tubal factor infertility was the original indication for which IVF was developed. *Uterine factor* - **Severe uterine factors**, such as significant structural abnormalities or severe intrauterine adhesions, are generally considered contraindications or make IVF less successful. - While IVF can bypass some reproductive challenges, it cannot overcome significant issues with the uterine environment needed for implantation and pregnancy maintenance. *None of the options* - This option is incorrect because **tubal blocks** are a well-recognized and primary indication for IVF. - IVF effectively addresses reproductive challenges linked to tubal patency issues. *Male factor (sperm count 12 million/ml)* - A sperm count of 12 million/mL represents **oligozoospermia** (normal >15 million/mL per WHO criteria). - While male factor infertility is an indication for assisted reproduction, **ICSI (Intracytoplasmic Sperm Injection)** rather than conventional IVF is typically the preferred treatment for significant male factor. - Treatment choice depends on comprehensive semen analysis including motility, morphology, and overall fertility assessment of both partners.

Q: Which of the following is the primary factor considered in the initial assessment of embryo viability in IVF before genetic testing?

Embryo quality. ***Embryo quality*** - **Embryo quality** is a comprehensive assessment based on developmental stage, cell number, fragmentation, and symmetry, all of which are critical indicators of viability prior to more sophisticated testing. - It encompasses multiple morphological and developmental parameters that provide the initial basis for selecting embryos for transfer. *Embryo age* - **Embryo age**, or developmental stage (e.g., day 3 cleavage stage or day 5/6 blastocyst), is a component of embryo quality but not the sole primary factor. - While blastocysts generally have a higher implantation potential, the quality within each age group is still paramount. *Genetic testing results* - **Genetic testing results** (e.g., PGT-A for aneuploidy) are a secondary assessment performed *after* initial embryo quality has been established and an embryo has been biopsied. - This testing provides chromosomal information but does not replace the initial morphological evaluation of embryo health and developmental potential. *Embryo morphology* - **Embryo morphology** is a crucial part of assessing embryo quality, but "embryo quality" is a broader term that also includes aspects like developmental rate and cellular dynamics, not just static appearance. - Morphology refers to the visual characteristics like cell number, degree of fragmentation, and symmetry of blastomeres or blastocyst expansion, which are all *components* of overall embryo quality.

Question 1

On which day LH & FSH should be measured?

Accepted Answer

1-3rd day

Answer

7th day

Answer

14th day

Answer

10th day

Question 2

Which drug is commonly used in the medical management of ectopic pregnancy?

Accepted Answer

Methotrexate

Answer

Leuprolide

Answer

Mifepristone

Answer

Carboprost

Question 3

What does teratozoospermia refer to?

Accepted Answer

Morphologically defective sperm

Answer

Low sperm count

Answer

Sperm with abnormal motility

Answer

Absence of sperm in semen

Question 4

Human sperm remains fertile for how many hours in a female genital tract ?

Accepted Answer

Up to 5 days (120 hrs)

Answer

6-8 hrs

Answer

12-24 hrs

Answer

24-48 hrs

Question 5

What is the most common site for ectopic pregnancies?

Accepted Answer

Ampulla

Answer

Isthmus

Answer

Fimbriae

Answer

Interstitial/Cornual

Question 6

The thickness of the endometrium at the time of implantation is:

Accepted Answer

7 - 10 mm

Answer

20 - 30 mm

Answer

30 - 40 mm

Answer

3 - 4 mm

Question 7

Blastocyst makes contact with endometrium on ?

Accepted Answer

5 - 7 days

Answer

< 3 days

Answer

8 - 11 days

Answer

15-16 days

Question 8

Which of the following is the least invasive assisted reproductive technique?

Accepted Answer

Intra-Uterine Insemination

Answer

GIFT

Answer

ZIFT

Answer

IVF

Question 9

What are the primary indications for in vitro fertilization (IVF)?

Accepted Answer

Tubal blocks

Answer

Uterine factor

Answer

None of the options

Answer

Male factor (sperm count 12 million/ml)

Question 10

Which of the following is the primary factor considered in the initial assessment of embryo viability in IVF before genetic testing?

Accepted Answer

Embryo quality

Answer

Genetic testing results

Answer

Embryo age

Answer

Embryo morphology

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

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