Fertility and Infertility — MCQs
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Most common site of ectopic pregnancy is -
What is the most common presenting symptom of TB endometritis?
Which drug is commonly used in the medical management of ectopic pregnancy?
Human sperm remains fertile for how many hours in a female genital tract ?
What is the most common site for ectopic pregnancies?
Blastocyst makes contact with endometrium on ?
The thickness of the endometrium at the time of implantation is:
What are the primary indications for in vitro fertilization (IVF)?
Which of the following is the least invasive assisted reproductive technique?
Which of the following is the primary factor considered in the initial assessment of embryo viability in IVF before genetic testing?
Fertility and Infertility Indian Medical PG Practice Questions and MCQs
Question 301: Most common site of ectopic pregnancy is -
- A. Cervical
- B. Tubal (Correct Answer)
- C. Abdominal
- D. Ovarian
Explanation: ***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 302: What is the most common presenting symptom of TB endometritis?
- A. Amenorrhoea
- B. Vaginal discharge
- C. Abdominal pain
- D. Infertility (Correct Answer)
Explanation: ***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.
Question 303: Which drug is commonly used in the medical management of ectopic pregnancy?
- A. Leuprolide
- B. Methotrexate (Correct Answer)
- C. Mifepristone
- D. Carboprost
Explanation: ***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.
Question 304: Human sperm remains fertile for how many hours in a female genital tract ?
- A. 6-8 hrs
- B. 12-24 hrs
- C. 24-48 hrs
- D. Up to 5 days (120 hrs) (Correct Answer)
Explanation: ***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.
Question 305: What is the most common site for ectopic pregnancies?
- A. Isthmus
- B. Ampulla (Correct Answer)
- C. Fimbriae
- D. Interstitial/Cornual
Explanation: ***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.
Question 306: Blastocyst makes contact with endometrium on ?
- A. < 3 days
- B. 5 - 7 days (Correct Answer)
- C. 8 - 11 days
- D. 15-16 days
Explanation: ***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.
Question 307: The thickness of the endometrium at the time of implantation is:
- A. 7 - 10 mm (Correct Answer)
- B. 20 - 30 mm
- C. 30 - 40 mm
- D. 3 - 4 mm
Explanation: ***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.
Question 308: What are the primary indications for in vitro fertilization (IVF)?
- A. Uterine factor
- B. Tubal blocks (Correct Answer)
- C. None of the options
- D. Male factor (sperm count 12 million/ml)
Explanation: ***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.
Question 309: Which of the following is the least invasive assisted reproductive technique?
- A. GIFT
- B. ZIFT
- C. IVF
- D. Intra-Uterine Insemination (Correct Answer)
Explanation: ***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.
Question 310: Which of the following is the primary factor considered in the initial assessment of embryo viability in IVF before genetic testing?
- A. Genetic testing results
- B. Embryo age
- C. Embryo morphology
- D. Embryo quality (Correct Answer)
Explanation: ***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.
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
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