Fertility and Infertility Practice Questions

Q: A post-coital test shows non-motile sperms in the cervical smear and motile sperms from the posterior fornix. What does this suggest?

Immunological defect. **Explanation:** The **Post-Coital Test (PCT)**, or Sims-Huhner test, evaluates the interaction between the cervical mucus and spermatozoa. **Why Option B is Correct:** The presence of motile sperms in the posterior fornix confirms that ejaculation was successful and the semen quality is adequate. However, the finding of **non-motile (or shaking/vibratory) sperms** specifically within the cervical mucus suggests a "hostile" environment. This is the classic presentation of an **immunological defect**, where antisperm antibodies (ASABs) are present in the cervical mucus. These antibodies bind to the sperm, causing them to lose forward progression or become immobilized upon contact with the mucus (the "shaking phenomenon"). **Why Other Options are Incorrect:** * **A. Faulty coital practice:** If coitus were faulty, no sperm would be found in either the posterior fornix or the cervical smear. * **C. Hypospadias:** This condition leads to failure of deposition of semen at the external os; typically, the PCT would show an absence of sperm in the cervical canal. * **D. Azoospermia:** This refers to the total absence of sperm in the ejaculate. The presence of motile sperm in the posterior fornix directly rules this out. **NEET-PG High-Yield Pearls:** * **Timing:** PCT must be performed during the **pre-ovulatory phase** (when estrogen is high and mucus is thin/Spinnbarkeit is high). * **Normal Result:** >5–10 motile sperm per high-power field (HPF) with good forward progression. * **Clinical Utility:** The PCT has largely been replaced by more reliable tests like the **Sperm-Cervical Mucus Contact (SCMC) test** and direct antibody testing (Immunobead assay), as it has high inter-observer variability and poor predictive value for pregnancy.

Q: In which of the following conditions is in-vitro fertilisation (IVF) indicated in a 28-year-old female?

Tubal block. **Explanation:** **Tubal block** is the classic and most definitive indication for **In-Vitro Fertilization (IVF)**. In cases of bilateral tubal obstruction (e.g., due to Pelvic Inflammatory Disease or previous surgery), the natural site of fertilization—the ampulla of the fallopian tube—is inaccessible. IVF bypasses the tubes entirely by retrieving oocytes directly from the ovaries, fertilizing them in a lab, and transferring the embryo into the uterus. **Analysis of Other Options:** * **Anovulatory cycles (Option A):** The first-line treatment is **Ovulation Induction** using drugs like Clomiphene Citrate or Letrozole. IVF is reserved only if medical induction fails. * **Azoospermia (Option C):** While IVF can be used, the specific procedure required for male factor infertility is **ICSI (Intracytoplasmic Sperm Injection)**. Furthermore, if it is obstructive azoospermia, surgical sperm retrieval is needed; if non-obstructive, donor insemination may be the first step. * **Uterine anomalies (Option D):** Conditions like a septate uterus are managed surgically (Hysteroscopic metroplasty). IVF does not bypass or fix a structural uterine defect that prevents implantation or causes miscarriage. **High-Yield NEET-PG Pearls:** * **Absolute Indication for IVF:** Bilateral tubal block. * **First-line for PCOD/Anovulation:** Letrozole (Aromatase inhibitor). * **Indication for ICSI:** Severe male factor infertility (oligoasthenoteratozoospermia) or failed fertilization in previous IVF cycles. * **Success Rate:** In a 28-year-old (young age), the prognosis for IVF is generally favorable, as ovarian reserve and oocyte quality are typically high.

Q: All of the following are techniques used for preimplantation genetic testing except?

Morula biopsy. **Explanation:** Preimplantation Genetic Testing (PGT) involves analyzing the genetic material of an embryo before transfer to the uterus. The correct answer is **Morula biopsy** because it is not a standard clinical technique for PGT. **Why Morula Biopsy is the exception:** The morula stage (Day 4, 16–32 cells) is characterized by **compaction**, where cells begin to adhere tightly to one another. Attempting a biopsy at this stage is technically difficult, risks significant damage to the embryo, and provides no clinical advantage over other methods. **Analysis of other options:** * **Polar body analysis:** Performed on the 1st and 2nd polar bodies of the oocyte/zygote. It only provides information on maternal genetic contribution and does not reflect paternal DNA or mitotic errors. * **Blastomere biopsy:** Performed on **Day 3** (6–8 cell stage). One or two cells (blastomeres) are removed. While common in the past, it is associated with higher rates of embryo mosaicism and potential reduction in implantation rates. * **Trophectoderm biopsy:** The current **gold standard**, performed on **Day 5/6 (Blastocyst stage)**. Multiple cells are taken from the outer layer (future placenta), leaving the inner cell mass (future fetus) intact. It provides more DNA and is less traumatic to the embryo. **High-Yield Clinical Pearls for NEET-PG:** * **PGT-A:** Screens for Aneuploidy (most common). * **PGT-M:** Screens for Monogenic/single-gene disorders (e.g., Thalassemia). * **PGT-SR:** Screens for Structural Rearrangements (e.g., translocations). * **Blastocyst stage** is preferred for biopsy because it offers the highest diagnostic accuracy and lowest risk of embryo injury.

Q: A 33-year-old woman presents with infertility and dyspareunia. On vaginal examination, tender nodularity is noted along the uterosacral ligaments. What is the most likely diagnosis?

Endometriosis. **Explanation:** The clinical presentation of **infertility, dyspareunia, and tender nodularity along the uterosacral ligaments** is a classic triad for **Endometriosis**. In this condition, functional endometrial tissue exists outside the uterine cavity. The uterosacral ligaments are one of the most common sites for deep infiltrating endometriosis; the "nodularity" felt on examination represents ectopic tissue and associated fibrosis, which becomes exquisitely tender due to cyclical bleeding and inflammation. **Analysis of Options:** * **Adenomyosis (A):** While it causes dysmenorrhea and infertility, it typically presents with a **globular, symmetrically enlarged, and soft (boggy) uterus**. It does not typically cause isolated uterosacral nodularity. * **DES-related disease (B):** Exposure to Diethylstilbestrol in utero is associated with structural anomalies like a **T-shaped uterine cavity**, cervical ridges, and clear cell adenocarcinoma, rather than tender pelvic nodules. * **Subserosal fibroids (C):** These may cause pelvic pressure or an irregular uterine contour, but they are generally **firm, non-tender**, and do not specifically target the uterosacral ligaments or typically cause deep dyspareunia unless degenerating. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Laparoscopy (visual confirmation with biopsy). * **Commonest Site:** The ovary (often presenting as a "Chocolate cyst" or Endometrioma). * **Powder-burn Appearance:** Classic laparoscopic finding of peritoneal implants. * **Sampson’s Theory:** Retrograde menstruation is the most widely accepted theory for its pathogenesis. * **Markers:** CA-125 may be elevated but is non-specific (used for monitoring, not diagnosis).

Q: Semen analysis of a male from an infertile couple shows absence of spermatozoa but presence of fructose. What is the most probable diagnosis?

Block in efferent duct system. **Explanation:** The presence of **fructose** in semen is a critical diagnostic marker in the evaluation of azoospermia (absence of spermatozoa). Fructose is produced and secreted exclusively by the **seminal vesicles**. 1. **Why the correct answer is right:** In this scenario, the presence of fructose confirms that the seminal vesicles are present and their ducts are patent. Since there are no spermatozoa (azoospermia) but fructose is present, the obstruction or pathology must be located **proximal** to the point where the seminal vesicles join the vas deferens (i.e., the ejaculatory duct). The **efferent duct system** (including the rete testis and epididymis) is located before this junction. Therefore, a block in the efferent ducts prevents sperm from reaching the ejaculate while allowing seminal vesicle fluid (and fructose) to pass through. 2. **Why incorrect options are wrong:** * **Prostatic infection:** While this can affect sperm motility or cause leukocytospermia, it does not typically cause a complete absence of spermatozoa. * **Mumps orchitis:** This leads to testicular atrophy and primary testicular failure (non-obstructive azoospermia). While sperm would be absent, this is a functional failure of production, not a diagnostic match specifically highlighted by the "presence of fructose" logic used to differentiate types of obstructive azoospermia. **High-Yield Clinical Pearls for NEET-PG:** * **Azoospermia + Fructose Negative:** Suggests Congenital Bilateral Absence of Vas Deferens (CBAVD) or Ejaculatory Duct Obstruction (since seminal vesicles are often absent or blocked). * **CBAVD** is strongly associated with mutations in the **CFTR gene** (Cystic Fibrosis). * **Normal Semen pH:** 7.2–8.0 (Alkaline). If the ejaculate is acidic and fructose-negative, it points toward seminal vesicle obstruction or agenesis.

Q: What are the functions of the endocervical cell lining?

All of the above. The endocervical canal is lined by a single layer of tall columnar epithelium, which plays a critical role in sperm transport and survival. **Explanation of the Correct Answer:** The correct answer is **D (All of the above)** because the endocervical lining acts as a biological filter and reservoir for spermatozoa: 1. **Ciliary Action (Option A):** The endocervical cells possess cilia that beat in a **downward direction** (towards the vagina). This creates a fluid current that helps orient the sperm to swim upstream (rheotaxis) toward the uterine cavity. 2. **Nutritional Support (Option B):** The cervical mucus, secreted by these cells, is rich in carbohydrates (glucose), amino acids, and electrolytes. This provides the necessary energy substrate for sperm to survive for up to 48–72 hours within the cervical crypts. 3. **Capacitation (Option C):** As sperm pass through the cervical mucus, the process of **capacitation** begins. This involves the removal of glycoprotein coats and seminal plasma proteins from the sperm head, making them capable of fertilizing an oocyte. **Clinical Pearls for NEET-PG:** * **Insulin-like Growth Factors:** Cervical mucus contains IGFs which enhance sperm motility. * **Spinnbarkeit Effect:** Under estrogen influence (ovulation), the mucus becomes thin, watery, and stretchy, facilitating sperm penetration. * **The "Filter" Function:** The endocervix filters out morphologically abnormal sperm and prevents the entry of vaginal bacteria into the upper genital tract. * **Cervical Crypts:** These act as a "reservoir," releasing sperm in waves over several days to increase the chances of fertilization.

Q: Which of the following drugs can affect male fertility?

All the above. **Explanation:** Male infertility can be induced by various pharmacological agents through mechanisms involving hormonal disruption, impaired spermatogenesis, or ejaculatory dysfunction. * **Marijuana (Option A):** Cannabinoids act on the hypothalamic-pituitary-gonadal (HPG) axis. Chronic use suppresses the release of GnRH, leading to decreased LH and FSH levels. This results in **reduced testosterone production** and impaired spermatogenesis (decreased sperm count and motility). * **Silodocin (Option B):** This is a highly selective **alpha-1A adrenergic receptor antagonist** used for Benign Prostatic Hyperplasia (BPH). It causes relaxation of the smooth muscles in the vas deferens and seminal vesicles, leading to **retrograde ejaculation** or "dry orgasm," which is a significant cause of reversible male infertility. * **Dutasteride (Option C):** As a **5-alpha reductase inhibitor**, it prevents the conversion of testosterone to the more potent dihydrotestosterone (DHT). Clinical studies show that it can lead to a significant **reduction in total sperm count, semen volume, and sperm motility** in some men. **High-Yield Clinical Pearls for NEET-PG:** * **Spironolactone & Ketoconazole:** Both can cause infertility and gynecomastia by inhibiting androgen synthesis and displacing testosterone from SHBG. * **Sulfasalazine:** A classic "high-yield" drug that causes reversible impairment of sperm count and motility (switch to Mesalamine to restore fertility). * **Anabolic Steroids:** Cause profound infertility via negative feedback on the HPG axis, leading to azoospermia and testicular atrophy. * **Cytotoxic drugs:** Cyclophosphamide is the most notorious for causing permanent germ cell depletion.

Question 1

A post-coital test shows non-motile sperms in the cervical smear and motile sperms from the posterior fornix. What does this suggest?

Accepted Answer

Immunological defect

Answer

Faulty coital practice

Answer

Hypospadias

Answer

Azoospermia

Question 2

In which of the following conditions is in-vitro fertilisation (IVF) indicated in a 28-year-old female?

Accepted Answer

Tubal block

Answer

Anovulatory cycles

Answer

Azoospermia

Answer

Uterine anomalies

Question 3

All of the following are techniques used for preimplantation genetic testing except?

Accepted Answer

Morula biopsy

Answer

Polar body analysis

Answer

Blastomere biopsy

Answer

Trophectoderm biopsy

Question 4

A 41-year-old woman with one healthy child presents with a 3-year history of infertility despite normal menstrual cycles and a biphasic basal body temperature chart. She denies sexually transmitted diseases. A hysterosalpingogram shows patent uterine tubes and a normal uterine cavity. Her husband's semen analysis is normal. In the presence of several normal infertility test results, a laparoscopic examination of the pelvic cavity is scheduled. The physician performing the procedure carefully places the trocar lateral to the rectus abdominis muscle and its sheath to avoid injury to a major artery. What artery is being avoided?

Accepted Answer

Inferior epigastric artery

Answer

Superior epigastric artery

Answer

Superficial epigastric artery

Answer

Superficial circumflex iliac artery

Question 5

Varicoceles appear to cause male infertility by which mechanism?

Accepted Answer

Increasing the likelihood of sperm antibody formation

Answer

Interfering with sperm production

Answer

Blocking epididymal sperm motility activation

Answer

Interfering with sperm movement through cervical mucus

Question 6

A 33-year-old woman presents with infertility and dyspareunia. On vaginal examination, tender nodularity is noted along the uterosacral ligaments. What is the most likely diagnosis?

Accepted Answer

Endometriosis

Answer

Adenomyosis

Answer

Diethylstilbestrol (DES)-related disease

Answer

Subserosal fibroids

Question 7

Semen analysis of a male from an infertile couple shows absence of spermatozoa but presence of fructose. What is the most probable diagnosis?

Accepted Answer

Block in efferent duct system

Answer

Prostatic infection

Answer

Mumps orchitis

Answer

All of the above

Question 8

Which of the following is true for patients treated with clomiphene?

Accepted Answer

Increased risk of ovarian hyperstimulation and polycystic ovaries

Answer

Decreased risk of ovarian carcinoma

Answer

Causes decreased sexuality if given in males

Answer

Risk of ectopic pregnancy

Question 9

What are the functions of the endocervical cell lining?

Accepted Answer

All of the above

Answer

Cilia are directed downwards

Answer

Provides nutrition to sperms

Answer

Allows capacitation of sperms

Question 10

Which of the following drugs can affect male fertility?

Accepted Answer

All the above

Answer

Marijuana

Answer

Silodocin

Answer

Dutasteride

Fertility and Infertility — MCQs

Fertility and Infertility — MCQs

On this page

Practice by Chapter

Want unlimited practice?