Psychological Aspects of Infertility — MCQs
The best drug to lower prolactin levels in a female with infertility is:
In Kartagener syndrome, the cause of infertility is?
A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?
What is the most common method of family planning sterilization practiced in India?
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
Which of the following is a cause of male infertility?
Minimum sperm count for normal semen analysis according to WHO:
A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. An ultrasound (USG) of the patient was done. What will be the diagnosis?
Which of the following statements about clomiphene citrate is true?
Antisperm antibodies are usually present in:
Psychological Aspects of Infertility Indian Medical PG Practice Questions and MCQs
Question 1: The best drug to lower prolactin levels in a female with infertility is:
- A. Bromocriptine (Correct Answer)
- B. GnRH
- C. Testosterone
- D. Corticosteroids
Explanation: ***Bromocriptine*** - **Bromocriptine** is a **dopamine agonist** that directly inhibits prolactin secretion from the pituitary gland [1]. - It is highly effective in lowering prolactin levels and restoring ovulatory function, making it the preferred treatment for **hyperprolactinemia-induced infertility** [1], [2]. *GnRH* - **Gonadotropin-releasing hormone (GnRH)** stimulates the release of LH and FSH, but it does not directly lower prolactin levels. - In cases of hyperprolactinemia, high prolactin can actually inhibit GnRH pulse frequency, so administering GnRH without addressing prolactin would be ineffective or counterproductive. *Testosterone* - **Testosterone** is a male androgen and has no direct role in lowering prolactin levels in women. - Administering testosterone to a female would likely cause virilizing effects and would not address the underlying cause of infertility. *Corticosteroids* - **Corticosteroids** are used to reduce inflammation and suppress the immune system, but they do not have a direct mechanism to lower prolactin levels. - While stress (which corticosteroids can sometimes help manage) can influence prolactin, corticosteroids are not a primary treatment for hyperprolactinemia.
Question 2: In Kartagener syndrome, the cause of infertility is?
- A. Oligospermia
- B. Asthenospermia (Correct Answer)
- C. Undescended testis
- D. Epididymal obstruction
Explanation: ***Asthenospermia*** - In Kartagener syndrome, **dynein arms** in sperm flagella are defective, leading to **poor sperm motility**. - This severely impairs the sperm's ability to reach and fertilize an egg, resulting in **infertility**. *Oligospermia* - This refers to a **low sperm count** and is not the primary cause of infertility in Kartagener syndrome. - While overall semen quality can be affected, the central issue is the **lack of sperm movement**, not insufficient numbers. *Undescended testis* - Also known as **cryptorchidism**, this condition involves one or both testes failing to descend into the scrotum. - It leads to impaired sperm production due to higher intra-abdominal temperatures, but is unrelated to the **ciliary dysfunction** seen in Kartagener syndrome. *Epididymal obstruction* - This involves a blockage in the **epididymis**, preventing sperm from being ejaculated. - While it causes infertility, it is a structural problem and does not account for the **motility defects** seen in Kartagener syndrome.
Question 3: A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?
- A. Hysterolaparoscopy
- B. Diagnostic hysteroscopy
- C. Reassure and review the couple after 6 months (Correct Answer)
- D. Semen analysis for husband
Explanation: ***Reassure and review the couple after 6 months*** - Infertility is defined as the inability to conceive after **12 months** of regular, unprotected intercourse in women under 35 years old. For women aged 35 or older, this period is 6 months. - Since the patient is 23 years old and has been trying for only 6 months, she does not yet meet the diagnostic criteria for infertility. The appropriate action is to advise them to continue trying and to return for evaluation if conception does not occur after a full year. *Semen analysis for husband* - While a semen analysis is a crucial initial step in an infertility workup, it is premature at this stage given the duration of attempted conception. - It would be appropriate to order this test after the couple has met the criteria for infertility (12 months for women under 35). *Hysterolaparoscopy* - This is an invasive procedure typically reserved for more advanced stages of an infertility workup, especially when suspected pathologies like endometriosis or tubal factor infertility are present. - It is not indicated as an initial step for a couple who has only been trying to conceive for 6 months and does not yet meet the definition of infertility. *Diagnostic hysteroscopy* - A diagnostic hysteroscopy is used to visualize the inside of the uterus to identify intrauterine pathologies that could contribute to infertility. - Like hysterolaparoscopy, it is an invasive diagnostic tool and should only be considered after initial, less invasive investigations have been performed and the couple meets the criteria for infertility.
Question 4: What is the most common method of family planning sterilization practiced in India?
- A. Female sterilization (Correct Answer)
- B. Male sterilization
- C. Intrauterine device (IUD)
- D. Condom use
Explanation: ***Female sterilization*** - **Female sterilization** (tubal ligation) is the most prevalent method of permanent contraception in India, accounting for over **95% of all sterilization procedures**. - This is primarily due to historical policies focusing on female methods and various **socio-cultural factors** including gender norms and male reluctance. - According to **NFHS data**, female sterilization is the single most common contraceptive method overall in India. *Male sterilization* - **Male sterilization** (vasectomy) is significantly less common compared to female sterilization in India, accounting for less than 5% of sterilization procedures. - This disparity is attributed to **gender norms**, misconceptions about masculinity, and limited promotion of vasectomy services. *Condom use* - While condoms are a common **temporary contraceptive method**, the question specifically asks about **sterilization methods**, which are permanent. - Condoms are barrier methods, not sterilization procedures. *Intrauterine device (IUD)* - IUDs are **reversible long-acting contraceptive methods**, not sterilization procedures. - Though IUDs are increasingly popular in India, they do not constitute a sterilization method as they can be removed.
Question 5: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 6: Which of the following is a cause of male infertility?
- A. Idiopathic
- B. Yq11 microdeletion
- C. Varicocele
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - **Idiopathic**, **varicocele**, and **Yq11 microdeletion** are all recognized causes of male infertility, making this the most comprehensive and correct answer. - Male infertility can stem from a variety of factors, including genetic, structural, hormonal, and unexplained (idiopathic) causes. *Idiopathic* - Refers to cases where no specific cause for infertility can be identified despite thorough investigation, accounting for a significant proportion of male infertility. - This diagnosis is made by **exclusion** after ruling out other known causes. *Varicocele* - A common and treatable cause of male infertility, characterized by **dilated veins in the pampiniform plexus** of the scrotum. - Varicoceles can impair sperm production and function due to **increased scrotal temperature** and oxidative stress. *Yq11 microdeletion* - Refers to deletions in the **azoospermia factor (AZF) region** on the long arm of the Y chromosome, which are genetic causes of severe spermatogenic failure. - These deletions disrupt genes essential for sperm production, leading to conditions ranging from **oligozoospermia** (low sperm count) to **azoospermia** (absence of sperm).
Question 7: Minimum sperm count for normal semen analysis according to WHO:
- A. 10 million/mL
- B. 2 million/mL
- C. 15 million/mL (Correct Answer)
- D. 5 million/mL
Explanation: ***15 million/mL*** - According to the **World Health Organization (WHO)** guidelines, a **minimum sperm concentration of 15 million/mL** is considered normal for a semen analysis. - This threshold is used to define **normozoospermia**, which indicates a healthy sperm count. *10 million/mL* - This value is **below the WHO reference range** for normal sperm concentration and would be considered **oligozoospermia**. - A sperm count of 10 million/mL suggests a **reduced likelihood of natural conception**. *2 million/mL* - A sperm count of 2 million/mL is significantly low and indicates **severe oligozoospermia**, which is associated with a very **low probability of natural conception**. - This value is far below the normal range defined by WHO. *5 million/mL* - This concentration is also below the normal WHO threshold, indicating **oligozoospermia**. - While higher than 2 million/mL, it still falls within the range suggesting **reduced fertility potential**.
Question 8: A lady on treatment for infertility developed ascites, abdominal pain, and dyspnea. An ultrasound (USG) of the patient was done. What will be the diagnosis?
- A. Theca lutein cysts
- B. Mucinous cystadenoma
- C. Polycystic Ovary Syndrome (PCOS)
- D. Ovarian Hyperstimulation Syndrome (OHSS) (Correct Answer)
Explanation: ***Ovarian Hyperstimulation Syndrome (OHSS)*** - The clinical presentation of infertility treatment followed by **ascites, abdominal pain, and dyspnea** is highly suggestive of OHSS. The ultrasound image shows **enlarged ovaries with multiple follicular cysts**, which is characteristic of severe OHSS. - OHSS is a potentially serious complication of **ovarian stimulation** during infertility treatment, where excessive ovarian response leads to systemic changes from increased vascular permeability. *Theca lutein cysts* - These cysts typically develop due to **excessive stimulation by hCG**, often seen with gestational trophoblastic disease or multiple pregnancies. - While they can be large and multiple, they are not typically associated with the rapid onset of severe systemic symptoms like **ascites and dyspnea** in the context of infertility treatment directly. *Mucinous cystadenoma* - This is a type of **benign ovarian tumor** that can grow very large and cause abdominal distension, but it is not typically associated with infertility treatment or the acute systemic symptoms of ascites and dyspnea as seen here. - Imaging would typically show a **multilocular cyst with internal septations**, not the numerous small follicular cysts seen in the image. *Polycystic Ovary Syndrome (PCOS)* - PCOS is a common cause of infertility, characterized by **anovulation, hyperandrogenism, and polycystic ovaries** on ultrasound (multiple small follicles in a string-of-pearls pattern). - While the ultrasound shares some similarities with multiple follicles, PCOS does not cause the acute symptoms of **ascites, abdominal pain, and dyspnea** that are directly linked to the rapid onset of severe OHSS.
Question 9: Which of the following statements about clomiphene citrate is true?
- A. It can also be used for male infertility with oligozoospermia
- B. Chance of pregnancy is threefold compared to placebo
- C. Risk of multiple pregnancy is 6-10%
- D. Enclomiphene has antiestrogenic effects (Correct Answer)
Explanation: ***Enclomiphene has antiestrogenic effects*** - **Enclomiphene** is the trans-isomer of clomiphene citrate and acts as a **selective estrogen receptor antagonist** at hypothalamic estrogen receptors. - Clomiphene citrate is a racemic mixture containing approximately **38% zuclomiphene** (cis-isomer with weak estrogenic effects) and **62% enclomiphene** (trans-isomer with antiestrogenic effects). - The **antiestrogenic action of enclomiphene** blocks negative feedback of estrogen on the hypothalamus, leading to increased GnRH release and subsequent FSH/LH secretion, which stimulates ovulation. - This statement is **medically accurate and true**. *Chance of pregnancy is threefold compared to placebo* - While clomiphene citrate does increase pregnancy rates in women with ovulatory dysfunction, the claim of a **"threefold" increase is not consistently supported** by high-quality evidence. - Live birth rates typically show more modest improvements (approximately **1.5-2x**) compared to expectant management. - The ovulation rate improvement is more dramatic, but live birth rate (the more clinically relevant outcome) is less than threefold. *Risk of multiple pregnancy is 6-10%* - This statement is actually **medically accurate** - the multiple pregnancy rate with clomiphene citrate is approximately **5-10%** (predominantly twins at 5-10%, with <1% higher-order multiples). - However, in the context of "which statement is true," option D is more definitively and universally correct. *It can also be used for male infertility with oligozoospermia* - While clomiphene has been explored **off-label** for male infertility, it is **not FDA-approved** for this indication. - Evidence for its efficacy in improving sperm parameters or pregnancy rates in male factor infertility is **limited and inconsistent**. - It is not considered a standard first-line treatment for oligozoospermia.
Question 10: Antisperm antibodies are usually present in:
- A. Vagina
- B. Fallopian tube
- C. Uterus
- D. Cervix (Correct Answer)
Explanation: ***Cervix*** - The **cervical mucus** is the most clinically significant site in the **female reproductive tract** where **antisperm antibodies** interfere with fertility. - These antibodies can **agglutinate sperm**, **immobilize sperm**, or reduce their ability to penetrate through cervical mucus and reach the ovum, contributing to **immunological infertility**. - In the context of local immune responses affecting fertilization, the **cervix** acts as a critical immunological barrier where ASAs are detected and clinically relevant. - Note: Antisperm antibodies can also be detected in **serum** (blood) and are commonly found in **seminal plasma** in males, but among reproductive tract sites in females, the **cervix** is the primary location of clinical significance. *Vagina* - The **acidic environment** (pH 3.8-4.5) of the vagina is generally hostile to sperm, but it is not a primary site for antisperm antibody formation or action. - While some immune cells exist, the vagina's protective function relies more on acidic pH and normal flora rather than specific antisperm antibodies. *Fallopian tube* - The fallopian tubes are primarily involved in **sperm transport**, **fertilization**, and **embryo transport**, but are not a primary site where antisperm antibodies cause clinical infertility problems. - Although sperm encounter the tubal environment, the **cervical mucus** at the cervix acts as a more significant and earlier immunological barrier. *Uterus* - The uterine cavity is generally more accommodating to sperm after they pass through the cervical barrier, and is not the primary site for antisperm antibody-mediated infertility. - The **cervix** serves as the critical immunological checkpoint before sperm reach the uterine environment.
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