Reproductive Endocrinology — MCQs

Reproductive Endocrinology Indian Medical PG Practice Questions and MCQs

Question 341: What is the most reliable test to confirm ovulation after it has occurred?

A. Serum estrogen
B. Serum progesterone (Correct Answer)
C. Both serum estrogen and progesterone
D. None of the options

Explanation: ***Serum progesterone*** - A **serum progesterone level** of greater than **3 ng/mL (or 10 nmol/L)** in the mid-luteal phase (approximately 7 days after the presumed ovulation) reliably indicates that ovulation has occurred. - After ovulation, the **corpus luteum** forms and produces progesterone, causing a characteristic rise in its serum level. *Serum estrogen* - Estrogen levels **peak before ovulation** to trigger the LH surge and also rise during the luteal phase, but a single measurement is not a reliable indicator that ovulation has successfully occurred. - Estrogen levels can fluctuate due to various factors and do not directly confirm the **formation and function of a corpus luteum** as progesterone does. *Both serum estrogen and progesterone* - While both hormones are involved in the menstrual cycle, relying on both simultaneously for confirming *occurred* ovulation is not the most precise method. - A significant rise in **progesterone** *after* the presumed ovulatory event is the key reliable biomarker. *None of the options* - This option is incorrect because **serum progesterone** is a well-established and reliable test for confirming ovulation.

Question 342: Decidual reaction is due to which hormone?

A. Progesterone (Correct Answer)
B. Estrogen
C. LH
D. FSH

Explanation: ***Progesterone*** - The **decidual reaction** is a specific uterine stromal cell differentiation process that prepares the endometrium for **implantation and pregnancy maintenance**. - This process is primarily induced and maintained by **progesterone**, which causes stromal cells to enlarge, accumulate glycogen and lipids, and secrete various factors essential for embryonic development. *Estrogen* - Estrogen plays a crucial role in the **proliferation of the endometrium** during the follicular phase, building up the uterine lining. - While estrogen is essential, it acts in conjunction with progesterone; progesterone is the **primary hormone** responsible for the decidualization process itself. *LH* - Luteinizing hormone (LH) is responsible for triggering **ovulation** and stimulating the corpus luteum to produce progesterone. - LH's direct role is not in the decidual reaction of the endometrium but rather in the **ovarian events** that lead to the production of the hormones that cause decidualization. *FSH* - Follicle-stimulating hormone (FSH) is vital for the growth and maturation of **ovarian follicles** and **estrogen production**. - FSH does not directly induce the decidual reaction but facilitates the production of estrogen, which then contributes to endometrial proliferation, a precursor to progesterone's decidualizing effect.

Question 343: A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?

A. Premature ovarian insufficiency (Correct Answer)
B. Menopause
C. Late menopause
D. Perimenopause

Explanation: ***Premature ovarian insufficiency (POI)*** - The patient's age (35 years) combined with 4 months of **amenorrhea**, increased **FSH** and **LH**, and decreased **estrogen** is characteristic of premature ovarian insufficiency (also called premature ovarian failure). - The hormonal profile (**hypergonadotropic hypogonadism**) indicates ovarian failure occurring before the age of **40 years**, which defines POI. - POI affects approximately **1% of women under 40** and can present with amenorrhea, infertility, and symptoms of estrogen deficiency. *Menopause* - Menopause is diagnosed after **12 consecutive months of amenorrhea** in a woman, typically occurring around age **51 years** (natural menopause). - While the hormonal profile of elevated FSH/LH and low estrogen is consistent with menopause, the patient's **age of 35 years** and **only 4 months of amenorrhea** do not meet the criteria for natural menopause. *Late menopause* - Late menopause refers to menopause occurring at a later age than average, typically after age **55 years**. - This diagnosis is completely inconsistent with the patient's age of 35 years. *Perimenopause* - Perimenopause is the transitional phase leading up to menopause, characterized by **irregular menstrual cycles** and **fluctuating hormone levels**. - While FSH levels may be elevated at times, perimenopause typically shows **variable hormone levels** rather than the sustained pattern of high FSH/LH with low estrogen seen in this case. - The **sustained amenorrhea** and pronounced hormonal shifts indicate ovarian failure (POI) rather than perimenopausal transition.

Question 344: All are causes of anovulatory amenorrhea except which of the following?

A. Hyperprolactinemia
B. Drugs
C. PCOD
D. Gonadal dysgenesis (Correct Answer)

Explanation: ***Gonadal dysgenesis*** - This condition is a cause of **primary ovarian insufficiency**, leading to amenorrhea but not primarily due to anovulation in a previously cycling individual. - In gonadal dysgenesis, the **ovaries are malformed or absent**, resulting in a lack of follicles and thus no ovulation or estrogen production from the start. *PCOD* - **Polycystic Ovarian Disease** (PCOD/PCOS) is a common cause of anovulatory amenorrhea, characterized by **oligo- or anovulation**, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. - The hormonal imbalance (e.g., elevated **androgens**, high **LH/FSH ratio**) disrupts normal follicular development and ovulation. *Hyperprolactinemia* - **Elevated prolactin levels** inhibit the pulsatile secretion of **GnRH (Gonadotropin-Releasing Hormone)** from the hypothalamus, which in turn reduces FSH and LH release from the pituitary. - This suppression of gonadotropins leads to impaired follicular development and **anovulation**, resulting in amenorrhea. *Drugs* - Various medications can cause anovulatory amenorrhea by interfering with the **hypothalamic-pituitary-ovarian axis**. - Examples include antipsychotics (which can increase **prolactin levels**), certain antidepressants, opioids, and chemotherapy agents that can damage ovarian function.

Question 345: What is thelarche?

A. Breast development in boys during puberty
B. Breast enlargement during pregnancy
C. Breast enlargement due to hormonal therapy in postmenopausal women
D. Hormone-related breast development in girls (Correct Answer)

Explanation: ***Hormone-related breast enlargement in girls*** - **Thelarche** specifically refers to the first sign of puberty in girls, which is the **onset of breast development**. - This development is primarily driven by the action of **estrogen** on breast tissue. *Breast development in boys during puberty* - This condition is known as **gynecomastia**, which is distinguishable from thelarche observed in girls. - While also hormone-related, **gynecomastia** often involves an imbalance between estrogen and androgens. *Breast enlargement during pregnancy* - Breast enlargement during pregnancy is a normal physiological change in preparation for lactation, driven by a surge in various hormones like **estrogen, progesterone, and prolactin**. - It is distinct from the initial, puberty-related breast development in girls. *Breast enlargement due to hormonal therapy in postmenopausal women* - This is an induced effect of **exogenous hormones** (e.g., hormone replacement therapy) and not a natural developmental stage like thelarche. - It is a side effect of medication, not the start of puberty.

Question 346: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

A. Premature ovarian failure (Correct Answer)
B. Pituitary dysfunction
C. Hypothalamic dysfunction
D. Polycystic Ovary Syndrome

Explanation: ***Premature ovarian failure*** - The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation. - This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility. *Pituitary dysfunction* - Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH. - In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described. *Hypothalamic dysfunction* - Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility. - This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here. *Polycystic Ovary Syndrome* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated. - It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.

Question 347: Spinnbarkeit is maximum shown at which phase?

A. Menstrual phase
B. Ovulatory (Correct Answer)
C. Post ovulatory
D. Follicular phase

Explanation: ***Ovulatory*** - **Spinnbarkeit** refers to the stringy, stretchy quality of cervical mucus, which is maximal during the ovulatory phase due to high **estrogen levels**. - This highly elastic mucus facilitates **sperm transport** to the uterus and fallopian tubes for fertilization. *Menstrual phase* - During the menstrual phase, **cervical mucus** is typically minimal and sticky, making it unfavorable for sperm survival. - This phase is characterized by low estrogen and progesterone levels, leading to the **shedding of the uterine lining**. *Post ovulatory* - After ovulation, under the influence of **progesterone**, cervical mucus becomes thick, sticky, and opaque, decreasing **spinnbarkeit**. - This change in mucus consistency forms a **barrier to sperm penetration** into the uterus. *Follicular phase* - In the early follicular phase, **estrogen levels** are low, resulting in thick, scanty, and opaque cervical mucus with low **spinnbarkeit**. - As the follicular phase progresses and estrogen levels rise, the mucus gradually becomes more **watery and elastic**, but it doesn't reach its peak stretchiness until ovulation.

Question 348: In an amenorrheic patient who has had pituitary ablation for a craniopharyngioma, which of the following regimens is most likely to result in an ovulatory cycle?

A. Continuous infusion of GnRH
B. Letrozole
C. Human menopausal or recombinant gonadotropin, followed by hCG (Correct Answer)
D. Clomiphene citrate

Explanation: ***Correct: Human menopausal or recombinant gonadotropin, followed by hCG*** - Pituitary ablation damages the **pituitary gland**, leading to a complete lack of endogenous **FSH** and **LH** production. Therefore, direct replacement of these gonadotropins is necessary to stimulate ovarian follicle development and induce ovulation. - Following the stimulation of follicular growth with **gonadotropins**, **hCG** acts as an LH surge analog to trigger the final maturation of the oocyte and ovulation. - This is the **only effective regimen** in patients without a functional pituitary, as it bypasses the hypothalamic-pituitary axis entirely. *Incorrect: Clomiphene citrate* - **Clomiphene citrate** works by blocking estrogen receptors in the hypothalamus, which then increases the pulsatile release of endogenous **GnRH** and subsequently **FSH** and **LH** from an *intact* pituitary gland. - Since this patient has had **pituitary ablation**, her pituitary gland cannot produce gonadotropins, rendering clomiphene ineffective. *Incorrect: Letrozole* - **Letrozole** is an **aromatase inhibitor** that lowers estrogen levels, thereby stimulating endogenous **FSH** and **LH** release from the pituitary via negative feedback mechanism. - Like clomiphene, letrozole relies on a functional pituitary gland to produce gonadotropins, which is absent after **pituitary ablation**. *Incorrect: Continuous infusion of GnRH* - **Continuous infusion of GnRH** (gonadotropin-releasing hormone) desensitizes and downregulates the pituitary's **GnRH receptors**, leading to a *decrease* in **FSH** and **LH** release. - While pulsatile **GnRH** can stimulate an *intact* pituitary, continuous infusion is typically used to *suppress* gonadotropin release (used in IVF protocols and hormone-sensitive conditions), not to induce ovulation in a patient with pituitary ablation. - Additionally, this patient lacks a functional pituitary to respond to GnRH.

Question 349: A 15-year-old female presents with primary amenorrhea. Her breasts are Tanner stage 4, but she has no axillary or pubic hair. What is the most likely diagnosis?

A. Turner's syndrome
B. Complete Androgen Insensitivity Syndrome (CAIS) (Correct Answer)
C. Premature ovarian failure
D. Mullerian agenesis

Explanation: ***Complete Androgen Insensitivity Syndrome (CAIS)*** - Previously known as **Testicular Feminization Syndrome**, this condition presents with **breast development (due to peripheral conversion of androgens to estrogens)** but **absent pubic/axillary hair** due to **androgen receptor insensitivity**. - Affected individuals are **genetically male (46, XY)** but have a female external phenotype and **no uterus**, leading to **primary amenorrhea**. *Turner's syndrome* - Characterized by **gonadal dysgenesis (streak gonads)**, leading to **absent or rudimentary breast development** and **primary amenorrhea**. - Individuals are typically **45, XO** and often present with short stature and characteristic physical features like a webbed neck. *Mullerian agenesis* - Involves the **agenesis or hypoplasia of the Mullerian ducts**, resulting in an **absent or hypoplastic uterus and vagina**. - Patients have **normal breast and pubic/axillary hair development** because their ovaries are functional and produce hormones. *Premature ovarian failure* - Involves the **cessation of ovarian function before age 40**, leading to **menopausal symptoms** and **amenorrhea**. - However, patients would have initially gone through **normal puberty**, including the development of pubic/axillary hair, which is absent in this case.

Question 350: Which of the following statements is true regarding Stein-Leventhal syndrome?

A. It is only characterized by oligomenorrhea and amenorrhea.
B. It is only characterized by amenorrhea.
C. It does not involve ovarian cysts.
D. It is associated with enlarged ovaries and multiple follicular cysts. (Correct Answer)

Explanation: ***It is associated with enlarged ovaries and multiple follicular cysts.*** - Stein-Leventhal syndrome, now known as **polycystic ovary syndrome (PCOS)**, is characterized by the presence of **multiple small follicular cysts** on enlarged ovaries. - These cysts are immature follicles that fail to ovulate and instead accumulate in the ovarian stroma, leading to the characteristic **"string of pearls" appearance** on ultrasound. - This ovarian morphology, combined with biochemical hyperandrogenism and ovulatory dysfunction, forms the diagnostic triad of PCOS. *It is only characterized by oligomenorrhea and amenorrhea.* - This statement is **incorrect** because it limits PCOS to only menstrual irregularities, ignoring other cardinal features. - While **oligomenorrhea** and **amenorrhea** are common manifestations of anovulation in PCOS, the syndrome also includes **hyperandrogenism** (hirsutism, acne), **metabolic features** (insulin resistance), and **polycystic ovarian morphology**. - The Rotterdam criteria require at least 2 of 3 features: oligo/anovulation, hyperandrogenism, and polycystic ovaries on ultrasound. *It is only characterized by amenorrhea.* - This statement is incorrect because **amenorrhea** is just one possible menstrual irregularity seen in PCOS; many patients have **oligomenorrhea** or irregular cycles rather than complete absence of periods. - The word "only" makes this doubly incorrect by excluding all other features of the syndrome. *It does not involve ovarian cysts.* - This statement is completely incorrect as the presence of **multiple ovarian cysts** (polycystic ovaries) is a hallmark feature of Stein-Leventhal syndrome (PCOS). - The characteristic ultrasound finding shows **12 or more follicles (2-9 mm diameter)** in each ovary and/or increased ovarian volume (>10 mL).

Practice by Chapter

Hypothalamic-Pituitary-Ovarian Axis

Practice Questions

Disorders of Puberty

Practice Questions

Hirsutism and Virilization

Practice Questions

Primary Ovarian Insufficiency

Practice Questions

Hyperprolactinemia

Practice Questions

Hyperandrogenism

Practice Questions

Metabolic Dysfunction in PCOS

Practice Questions

Neuroendocrine Disorders and Reproduction

Practice Questions

Hormonal Evaluation and Testing

Practice Questions

Ovulation Induction

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free