Research Ethics in Reproductive Medicine — MCQs
For medical termination of pregnancy, consent is given by-
False about MTP is -
In the context of Indian regulations, what is the minimum number of Medical Termination of Pregnancy (MTP) cases a doctor must have performed to be eligible to perform an MTP?
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 are the primary indications for in vitro fertilization (IVF)?
All are steps of GIFT, except:
A 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
MTP cannot be done after :
Which one of the following statements regarding pre-conceptional counseling is NOT correct?
The net reproduction rate of 1 is primarily determined by which of the following demographic rates?
Research Ethics in Reproductive Medicine Indian Medical PG Practice Questions and MCQs
Question 1: For medical termination of pregnancy, consent is given by-
- A. Guardian
- B. Husband of the lady
- C. Concerned lady (Correct Answer)
- D. Both husband and wife
Explanation: ***Concerned lady*** - For a medical termination of pregnancy, **informed consent** must be given directly by the woman seeking the procedure. - This upholds her **autonomy** and right to make decisions regarding her own body and healthcare. *Guardian* - A guardian's consent is typically required only if the woman is a **minor** or is otherwise **legally incapacitated** and unable to provide consent herself. - In most cases, an adult woman is presumed to be competent to consent for her own medical procedures. *Husband of the lady* - The husband's consent is **not legally required** for a medical termination of pregnancy, as it is the woman's fundamental right to decide. - Requiring a husband's consent would infringe upon the woman's **bodily autonomy** and reproductive rights. *Both husband and wife* - While open communication with a spouse is often encouraged, **joint consent** from both the husband and wife is not a legal prerequisite for a medical termination of pregnancy. - The ultimate decision-making authority rests solely with the **pregnant woman**.
Question 2: False about MTP is -
- A. Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks
- B. Consent of husband is must (Correct Answer)
- C. >16 weeks, hysterotomy can be done
- D. Illegal if >20 weeks of pregnancy
Explanation: ***Consent of husband is must*** - The **Medical Termination of Pregnancy (MTP) Act** (amended in 2021) in India explicitly states that **only the consent of the pregnant woman** is required for an abortion. - The husband's consent is **not legally necessary** and cannot be a barrier to accessing MTP services. - **This statement is FALSE**, making it the correct answer to this negation question. *Requires opinion of at least two registered medical practitioners when pregnancy exceeds 12 weeks* - This statement is **TRUE**; for pregnancies between **12 and 20 weeks**, the opinion of **two registered medical practitioners** is required. - For pregnancies between **20 and 24 weeks**, two registered medical practitioners are required for specific vulnerable categories of women. *>16 weeks, hysterotomy can be done* - **Hysterotomy** is a surgical procedure similar to a mini-C-section, used in specific cases for MTP, often in later gestations or when other methods are contraindicated. - While exact gestational limits vary by clinical judgment and local regulations, it is indeed a method considered for **later second-trimester terminations**, including those beyond 16 weeks, under proper medical indication. - **This statement is TRUE**. *Illegal if >20 weeks of pregnancy* - This statement was largely true under the **MTP Act of 1971**, which set the upper limit for MTP at 20 weeks. - However, the **MTP (Amendment) Act of 2021** has expanded this limit, allowing termination up to **24 weeks for specific categories of women** and in cases of substantial fetal abnormalities, there is **no upper gestational limit** for termination. - **This statement is now FALSE** as per the 2021 amendments, though it requires contextual understanding.
Question 3: In the context of Indian regulations, what is the minimum number of Medical Termination of Pregnancy (MTP) cases a doctor must have performed to be eligible to perform an MTP?
- A. 10
- B. 15
- C. 25 (Correct Answer)
- D. 35
Explanation: ***25*** - As per the **MTP Act of India (1971)**, a registered medical practitioner needs to have assisted in or performed a minimum of **25 medical termination of pregnancies** in an approved training center to be certified to perform MTPs independently. - This regulation ensures a certain level of practical experience and competence before a doctor can perform this procedure. *10* - This number is **insufficient** according to Indian MTP regulations for a doctor to be eligible to perform MTPs independently. - The required practical experience is set higher to ensure adequate skill and safety for the procedure. *15* - This number also **falls short** of the minimum requirement stipulated by the Indian MTP Act. - The legislative framework emphasizes a more extensive practical exposure for practitioners. *35* - While performing 35 MTPs would certainly meet the experience requirement, it is **not the minimum specified** by the Indian MTP regulations. - The law requires a lower threshold of practical experience, which is 25 cases.
Question 4: 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 5: 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 6: All are steps of GIFT, except:
- A. Transfer of unfertilized egg into the fallopian tube
- B. Fertilization of oocyte in lab (Correct Answer)
- C. Ovulation stimulation
- D. Oocyte retrieval
Explanation: ***Fertilization of oocyte in lab*** - **Gamete intrafallopian transfer (GIFT)** involves the transfer of both sperm and eggs directly into the fallopian tube, where **fertilization occurs naturally** within the body. - The step of **fertilization in the lab** (in vitro fertilization) is characteristic of **IVF**, not GIFT. *Transfer of unfertilized egg into the fallopian tube* - In GIFT, **harvested eggs** (oocytes) are mixed with sperm and then immediately **transferred into the fallopian tube**. - This allows natural fertilization to occur within the woman's body, which is a key distinction of GIFT from IVF. *Ovulation stimulation* - Before GIFT, women undergo **controlled ovarian hyperstimulation** to produce multiple mature follicles and increase the chances of successful egg retrieval. - This process is essential for obtaining a sufficient number of **oocytes** for transfer. *Oocyte retrieval* - Once the follicles are mature, **oocytes are retrieved** from the ovaries, typically through transvaginal ultrasound-guided aspiration. - These retrieved oocytes are then prepared for transfer along with sperm into the fallopian tubes.
Question 7: A 14 years old rape victim with 22 weeks of gestation coming to hospital. All of the following can be done except:
- A. Male doctor can examine her with female attendant
- B. UPT not required
- C. Gynecologist can abort the fetus upon the patient request
- D. No need to collect vaginal swab (Correct Answer)
Explanation: ***No need to collect vaginal swab (INCORRECT STATEMENT - This CANNOT be said)*** - Collecting a **vaginal swab is MANDATORY** in all cases of sexual assault for **forensic evidence collection** to identify the perpetrator through DNA analysis. - This is a **medico-legal requirement** and must be done even if pregnancy has occurred, as it provides crucial evidence for prosecution. - The statement "no need to collect vaginal swab" is completely wrong, making it the correct answer to this "except" question. *Male doctor can examine her with female attendant (Can be done)* - It is **legally permissible and ethical** for a male doctor to examine a female patient in the presence of a **female attendant**. - This ensures patient comfort, privacy protection, and safeguards the doctor against false allegations. - This is standard medical practice in sensitive situations like sexual assault. *UPT not required (Can be done/said)* - A 14-year-old presenting with **22 weeks of gestation** has clinically evident pregnancy through abdominal examination and ultrasound. - Urine pregnancy test (UPT) is **not necessary** at this advanced gestational age as pregnancy is already confirmed. - Resources should focus on comprehensive care rather than redundant testing. *Gynecologist can abort the fetus upon the patient request (Can be done)* - Under the **Medical Termination of Pregnancy (MTP) Amendment Act 2021**, termination is permissible up to **24 weeks for rape survivors**. - For a minor, **consent of guardian** and opinion of **two registered medical practitioners** is required. - At 22 weeks, this patient is within the legal timeframe for termination given the circumstances of sexual assault.
Question 8: MTP cannot be done after :
- A. 24 weeks (Correct Answer)
- B. 28 weeks
- C. 12 weeks
- D. 20 weeks
Explanation: ***24 weeks*** - As per the **MTP (Amendment) Act, 2021**, 24 weeks is the **upper gestational limit** for medical termination of pregnancy in special categories of women. - MTP can be performed **up to 24 weeks** with the opinion of two registered medical practitioners for specific categories: rape survivors, victims of incest, minors, women with physical/mental disabilities, and cases of fetal abnormalities. - Beyond 24 weeks, MTP is permitted **only for substantial fetal abnormalities** diagnosed by a Medical Board, with no specified upper limit for such exceptional cases. - For general MTP purposes and examination context, **24 weeks is the definitive upper limit** beyond which termination cannot be routinely performed. *28 weeks* - There is **no specific mention of 28 weeks** as a cut-off in the MTP Act. - This is not a legally recognized gestational age limit for MTP in India. - While MTP may theoretically be performed beyond 24 weeks for substantial fetal abnormalities, 28 weeks is not the defined limit. *20 weeks* - Under the **MTP (Amendment) Act, 2021**, MTP up to 20 weeks can be performed with the opinion of **one registered medical practitioner** for all women. - This was the **original upper limit** under the MTP Act, 1971, but has since been extended to 24 weeks for special categories. - This is not the absolute upper limit under current legislation. *12 weeks* - MTP before 12 weeks is considered the **safest period** and can be performed with minimal procedural complexity. - This represents an **early gestational age**, well within the permissible limits for MTP. - This is definitely not the upper limit beyond which MTP cannot be performed.
Question 9: Which one of the following statements regarding pre-conceptional counseling is NOT correct?
- A. It helps in early detection of risk factors
- B. It is needed only in selected complicated pregnancies (Correct Answer)
- C. It is a part of preventive medicine
- D. It helps in reducing maternal morbidity and mortality
Explanation: ***It is needed only in selected complicated pregnancies*** - Pre-conceptional counseling is important for **all women of reproductive age**, especially those planning a pregnancy, not just for complicated cases. - Its purpose is to **optimize maternal health before conception** to prevent adverse outcomes, regardless of initial perceived risk. *It helps in early detection of risk factors* - Pre-conceptional counseling identifies **maternal and fetal risk factors** such as chronic medical conditions, genetic predisposition, and lifestyle choices before pregnancy. - Early detection allows for ** timely interventions** to mitigate these risks. *It is a part of preventive medicine* - Counseling before pregnancy focuses on **prevention of adverse pregnancy outcomes** by optimizing health and addressing potential issues. - This proactive approach aligns directly with the principles of **preventive healthcare**. *It helps in reducing maternal morbidity and mortality* - By addressing risk factors, optimizing health, and educating women about healthy behaviors, pre-conceptional counseling can significantly **lower the incidence of complications** during pregnancy. - This ultimately contributes to a **reduction in maternal illness and death**.
Question 10: The net reproduction rate of 1 is primarily determined by which of the following demographic rates?
- A. Couple protection rate
- B. Total marital fertility rate
- C. Age specific marital fertility rate
- D. Total fertility rate (Correct Answer)
Explanation: ***Total fertility rate*** - The **Net Reproduction Rate (NRR)** is a refinement of the **Gross Reproduction Rate (GRR)**, which itself is derived from the **Total Fertility Rate (TFR)**. - An NRR of 1 implies that a generation of women is exactly replacing itself, meaning that, on average, each woman is giving birth to enough daughters who survive to reproductive age to take her place. This is directly linked to the overall fertility level represented by the Total Fertility Rate. *Couple protection rate* - The **couple protection rate** measures the percentage of eligible couples effectively protected against conception, typically through family planning methods. - While it influences the **Total Fertility Rate**, it is not the primary determinant of the **Net Reproduction Rate** itself. *Total marital fertility rate* - The **total marital fertility rate** measures the average number of children born to a woman within marriage. - It does not account for births outside of marriage or for the mortality of women before or during their reproductive years, which are crucial components of the **Net Reproduction Rate**. *Age specific marital fertility rate* - The **age-specific marital fertility rate** measures the number of births to married women within a specific age group. - This is a more granular component of fertility measurement but not the primary determinant of the overall replacement level indicated by an **NRR of 1**, which requires a broader measure like the **Total Fertility Rate**.
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