Fertility and Infertility

Fertility and Infertility Indian Medical PG Question 1: Most important criterion in semen analysis is

• A. Sperm concentration
• B. Sperm motility (Correct Answer)
• C. Semen volume
• D. Total sperm count

Fertility and Infertility Explanation: ***Sperm motility*** - **Sperm motility** (particularly progressive motility) is considered the most critical criterion in semen analysis as it directly reflects the functional ability of sperm to reach and fertilize an egg. - According to WHO guidelines, at least **32% progressive motility** is required for normal fertility. - A high concentration of non-motile or poorly motile sperm will not result in successful natural conception, regardless of other parameters. - **Progressive motility** is the best single predictor of natural fertility potential. *Sperm concentration* - **Sperm concentration** refers to the number of sperm per milliliter of semen (normal ≥15 million/mL). - While low concentration (oligozoospermia) affects fertility, adequate motility is essential for these sperm to reach the egg. - High concentration with poor motility has limited clinical value. *Semen volume* - **Semen volume** (normal ≥1.5 mL) is important for sperm delivery but does not directly assess sperm quality or function. - Abnormal volume can affect fertility, but motility remains the key functional parameter. *Total sperm count* - **Total sperm count** is calculated as volume × concentration (normal ≥39 million per ejaculate). - While important, total count without assessment of motility does not predict fertilization capacity.

Fertility and Infertility Indian Medical PG Question 2: On which day LH & FSH should be measured?

• A. 1-3rd day (Correct Answer)
• B. 7th day
• C. 14th day
• D. 10th day

Fertility and Infertility Explanation: ***1-3rd day*** - Measuring **LH** (Luteinizing Hormone) and **FSH** (Follicle-Stimulating Hormone) on cycle days 1-3 provides a baseline assessment of **ovarian reserve** and pituitary function. - At this early follicular phase, hormone levels are relatively stable and reflect the intrinsic **gonadal feedback** mechanisms before significant follicular development begins. *7th day* - By day 7, **follicular development** is usually well underway, and FSH levels might be decreasing as a dominant follicle is selected. - Measuring hormones on this day would not provide an accurate baseline assessment, as the levels are already influenced by **follicular growth**. *14th day* - Day 14 is often associated with the **LH surge** that triggers ovulation, making it unsuitable for a baseline assessment of ovarian reserve. - FSH levels would also be significantly different from the early follicular phase due to the ongoing **ovarian cycle events**. *10th day* - On day 10, **estrogen levels** are typically rising, which would already be providing negative feedback to the pituitary, affecting FSH and LH levels. - This timing would not be ideal for assessing baseline hormone levels for **fertility evaluations**.

Fertility and Infertility Indian Medical PG Question 3: 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

Fertility and Infertility 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.

Fertility and Infertility Indian Medical PG Question 4: Ovulation is influenced by

• A. LH+FSH
• B. LH (Correct Answer)
• C. FSH
• D. GnRH

Fertility and Infertility Explanation: ***LH*** - A surge in **luteinizing hormone (LH)** is the primary trigger for ovulation, inducing the final maturation of the oocyte and rupture of the dominant follicle. - The **LH surge** leads to the release of the ovum from the ovary, typically occurring about 24-36 hours after its onset. *LH+FSH* - While both **LH** and **FSH** are essential for follicular development, the *final act of ovulation itself is primarily driven by the LH surge*, not a combined surge of both. - **FSH** mainly promotes the growth of ovarian follicles in the early to mid-follicular phase. *FSH* - **Follicle-stimulating hormone (FSH)** is crucial for the *development and maturation* of ovarian follicles but does not directly trigger the release of the egg. - High levels of **FSH** alone do not induce ovulation; its role is completed before the actual ovulatory event. *GnRH* - **Gonadotropin-releasing hormone (GnRH)** is released from the hypothalamus and stimulates the pituitary gland to release **LH** and **FSH**. - **GnRH** is a precursor to the release of LH and FSH, but it does not directly act on the ovary to cause ovulation.

Fertility and Infertility Indian Medical PG Question 5: In the transition from a Graafian follicle to a functional corpus luteum, which of the following cellular events occurs?

• A. Granulosa cells begin to express estrogen receptors
• B. Granulosa cells begin to express LH receptors (Correct Answer)
• C. Theca cells begin to express androgen receptors
• D. Granulosa cells begin to express progesterone receptors

Fertility and Infertility Explanation: ***Granulosa cells begin to express LH receptors*** - During the late follicular phase, under **FSH** stimulation, **granulosa cells** in the developing Graafian follicle acquire **LH receptors**. - This acquisition of LH receptors is essential for the transition to a corpus luteum, as it enables the **LH surge** to trigger ovulation and subsequently stimulate **luteinization** and **progesterone production** by the corpus luteum. - While the initial expression occurs before ovulation, the functional significance becomes apparent during the transformation to the corpus luteum, making this the most critical receptor-related event in this transition among the given options. *Granulosa cells begin to express estrogen receptors* - Granulosa cells already express **estrogen receptors** in early follicular stages, which are essential for their proliferation and **aromatase synthesis**. - Estrogen receptor expression is characteristic of developing follicles throughout folliculogenesis, not specifically associated with corpus luteum formation. *Theca cells begin to express androgen receptors* - **Theca cells** produce **androgen precursors** (androstenedione, testosterone) under LH stimulation during the follicular phase, which granulosa cells convert to estrogen. - While theca cells contribute to the corpus luteum (theca-lutein cells), androgen receptor expression is not the primary defining cellular event of this transition. *Granulosa cells begin to express progesterone receptors* - The corpus luteum is the major source of **progesterone** in the luteal phase, but granulosa cells do not significantly upregulate progesterone receptors as part of their luteinization. - The key functional change is the cells' ability to *produce* large amounts of progesterone in response to LH, not increased progesterone receptor expression.

Fertility and Infertility Flashcard 1 of 5

Question: _____ is the fertilization of two different ova released in the same cycle, by separate acts of coitus within a short period of time.

Answer: Superfecundation

Fertility and Infertility Flashcard 2 of 5

Question: Treatment of infertility due to severe endometriosis is _____ to remove the endometriotic areas, followed by IVF

Answer: laparoscopy

Fertility and Infertility Flashcard 3 of 5

Question: _____ test is done to check the presence of anti-sperm antibodies and their source

Answer: Semen cervical mucus contact

Fertility and Infertility Flashcard 4 of 5

Question: What is the best test for ovarian reserve?_____

Answer: AMH levels

Fertility and Infertility Flashcard 5 of 5

Question: Ovarian reserve is most commonly tested by determining day _____ of menstrual cycle FSH levels being more than 40 IU as diagnostic of failure

Answer: 3