EBCOG Part-1 High Yield questions Subfertility

A. Daily follicle- stimulating hormone (FSH) injections
B. Donated embryos
C. Donor insemination
D. Intracytoplasmic sperm injection (ICSI)
E. ICSI with donated eggs
F. ICSI with donor eggs and donor sperm
G. Intrauterine insemination with donor sperm
H. Intrauterine insemination with partner sperm
I. In vitro fertilisation (IVF)
J. IVF with donor eggs and donor sperm
K. No treatment required
L. Ovulation induction and donor insemination
M. Ovulation induction and donor intrauterine insemination
N. Ovualtion induction with clomifene
O. Surgical sperm retrieval followed by ICSI
P. Surgical sperm retrieval followed by intrauterine insemination
Q. Surgical sperm retrieval followed by IVF

For each of the following clinical scenarios, what is the most appropriate treatment option from the list above? Each option may be used once, more than once or not at all.

1. A 46-year-old woman presents to the IVF clinic with her new partner. She wishes to become pregnant. Her menstrual cycle is irregular with a duration of 28–45 days, with periods lasting 1–2 days. Her serum FSH is 18.7 IU/l and her AMH level is <1.1 pmol/l. A pelvic ultrasound scan is normal. Her partner’s semen analysis results are: Semen count analysis: 8.3 × 106/ml Progressive motility 11% Morphology 2%

2. A couple attend the fertility clinic. The woman has irregular periods and clinical evidence of hyperandrogenism. Her AMH level is 67 pmol/l. An HSG confirms patent fallopian tubes. The man has azoospermia. In the past, he has been investigated and a testicular biopsy showed maturation arrest.

3. A couple are referred to the fertility clinic for investigation. The woman is 32 years of age and has no significant past medical history. She has a regular 28- day cycle. The man is 34 years of age and has a history of orchidopexy as a child for a left undescended testis. He has two semen analyses, both of which are normal. The woman’s results are: Day 2 FSH 4.5 IU/l Day 21 progesterone 35 nmol/l Pelvic ultrasound scan Normal HSG Normal cavity, bilateral patent tubes

A. Anastrozole
B. Bromocriptine
C. Cabergoline
D. Clomifene citrate
E. Follicle-stimulating hormone (FSH) injections
F. Human chorionic gonadotropin (hCG) injections
G. Laparoscopic ovarian drilling
H. Letrozole
I. Metformin
J. No treatment required
K. Oral cetrorelix
L. Oral progestogen for 10 days
M. Ovarian wedge resection
N.Tamoxifen
O. Weight gain
P. Weight loss

For each of the following clinical scenarios, what is the most appropriate treatment option from the list above? Each option may be used once, more than once or not at all.

4. During the course of fertility investigations, a 28-year-old woman with a BMI of 35 kg/m2 is found to have polycystic ovaries on ultrasound scanning. Her menstrual cycle has a length of 35–70 days. Her partner’s semen analysis is normal.

5. A 32-year-old woman and her husband present to the clinic with 1 year of subfertility. Investigations show them to have unexplained infertility. The woman requests treatment as she has read on the internet that there are drugs that can be used to ‘boost fertility’.

6. A woman with a BMI of 28 kg/m2 and polycystic ovarian syndrome (PCOS) has attempted ovulation induction with clomifene citrate without success. She now returns to the clinic with pelvic pain that is worse around the time of menstruation.

A. Serum androstenedione
B. Serum anti-Müllerian hormone (AMH)
C. Serum CA125
D. Serum follicle- stimulating hormone (FSH) on days 10–12 of cycle
E. Serum FSH on day 21 of cycle
F. Serum FSH on days 2–5 of cycle
G. Serum luteinising hormone (LH) on day 5 of cycle
H. Serum LH on day 14 of cycle
I .Serum LH on day 21 of cycle
J. Serum progesterone on day 14 of cycle
K. Serum progesterone on day 21 of cycle
L. Serum progesterone on day 28 of cycle
M. Serum prolactin
N. Serum testosterone
O.Thyroid function tests

For each of the following clinical scenarios, what is the most appropriate investigation option from the list above? Each option may be used once, more than once or not at all.

7. A woman with a regular 35- day cycle attends the fertility clinic. Investigations are instigated. Which test should be arranged to check for ovulation?

8. Which test is probably the best biochemical marker of polycystic ovaries?

9. A 28-year-old woman with a BMI of 21 kg/m2 attends the fertility clinic with her partner. She has very infrequent periods. She is treated with clomifene therapy to induce ovulation, but the treatment fails. Which test will indicate if this woman is likely to have a good clinical and endocrine response to laparoscopic ovarian drilling?

A.Abdominal examination
B. Abdominal ultrasound scan
C. Barium enema
D. Colonoscopy
E. CT scan of pelvis
F. Diagnostic laparoscopy
G. Diagnostic laparoscopy and peritoneal biopsy
H. Endoanal ultrasound
I. Endometrial biopsy
J. Endometrial cytokine levels
K. MRI of pelvis
L. Rectal examination
M. Serum CA125
N. Transperineal ultrasound scan
O.Transvaginal ultrasound scan
P. Vaginal examination

For each of the following clinical scenarios, what is the most appropriate management option from the list above? Each option may be used once, more than once or not at all.

10. A 35-year-old woman presents to the gynaecology clinic with pelvic pain and dysmenorrhoea. A pelvic examination demonstrates tenderness and fullness in the right iliac fossa. Which test should be used to diagnose or exclude an ovarian endometrioma?

11. A 24-year-old woman, virgo intacta, presents to the gynaecology clinic with abdominal and pelvic pain, dysmenorrhoea and dyschezia. What is the most appropriate initial assessment for the diagnosis of endometriosis?

12. A woman with a previous diagnosis of pelvic endometriosis presents to the clinic with cylical rectal bleeding. Vaginal and rectal examinations are inconclusive. What is the most appropriate initial assessment to identify or exclude rectal endometriosis?

A. Anabolic steroid abuse
B. Congenital bilateral absence of vas deferens (CBAVD)
C. Idiopathic
D. Kallmann syndrome
E. Kartagener’s syndrome
F. Klinefelter syndrome
G. Maturation arrest
H. Noonan syndrome
I. Pituitary adenoma
J. Primary testicular failure
K. Retrograde ejaculation
L. Seminoma
M. Sertoli cell-only syndrome
N. Varicocele
O. Vasectomy
P.Y chromosome microdeletion

For each of the following clinical scenarios, what is the most likely diagnosis from the options listed? Each option may be used once, more than once or not at all.

13. A man is found to have azoospermia during the course of fertility investigations. He has two children from a previous relationship. He denies any significant medical history. On examination, he is muscular and both testes are small and soft.

14. A man is found to have azoospermia. His serum FSH and testosterone levels are normal. On examination, he has normal secondary sexual characteristics and both testes are of normal size. His karyotype is normal and a cystic fibrosis screen is negative. A testicular biopsy shows germ cells to be present.

15. A man is found to have azoospermia. His serum FSH level is elevated but his testosterone is normal. On examination, the man is tall and has gynaecomastia. Both testes are in the scrotum but are small and soft.

A. Laparoscopic ovarian drilling
B. Metroplasty
C. Surrogacy
D. Adoption
E. Ovum donation
F. Intracytoplasmic sperm injection (ICSI)/in vitro fertilisation (IVF)
G. In vitro fertilisation
H. Tubal reconstructive surgery
I. Clomiphene
J.Metformin
K. Weight reduction
L. Laparoscopic ablation of endometriosis/ovarian cystectomy
M. Intrauterine insemination
N. Donor insemination
O. Gamete intrafallopian tube transfer

For each description below, choose the single most appropriate answer from the above list of options. Each option may be used once, more than once, or not at all.

16. A couple are seen in infertility clinic for follow-up of their results. The female partner has a normal day 21 progesterone level. Hysterosalpingography (HSG) shows bilateral patent tubes. Repeat semen analysis shows a volume of 2.8 ml, a pH of 7.4 and a sperm count of 3 106 million/ml. The couple are very keen on being genetic parents

17. A 34-year-old woman with a body mass index (BMI) of 26 has a day 23 proges- terone level of 10 nmol/L. HSG shows bilateral patent tubes. Her partner’s semen analysis shows a volume of 3 ml, a pH of 7 and a sperm count of 20 106 million/ml. She had tried 6 months of clomiphene with documented anovula- tion. A trial of metformin was not successful. What is the next appropriate step?

18. A 31-year-old lady is seen in the subfertility clinic. She has a long history of deep dyspareunia. Her partner’s semen analysis shows a volume of 3 mL, a pH of 7 and a sperm count of 20 106 million/ml. Ovulation is confirmed with day 21 proges- terone. Previous laparoscopy showed stage 2 endometriosis. What is the next appropriate step?

19. A 34-year-old lady presents with a 2-year history of amenorrhoea. Her partner’s semen analysis is normal. Tubal patency is confirmed on HSG. Her serum luteinising hormone level is 100 units/L and her follicle-stimulating hormone level is 120 units/L. She is medically fit and healthy. What is the next appropriate step?

20. A 24-year-old woman presents with a 3-year history of subfertility. Investigations show bilateral patent tubes, there is a day 21 progesterone of 18 nmol/L and her partner’s semen analysis is reported as normal. Her BMI is 37. What is the next appropriate step?