Welcome to your Subfertility

A. Vaccinate the partner and sperm washing
B. IUI without sperm washing
C. Timed unprotected intercourse
D. Try for spontaneous conception
E. IUI with sperm washing
F. Vaccinate the partner and sperm washing not required
Choose the most appropriate answer for the scenarios given. The option may be used once or more than once or not at all.

1. A couple being evaluated for primary infertility was found to have discordancy for HIV. The male partner is found to be HIV positive, and he is on HAART for the past 6 months. His Viral load is low and the other infection screen is negative. The best way to achieve a pregnancy with a low risk of transmission to the partner is
2. A couple has presented to the fertility clinic and they are trying for conception for the past 1 year. The male partner had been diagnosed to be HIV positive and he is in good health with viral load less than 50 copies/ml. He is very complaint with HAART for almost a year. They wish to achieve a pregnancy with a low transmission rate to the female partner. The best way is
3. Discordant infertile couple with male partner positive for HIV, who is very compliant with HAART for the past 2 years, with no other health problems is found to have an undetectable viral load. The partner has taken pre-exposure prophylaxis and does not want any risk of transmission of HIV. She is not contemplating donor insemination also. What is the best way to achieve a pregnancy?
4. A couple has been trying to achieve a pregnancy for the past 1 year. The male partner is found to be positive for Hepatitis C. There are no other problems detected and the couple wishes to achieve a pregnancy. The best treatment advice would be?
A. Clomiphene citrate induction
B. Gonagotrophins
C. Laparoscopic ovarian drilling
D. Pulsatile gonadotrophins
E. Invitro fertilisatiton
F. Oocyte donation
G. Life style modificatiton and weight reduction
H. Metformin therapy
Choose the appropriate answer for the scenario described, each option can be used once, more than once or not at all.

5. 30year old presented with secondary infertility, has been evaluated and found to have Sheehans syndrome. She is anxious to conceive. The best management option is
6. 36 years old has presented to the fertility clinic and is anxious to conceive. She gives a history of mumps 2 years back following which she had irregular cycles once in 6 months and now has amenorrhoea for the past 1 year. The best management option for her fertility treatment is
7. 32 year old women being evaluated for primary infertility is diagnosed to have PCOS. Clinically she has acanthosis nigricans, very irregular periods and her serum progesterone was 3 ng/ml. Her BMI is 39. She wishes to conceive as early as possible. The best management option is
A. USG scrotum
B. Repeat semen analysis
C. Karyotyping including y-chromosome microdeletion
D. Scrotal Doppler with Valsalva manoeuvre
E. TSH and Prolactin testing
F. Cystic fibrosis gene testing
Choose the most appropriate investigation done for the scenario given. The option may be used once, more than once or not at all.

8. 31 year old male, with congenital absence of bilateral vas deferens and the hormone testing was normal
9. 29 year old male found to have severe oligozoospermia. The FSH and LH were raised with low testosterone levels
10. 30 year old male found to have obstructive azoospermia and the cause of which is not known.
A. Laparoscopic cystectomy
B. Diagnostic Laparoscopy to see for endometriosis not identified by ultrasound
C. Letrozole
D. Weight reduction
E. Invitro fertilisation
F. Gonadotrophins
G. Metformin
H. Expectant management

11. A couple has been referred by the GP to 4 years primary infertility clinic. She has regular menstrual cycles with no other problems with the menstruation. On evaluation of the female, the mid-luteal phase progesterone was 19ng/ml and ultrasound revealed 2.5cm endometrioma. The most appropriate management
12. A couple with Primary infertility of 18 months on evaluation found to have no obvious reasons for infertility. The most appropriate management is
13. A couple with primary infertility of 3 years. She has a BMI of 30 kg/m2 and was found to have PCOS. She was found to have anovulation with increasing doses of Clomiphene citrate. The next most appropriate management is

Option List
A. Karyotyping
B. Serum Estradiol
C. Serum Progesterone
F. IVF with donor oocyte
G. IVF with donor sperm
H. Cardiovascular risk
I. Neurological risk
K. ICSI with donor sperm
L. Karyotyping
M. Testicular biopsy

14. A 22 years old short stature woman is being referred by her GP with amenorrhea since 6 months. Her pregnancy test is negative.USG done shows small uterus and ovaries are present. Her test result shows: FSH – 12.5
What is your next investigation of choice?

15. The woman in last question has been diagnosed with Mosaic Turner syndrome. What is the most appropriate choice for her?

16. She gets infertility treatment and gets pregnant. You are about to see her in antenatal clinic. What is the additional serious risk associated with her pregnancy for which you need multidisciplinary input?

17. A couple comes with husband semen analysis report stating azoospermia. The test has been repeated again and is found to be same. On further investigation the diagnosis of CABVD is made. What will you advise the couple for the fertility treatment?

18. A 30 years old man comes to you to show his semen analysis report and some hormone report which was advised by her GP. His report suggests azoospermia. His hormone report suggests :
FSH 1.16mIU/ ml, LH : 1.5mlu/ml , Testosterone : 0.98 ng/ ml
What investigation would you advise next?

Option List
A. Ovarian ectopic pregnancy
B. Interstitial ectopic pregnancy
D. IUI with donor semen
G. Unprotected intercourse limited to time of ovulation
H. Vaccination of female partner
I. Treatment of female partner
J. Tubal ectopic pregnancy
K. Cannot get pregnant in same sex relationship
L. Heterotropic pregnancy
M. Abdominal pregnancy
N. Pregnancy in both cornua of bicornuate Uterus
O. Surrogacy
P. Hysteroscopic metroplasty
Q. Laparoscopic septal resection
R. Hysterectomy

19. A 26 years old nulliparous woman presents to A & E with severe pain abdomen. She gives history of spotting p/ v one night before. She had embryo transfer 4 weeks back and her pregnancy test was positive. You send her for urgent scan. The transvaginal scan image is as below. What is your diagnosis?

20. A woman presents in your clinic with secondary infertility. She conceived twice 2 years back but had miscarriage by 6 weeks. She is fit and healthy. She has undergone 3 cycles of unstimulated and 3 cycles of stimulated IUI. You decide to do diagnostic laparoscopy and hysteroscopy. During hysteroscopy, you find following picture. What is her management?

21. A 32 year old comes to you in fertility clinic. She is keen to concieve, She is in same sex relationship. She is healthy, gets regular menses. She does not have any significant medical and surgical history. What option would you advise et to achieve conception?

22. You are a ST5. You see a couple in fertility clinic, seeking consultation for conception. The husband is HIV positive and is on HAART. His viral is <30 copies / ml .An earlier report of 8 months back suggests a viral load of 40 copies/ml. What is their best way of achieving conception with negligible risk of transmission of infection to wife?

23. A couple is planning for pregnancy and seeks your advise. The husband is positive for Hepatitis B and is on treatment. What is your first advise?