EBCOG Part-1 High Yield Questions Subfertility

1. A 35-year-old woman with known endometriosis has been using progesterone therapy to control her symptoms. Her symptoms have worsened but she is keen to avoid surgery. She is planning to start a monthly gonadotropin-releasing hormone (GnRH) analogue for a course of 6 months. This is her first course of treatment.
What prescription or investigation should occur alongside this?

2. A 32-year-old woman with known endometriosis has a symptomatic 6 cm endometrioma diagnosed on transvaginal ultrasound scan. Her CA-125 is 157 KU/L. A subsequent MRI scan shows no suspicious features. She has one child and is uncertain about whether her family is complete. What is the most appropriate management of her endometrioma?

3. A 45-year-old woman with known endometriosis has a symptomatic 6 cm endometrioma diagnosed on transvaginal ultrasound scan Her CA-125 is 157 KU/L A subsequent MRI scan shows no suspicious features. She has one child and is certain that her family is complete.

What is the most appropriate management of her endometrioma?

4. A 40-year-old patient with known endometriosis has dysmenorrhoea, pelvic pain, dyspareunia and menorrhagia. Oral hormonal therapy and the levonorgestrel intrauterine system have been ineffective. She achieved partial symptom relief with GnRH analogues as she became amenorrhoeic. An MRI scan shows a 4 cm endometrioma in the left ovary, a normal right ovary, evidence of thickening of
What is the most appropriate management to offer her?

5. A 25-year-old patient presents with dysmenorrhoea, pelvic pain and infertility. Her symptoms are gradually worsening and are interfering with her work as a primary school teacher. She is otherwise well, has never been pregnant and has a regular menstrual cycle. She is married and has been trying to conceive for 6 months. Her husband’s semen analysis is normal. A clinical examination and transvaginal ultrasound are unremarkable.
What is the most appropriate management?

6. Comparing letrozole with clomifene citrate in patients with polycystic ovarian syndrome, clomifene citrate is associated with:

7. A 29-year-old with primary subfertility and a BMI of 30 kg/m2 is known to have polycystic ovarian syndrome based on anovulation, transvaginal ultrasound appearances of the ovaries and a raised
testosterone. She has remained anovulatory despite increasing doses of clomifene citrate over six cycles.
What is the most appropriate next step in her management?

8. A 25-year-old athlete with a BMI of 18 presents to the fertility clinic a er trying for a pregnancy for 2 years. She has oligomenorrhoea and her partner’s semen analysis is within the normal range. Her gonadotropin pro le shows a low FSH and LH. T e oestrogen levels are also low, although the androgen pro le is normal.
What is the best strategy for her ovarian stimulation?

9. A 36-year-old para 1 is undergoing an IVF cycle. She has egg retrieval and two fresh embryos are transferred. Her initial beta human chorionic gonadotropin is 1600 mIU/ml, and she begins to develop abdominal pain, nausea and vomiting. An ultrasound reveals two gestational sacs and free abdominal uid. She is not short of breath, her pulse oximetry is 98% on room air and electrolytes and haematocrit and liver function tests are within normal limits.
What grade of ovarian hyperstimulation syndrome should she be categorized as having?

10. A 35-year-old para 0 is in the midst of an IVF cycle. She has undergone egg retrieval following human chorionic gonadotropin administration, and you have just implanted two fresh embryos.
What is the chance that she will develop OHSS?

11. A patient with subfertility is found to have tubal obstruction following an HSG. T ere are no known additional pelvic comorbidities (such as PID, previous ectopic pregnancy or endometriosis).
What is the chance that laparoscopy will con rm these ndings of occlusion?

12. A 37-year-old para 0, who has undergone controlled ovarian stimulation for IVF treatment 3 weeks previously, presents with abdominal pain, bloating, nausea and vomiting. She is known to have PCOS and had not ovulated previously with clomifene citrate treatment. She went on to receive antagonist recombinant FSH protocol and was later given human chorionic gonadotropin to trigger ovulation. Ultrasound has shown evidence of ascites with an ovarian size of 14 cm. Her haematocrit was 46%. T e patient was admitted to hospital for inpatient treatment.
What is the recommended regime of thromboprophylaxis?

13. A 39-year-old male presents to a fertility clinic following a repeat semen analysis for oligoasthenoteratozoospermia. T e semen analysis results show semen volume (1.0 ml), sperm concentration (2 × 106/ml), total motility (10%), normal forms (1%) and vitality (10%).
What is the appropriate next step in management?

14. A male patient presents with history of anosmia, azoospermia, bilateral small testes and gynaecomastia.
What is the best treatment modality?

15. A er an IVF cycle and a subsequently positive pregnancy test, apatient develops abdominal pain, nausea, vomiting and mild shortness of breath. Further evaluation reveals normal lung sounds, palpable ascites and a pulse oximetry of 97% on room air. A chest x-ray is normal, the haematocrit is 40% and an ultrasound shows ovaries of 9 cm with evident ascites.
Which of the following is most consistent with severe OHSS?

16. A woman is diagnosed with hyperthyroidism as part of fertility investigations and opts to have treatment with radioactive iodine.
What is the minimum time she should delay conception after radioactive iodine treatment?

17. What is the most common cause of testicular failure?

18. One hundred couples are investigated for failure to conceive after 1 year of regular unprotected intercourse.
What proportion of these couples will have unexplained infertility?

19. What is the single most important factor in determining female reproductive outcome?

20. What is the most frequently used test of ovarian reserve?