EBCOG Part 1 – 2 Months Subfertility – DAY 3

1. A 42 year old woman is undergoing IVF treatment at the IVF centre.She is attending her follow up appointment after being on the gonadotrophin stimulation protocol.She had various tests to test her response to treatment.Which one of the following results indicates a higher response to gonadotrophin stimulation?

2. A 30 year old womans presents to the A & E 3 days after an oocyte retrieval was done .She is complaining of abdominal pain ,vomiting,dizziness & shortness of breath.You are on the way to assess her.What would you instruct the attending nurse to do while waiting  for you to arrive?

3. What is the triggering factor for severe OHSS,which is a recognised serious complication of fertility treatment?

4. Which protocol for ovarian stimulation will be advisable in the following case to prevent OHSS-28 year old female with PCOS undergoing IVF.

5.Out of 100 couples investigated for failure to conceive after1 year of regular unprotected intercourse ,what proportion will have unexplained infertility?

6. Which cases of OHSS should be reported to the HFEA?

7. Following IVF treatment a woman attends the A&E with mild lower abdominal pain & bloating.15 oocytes were collected in the cycle.Her GP suspects she has OHSS.An ultrasound is performed & ovarian size is 6 cm.There is no ascites.What type of OHSS is this?

8. A 24 year old woman attends the subfertility clinic with h/o failure to achieve a pregnancy with 18 months of regular unprotected sexual intercourse.Her medical history is insignificant & her menstrual cycle is regular.Her partner is healthy & has a 3 year old child from a previous relationship.What would be the most appropriate investigation to confirm the diagnosis of unexplained IF?

9. 38 years old Annie presented to subfertility clinic with h/o failure to conceive after 1 year of unprotected regular sexual intercourse.The medical history is insignificant.Midluteal progesterone level is 36 nmol/L & HSG reveals patent tubes.Semen analysis of partner is normal.What is the best advise for this couple?

10. A 21 year old presented to subfertility clinic with failure to conceive for 18 months.She has previously a similar history another partner.Her medical history is insignificant.Menstrual cycle is regular with dysmenorrhea.Midluteal progesterone was 38 & a lap & dye test did not show any abnormality.semen analysis of the partner is normal.What is the next step in management for this couple?

11. A 25 year old woman who has undergone IVF presents to the A & E with signs & symptoms of OHSS.She was diagnosed as a case of moderate to severe OHSS & advised admission for observation & management.But the woman refused & asked for outpatient management.The consultant was informed & after explaining the red flag symptoms it was agreed to manage the woman on an outpatient basis.Which of the following sign or symptom would be an indication for termination of outpatient management?

12. .A woman diagnosed with tubal disease wishes to conceive.She has been advised to undergo IVF.On reading the PIL she is very concerned about the risk of OHSS.What is her chance of developing OHSS & requiring hospitalisation following controlled ovarian hyperstimulation?

13. A patient presented to A&E with c/o abdominal pain,nausea & vomiting.She gives h/o IVF treatment ,where 20 oocytes were collected 2 days ago.A scan done reveals ovaries are enlarged with a diameter of 10 cm.Minimal ascitic fluid is seen.What is the likely diagnosis?

14. You are examining Mrs Rosie ,35 years old in the A&E who is diagnosed to have OHSS following IVF treatment.You ordered a few tests to be run for her.What type of electrolyte disturbance is often seen in association with severe cases of OHSS?

15. Mrs Annie is a case of critical OHSS following IVF treatment.She initially presented with tense ascites,oliguria & a hematocrit of 47%.She was admitted & treated with appropriate fluid replacement & her hematocrit is now in the normal range.However she still remains oliguric.What would be the most appropriate management for her now?