Subfertility Extra Questions

1. All of the following are causes of premature ovarian failure except:

2. Among the following, select the strongest prognostic factor associated with recur- rent miscarriages:

3. All of the following may adversely affect male fertility except:

4. Post testicular causes account for the following percentage of male infertility:

5. Choose the first option of management for mild male factor infertility:

6. Average pregnancy rated with ICSI (intracytoplasmic sperm injection)

7. The growth factor implicated in mediating the effects of ovarian hyperstimulation is:

8. Which one of the following statements is correct regarding recurrent miscarriage?

9. Which ONE of the following is correct in relation to the prevalence of the main causes of infertility in the UK?

10. Which ONE of the following clinical scenarios is considered diagnostic of polycys- tic ovarian syndrome?

11. A 34 year-old woman, who has been trying to conceive for 3 years, is referred to the infertility clinic for further management. Which ONE of the following is an appropriate discussion issue during her clinic counselling?

12. A 40 year-old woman, who has been trying to conceive for 3 years, is offered IVF (in vitro fertilisation) as a treatment option by her fertility specialist. Which ONE of the following is an appropriate discussion issue during her clinic counselling?

13. Which ONE of the following clinical scenarios is considered diagnostic of polycystic ovarian syndrome?

14. Which ONE of the following is likely to predict a favourable ovarian response to gonadotrophin stimulation in IVF (in vitro fertilisation)?

15. A 30 year-old woman has been trying to conceive for 3 years. She has infrequent menstrual cycles. Ultrasound confirms a normal uterus and polycystic ovaries. X-ray hysterosalpingogram has confirmed bilateral patent fallopian tubes. Her part-2 ner’s semen analysis is reported as within normal limits. Her BMI is 25 kg/m . She has normal prolactin, FSH, oestradiol and testosterone. Of the options listed, which one of the following therapies is considered the most appropriate initial therapy?

16. The WHO classification of ovulation disorders describes three classes. Which one of the following

17. The WHO classification of ovulation disorders describes three classes. Which one of the following is characteristically associated with high FSH and low oestrogen (WHO Class III)?

18. In cases of infertility:

19. The mother of a 10-year-old girl with beta-thalassemia major seeks consultation in order to enquire about how the fertility prospects of her daughter may be affected due to her medical condition. Which of the following statements would be incorrect to tell her?

20. A 40-year-old man undergoes a semen analysis test. Which one of the following components listed in his test result is considered to be ABNORMAL according to WHO 2010 semen analysis criteria?

21. The single largest cause of acquired tubal pathology is:

22. Ms XY is 38 years old and suffers from primary infertility and endometriosis. Her recent TV scan suggests the presence of a 2.5 cm endometrioma. Her pain is well controlled using simple analgesics. She is due to undergo IVF. Which treatment is best suited to deal with her endometrioma?

23. Ms XY (30 years) and her male partner (26 years) have been trying to conceive naturally for the last 3 years. They have had infertility investigations over the last year. These include a normal semen analysis, normal USS pelvis, normal HSG, normal TSH, prolactin, D3 FSH, LH and normal AMH. Her day 21 progesterone suggest ovulation. Ms XY is rubella immune and has negative swabs for an STI. Her recent cervical smear is normal. Which of the following treatment options are best suited to her?

24. Which of the following statements correctly describes salpingitis isthmica nodosa?

25. Women with OHSS are specially prone to:

26. Measures to predict ovarian response to gonadotrophin stimulation in IVF are all except:

27. Fertiloscopy is an outpatient technique that includes (THL=transvaginal hydrolaparoscopy):

28. Risk of transmission of HIV from HIV-positive male to female partner is negligible when all the following criteria are met except:

29. Hypogonadotropic hypogonadism as a cause for male subfertility is seen in:

30. Which of the following statements regarding androgen metabolism in women is not true?

31. In counselling women planning for fertility treatment about the risk of malignancy associated with use of fertility drugs, which of the following statements is true?

32. Surgical reversal of tubal sterilisation:

33. The primary metabolic problem in congenital adrenal hyperplasia is a deficiency in production of:

34. Ms XY is 7 weeks pregnant. She has been diagnosed with her 3 consecutive first- trimester miscarriages before this pregnancy. She is 28 years old and with the same partner. She is presently on folic acid supplementation. Her miscarriages remain unexplained. Which of the following treatment options are best suited to her?

35. The direct biochemical evidence of hyperandrogenism is obtained by measurement of serum:

36. A 28-year-old amenorrhoeic woman who wishes to become pregnant attends the fertility clinic complaining of galactorrhoea and mild visual disturbance. Her serum prolactin level was found to be elevated. An MRI scan of the head is performed, which showed the presence of a macroprolactinoma, but without supracellar extension. What is the most appropriate first line management?

37. In the female, which cell type secretes Anti-Mullerian hormone?

38. A woman with tubal disease is advised to have IVF treatment to maximise her chances of pregnancy. On reading the information leaflet, she is very concerned about the risks of ovarian hyper stimulation syndrome. What is the chance of developing severe ovarian hyper stimulation syndrome (OHSS) and requiring hospitalisation in women under- going controlled ovarian hyper stimulation?

39. What is the predominant cause of an ovulatory infertility?

40. What is the first-line pharmacological treatment for an ovulatory polycystic ovary syndrome?

41. A 32-year-old woman presents to the gynaecology clinic with galactorrhoea and secondary amenorrhoea. A serum prolactin level is measured and found to be elevated. What is the main mechanism by which hyperprolactinemia causes secondary amenorrhoea?

42. Following an IVF treatment cycle where 15 oocytes were collected, a patient presents to the clinic with abdominal pain, nausea and vomiting. An ultrasound scan is performed, which shows the ovaries to be enlarged with a mean diameter of 10 cm. There is a small amount of ascites., What is the diagnosis?

43. What type of electrolyte disturbance is often seen in association with severe cases of OHSS?

44. A woman with a severe cases of OHSS initially presented with tense ascites, oliguria and a haematocrit of 46%. She was treated with appropriate fluid replacement and the haematocrit is now in the normal range. However, she remains markedly oliguric. What is the appropriate management?

45. What is the recommended test for the biochemical detection of hyperandrogenism?

46. What is the mechanism of action of Metformin?

47. What is the estimated prevalence of endometriosis in infertile women?

48. During fertility investigations, a woman is found to be susceptible to Rubella and is offered vaccination. How long should she use contraception before trying to conceive again?

49. Following fertility investigations, a man is found to have idiopathic oligozoospermia. He enquires if there is any treatment he can take to improve his sperm count. What would you recommend?

50. Following a full set of investigations in the fertility clinic, a couple are diagnosed as having unexplained infertility since all the tests have been reported as normal. The couple have been trying to conceive for 3 years. What treatment would be recommended?

51. Prior to a frozen embryo transfer, a woman takes a course ofoestra-diol valerate to induce endometrial proliferation. She attends for an ultrasound scan after 10 days to measure the endometrial thickness. What endometrial thickness should have been achieved in order for the embryo transfer to proceed?

52. Which form of contraception is most strongly associated with a delay in return of fertility?

53. Fertility declines with age. What percentage of women aged 35 will take longer than a year to conceive with regular intercourse?

54. According to the current WHO criteria, what is the reference limit for the total number of spermatozoa in an ejaculate?

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

56. 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 an ovulatory despite increasing doses of clomifene citrate over six cycles. What is the most appropriate next step in her management?

57. A 25-year-old athlete with a BMI of 18 presents to the fertility clinic are 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. The oestrogen levels are also low, although the androgen pro le is normal. What is the best strategy for her ovarian stimulation?

58. 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 hyper stimulation syndrome should she be categorized as having?

59. 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?

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

61. 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?

62. A 39-year-old male presents to a fertility clinic following a repeat semen analysis for oligoas the no teratozoospermia. The 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?

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

64. Are an IVF cycle and a subsequently positive pregnancy test, a patient 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?