MRCOG Part 2 – Subfertility EMQ

Option List
A. Karyotyping
B. Serum Estradiol
C. Serum Progesterone
D. ICSI
E. ART
F. IVF with donor oocyte
G. IVF with donor sperm
H. Cardiovascular risk
I. Neurological risk
J. PESA + ICSI
K. ICSI with donor sperm
L. Testicular biopsy
M. TRUS
What is the next step in management for all the scenarios given below?
Each option can be used once, more than once or not at all.

1. 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?

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

3. 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?

4. 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
C. IUI
D. IUI with donor semen
E. IVF
F. ICSI
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

5. 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?

6. Ellen is 26 years and is trying for conception since 1 year now. She is otherwise fit and healthy. In the list of investigations for fertility workup, she underwent hysterosalpingography for tuba patency. The image of which is provided below. What is the management of the given condition?

7. 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?

8. 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?

9. 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?