Subfertility ( Platinum ) – EMQ

Option List:

A. Karyotyping.
B. Serum testing for cystic fibrosis
C. Repeat semen analysis immediately.
D. Repeat semen analysis after 3months
E. Repeat FSH, LH & testosterone.
F. Refer for urologist.
G. Measure prolactin level.
H. Urine for microscopy & culture.
I. US/doppler scrotum.
J. Test for smell.
K. Culture of semen.
L. Advanced sperm quality test
M. DNA fragmentation test of sperm.

Each of the following scenarios describes various tests for male infertility. For each patient select the single most appropriate test from the list above. Each option may be used once, more than once or not at all.

1. 24 years old Caucasian presented for evaluation of infertility. No problem in erection or ejaculation. Examination -showed bilateral absence of the vas. Semen analysis confirmed azoospermia.

2. A 30 years old, tall healthy man presented for infertility evaluation. He has no problem in erection or ejaculation. Semen analysis showed count of 6 million/ml. Repeated twice .

3. 34 years old man who was previously healthy & has fathered a child before but now complains of excessive fatigue, headache.He failed to produce semen for testing twice. His hormonal profile showed low FSH, LH & testosterone.

4.  A 28 years old healthy male, who has fathered 2 children before, noticed some urgency, dysuria & turbid/cloudy urine after sexual intercourse

Option List:
A. 3-6%
B. 15%
C. 20%
D. 5%.
E. 10%.
F. 50%
G. 30%.
H. 40%.
I. 80%
J. 90%
K. 3-8%
L. 3-5%

Each of the following scenarios of different severity of OHSS, Options above show various percentages . For each patient select the SINGLE most appropriate answer from the list above. Each option may be used once, more than once or not at all.

5. 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 hyperstim- ulation syndrome. Her chances of Developing Mild OHSS

6. 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. Her chance of developing severe OHSS

7. A 37-year-old para 1 is undergoing an IVF cycle. She has egg retrieval .2 embryos 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 fluid. 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.Whats incidence of women having moderate OHSS

Option List:

A. Letrozole
B. Laparoscopic ovarian drilling
C. 5000 IU HCG
D. 1000 IU HCG
E. 250 mcg recombinant HCG
F. GnRH agonist
G. GnRH antagonist
H. OHSS
I. PCOS
J. VTE
K. Ectopic pregnancy
L. Dialysis
M. Reassure
N. Paracecentesis
O. Advise on adequate oral fluid intake
P. Mild OHSS
Q. Moderate OHSS
R. Severe OHSS

8. A 26 years old woman visits you in infertility clinic . She is trying for pregnancy since 2 years.Her BMI is 27. She is a diagnosed case of PCOS. She gets menses only after progesterone withdrawal . Husbands semen analysis is normal. She has reduced her weight and also having a healthy lifestyles . She has received Clomiphene for 3 cycles and letrozole for 1 cycle . But failed to ovulate with any of these . What will be your next management ?

9. After further management,she starts ovulating but fails to concieve after 6 months of treatment. Finally she has been decided for ART. Her AMH is 12 and AFC is 18 . What is the most serious risk associated with the ovulation stimulation in her ?

Option List:

A. Clomiphene citrate induction
B. Gonagotrophins
C. Laparoscopic ovarian drilling
D. Pulsatile gonadotrophins
E. Invitro fertilisatiton
F. Oocyte donation
G. Oocyte Freezing
H. Life style modification and weight reduction
I. Metformin therapy

Choose the appropriate answer for the scenario described, each option can be used once, more than once or not at all

10. 30 year old presented with secondary infertility, has been evaluated and found to have Sheehans syndrome. She is anxious to conceive. The best management option is

11. 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

Option List:

A. Letrozole
B. Clomiphene
C. Hysterosalpingography
D. Diagnostic hysteroscopy
E. Diagnostic laparoscopy
F. Chromopertubation
G. Donor insemination
H. Unprotected intercourse limited to time of ovulation
I. Gonadotropin stimulation
J. GnRH agonist and step up protocol and minimal dose of HCG
K. GnRH antagonist protocol with GnRH agonist for ovulation induction
L. IUI
12. A 22 year old nulliparous woman with primary amenorrhea was found to have hypogonadotrophic hypogonadism related amenorrhea. What will be treatment choice for infertility management?

13. A 28 year old nulliparous woman who is in same sex relation . Method of conception?

14. A 28 year old woman being investigated for infertility for 3 years has dysmenorrhea, dyspareunia and dyschezia. What is the gold standard method for diagnosis of her condition?

15. A 32 year old couple with Husband HIV positive and compliant with HAART and viral load < 50 copies / ml. What is the best advice for them to conceive?

16. A 28 year old woman known case of PCOS undergoing IVF treatment. Which protocol is best to avoid OHSS ?

Option List:

A. Anovualtion
B. PMS
C. Endometriosis
D. gonorrheal  salpingitis
E. Genital tuberculosis
F. Asherman  syndrome
G. salpingitis  isthmica  nodosa
H. Sub mucous fibroid
I. Bilateral Hydrosalpinx
J. Ovulation
K. Sub serous fibroid
L. Endometrial polyp

Following scenarios   Show various women  presenting to  infertility clinic.choose the single most appropriate diagnosis from above list for these women

17. Tracking Basal body temperature (BBT) is an easy way to get an idea of if and when you’re ovulating.By looking at At BBT Curve , the image shows  the  basal  temperature  graph  made  by  the couple   Mr & Mrs.Adams , the  previous  month.

What thisBBT chart  implies ?

18. Ms. Kenchamma, 33-year-old  Asian  woman has been trying for pregnancy for 1    Year , now she complains  of  pelvic  pain  and  amenorrhea   For 3 months associated  with  low-grade fever  and  weight  loss.

Physical  examination  demonstrates  a  tender  pelvic  mass.
Surgical  findings include  dense  pelvic  adhesions,  segmental  dilatation  of  the  fallopian  tubes,  and  everted  fimbria.
Microscopic  examination  of  the  right  fallopian  tube  shows  proliferation  of  tubal  folds  with  giant  cells within  the  tube.
Which   Is probable diagnosis  ?

19. Mrs.  A.Is 25year old , she is known case of infertility .she has undergone surgical evacuation 6 weeks back for a missed miscarriage her partners semen analysis normal , .Diagnostic  Laprosocpy  bilateral tubes are  normal .serum progesterone is 40 .She  also complains of light periods .
Her HSG is as follows

20. Mrs X,  42 year old nulliparous from Ghana  has presented with dysmenorrhoea ,  and infertility . her partners semen analysis normal , .Diagnostic  Laparoscopy  bilateral tubes are  normal .Serum progesterone is 38 on day 15 .
Her Hysteroscopy Image is attached ,what is the cause of her infertility ?

Option List:

A. Pituitary Adenoma
B. Pelvic inflammatory disease
C. Prolactinoma
D. Androgen Insensitivity syndrome
E. Premature ovarian Insufficiency
F. Pregnancy
G. Tuberculosis
H. Fitz-Hugh-Curtis syndrome
I. Endometriosis
K. polycystic ovarian syndrome .
L. Mayer–Rokitansky–Küster–Hauser syndrome.
M. Left Hydrosalpinx
N. Gonorrhoea
O. Bilateral Hydrosalpinx
P. None of the above

Above options show various reasons for Infertility .The following scenarios explain various women with amenorrhea and Infertility .
Choose the  option  corresponding  to the scenario .each option can be done once or more than once or none at all .

21.Mrs. A is  30-year-old woman is referred for management of infertility. After menarche at age 12, menses occurred irregularly for a year and then became regular. She initiated use of oral contraceptive pills at the age of 18, then stopped at age 27 to try to conceive. Evaluation revealed presenting with amenorrhoea for 3 months,complains of headache .

On further evaluation her
FSH 2 IU/mL
LH 7 IU/mL
TESTOSTERONE 15 ng/dl
PROLACTIN 1500 ng/mL
Beata Hcg – 5 mIU/mL
What is the Cause of  her infertility

22. Mrs. B, 32yearold with secondary amenorrhoea 4months ,presented with infertility ,  who intentionally   lost 12kgs BMI;26,FHS:56Iu/L, LH: 43 IU/L
Estradiol ;25mmol
Probable reason for her Infertilty

23.Mrs. C , 18 year old ,  presents with normal secondary  sexual characters .
She says she has never got her periods but want to become pregnant  .Ultrasound shows absent uterus ,
her  Karyotyping  is enclosed

24. Mrs. D , 32year old , presented to infertility clinic , she gives history of dysmenorrhoea and chronic pelvic pain .Diagnostic laparoscopy image is enclosed .

25.Mrs. E. Is 30 year old  has been treated  for chronic pelvic  pain , Dyspareunia and infertility .she has been treated  for Pelvic  inflammatory disease , many times .
Had presented severe pain in the upper right area of the abdomen, fever, chills, headaches, and a general feeling of poor health (malaise).she has undergone diagnostic laparoscopy image is enclosed .

Diagnosis is