Subfertility Extra Questions Batch B – MCQ

1.Prior to a frozen embryo transfer,awomantakesacourseofoestra- 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?

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

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

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

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

6. 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?

7. 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?

8. 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?

9. 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?

10. 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 occlusion?

11. 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?

12. 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?

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

14. A er 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?