Exam 2 - Chapter 9 Flashcards

1
Q
Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle?
a.
Hysterosalpingogram
b.
Endometrial biopsy
c.
Laparoscopy
d.
Follicle-stimulating hormone (FSH) level
A

B - Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle.
A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity.
Laparoscopy usually is scheduled early in the menstrual cycle.
Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

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2
Q

A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurse’s most appropriate response is:
a.
“This is a legitimate concern. Would you like to discuss this further before your treatment begins?”
b.
“No one has ever had more than triplets with Clomid.”
c.
“Ovulation will be monitored with ultrasound so that this will not happen.”
d.
“Ten percent is a very low risk, so you don’t need to worry too much.”

A

A - The incidence of multiple pregnancies with the use of these medications is higher than 25%. The client’s concern is legitimate and should be discussed so that she can make an informed decision.
Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the client’s concerns.
Ultrasound cannot ensure that a multiple pregnancy will not occur.
Ten percent is inaccurate. Furthermore, the client’s concern is discredited with a statement such as “don’t worry.”

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3
Q

A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. The nurse’s most appropriate response is:
a.
“Your sperm count seems to be okay in the first semen analysis.”
b.
“Only marijuana cigarettes affect sperm count.”
c.
“Smoking can give you lung cancer, even though it has no effect on sperm.”
d.
“Smoking can reduce the quality of your sperm.”

A

D - Cigarette smoking has been associated with abnormal sperm, a decreased number of sperm and chromosome damage.
Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility.
Marijuana use may depress the number and motility of sperm.
Smoking is indeed a causative agent for lung cancer. The use of tobacco also has detrimental effects on sperm.

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4
Q
A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional test is needed?
a.
Testicular biopsy
b.
Antisperm antibodies
c.
Follicle-stimulating hormone (FSH) level
d.
Examination for testicular infection
A

C - The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles.
A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells).
Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here because the husband has already produced children.
Examination for testicular infection would be done before semen analysis. Furthermore, infection would affect spermatogenesis.

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5
Q

A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurse’s most appropriate response is:
a.
“Tell your friends and family so that they can help you.”
b.
“Talk only to other friends who are infertile, because only they can help.”
c.
“Get involved with a support group. I’ll give you some names.”
d.
“Start adoption proceedings immediately, because obtaining an infant is very difficult.”

A

C - Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others’ experiences.
Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couple’s relationships with family and friends.
Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs, but depending on where the other couple is in their own recovery process, this may or may not be of assistance to them.
Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

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6
Q
The nurse working with a client who has infertility concerns should be aware that leuprolide acetate (Lupron), a gonadotropin-releasing hormone (GnRH) agonist, may be prescribed for an infertile woman to treat:
a.
Anovulatory cycles
b.
Uterine fibroids
c.
Polycystic ovary disease (PCOD)
d.
Luteal phase inadequacy
A

B

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7
Q
Danazol (androgens) may be prescribed for an infertile woman if she has:
a.
Thyroid dysfunction
b.
Elevated levels of prolactin
c.
Inadequate levels of follicle-stimulating hormone (FSH)
d.
Endometriosis
A

D - Danazol treats endometriosis by suppressing ovarian activity and eliminating stimulation of endometrial tissue.
Thyroid dysfunction is not treated with danazol.
Danazol is not an appropriate treatment for a client with elevated levels of prolactin.
Inadequate levels of FSH do not respond to treatment with danazol.

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8
Q

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurse’s most appropriate response is:
a.
“IVF is a type of assisted reproductive therapy that involves collecting eggs from your wife’s ovaries, fertilizing them in the lab with your sperm, and transferring the embryo to her uterus.”
b.
“A donor embryo will be transferred into your wife’s uterus.”
c.
“Donor sperm will be used to inseminate your wife.”
d.
“Don’t worry about the technical stuff; that’s what we are here for.”

A

A - A woman’s eggs are collected from her ovaries, fertilized in the laboratory with sperm, and transferred to her uterus after normal embryonic development has occurred.
Transferring a donor embryo to the woman’s uterus describes the procedure for a donor embryo.
Inseminating the woman with donor sperm describes therapeutic donor insemination.
Telling the client not to worry discredits the client’s need for teaching and is not the most appropriate response.

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9
Q

With regard to the assessment of female, male, and couple infertility, nurses should be aware that:
a.
The couple’s religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis
b.
The investigation takes several months and can be very costly
c.
The woman is assessed first; if she is not the problem, the male partner is analyzed
d.
Semen analysis is for men; the postcoital test is for women

A

B - Fertility assessment and diagnosis take time, money, and commitment from the couple.
Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment.
Both partners are assessed systematically and simultaneously, as individuals and as a couple.
Semen analysis is for men, but the postcoital test is for the couple.

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10
Q

In their role of implementing a plan of care for infertile couples, nurses should:
a.
Be comfortable with their own sexuality and nonjudgmental about others to effectively counsel their clients
b.
Know about such nonmedical remedies as diet, exercise, and stress management
c.
Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid
d.
Do all of these plus be knowledgeable about potential drug and surgical remedies

A

D - Nurses should also be cognizant that a number of surgical procedures can be used for problems related to female infertility.
Nurses can help couples express and discuss their feelings as honestly as possible. The nurse must be comfortable with his or her own sexuality.
The nurse should be aware that simple changes in lifestyle may be effective in assisting the infertile couple.
Most herbal remedies have not been proven effective.

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11
Q
Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. These alterations in physiology belong to one of five categories. Choose all that apply.
a.
Congenital or developmental factors
b.
Hormonal or ovulatory factors
c.
Tubal or peritoneal factors
d.
Uterine factors
e.
Emotional or psychologic factors
A

A,B,C,D - Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors.
The diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress. However, this is not considered one of the factors associated with infertility. Feelings connected with infertility are many and complex. Resolve is an organization that provides support, advocacy, and education for both clients and health care providers.

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12
Q

Which test is performed around the time of ovulation to diagnose the basis of infertility?

a. Hysterosalpingogram
b. Ultrasonography
c. Laparoscopy
d. Follicle-stimulating hormone (FSH) level

A
B - Ultrasonography is performed around the time of ovulation to assess pelvic structures for 
abnormalities, to verify follicular development, and to assess the thickness of the endometrium. 
A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially
fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually 
scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine 
function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or 
irregular
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13
Q

An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman
experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the
nurses most appropriate response?
a. This is a legitimate concern. Would you like to discuss further the chances of multiple
pregnancies before your treatment begins?
b. No one has ever had more than triplets with Clomid.
c. Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not
happen.
d. Ten percent is a very low risk, so you dont need to worry too much.

A

A - The incidence of multiple pregnancies with the use of these medications is higher than 25%. The
clients concern is legitimate and should be discussed so that she can make an informed decision.
Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the
clients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is
inaccurate. Furthermore, the clients concern is discredited with a statement such as, dont worry.

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14
Q

A man smokes two packs of cigarettes a day. He wants to know if smoking is
contributing to the difficulty he and his wife are having getting pregnant. Which guidance should
the nurse provide?
a. Your sperm count seems to be okay in the first semen analysis.
b. Only marijuana cigarettes affect sperm count.
c. Although smoking has no effect on sperm count, it can give you lung cancer.
d. Smoking can reduce the quality of your sperm

A

D - Cigarette smoking has detrimental effects on sperm and has been associated with abnormal
sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a
smoking cessation program to increase the fertility of the male partner. Sperm counts vary from
day to day and are dependent on emotional and physical status and sexual activity. Therefore, a
single analysis may be inconclusive. A minimum of two analyses must be performed several
weeks apart to assess male fertility. Marijuana use may depress the number and motility of
sperm. Smoking is indeed a causative agent for lung cancer.

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15
Q

A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2
years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise
healthy. The man has fathered two children from a previous marriage and had a vasectomy
reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be
clumped together. What additional testing is needed?
a. Testicular biopsy
b. Antisperm antibodies
c. FSH level
d. Examination for testicular infection

A

C - This scenario does not indicate that the woman has had any testing related to her irregular
menstrual cycles. Hormone analysis is performed to assess endocrine function of the
hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining
the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and
thyroid hormones may be necessary to diagnose the cause of the womans irregular menstrual
cycles

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16
Q

A couple is attempting to cope with an infertility problem. They want to know what they
can do to preserve their emotional equilibrium. What is the nurses most appropriate response?
a. Tell your friends and family so that they can help you.
b. Talk only to other friends who are infertile, because only they can help.
c. Get involved with a support group. Ill give you some names.
d. Start adoption proceedings immediately, because adopting an infant can be very difficult.

A

C - Venting negative feelings may unburden the couple. A support group may provide a safe haven
for the couple to share their experiences and gain insight from others experiences. Although
talking about their feelings may unburden them of negative feelings, infertility can be a major
stressor that affects the couples relationships with family and friends. Limiting their interactions
to other infertile couples may be a beginning point for addressing psychosocial needs. However,
depending on where the other couple is in their own recovery process, limiting their interactions
may not be of assistance to them. Telling the couple to start adoption proceedings immediately is
not supportive of the psychosocial needs of this couple and may be detrimental to their wellbeing.

17
Q

The nurse working with clients who have infertility concerns should be aware of the use
of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which
condition would this medication be prescribed?
a. Anovulatory cycles
b. Uterine fibroids
c. Polycystic ovary disease (PCOD)
d. Luteal phase inadequacy

A

B - Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are
treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction.
Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy.

18
Q
Which condition would be inappropriate to treat with exogenous progesterone (human 
chorionic gonadotropin)?
a. Thyroid dysfunction
b. Recent miscarriage
c. PCOD
d. Oocyte retrieval
A

A - Synthroid is administered for anovulation associated with hypothyroidism. For women with
polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have insufficient
progesterone and require exogenous progesterone until placental production is sufficient.

19
Q

In vitro fertilizationembryo transfer (IVF-ET) is a common approach for women with
blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts.
A
husband and wife have arrived for their preprocedural interview. Which explanation regarding
the procedure is most accurate?
a. The procedure begins with collecting eggs from your wifes ovaries.
b. A donor embryo will be transferred into your wifes uterus.
c. Donor sperm will be used to inseminate your wife.
d. Dont worry about the technical stuff; thats what we are here for.

A

A - A womans eggs are collected from her ovaries, fertilized in the laboratory with the partners
sperm, and transferred to her uterus after normal embryonic development has occurred.
Transferring a donor embryo to the womans uterus describes the procedure for a donor embryo.
Inseminating the woman with donor sperm describes therapeutic donor insemination. Telling the
client not to worry discredits the clients need for teaching and is not the most appropriate
response

20
Q

With regard to the assessment of female, male, or couple infertility, the nurse should be
aware of which important information?
a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that
does not affect the clinical scientific diagnosis.
b. The investigation will take several months and can be very costly
c. The woman is assessed first; if she is not the problem, then the male partner is analyzed.
d. Semen analysis is for men; the postcoital test is for women.

A

B - Fertility assessment and diagnosis take time, money, and commitment from the couple.
Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an
effect on diagnosis and assessment. Both partners are systematically and simultaneously
assessed, first as individuals and then as a couple. Semen analysis is for men; however, the
postcoital test is for the couple.

21
Q

The nurse is having her first meeting with a couple experiencing infertility. The nurse has
formulated the nursing diagnosis, Deficient knowledge, related to lack of understanding of the
reproductive process with regard to conception. Which nursing intervention does not apply to
this diagnosis?
a. Assess the current level of factors promoting conception.
b. Provide information regarding conception in a supportive manner.
c. Evaluate the couples support system.
d. Identify and describe the basic infertility tests

A

C - Evaluating the couples support system would be a nursing action more suitable to the diagnosis,
Ineffective individual coping, related to the ability to conceive.

22
Q

Male fertility declines slowly after age 40 years; however, no cessation of sperm
production analogous to menopause in women occurs in men. What condition is not associated
with advanced paternal age?
a. Autosomal dominant disorder
b. Schizophrenia
c. Autism spectrum disorder
d. Down syndrome

A

D - Paternal age older than 40 years is associated with an increased risk for autosomal dominant
disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down
syndrome can occur in any pregnancy, it is often associated with advanced maternal age.

23
Q

A woman inquires about herbal alternative methods for improving fertility. Which
statement by the nurse is most appropriate when informing the client on which herbal
preparations may improve ovulation induction therapy?
a. You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get
pregnant.
b. You may want to try black cohosh or phytoestrogens.
c. You should take vitamins E and C, selenium, and zinc.
d. Herbs have no bearing on fertility

A

B - Ovulation therapy may have better outcomes when supplemented by black cohosh, progesterone,
or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10, and ginseng
have been shown to improve male fertility. Although most herbal remedies have not been
clinically proven, many women find them helpful. They should be prescribed by a health care
provider who has knowledge of herbalism.

24
Q

To provide adequate care, the nurse should be cognitive of which important information
regarding infertility?
a. Is perceived differently by women and men.
b. Has a relatively stable prevalence among the overall population and throughout a
womans potential reproductive years.
c. Is more likely the result of a physical flaw in the woman than in her male partner.
d. Is the same thing as sterility.

A

A - Women tend to be more stressed about infertility tests and to place more importance on having
children. The prevalence of infertility is stable among the overall population, but it increases
with a womans age, especially after age 40 years. Of cases with an identifiable cause,
approximately 40% are related to female factors, 40% to male factors, and 20% to both partners.
Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a prolonged
time to conceive.

25
Q

Although remarkable developments have occurred in reproductive medicine, assisted
reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide
accurate information about the risks and benefits of treatment alternatives to enable couples to
make informed decisions about their choice of treatment. Which concern is unnecessary for the
nurse to address before treatment?
a. Risks of multiple gestation
b. Whether or how to disclose the facts of conception to offspring
c. Freezing embryos for later use
d. Financial ability to cover the cost of treatment

A

D - Although the method of payment is important, obtaining this information is not the responsibility
of the nurse. Many states have mandated some form of insurance to assist couples with coverage
for infertility. Multiple gestation is a risk of treatment of which the couple needs to be aware. To
minimize the chance of multiple gestation, generally only three or fewer embryos are transferred.
The couple should be informed that multifetal reduction may be needed. Nurses can provide
anticipatory guidance on this matter. Depending on the therapy chosen, donor oocytes, sperm,
embryos, or a surrogate mother may be needed. Couples who have excess embryos frozen for
later transfer must be fully informed before consenting to the procedure. A decision must be
made regarding the disposal of embryos in the event of death or divorce or if the couple no
longer wants the embryos at a future time.

26
Q

Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate?

a. Semen is collected after laparoscopy.
b. Women must have two normal fallopian tubes.
c. Ovulation spontaneously occurs.
d. Ova and sperm are transferred to one tube.

A

D - Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal tube.
Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is collected
before laparoscopy. The ova and sperm are then transferred to one uterine tube, permitting
natural fertilization and cleavage.

27
Q

Significant advances have been made with most reproductive technologies. Which
improvement has resulted in increased success related to preimplantation genetic diagnosis?
a. Embryos are transferred at the cleavage stage.
b. Embryos are transferred at the blastocyst stage.
c. More than two embryos can be transferred at a time.
d. Two cells are removed from each embryo

A

B - Preimplantation genetic diagnosis can be performed on a single cell removed from each embryo
after 3 to 4 days. With the availability of extended culture mediums, embryos are transferred at
the blastocyst stage (day 5), which increases the chance of a live birth, compared with the older
practice of transferring embryos at the cleavage stage (day 3). No more than two embryos should
be transferred at a time.

28
Q

An infertile woman is about to begin pharmacologic treatment. As part of the regimen,
she will take purified FSH (Metrodin). The nurse instructs her that this medication is
administered in the form of what?
a. Intranasal spray
b. Vaginal suppository
c. Intramuscular (IM) injection
d. Tablet

A

C - Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or a
vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by mouth
in tablet form.

29
Q

A couple arrives for their first appointment at an infertility center. Which of the following
is a noninvasive test performed during the initial diagnostic phase of testing?
a. Hysterosalpingogram
b. Endometrial biopsy
c. Sperm analysis
d. Laparoscopy

A

C - Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of testing
for male infertility. Radiographic film examination allows visualization of the uterine cavity after
the instillation of a radiopaque contrast medium through the cervix. The endometrial biopsy is an
invasive procedure, during which a small cannula is introduced into the uterus and a portion of
the endometrium is removed for histologic examination. Laparoscopy is useful to view the pelvic
structures intraperitoneally and is an invasive procedure.

30
Q
Many factors, male and female, contribute to normal fertility. Approximately 40% of 
cases of infertility are related to the female partner. Which factors are possible causes for female 
infertility? (Select all that apply.)
a. Congenital or developmental
b. Hormonal or ovulatory
c. Tubal or peritoneal
d. Uterine
e. Emotional or psychologic
A

A,B,C,D - Female infertility can be attributed to alterations in any one of these systems along with possible
vaginal-cervical factors. Although the diagnosis and treatment of infertility require considerable
emotional investment and may cause psychologic stress, these are not considered factors
associated with infertility. Feelings connected with infertility are many and complex. Resolve is
an organization that provides support, advocacy, and education for both clients and health care
providers.

31
Q

A probable cause for increasing infertility is the societal delay in pregnancy until later in

life. What are the natural reasons for the decrease in female fertility? (Select all that apply.)
a. Ovulation dysfunction
b. Endocrine dysfunction
c. Organ damage from toxins
d. Endometriosis
e. Tubal infections

A

A,C,D,E - All of these factors may result in a cumulative effect, decreasing fertility in women. Male
infertility is more often caused by unfavorable sperm production attributable to endocrine
dysfunction or cumulative metabolic disease.

32
Q

Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect
may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are
accurate? (Select all that apply.)
a. Donor is inseminated with semen from the parent.
b. Donor eggs are fertilized with the male partners sperm.
c. Donors are under 35 years of age.
d. Recipient undergoes hormonal stimulation.
e. Ovum is placed into a surrogate.

A

B,C,D - Oocyte donation is usually provided by healthy women under the age of 35 years, who are
recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are
fertilized in a laboratory with the male partners sperm. The woman undergoes hormonal
stimulation to allow the development of the uterine lining. Embryos are then transferred. A donor
that is inseminated with the male partners semen or receives the fertilized ovum and then carries
it to gestation is known as a surrogate mother

33
Q

Which procedure falls into the category of micromanipulation techniques of the follicle?
(Select all that apply.)
a. Intrauterine insemination
b. Preimplantation genetic diagnosis
c. Intracytoplasmic sperm injection (ISCI)
d. Assisted hatching
e. IVF-ET

A

C,D - ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by
introducing sperm beneath the zone pellucid into the egg. Another micromanipulation technique
is assisted hatching.