Infertility

Question 1

Concerning assisted reproductive technologies, which one of the following is correct:

a) Sperm can not be surgically extracted from the testis if a man has non-obstructive azoospermia

b) Blastocyst embryo transfer improves the pregnancy rate compared to cleavage stage embryo transfer

c) Eggs are easier to freeze-store than embryos

d) Laparoscopic salpingectomy prior to IVF improves the outcome in women with hydrosalpinges

e) ICSI improves the likelihood of pregnancy for all couples undergoing IVF

Answer 1

d) Laparoscopic salpingectomy prior to IVF improves the outcome in women with hydrosalpinges

Question 2

Fertilisation normally occurs

a) in the interstitial portion of the tube

b) in the isthmus of the tube

c) in the fundus of the uterus

d) in the ampulla of the tube

e) within 48 hours of ovulation

Answer 2

d) in the ampulla of the tube

Question 3

What would preclude a couple from assisted conception treatment provided through the public system?

a) Obstructive Azoospermia in a male

b) Bilateral blocked fallopian tubes in a female

c) Unexplained infertility

d) A couple who only gave up smoking (both male and female) 3 months ago

e) Body mass index greater than 32 in a female

Answer 3

e) Body mass index greater than 32 in a female

Question 4

What would you NOT expect to evaluate or organise to test at a first consultation about fertility in primary care?

a) Symptoms of ovulation

b) Tubal patency

c) Rubella immunity

d) Semen analysis

e) That the woman is taking folic acid

Answer 4

b) Tubal patency

Question 5

Which of the following statements is true regarding sterilisation regret?

a) A woman and her husband should make the decision - there is no need for the doctor to explore decision making

b) Women consistently regret tubal ligation performed at the time of termination of pregnancy

c) Tubal ligation is easy and conveniently done at caesarean section - this should be recommended

d) Careful discussion of the procedure and the woman’s circumstances provide the best means of preventing sterilisation regret

e) A woman of 25 years of age, with 2 children age 2 and 3 months should be encouraged to consider tubal ligation for her contraceptive method

Answer 5

d) Careful discussion of the procedure and the woman’s circumstances provide the best means of preventing sterilisation regret

Question 6

Nigel had cryptorchid testes operated on when aged none and three semen analysis over the last year show less than 2 million sperm per ml on each occasion. His FSH is 21. Melissa, his partner, is 29 years and the couple have been trying to conceive for three years you advise

a) Melissa should have a tubal check

b) Intra cytoplasmic sperm injection

c) Fertility will be improved with testosterone injections

d) They should wait another two years since with Melissa’s young age, there is a 50% change of a pregnancy

e) Clomiphene or gonadotrophin therapy would be worth trying

Answer 6

b) Intra cytoplasmic sperm injection

Question 7

For which of the following treatments is there evidence of effectiveness in unexplained infertility?

a) Danazol for women

b) Bromocriptine for women

c) Metformin for women

d) Kinin enhancing drugs for men

e) Lipiodol tubal flushing for women

Answer 7

e) Lipiodol tubal flushing for women

Question 8

Stress and anxiety are a significant cause of infertility – true or false?

a) true as they interfere with pituitary and ovarian feedback control

b) true as reduction in sperm quality is usually a direct consequence

c) true, only if sexual relationship affected

d) false, there is no evidence to show fertility is impaired

e) false, stress impacts adversely on ovulation but this doesn’t alter pregnancy rate

Answer 8

c) true, only if sexual relationship affected

Question 9

Trevor (34) and Sarah (32) have been trying for a family for 2 years. Following extensive investigation the following are the key findings:

Trevor has sperm density of 15 million / ml. He has normal testes. Sarah has BMI 35, and has variable cycles of 28-42 days
What would you advise if you were this couple’s GP?

a) Start Sarah on clomiphene

b) Advise Sarah on ways in reducing weight and refer to specialist for further assessment

c) Refer to specialist to consider AIH because of Trevor’s low sperm count

d) Advise Sarah on ways in reducing weight and refer to specialist in 1 year if not successful

e) Advise that all is well and will refer in 1 year if still unsuccessful

Answer 9

b) Advise Sarah on ways in reducing weight and refer to specialist for further assessment

Question 10

Which one of the following would preclude a couple from assisted conception treatment provided through the public system?

a) Obstructive Azoospermia in a male

b)Unexplained infertility

c) Body mass index greater than 32 in a female

d) A couple who only gave up smoking (both male and female) 3 months ago

e) Bilateral blocked fallopian tubes in a female

Answer 10

c) Body mass index greater than 32 in a female

Question 11

Which one of the following would preclude a couple from assisted conception treatment provided through the public system?

a) Unexplained infertility

b) Female age above 38

c) Female age 40 and over

d) Male age above 40

e) The male partner doesn’t stop smoking

Answer 11

c) Female age 40 and over

Question 12

Which one of the following is the best clinical indicator of normal ovulation?

a) Mucus changes

b) Dysmenorrhoea

c) Periodic increased libido

d) A regular menstrual cycle

e) Premenstrual mood changes

Answer 12

d) A regular menstrual cycle

Question 13

Causes of secondary amenorrhoea do not include

a) prolactinoma

b) severe psychological stress

c) anorexia nervosa

d) puerperal psychosis

e) intrauterine synechiae

Answer 13

d) puerperal psychosis

Question 14

A 27 year old woman and her partner present with a 3 year history of primary infertility. A diagnostic laparoscopy reveals stage II endometriosis. The remaining investigations for infertility in this couple are normal. The most appropriate management option for this patient is:

a) Oral Provera

b) Danazol treatment

c) Combined oral contraceptive pill

d) Gonadotrophin releasing hormone therapy

e) Laparoscopic excision of endometriosis

Answer 14

e) Laparoscopic excision of endometriosis

Question 15

Which of the following would not be particularly useful in investigating azoospermia?

a) LH level

b) FSH level

c) Karyotype

d) Testosterone Level

e) A repeat semen analysis

Answer 15

a) LH level

Question 16

For couples waiting to conceive, frequent sexual intercourse in the lead up to, and the time of ovulation is:

a) Not required, as sperm numbers should be allowed to accumulate for one good attempt at conception mid cycle.

b) Typically harmful to a couple’s chance of conceiving owing to the stress if can generate

c) Advisable as it allows regular exposure to sperm in the peri-ovulatory phase, although frequent ejaculation leads to lower sperm quality

d) Advisable, as frequent ejaculation improves sperm quality and allows regular exposure to sperm in the peri-ovulatory phase

e) Not required, as sperm can survive in the female genital tract for several days

Answer 16

d) Advisable, as frequent ejaculation improves sperm quality and allows regular exposure to sperm in the peri-ovulatory phase

Question 17

Which of the following does NOT form part of the Rotterdam consensus criteria contributing to the diagnosis of polycystic ovary syndrome?

a) Hirsutism

b) Oligomenorrhoea

c) 12 or more small follicles in at least one ovary

d) Insulin resistance

e) Elevated serum free testosterone level

Answer 17

d) Insulin resistance

Question 18

Which of the following is not appropriate in the INITIAL diagnostic work of a young couple with primary infertility where the woman has a regular menstrual cycle and consistent midcycle mucus changes?

a) Early follicular FSH level for the woman

b) Prolactin level for the woman

c) Antenatal blood tests for the woman

d) Day 21 progestorone level for the woman

e) Semen analysis for the man

Answer 18

b) Prolactin level for the woman

Question 19

Which of the following would NOT be an automatic exclusion of a couple from publicly funded assisted conception treatment in New Zealand if they have infertility

a) Couple in a lesbian relationship where insemination has not previously been attempted

b) Woman’s age over 40 years

c) Woman continuing to smoke

d) Woman’s BMI greater than 32

e) Male partner previously having had a vasectomy

Answer 19

e) Male partner previously having had a vasectomy

Question 20

Which one of the following is true about the use of IVF since 2008?

a) ICSI is used only for severe male factor infertility

b) Single embryo transfer is used in most cycles

c) Gamete intrafallopian transfer is the most common form of ART

d) Double embryo transfer is used in most cycles

e) Egg collection is performed by laparoscopy

Answer 20

b) Single embryo transfer is used in most cycles

Question 21

Which of the following has been shown NOT to be of any value in treating the anovulatory woman with polycystic ovary syndrome

a) Clomiphene citrate

b) Spironolactone

c) Weight reduction

d) Ovarian drilling

e) Metformin

Answer 21

b) Spironolactone

Question 22

A woman had a tubal ligation aged 33. She is in a new relationship and wants fertility treatment. Her partner has a normal semen analysis. Which of the following is NOT true?

a) Approximately 50% of women do not proceed with any treatment option

b) Reversal surgery in the public system is available 3 years after the first specialist assessment

c) Reversal surgery will give at least 80% success

d) IVF is the treatment option with the highest success rate

e) Reversal surgery increases her risk of ectopic pregnancy

Answer 22

d) IVF is the treatment option with the highest success rate