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Flashcards in BC Infertility Deck (39):
1

A significant decline in the fecundability rate does not begin until age(years)



A- 27
B- 38
C- 32
D-40
E- 43

32

2

In general, infertility evaluation is initiated after a couple fails to conceive
after one year of unprotected intercourse of reasonable frequency.
When should earlier be considered.


A- age >35
B- chronic anovulatory cycles
C- previous PID
D- Secondary dysmenorrhea
E- All of the above

All of the above

3

Infertility can be attributed to the male partner in approximately 1/3 and to both
parents in approximately what percentage?


A- 1%
B- 15%
C- 60%
D- 33%
E- 50%

33%

4

Regarding couples attempting pregnancy, what percentage of women are expected to have conceived at one year?


A- 60%
B- 85%
C- 30%
D- 65%
E- 10%

85%

5

A 31 year old nulligravida has been trying to conceive for the last three years. She consumes five alcoholic drinks weekly, smokes approximately 10 cigarettes and drinks 3 extra large coffees daily. She works as a retailer with daily Dry cleaning fluid exposure. She was treated for Hodgkin’s lymphoma 10 years ago.
Which of the following exposure is least likely affecting her fertility?


A- caffeine
B- Dry cleaning fluid exposure
C- cigarettes
D- alcohol
E- pelvic radiation

Dry cleaning fluid exposure`

6

Which of the following is not known to impair sperm production


A- tight underwear
B- chronic hot tub use
C- chemotherapy
D- local radiation
E- Febrile illness

Tight undies

7

With regards to varicoceles and infertility, which of the following is true?

A- A vacricocele is present in nearly 20% of adult male general
population
B- repair of subclinical varicocele leads to correction of semen abnormalities
C- all should be repaired
D- they are an established cause of infertility
E- they carry risk of developing lymphoma

A- A vacricocele is present in nearly 20% of adult male general
population

8

What are RF for infertility?

Obesity, Underweight, smoking, alcohol, illicit drugs, toxins, caffeine

9

Use of which of these is most likely to damage testicular function permanently?


A- Gentamycin
B- spironolactone
C- Amiloride
D- Anabolic steroids
E- Alcohol consumption

Anabolic steroids

10

Which of the following should be completed during the initial infertility evaluation,
If not already up to date as part of routine well woman care?


A- Determine rubella immunity
B- screen for cervical cancer
C- N. gonorrhoeae screening
D- Chlamydia Trachomatis screeing
E- all of the above

All of the above

11

Gynecomastia in a male patient may suggest the presence of which of the following?


A- Klinefelter syndrome
B- pituitary prolactona
C- Edwards syndrome
D- Patau syndrome
E- 17B- hydroxysteroid dehydrogenase deficiency

Klinefelter Syndrome

12

Congenital bilateral absence of vas deferens is genetically related to which of the following?



A- Klinefelter syndrome
B- cystic fibrosis
C- Autosomal dominant type- PCKD
D- Fragile X syndrome
E- Autosomal recessive type-PCKD

Cystic Fibrosis

Other CF things (rectal prolapse, mec ileus, lung disease)

13

What is the most common cause of male infertility?

Varicocele

14

Regarding commercially available urinary luteinizing hormone kits, when does ovulation take place in relation to a positive result?


A- Day before
B- Day after
C- same day
D- 48 hours after
E- 72hours after

Day After

15

In reproductive aged women, which of the following increases with the passage of time?


A- Ovarian reserve
B- Fertility
C- Risk of spontaneous abortion
D- success of donor insemination
E- none of the above

Risk of spontaneous abortion

16

Hysteropsalpingography is least helpful for detecting which of the following?



A- Tubal patency
B- Asherman syndrome
C- pelvic adhesions
D- congenital uterine anomaly
E- uterine mass

pelvic adhesions

17

Liquefaction of the semen specimen after ejaculation is due to secretions from which of the following


A- Epididymis
B- Cowper gland
C- seminiferous tubules
D- Prostate
E- Bartholin glands

What glands that lubricate the vagina

Prostate

18

42 year old male on a beta blocking agent for Hypertension, which of the
following semen abnormalities may be seen due to retrograde ejaculation?


A- Azoospermia
B- Low semen volume
C- Oligospermia
D-Teratospermia
E- abnormal sperm morphology

low semen volume

19

A couple seeking fertility has undergone a thorough infertility evaluation.
The female partner is N. Semen analysis is performed. Sperm count- 4 million/ml
Semen volume is less than 1 ml.. In addition to a serum testosterone level
Which of the following should be measured during the hormonal evaluation of the male partner if an endocrinopathy is suspected?

A- prolactin
B- FSH
C- LH
D-TSH
E- all of the above

All of the above

20

What glands lubricate the vagina?

Bartholin glands

21

Genetic testing should be performed in response to which of the following
Semen analysis results?


A- semen volume of 2mls
B- sperm concentration of 2 million/ml
C- presence of fructose in semen sample
D- 8- percent normal sperm morphology
E- 40 percent progressive mortility

Sperm concentration of 2 million.

NORMAL
Volume – 1.5 mL
●Sperm concentration – 15 million spermatozoa/mL
●Total sperm number – 39 million spermatozoa per ejaculate
●Morphology – 4 percent normal forms
●Vitality – 58 percent live
●Progressive motility – 32 percent
●Total (progressive + nonprogressive motility) – 40 percent

22

What is the normal volume of sperm?

1.5ml

23

What is the normal sperm concentration?

15 million

24

What is the normal morphology?

4% normal forms

25

Which of the following are currently recommended components of a basic
Male factor infertility evaluation?


A- sperm penetration test
B- DNA integrity analysis
C- antisperm antibody assay
D- all of the above
E- none of the above

None

26

How do you work up male infertility?

History, sexual dysfunction, infection, surgical issues, medications, chemo/rads, frequency of intercourse, family hx

27

A couple is seeing you for infertility list initial tests you would order?

1) semen analysis 2) menstrual hx, LH surge in urine prior to ovulation 3) Hysterosalpingography 4) day 3 serum FSH and estradiol levels 5) thyroid stimulating hormone.

28

If the initial infertility tests are normal what would you order in select couples?

1) pelvis US; uterine myomas/ovarian cysts 2) laparoscopy if you suspect endometriosis or other pelvic pathology 3) assessment of ovarian reserve (women over 35)

29

A 32 yo nulligravid woman comes to clinic with her 34-yo husband because she has been unable to conceive for 3 yrs. Menarche was at age 12 and menses occurred at regular 28-day intervals. She used an oral contraceptives for 3 yrs and has had multiple sexual partners. Pelvic examination shows no abnormalities and cervical cultures are negative. Her husband’s semen analysis is within normal limits.

Which of the following is the most appropriate next step in diagnosis?

a)Endometrial biopsy
b)Hysterosalpingography
c)Karyotype analysis
d)Laparoscopy
e)Measurement of serum follicle-stimulating hormone concentration

Hysterosalpingography

30

A 33 yo nulligravid woman comes to the physician b/c she has been unable to conceive for 3 yrs. She has also had irregular menses during this time and her last menstrual period was 11 wks ago. She is otherwise healthy and takes no medications. She has a BMI of 30 kg/m2. Examination shows normal hair distribution and velvety hyperpigmented skin over the axillae. There are no adnexal masses on pelvic examination.


This patient is at increased risk for which of the following conditions?

a)Hypothyroidism
b)Hyperthyroidism
c)Hypercortisolism
d)Hypercalcemia
e)Type 2 diabetes mellitus
f)Premature ovarian failure

T2DM

31

A 33 years old female consults you for not being able to conceive for over 8 months. She has 2 children from a previous marriage. Temperature charting shows ovulation. What is your next step?

a)B-HCG
b)Hysterosalpingogram
c)Progesterone at 21 day
d)Semen analysis
e)Counselling

Counselling

32

What are the long term complications of PCOS

DM, Endometrial Ca, Endometrial hyperplasia, CV complications

33

Which of the following patients is most likely to develop adenomatous hyperplasia?

a)A 24 year old on low-dose oral contraceptives
b)An obese female with a history of oligoovulation and infertility
c)A post menopausal black female with multiple fibroids
d)A 30 year old G3P3 female with dysfunctional uterine bleeding
e)A 23 year old student with anorexia nervosa

b)An obese female with a history of oligoovulation and infertility

34

A 33 year old woman with a history of infertility presents with chronic pelvic pain. Examination of the pelvis reveals bilateral adnexal thickening. Which of the following is the most appropriate diagnosis?

a)Salpingitis isthmica nodosum
b)Polycystic ovarian disease
c)Chronic salpingitis
d)Uterine fibroids
e)Adenomyosis

Chronic Salpingitis

35

Which of the following does not support evidence of ovulation?

a)Mittelschmerz
b)Elevated serum progesterone
c)Elevated basal body temperature
d)Elevated prolactin
e)Thin, watery discharge

Elevated prolactin

36

Which of the following is the best treatment for a woman with significant decline in ovarian function?



A- Clomiphene citrate to induce ovulation
B- Use of donor eggs
C- Exogenous gonadotropin ovulation induction
D- In vitro fertilization with intracytoplasmic sperm injection.
E- Flax seed oil supplementation

Use of donor eggs

37

Thin watery clear discharge is more common when?

mid cycle, in pregnancy (high estrogen states)

38

26 year old obese nulliparous with PCOS seeking pregnancy. what is the recommended first line management of her anovulation?


A- Clomiphene citrate
B- Gonadotropins
C- Insulin-sensitizing agents
D- weight loss and exercise
E- Bromocriptine

Wt Loss Exercise

39

What do you give your patients with prolactinoma

Bromocriptine (dopamine agonists)