Infertility MCQs

Patient is complaining of abdominal pain and vaginal discharge. On examination, cervicitis and mucopurulent discharge is seen - which indicates she is having PID. The presence of pus cells in the absence of an organism indicates chlamydial infection (most common STD today). It is an intracellular organism that grows only on McCoy or HeLa cell cultures. It cannot be grown on other media and hence, often goes unnoticed, later leading to infertility. Culture in McCoy cells is 100% specific for chlamydia but is inexpensive, technically difficult and takes 3-7 days to obtain the result. Reference: Harrion 18th/ed p 1426.

If a couple fails to achieve pregnancy after one year of “unprotected” and regular intercourse, it is an indication to investigate the couple for infertility. Infertility: Primary When no previous pregnancies have occurred. Secondary When a prior pregnancy although not necessary although not necessarily a live birth, has occurred Reference : Shaw 15 th /ed, p 200 Reference : Novak 13 th /ed, p 973

M/C used drug for ovulation Induction: clomiphene citrate Clomiphene Citrate: It is a racemic mixture of enclomiphene and zuclomiphene. Enclomiphene is a more potent isomer responsible for its ovulation-inducing action. Dose = 50–250 mg. However, the US FDA-approved maximum dose for clomiphene citrate is 100 mg Clomiphene blocks “Estrogen” receptors → increase FSH from pituitary →growth of follicles Thus it can be used only in patients with intact hypothalamic –pituitary ovarian axis With clomiphene success rate for ovulation is 80% and success rate for pregnancy is 40% Reference: JB Sharma textbook of Gynecology e1 p218

Tubal reconstruction surgery can be done for a number of reasons including for reversal of sterilisation procedure. The most favourable outcome is seen when it is done for reversal of sterilisation procedures. Factors for Poor Outcome Following Tuboplasty Dense pelvic adhesions. Loss of fimbriae. Bilateral hydrosalpinx > 3 cm. Length of the reconstructed tube Reversal done after 5 years of sterilization operation. Presence of other factors for infertility Reference: Dutta Gynae 6 th /ed p 248.

Side effects of clomiphene: Multiple pregnancy (6-8%) Ovarian cysts Ovarian hyperstimulation syndrome ( Anti Estrogenic side effects Hot Flashes, osteoporosis Long Term use-ovarian malignancy Note: No congenital malformation seen Most common effects are hot flashes and ovarian cyst formation. Reference: Jeffcoate 7 th /ed p 652

A young woman presenting in the third decade with obesity, oligomenorrhea, infertility and hirsutism leaves no doubt for the diagnosis of PCOS. Ovulatory dysfunction such as oligomenorrhea or hyperandrogenism. Clinical or biochemical evidence of hyperandrogenism. USG criteria Since this female has oligomenorrhea and hirsutism, 2 of the criteria are being fulfilled. Reference: Shaw 15th/ed pg no: 371

HSG showing 'Bead-like fallopian tube and clubbing of ampulla are suggestive of genital tuberculosis' HSG findings in case of tuberculosis: Rigid non-peristaltic pipe like tube called as lead pipe appearance. Beading of tube and variation in filling density. Elongated and distended tube with everted fimbriae and patent abdominal ostium called 'tobacco pouch' appearance. Calcification of tube, Bilateral cornual block. Vascular or lymphatic intravasation of dye. Tubal diverticula Uterine cavity - irregular outline, honeycomb appearance or presence of uterine synechiae (Asherman’s syndrome). In a proven case of genital tuberculosis, HSG is contraindicated as it may spread the infection. So, HSG should not be performed until pelvic tuberculosis is excluded by endometrial study. Reference : Dutta Gynae 5th/ed p 137-38

HSG findings in case of tuberculosis: Rigid non-peristaltic pipe-like tube called lead pipe appearance. Beading of tube and variation in filling density. Elongated and distended tube with everted fimbriae and patent abdominal ostium called ‘tobacco pouch’ appearance. Calcification of tube. Bilateral cornual block. Vascular or lymphatic intravasation of dye. Tubal diverticula and/or fluffiness of tubal outline. Uterine cavity—irregular outline, honeycomb appearance or presence of uterine synechiae (Asherman’s syndrome). Reference: Shaw 15th/ed p 157; Dutta Gynae 5th/ed p 137-38