Williams Gynecology, Second Edition (Schorge,Williams Gynecology), 2nd Edition

CHAPTER 19
Evaluation of the Infertile Couple

19–1. What is the expected per-cycle fecundability rate (percent)?

a. 25

b. 50

c. 75

d. 85

19–2. In couples attempting pregnancy, what percentage of women are expected to conceive within 1 year?

a. 15

b. 30

c. 60

d. 85

19–3. Of the causes of infertility, which of the following is most likely encountered?

a. Unexplained

b. Male factors

c. Tubal disease

d. Ovulatory dysfunction

19–4. A 30-year-old nulligravida has been trying to conceive for the past 2 years. She has no medical problems. She consumes five alcoholic drinks weekly and smokes one half pack of cigarettes daily. She describes herself as a heavy coffee drinker. She works in a dry cleaning facility. Which of the following exposures is LEAST likely to be affecting her fertility?

a. Alcohol

b. Caffeine

c. Cigarettes

d. Dry cleaning fluid

19–5. How long does the spermatogenesis process take, starting from stem cell to mature sperm?

a. 10 days

b. 30 days

c. 60 days

d. 90 days

19–6. Which of the following letters points toward the sperm nucleus?

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Reproduced, with permission, from McKinley M, O’Loughlin VD (eds): Reproductive system. In Human Anatomy. New York, McGraw-Hill, 2006, Figure 28-13.

a. A

b. B

c. C

d. D

19–7. In the figure in Question 19-6, which letter indicates the source of kinetic energy generated by mitochondria in the sperm?

a. A

b. B

c. C

d. D

19–8. With regard to a varicocele, which of the following is most likely true?

a. It should be repaired once encountered.

b. It is a frequent cause of male infertility.

c. Repair of subclinical varicoceles leads to correction of semen abnormalities.

d. Its negative effect on fertility is secondary to elevated scrotal temperatures.

19–9. Which of the following may lead to permanent damage to sperm production?

a. Spironolactone

b. Anabolic steroids

c. Diabetes mellitus

d. Alcohol consumption

19–10. Gynecomastia in a male patient may suggest the presence of which of the following conditions?

a. Noonan syndrome

b. Klinefelter syndrome

c. Pituitary prolactinoma

d. 17β-Hydroxysteroid dehydrogenase deficiency

19–11. Which of the following is LEAST likely true of basal body temperature testing in the adult female?

a. It can be an insensitive test in many women.

b. With ovulation, the temperature rises roughly 0.8°F.

c. It is an inexpensive and easy test for ovulation monitoring.

d. Once the temperature rises, a patient should expect ovulation in the next 12 hours.

19–12. When does ovulation take place in women monitoring with urinary luteinizing hormone (LH) kits?

a. Day of positive results

b. Day after positive results

c. Day prior to positive results

d. Two days after positive results

19–13. Which of the following midluteal progesterone level values signifies ovulation?

a. 0.5 ng/mL

b. 1.0 ng/mL

c. 2.5 ng/mL

d. 5.0 ng/mL

19–14. Which of the following is true of luteal phase deficiency?

a. It affects approximately 50% of menstrual cycles.

b. It is seen when the follicular phase is shorter than 14 days.

c. Fertile women have the same incidence of luteal phase deficiency as infertile women.

d. It is determined by histologic analysis of the endometrium and defined by a greater than 4-day discrepancy between the specimen-derived cycle date and the actual menstrual cycle day.

19–15. At the onset of puberty, what is the estimated number of follicles in a woman’s ovaries?

a. 2 million

b. 7 million

c. 1 thousand

d. 300 thousand

19–16. In the evaluation of ovarian function, all EXCEPT which of the following laboratory tests are helpful?

a. Cycle day 3 inhibin B level

b. Cycle day 3 estradiol level

c. Random anti-müllerian hormone level

d. Cycle day 3 follicle-stimulating hormone (FSH) level

19–17. Reduction in secretion of which of the following hormones is most likely responsible for the rising serum follicle-stimulating hormone (FSH) level seen as a woman ages?

a. Activin

b. Inhibin B

c. Estradiol

d. Follistatin

19–18. Which of the following is the protocol for a clomiphene citrate (Clomid) challenge test (CCCT)?

a. 50 mg Clomid, cycle days 3–7

b. 50 mg Clomid, cycle days 5–9

c. 100 mg Clomid, cycle days 3–7

d. 100 mg Clomid, cycle days 5–9

19–19. What is the estimated tubal infertility rate after three episodes of pelvic inflammatory disease (PID)?

a. 10%

b. 20%

c. 30%

d. 50%

19–20. What is your interpretation of the following hysterosalpingogram (HSG)?

Image

Image contributed by Dr. Kevin Doody. Reproduced, with permission, from Halvorson LM: Evaluation of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 19-5C.

a. Normal

b. Uterine didelphys

c. Bilateral hydrosalpinges

d. Unilateral proximal tubal blockage

19–21. What is your interpretation of the following hysterosalpingogram?

Image

Image contributed by Drs. Kevin Doody. Reproduced, with permission, from Halvorson LM: Evaluation of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 19-6A.

a. Normal

b. Asherman syndrome

c. Submucous leiomyoma

d. Bilateral hydrosalpinges

19–22. Which of the following is the gold standard technique for tubal evaluation?

a. Hysterosalpingography

b. Laparoscopic evaluation

c. Saline infusion sonography

d. Magnetic resonance imaging

19–23. Which of the following is most likely true regarding hysterosalpingography?

a. It has 98% sensitivity for tubal obstruction.

b. It has 98% sensitivity for detecting intrauterine pathology.

c. It is a reliable method to detect peritubal and pelvic adhesions.

d. The most common cause for proximal tubal obstruction found during HSG is tubal agglutination.

19–24. In this sample of cervical mucus, the effect of which of the following hormones can be seen?

Image

Image contributed by Dr. James C. Glenn. Reproduced, with permission, from Halvorson LM: Evaluation of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, 2008, Figure 19-9A.

a. Estrone

b. Estradiol

c. Progesterone

d. Testosterone

19–25. Liquefaction of the semen specimen after ejaculation is due to secretions from which of the following?

a. Prostate

b. Epididymis

c. Cowper gland

d. Seminiferous tubules

19–26. In treating hypertension with β-blockers, which of the following semen parameter abnormalities may be seen?

a. Azoospermia

b. Oligospermia

c. Teratospermia

d. Low semen volume

19–27. Asthenospermia refers to which of the following semen abnormalities?

a. Sperm count

b. Semen volume

c. Sperm motility

d. Sperm morphology

19–28. Which of the following tests can differentiate between dead and nonmotile sperm?

a. Zona penetration assay

b. DNA fragmentation index

c. Hypoosmotic swelling test

d. Mannose fluorescence assay

19–29. Genetic testing should be performed in which of the following male patients?

a. Those with semen volume<2.0 mL

b. Those with sperm concentration<5 million/mL

c. Those with fructose present in semen sample

d. Those with normal sperm morphology<8% by Kruger criteria

19–30. Which of the following Y-chromosome deletions carries the best prognosis for recovering sperm from the testes in an azoospermic patient?

a. AZFa

b. AZFb

c. AZFc

d. AZFd

Chapter 19 ANSWER KEY

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