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

CHAPTER 20
Treatment of the Infertile Couple

20–1. Which of the following is the most widely used pharmacologically active substance in the world?

a. Caffeine

b. Nicotine

c. Marijuana

d. Ethyl alcohol

20–2. All EXCEPT which of the following are true regarding smoking and fertility?

a. Male smokers may have reduced sperm motility.

b. Smoking increases the risk of miscarriage in assisted conception cycles.

c. Smoking in pregnant women is associated with an increased risk of trisomy 21.

d. The effects of smoking on fecundity can be overcome by fertility treatments such as in vitro fertilization (IVF).

20–3. This smoking cessation agent is considered what pregnancy category by the U.S. Food and Drug Administration?

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a. A

b. B

c. C

d. D

20–4. A 28-year-old obese female who is seeking pregnancy is recently diagnosed with polycystic ovarian syndrome (PCOS). Which of the following should be recommended as first-line management for her anovulation?

a. Gonadotropins

b. Clomiphene citrate

c. Weight loss and exercise

d. Insulin-sensitizing agents

20–5. In women with hyperprolactinemia caused by a pituitary microprolactinoma, which of the following is true?

a. Surgical therapy is preferred over medical therapy.

b. During pregnancy, cabergoline is preferred over bromocriptine.

c. Clomiphene citrate may be ineffective for ovulation induction.

d. Dopamine-agonist therapy should be increased once pregnancy is achieved.

20–6. Compared with clomiphene citrate therapy, gonadotropin therapy has which of the following characteristics?

a. Higher ovulation rate

b. Lower multiple pregnancy rate

c. Lower ovarian hyperstimulation rate

d. Greater negative effect on the endometrium

20–7. Which of the following is LEAST likely to be true regarding clomiphene citrate therapy?

a. The typical starting dose is 100 mg.

b. It is classified as a category X drug by the Food and Drug Administration (FDA).

c. It can be initiated on the second day of the menstrual cycle.

d. Most pregnancies will occur during the first three treatment cycles.

20–8. Which of the following gonadotropins is a recombinant product?

a. Menopur

b. Bravelle

c. Repronex

d. Follistim

20–9. As shown below, this treatment protocol is consistent with which of the following?

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GnRH = gonadotropin-releasing hormone; hCG = human chorionic gonadotropin; IM = intramuscularly. Reproduced, with permission, from Doody KJ: Treatment of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, Figure 20-2C.

a. GnRH antagonist protocol

b. GnRH agonist flare protocol

c. Downregulation GnRH agonist protocol

d. None of the above

20–10. Which of the following is most likely true regarding letrozole?

a. It is FDA approved for ovulation induction.

b. It is typically used in doses of 10 mg daily.

c. Compared with clomiphene citrate, it is associated with a thicker endometrium.

d. It acts through inhibition of the estrogen receptor at the level of the hypothalamus.

20–11. Which of the following hormones is thought to play a major role in ovarian hyperstimulation syndrome?

a. Progesterone

b. Luteinizing hormone (LH)

c. Human chorionic gonadotropin (hCG)

d. Follicle-stimulating hormone (FSH)

20–12. A 38-year-old with infertility secondary to tubal blockage just underwent in vitro fertilization (IVF). Her peak estradiol was 4500 pg/mL. Seventeen oocytes were retrieved, and two embryos were transferred. She conceived with a singleton gestation. She developed ovarian hyperstimulation syndrome. Which of the following was a predisposing factor in developing ovarian hyperstimulation?

a. Her age

b. Estradiol level

c. Etiology of her infertility

d. Number of embryos transferred

20–13. If concern for ovarian hyperstimulation is present during ovulation induction, which of the following can be used to induce the endogenous luteinizing hormone (LH) surge?

a. Urinary human chorionic gonadotropin (hCG)

b. Recombinant human chorionic gonadotropin (hCG) (Ovidrel)

c. Gonadotropin-releasing hormone (GnRH) agonist (Leuprolide)

d. Gonadotropin-releasing hormone (GnRH) antagonist (Ganirelix)

20–14. Which of the following is LEAST likely required in the treatment of ovarian hyperstimulation syndrome?

a. Oophorectomy

b. Paracentesis

c. Fluid resuscitation

d. Thromboembolism prophylaxis

20–15. The image below is from a patient who just underwent in vitro fertilization (IVF). What is the concern based on this sonographic image?

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Reproduced, with permission, from Doody KJ: Treatment of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, Figure 20-5A.

a. Bowel injury

b. Vascular injury

c. Ectopic gestation

d. Ovarian hyperstimulation syndrome

20–16. Which of the following serum hormone levels are most likely to increase after ovarian drilling?

a. Luteinizing hormone (LH)

b. Follicle-stimulating hormone (FSH)

c. Testosterone

d. Androstenedione

20–17. Which of the following is the best treatment for a woman with a significant decline in ovarian reserve?

a. Donor egg

b. Clomid ovulation induction

c. Gonadotropin ovulation induction

d. In vitro fertilization (IVF) and intracytoplasmic sperm injection

20–18. Which of the following tubal obstruction locations is LEAST amenable to surgical repair?

a. Isthmic

b. Fimbrial

c. Ampullary

d. Interstitial

20–19. Which of the following treatment options would yield the highest pregnancy opportunity in a patient with the following problem?

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Photograph contributed by Dr. Karen Bradshaw. Reproduced, with permission, from Heinz-man AB, Hoffman BL: Pelvic mass. In Hoffman BL, Schorge JO, Schaffer JI, et al (eds): Williams Gynecology, 2nd ed. New York, McGraw-Hill, 2012, Figure 9-25.

a. In vitro fertilization (IVF)

b. Clomid ovulation induction

c. Gonadotropin ovulation induction

d. Intracytoplasmic sperm injection (ICSI)

20–20. Compared with in vitro fertilization (IVF), bilateral tubal reanastomosis after tubal sterilization has higher rates of which of the following?

a. Fetal malformation rate

b. Multifetal gestation rate

c. Cumulative pregnancy rate

d. Intrauterine implantation rate in cases correcting fimbriectomy

20–21. Which of the following assisted reproductive technologies (ART) techniques is shown in the image below?

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Reproduced, with permission, from Doody KJ: Treatment of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, Figure 20-10A.

a. Intracytoplasmic sperm injection (ICSI)

b. Embryo biopsy

c. Assisted hatching

d. Oocyte in vitro maturation

20–22. By definition, patients with severe oligospermia have sperm counts less than which of the following per milliliter of semen?

a. <5 million/mL

b. <15 million/mL

c. <25 million/mL

d. <35 million/mL

20–23. In cases of male hypogonadotropic hypogonadism, which of the following semen analysis abnormalities is most likely to be seen?

a. Aspermia

b. Oligospermia

c. Asthenospermia

d. Teratozoospermia

20–24. During in vitro fertilization (IVF), prevention of a premature luteinizing hormone (LH) surge is important. Which of the following medications achieves this goal?

a. Recombinant LH

b. Recombinant follicle-stimulating hormone (FSH)

c. Leuprolide acetate

d. Human menopausal gonadotropins

20–25. Which of the following infertility scenarios would warrant intracytoplasmic sperm injection (ICSI)?

a. Infertility secondary to anovulation

b. Infertility secondary to diminished ovarian reserve

c. Infertility secondary to bilateral distal fallopian tube occlusion

d. Infertility secondary to the male partner’s severe oligospermia

20–26. Egg donor recipients typically discontinue progesterone supplementation at which time?

a. Positive pregnancy test found

b. 6 weeks’ gestation

c. 10 weeks’ gestation

d. 14 weeks’ gestation

20–27. Which of the following avoids fertilization outside the body?

a. In vitro fertilization (IVF)

b. Intracytoplasmic sperm injection (ICSI)

c. Gamete intrafallopian tube transfer (GIFT)

d. Zygote intrafallopian tube transfer (ZIFT)

20–28. Lowest rates of successful cryopreservation are seen with which of the following?

a. Sperm

b. Oocytes

c. Eight-cell embryo

d. Blastocyst stage embryo

20–29. Which of the following assisted reproductive technologies (ART) techniques is shown in the image below?

Image

Reproduced, with permission, from Doody KJ: Treatment of the infertile couple. In Schorge JO, Schaffer JI, Halvorson LM, et al (eds): Williams Gynecology, 1st ed. New York, McGraw-Hill, Figure 20-15A.

a. Embryo biopsy

b. Assisted hatching

c. Oocyte in vitro maturation

d. Intracytoplasmic sperm injection (ICSI)

Chapter 20 ANSWER KEY

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