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Subfertility EMQ Test Part 2

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1) A man is found to have azoospermia during the course of fertility investigations. He has two children from a previous relationship. He denies any significant medical history. On examination, he is muscular and both testes are small an soft.

2) A man is found to have azoospermia. His serum FSH level is elevated but his testosterone is normal. On examination, the man is tall and has gynaecomastia. Both testes are in the scrotum but are small and soft.

3) A woman with a previous diagnosis of pelvic endometriosis presents to the clinic with cylical rectal bleeding. Vaginal and rectal examinations are inconclusive. What is the most appropriate initial assessment to identify or exclude rectal endometriosis?

4) A man is found to have azoospermia. His serum FSH and testosterone levels are normal. On examination, he has normal secondary sexual characteristics and both testes are of normal size. His karyotype is normal and a cystic fibrosis screen is negative. A testicular biopsy shows germ cells to be present.

5) A woman with unilateral 3 cm endometrioma.

6) A 35-year-old woman presents to the gynaecology clinic with pelvic pain and dysmenorrhoea. A pelvic examination demonstrates tenderness and fullness in the right iliac fossa. Which test should be used to diagnose or exclude an ovarian endometrioma?

7) A 24-year-old woman, virgo intacta, presents to the gynaecology clinic with abdominal and pelvic pain, dysmenorrhoea and dyschezia. What is the most

appropriate initial assessment for the diagnosis of endometriosis?

8) A 28-year-old has PCOS and a BMI of 33. She has a 2-year history of second-ary subfertility. There are no other factors affecting fertility.

9) A woman with a regular 35-day cycle attends the fertility clinic. Investigations are instigated. Which test should be arranged to check for ovulation?

10) A woman with hydrosalpinges needs IVF treatment.

 

11) Which test is probably the best biochemical marker of polycystic ovaries?

12) A 32-year-old woman and her husband present to the clinic with 1 year of subfertility. Investigations show them to have unexplained infertility. The woman requests treatment as she has read on the internet that there are drugs that can be used to ‘boost fertility’

 

13) A woman with a BMI of 28 kg/m2 and polycystic ovarian syndrome (PCOS) has attempted ovulation induction with clomifene citrate without success. She now returns to the clinic with pelvic pain that is worse around the time of menstruation

14) A  32-year-old woman presents to the fertility clinic with primary subfertility. Her periods are regular and her husband’s semenalysis is reported to be normal. She undergoes a hysterosalpingogram, which shows filling of the uterine cavity but no further progression of the dye beyond both cornua.

For each of the following questions, choose an appropriate management option from the list A–L. Each response may be chosen once, more than once or not at all.

15) A 36-year-old HIV-negative patient wishes to conceive with a man who is HIV positive. However, he is not compliant with HAART.

16) A  30-year-old man presents to the fertility clinic with his partner to discuss about starting a family. He  admits to being HIV positive and is very compliant with his medications and is under follow-up with the local sexual health service team. His viral load is found to be 30 copies per mL recently. The woman is 26 years old and has regular cycles and has had a child in her previous relationship.

For each of the following questions, choose an appropriate management option from the list A–L. Each response may be chosen once, more than once or not at all.

17) A 28-year-old woman with a BMI of 21 kg/m2  attends the fertility clinic with her partner. She has very infrequent periods. She is treated with clomifene therapy to induce ovulation, but the treatment fails. Which test will indicate if this woman is likely to have a good clinical and endocrine response to laparoscopic ovarian drilling?

18) A  30-year-old woman and her partner present to the subfertility clinic anxious to conceive. They have been trying for a pregnancy for 2 years now. The woman has regular

cycles with normal BMI and no prior medical illness. Semenalysis shows a volume of 2 mL with a count of 4 million/mL and 5% normal forms; 35% have progressive motility.

For each of the following questions, choose an appropriate management option from the list A–L. Each response may be chosen once, more than once or not at all.

19) A 27-year-old woman presents to the fertility clinic with secondary subfertility. She has a 7-year-old child born of normal conception and had a normal delivery. She has ever

used only male condom for contraception. Her cycles have been regular until a year ago. She gets very slight bleeding and has not had a period for 3 months. She complains

of vague headache and difficulty in looking out of the corner of both her eyes. Urine pregnancy test is negative in the clinic today.

For each of the following questions, choose an appropriate management option from the list A–L. Each response may be chosen once, more than once or not at all.

20) During the course of fertility investigations, a 28-year-old woman with a BMI of 35 kg/m2  is found to have polycystic ovaries on ultrasound scanning. Her menstrual cycle has a length of 35–70 days. Her partner’s semen analysis is normal.

 

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