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MRCOG PART 2 SBAs and EMQs

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Week 15 - Infertility

Week 15 - Infertility Posted by PAUL A.

Question1

A healthy year old woman and her partner undergo IVF because of unexplained primary infertility. Following an episode of ovarian stimulation, there are 6 embryos. Two embryos are replaced culminating in a delivery at term. Two years later, 2 embryos are replaced but no pregnancy is confirmed. Six months after this, another 2 embryos are replaced.

A.    The couple has undergone 6 cycles of IVF

B.    The couple has undergone 1 cycle of IVF        

C.   The couple has undergone 2 cycles of IVF

D.   The couple has undergone 3 cycles of IVF

E.    The couple is no longer eligible for IVF treatment under the NHS

F.    Further IVF should not be offered if the current treatment is unsuccessful

G.   The couple should not be offered IVF treatment if the woman is aged 35 years or over

H.   The couple should not be offered IVF if the male partner is aged 40 years or over

I.      If the woman reaches the age of 40 years during an IVF treatment cycle, the cycle should be abandoned

J.     IVF should not have been offered to this couple irrespective of their age

 

 

Question2

 

A 39 year old woman and her partner are undergoing IVF because of unexplained sub-fertility. The woman has undergone one episode of ovarian stimulation and there are 6 embryos. Two embryos are replaced but there is no pregnancy. The woman attends 6 months later for further treatment at which point she is aged 40 years.

 

A.    Treatment can proceed if her partner is under 40 years old

 

B.    Treatment can proceed but it will not be funded by the NHS

 

C.   Further treatment is not recommended

 

D.   Treatment can proceed and should be funded by the NHS          

 

E.    Treatment can continue until the woman is aged 42 years

 

F.    Treatment can continue until the woman is aged 45 years

 

G.   Treatment can proceed on a case-by-case basis depending on the woman’s general practitioner

 

H.   Treatment can proceed but 2 or 3 embryos should be replaced to improve success rate

 

I.      Treatment can proceed if FSH levels are within the pre-menopausal range

 

J.     Treatment can only proceed after authorization from the Human Fertility and Embryology Authority

 

 

 

Question3

 

A 41 year old woman and her 50 year old partner have been referred for IVF treatment because of a 5 year history of unexplained infertility. The couple has undergone 12 cycles of artificial insemination.

 

A.    The couple is not eligible for IVF paid for by the NHS

 

B.    The couple should be offered 3 full cycles of IVF

 

C.   The couple should be offered one full cycle of IVF if conditions are met       

 

D.   The couple should be offered two full cycles of IVF if conditions are met

 

E.    Adoption or surrogacy should be recommended

 

F.    The couple should be offered one cycle of IVF even if they have had IVF before

 

G.   The couple should be offered two cycles of IVF even if they have had IVF before

 

H.   The couple should be offered 3 cycles of IVF even if they have had IVF before

 

I.      The couple should only be offered IVF if neither of them has any other health problems

 

J.     The couple should be offered 6 more cycles of intra-uterine insemination

 

 

 

Question4

Which one of these conditions must be met before a 41 year old woman can be offered IVF treatment paid for by the NHS?

A.    The woman does not have any living children

B.    The woman has not had any children

C.   The woman’s partner is less than 50 years old

D.   The woman has no health problems

E.    The woman and her partner have no health problems

F.    The woman is in a heterosexual relationship

G.   The woman has never previously had IVF treatment          

H.   The woman’s partner does not have any children from a previous relationship

I.      The woman has not previously been pregnant following IVF treatment

J.     The woman or her partner have a stable income

K.    The woman does not have any previous children conceived through IVF

 

Question5

 

A 38 year old woman and her 45 year old partner have been referred for IVF treatment because of oligospermia. The couple has undergone 2 previous unsuccessful cycles funded privately.

 

A.    The couple is not eligible for IVF funded by the NHS

 

B.    The couple is eligible for 2 cycles of IVF funded by the NHS and 2-3 embryos should be replaced if available

 

C.   The couple should only be offered 1 more cycle of IVF regardless of funding

 

D.   The couple should only be offered 2 more cycles of IVF regardless of funding

 

E.    The couple should be offered up to 3 more cycles of IVF if they are prepared to pay for it

 

F.    The couple can have IVF within the NHS if they fund 50% of the costs

 

G.   The couple is eligible for 1 cycle of IVF funded by the NHS         

 

H.   The couple is eligible for 2 cycles of IVF funded by the NHS

 

I.      The couple is eligible for 3 cycles of IVF funded by the NHS

 

J.     The couple is eligible for IVF treatment funded by the NHS until the woman is aged 40 years old

 

K.    The couple is eligible for IVF funded by the NHS until she falls pregnant or decides to stop

 

 

Question6

With respect to pre-treatment in an IVF cycle

A.    The oral contraceptive pill is not used for pre-treatment

B.    Neither progestogens nor oestrogens can be used for pre-treatment

C.   GnRH agonists are recommended

D.   Pre-treatment does not alter the likelihood of live birth          

E.    Pre-treatment increases the risk of ovarian hyperstimulation syndrome

F.    Pre-treatment increases the pregnancy rate

G.   Pre-treatment reduces the risk of miscarriage

H.   Pre-treatment is associated with an increased risk of ovarian cysts

I.      Pre-treatment allows the IVF cycle to be synchronized with the woman’s menstrual cycle

J.     Pre-treatment is recommended in women with PCOS

K.    Pre-treatment is recommended in women at increased risk of OHSS

 

 

Question7

During an IVF cycle, pre-treatment is typically used to

A.    Increase the number of oocytes recovered

B.    Improve the quality of the oocytes recovered

C.   Increase pregnancy rates

D.   To schedule the timing of oocyte recovery        

E.    Schedule the timing of embryo replacement

F.    Schedule tie timing of fertilization

G.   Reduce the risk of OHSS

H.   Improve ovarian response in women with poor ovarian reserve

I.      Reduce the risk of ovarian cysts

J.     Reduce the cost of IVF treatment

 

Question8

Down-regulation during an IVF cycle

 

A.    Uses GnRH agonists or GnRH antagonists       

B.    Cannot be undertaken using GnRH antagonists

C.   Uses GnRH antagonists but not GnRH agonists

D.   Uses GnRH agonists but not GnRH antagonists

E.    Is intended to block ovarian function

F.    Is typically started 1 week before ovarian stimulation

G.   Is typically continued until 1 week before the ovulation trigger is administered

H.   Is typically done for one cycle before the IVF cycle

I.      Is usually done for 2 cycles before the IVF cycle

J.     Has been shown to increase clinical pregnancy rates

 

Question9

With respect to pituitary down-regulation during an IVF cycle

A.    Down-regulation is not recommended during a gonadotrophin-stimulated IVF cycle

B.    GnRH agonist down-regulation is recommended for women at high risk of OHSS

C.   Down-regulation should not be offered to women with PCOS

D.   A long protocol is recommended if GnRH agonists are used          

E.    Down-regulation should only be offered to women with low ovarian reserve

F.    Down-regulation has been shown to increase the live birth rate

G.   Down-regulation has been shown to increase pregnancy rates

H.   Down-regulation has been shown to increase clinical pregnancy rates

I.      Down-regulation should not be offered to women with a previous unsuccessful IVF cycle

J.     Down-regulation reduces the risk of multiple pregnancy

 

 

Question10

During an IVF cycle, ovarian stimulation is achieved

A.    With gonadotrophins           

B.    With gonadotrophin agonists

C.   With gonadotrophins or gonadotrophin agonists

D.   With gonadotrophin agonists or clomefene citrate

E.    With gonadotrophin antagonists or clomifene citrate

 

 

 

Question11

With respect to IVF and ovarian stimulation

 

A.    IVF should not be undertaken with an unstimulated cycle

 

B.    Ovarian stimulation can be undertaken with recombinant FSH or gonadotrophin agonists

 

C.   Ovarian response should be monitored by ultrasound scanning but oestradiol levels are not recommended

 

D.   Ovarian stimulation can be undertaken with human menopausal or recombinant FSH         

 

E.    In women with low ovarian reserve, growth hormone is recommended during ovarian stimulation

 

 

Question12

With respect to the ovulation trigger during an IVF cycle

A.    HCG should not be used to trigger ovulation

B.    Recombinant LH and GnRH can both be used to trigger ovulation        

C.   Both GnRH and GnRH agonists can be used to trigger ovulation

D.   Urinary HCG is better than recombinant HCG with respect to number and quality of oocytes

E.    Use of gonadotrophin agonists is associated with a lower risk of OHSS

 

 

Question13

With respect to monitoring of ovarian response during an IVF cycle

A.    A baseline ultrasound scan should be performed 1 week before the start of ovarian stimulation in a GnRH agonist cycle

B.    An ultrasound scan should be undertaken on days 7-9 and again on days 11-14       

C.   An ultrasound scan should be undertaken on days 10-12 and again on days 16-18

D.   More intensive monitoring is required in GnRH antagonist controlled cycles

E.    The risk of OHSS is higher in cycles monitored by ultrasound alone compared to cycles monitored by ultrasound + serum oestradiol

 

Question14

With respect to luteal phase support during an IVF cycle

A.    This is usually undertaken using recombinant LH or GnRH antagonist

B.    Support can be undertaken using progesterone or GnRH antagonist

C.   Use of HCG reduces the risk of OHSS

D.   Use of GnRH antagonist reduces the risk of OHSS

E.    Support can be undertaken using progesterone or HCG        

 

Question15

Which one is the recommended option for analgesia / anaesthesia in women undergoing trans-vaginal oocyte retrieval for IVF?

 

A.    Paracervical block

B.    Oral analgesia

C.   Intra-muscular opiates

D.   Epidural or spinal analgesia

E.    Conscious sedation         

 

Question16

With respect to oocyte retrieval for IVF

 

A.    Follicle flushing is recommended for all women

B.    Paracervical block is the recommended analgesia for women undergoing trans-vaginal oocyte retrieval

C.   Women who have developed more than 3 follicles should not be offered follicle flushing         

D.   Women who have developed more than 5 follicles should not be offered follicle flushing

E.    Conscious sedation should not be offered unless there are adequate facilities to perform general anaesthesia

 

Question17

With respect to sperm recovery for IVF

A.    Sperm is usually recovered by masturbation         

B.    Sperm should not be recovered by masturbation in men with oligospermia

C.   Sperm can be recovered by masturbation in men with azoospermia

D.   Sperm that is recovered surgically is unsuitable for standard IVF

E.    In men with obstructive azoospermia, sperm cannot be recovered using percutaneous epididymal sperm aspiration

 

Question18

Which technique is suitable for sperm recovery in men with non-obstructive azoospermia?

A.    Microsurgical epididymal sperm aspiration (MESA)

B.    Percutaneous epididymal sperm aspiration (PESA)

C.   Testicular sperm extraction (TESE)        

D.   Masturbation

E.    Testicular fine needle aspiration (TEFNA)

 

Question19

 

With respect to the origin of spermatozoa used for IVF

 

A.    Epididymal spermatozoa result in higher fertilization rates compared to testicular spermatozoa when ICSI is undertaken

 

B.    Cryopreservation of spermatozoa reduces fertilization rates

 

C.   Cryopreservation of spermatozoa is associated with an increased risk of miscarriage

 

D.   When ICSI is performed, there is no difference in on-going pregnancy rates when testicular spermatozoa are compared to epididymal spermatozoa       

E.    Spermatozoa obtained through microsurgical epididymal sperm aspiration should not be cryopreserved as pregnancy rates are poor

 

 

Question20

With respect to the rate of multiple pregnancy associated with IVF

A.    1 in 10 IVF pregnancies resulting in live birth were multiple pregnancies

B.    2 out of 5 live born babies from IVF were from multiple pregnancies       

C.   1 in 20 IVF pregnancies resulting in live birth were multiple pregnancies compared to 1 in 80 live births from spontaneous pregnancies

D.   2 out of 5 live born babies from IVF were from multiple pregnancies compared to 1 in 80 live born babies from spontaneous pregnancies

E.    1 in 80 IVF pregnancies are multiple pregnancies

Posted by abdulnasir O.

B,E,C,G,C,D,D,A,D,A,D,B,B,E,E,C,D,C,D,B.

infertility Posted by rasheeda B.

1d 2b 3c 4i 5i 6d 7d 8a 9d 10a 11d 12b 13b 14e 15e 16c 17a 18c 19d 20b

Posted by roshan J.

1  B   2 G   3C   4G  5D    6B    7D    8D   9D   10A    11A   12E   13B   14 E 15E   16 C   17 A   18C  19 D 20 C

Posted by PAUL A.

ANSWERS

 

1)   B

2)   D

3)   C

4)   G

5)   G

6)   D

7)   D

8)   A

9)   D

10)                  A

11)                  D

12)                  B

13)                  B

14)                  E

15)                  E

16)                  C

17)                  A

18)                  C

19)                  D

20)                  B