Infertility, PCOS, and Contraception MCQs

Obstetrics & Gynaecology · 190 free questions with answers & explanations.

A 28-year-old woman with oligo-amenorrhea, acne, and hirsutism has ultrasound showing bilateral polycystic ovaries. Serum LH:FSH ratio is 2.8:1, testosterone is mildly elevated, and fasting insulin is elevated. She is trying to conceive. What is the FIRST-LINE pharmacological treatment for ovulation induction in this patient?
A 32-year-old woman has primary infertility for 3 years. Her husband's semen analysis shows total motile sperm count of 3 million with 2% normal morphology. Her investigations are normal. Which is the MOST appropriate treatment?
A 25-year-old woman requests contraception. She is a smoker (15 cigarettes/day) and is 35 years old. She had a prior deep vein thrombosis. Which contraceptive method is ABSOLUTELY contraindicated?
A woman with PCOS and BMI of 32 kg/m² is diagnosed with insulin resistance. She is not trying to conceive. Which medication reduces both androgen levels and cardiovascular risk markers in PCOS?
A 28-year-old woman with PCOS fails to conceive after 3 cycles of clomiphene citrate at 150 mg/day. Her BMI is 26 kg/m². The NEXT evidence-based ovulation induction agent with reduced multiple pregnancy risk compared to clomiphene is:
A 32-year-old woman wishes to insert a levonorgestrel IUS (Mirena). She has a uterine cavity length of 8 cm on hysteroscopy. Which contraindication is ABSOLUTE for IUS insertion?
A 24-year-old nurse requests emergency contraception 36 hours after unprotected intercourse. She has no contraindications to any method. Which emergency contraceptive has the highest efficacy at this interval?
In the diagnostic work-up of male factor infertility, a semen analysis shows: volume 1.8 mL, total motility 25%, progressive motility 18%, normal morphology 3% (Kruger strict criteria). This pattern is BEST described as:
A 30-year-old woman with PCOS (BMI 32 kg/m²) is prescribed metformin for insulin resistance. The PRIMARY mechanism by which metformin improves ovulation in PCOS is:
A 28-year-old woman with PCOS undergoes ovulation induction with clomiphene citrate 100 mg for 5 days. Follicular monitoring at Day 10 shows multiple follicles >18 mm. She develops sudden onset abdominal distension, nausea, and shortness of breath on Day 14. Ultrasound shows large ovaries with free fluid. What is the MOST appropriate management?
In Rotterdam criteria for PCOS diagnosis, how many of the three features must be present, and which feature is NOT part of the Rotterdam criteria?
A 35-year-old woman who smokes 15 cigarettes/day requests combined oral contraceptive pills (COCPs). What is the MOST appropriate contraceptive counselling?
A couple is investigated for infertility. Semen analysis shows: volume 2.5 mL, total count 10 million/mL, motility 30% (progressive), morphology 2% (Kruger strict criteria). What is the correct terminology for this semen analysis?
A 28-year-old woman with PCOS has oligomenorrhea, biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. She fails to ovulate on clomiphene citrate 150 mg for 3 cycles. The NEXT best ovulation induction strategy is:
The Rotterdam criteria (2003) for PCOS diagnosis require the presence of at least 2 of 3 features. A 22-year-old has regular cycles, clinical acne, serum total testosterone 0.8 ng/mL (ULN 0.6), and an ultrasound showing 14 follicles per ovary, each 4–9 mm. Which FIGO criteria designation applies?
Copper-releasing intrauterine devices (IUDs) prevent pregnancy through multiple mechanisms. The SINGLE MOST IMPORTANT contraceptive mechanism of copper IUDs is:
A 32-year-old woman presents for IVF counseling. She has a poor ovarian reserve (AMH 0.4 ng/mL, AFC 3). Which stimulation protocol is MOST appropriate to minimize the risk of premature LH surge while preserving the limited follicular cohort?
A 28-year-old woman with PCOS and BMI 34 kg/m² has oligo-ovulation and a partner with normal semen analysis. She has failed 3 cycles of letrozole (5 mg days 3–7). Which second-line intervention is supported by the largest RCT evidence and demonstrated non-inferior live birth rates compared to laparoscopic ovarian drilling in PCOS?
A 24-year-old with hyperandrogenism, oligomenorrhoea, and polycystic ovarian morphology on ultrasound (right ovary volume 14 mL with 16 follicles 2–9 mm) is diagnosed with PCOS using Rotterdam criteria. Which Rotterdam criterion combination is the minimum requirement for diagnosis?
A 35-year-old woman with three previous cesarean sections requests permanent contraception. She is counselled on bilateral tubal ligation techniques. Which method provides the highest long-term failure rate, and what is its mechanism of failure?
A 32-year-old wishes to start a combined oral contraceptive pill (COCP). She is a non-smoker, BMI 24, migraines with aura. Her mother had DVT. Which WHO Medical Eligibility Criterion (MEC) category applies to migraine with aura, and what does it mean for prescribing COCPs?
According to the Rotterdam 2003 criteria, PCOS requires at least 2 of 3 criteria. A woman has hirsutism and oligo-ovulation but a normal pelvic ultrasound (no polycystic ovarian morphology). Which additional investigation is MOST important to exclude before diagnosing PCOS?
The LOTUS I and LOTUS II trials compared letrozole versus clomiphene citrate in anovulatory PCOS for ovulation induction. Which of the following best summarises the key finding?
A 32-year-old woman with WHO Class III heart disease (Marfan syndrome with aortic root dilation >4 cm) desires contraception. Which method is MOST appropriate?
Regarding the prognostic significance of ovarian reserve testing, which single test has the best sensitivity and specificity for predicting poor ovarian response to controlled ovarian stimulation (COS)?
A 27-year-old woman with PCOS (Rotterdam criteria: oligomenorrhea, polycystic ovarian morphology on USG, hyperandrogenism) is being evaluated for infertility. AMH is 11.2 ng/mL. Antral follicle count is 28. Her BMI is 32 kg/m². Ovulation induction with letrozole is planned. What is the pharmacological mechanism of letrozole that makes it preferred over clomiphene citrate in PCOS-related anovulatory infertility?
A 30-year-old woman with PCOS and infertility undergoes IVF stimulation with gonadotropins. On day 8 of stimulation, she has 18 follicles ≥11 mm. Her estradiol is 4,800 pg/mL. She is at high risk for ovarian hyperstimulation syndrome (OHSS). Which trigger is recommended instead of hCG to minimize severe OHSS risk in GnRH antagonist protocols?
A 25-year-old woman with one child requests permanent contraception. She undergoes hysteroscopic sterilization with the Essure microinsert. At 3-month follow-up, hysterosalpingography is performed. What is being assessed, and what is the mechanism of action of Essure?
A 32-year-old woman with severe thrombophilia (antiphospholipid antibody syndrome, prior DVT) requires effective contraception. She is breastfeeding a 6-week-old infant. Which of the following contraceptive options is most appropriate?
The anti-Müllerian hormone (AMH) in assessment of ovarian reserve has specific biological properties. Which of the following correctly describes the cell type producing AMH and its regulatory control?
The Rotterdam criteria (2003) for PCOS require 2 of 3 features. A woman has irregular periods (cycle length 45-60 days) and clinical hyperandrogenism (Ferriman-Gallwey score 12) but a polycystic ovarian morphology (PCOM) is absent on ultrasound. She has PCOS by Rotterdam criteria. She now presents with infertility. According to ACOG/ESHRE 2023 international evidence-based guidelines, what is the FIRST-LINE ovulation induction agent?
In IVF-ET, controlled ovarian stimulation with gonadotrophins and a GnRH antagonist protocol is used. Which correctly describes the 'progestin-primed ovarian stimulation (PPOS)' protocol and its main advantage?
A 26-year-old woman with a history of superficial venous thrombosis (not deep vein thrombosis) requests combined oral contraceptive pill (COCP). Which is the most accurate statement regarding WHO Medical Eligibility Criteria (MEC) category for COCPs in this patient?
Which antifungal drug used for vaginal candidiasis is classified as WHO MEC Category 4 (unacceptable risk) when combined with the levonorgestrel-releasing IUS (Mirena) due to risk of device failure?
Regarding male factor infertility evaluation, sperm DNA fragmentation index (DFI) testing is indicated in couples with unexplained infertility or recurrent pregnancy loss. Which DFI threshold by TUNEL or SCSA assay predicts poor IVF outcomes and is an indication for ICSI over conventional IVF?
In the pathophysiology of PCOS, the primary site of excess androgen production leading to LH-driven testosterone synthesis involves which specific cell type?
The ESHRE/ASRM Rotterdam criteria (2003) require at least 2 of 3 features for PCOS diagnosis. A non-obese young woman has oligomenorrhea with cycle length 45 days and multiple follicles (20 follicles in one ovary) on transvaginal ultrasound. Biochemically, LH/FSH ratio is 2.8 but free testosterone and DHEAS are normal. Does she meet Rotterdam criteria?
In patients with PCOS undergoing ovulation induction with gonadotropins, a particular protocol minimizes ovarian hyperstimulation syndrome (OHSS) risk by avoiding an LH surge. Which protocol best achieves this while preserving cycle efficacy?
Progestin-only pills (minipills) primarily prevent pregnancy through which mechanism in compliant users with consistent timing?
A 38-year-old woman with unexplained infertility for 3 years has been advised IUI. Controlled ovarian stimulation (COS) for IUI uses clomiphene. Which statement about IUI outcome is most evidence-based?
In a woman with WHO Group II anovulation (PCOS) who fails clomiphene citrate, the mechanism by which letrozole (aromatase inhibitor) achieves ovulation induction more effectively is:
The 2023 International Evidence-Based Guideline for PCOS recommends anti-Müllerian hormone (AMH) as:
A 32-year-old woman requires emergency contraception 60 hours after unprotected intercourse. She has a BMI of 32 kg/m² and is not breastfeeding. The most effective method at this time interval is:
Subcutaneous etonogestrel implant (Nexplanon) prevents pregnancy primarily through which mechanism?
A couple undergoes IVF. After oocyte retrieval, the embryologist reports that 4 oocytes are retrieved, 3 are MII (metaphase II) and fertilize normally. On day 3, two 8-cell embryos are transferred. The woman develops abdominal distension, nausea, and ovarian enlargement on day 8 post-retrieval. The pathophysiological key mediator responsible for ovarian hyperstimulation syndrome (OHSS) is:
The revised Rotterdam 2023 International Evidence-Based Guidelines for PCOS diagnosis require which minimum criterion combination in adults?
A 30-year-old woman with PCOS (BMI 28 kg/m²) undergoes ovulation induction with letrozole 5 mg on Days 3–7. She develops follicular monitoring showing 4 follicles >16 mm. According to ESHRE/ASRM guidelines, the MOST appropriate action to prevent multiple pregnancy while still achieving conception this cycle is:
A 35-year-old woman on a progestin-only pill (desogestrel 75 mcg) develops breakthrough bleeding. The mechanism of action of desogestrel POP that differs MOST from levonorgestrel POP (traditional dose) is:
A couple with unexplained infertility for 3 years undergoes evaluation. The male has normal semen parameters. The female (32 years, ovulatory, patent tubes on HSG) undergoes stimulated IUI for 3 cycles without success. According to current NICE and ESHRE guidelines, the MOST appropriate next step is:
A 25-year-old woman requests emergency contraception 60 hours after unprotected intercourse. She has a BMI of 32 kg/m². Which emergency contraception method provides the highest efficacy for her?
The Rotterdam criteria (2003) for PCOS diagnosis require 2 out of 3 features. A woman has oligomenorrhoea and elevated serum androgens but a normal ultrasound. She asks about the mechanism by which elevated LH (characteristic of PCOS) contributes to anovulation. Which best describes this mechanism?
A woman with PCOS-associated infertility who is obese (BMI 34 kg/m²) undergoes ovulation induction with clomiphene citrate (CC) 150 mg without success for 3 cycles. What is the first-line management option for CC-resistant PCOS, as per current ESHRE 2023 evidence-based guidelines?
A woman requesting emergency contraception presents 96 hours after unprotected intercourse. A copper intrauterine device (Cu-IUD) is discussed. What is the proposed mechanism by which the Cu-IUD prevents implantation when used as emergency contraception?
In assisted reproductive technology (ART), the freeze-all strategy has become increasingly used to prevent ovarian hyperstimulation syndrome (OHSS). In a GnRH antagonist cycle, a GnRH agonist trigger is used instead of hCG trigger to prevent OHSS. This GnRH agonist trigger works by which mechanism?
A 25-year-old woman with unexplained infertility for 2 years undergoes IUI. Before each cycle, hysterosalpingography (HSG) showed patent tubes bilaterally. The NICE 2023 fertility guidelines recommend IVF for unexplained infertility. For women under 40 with 2 years of unexplained infertility, what is the recommended number of IVF cycles offered in the NHS?
The PPCCOS trial (2014) compared clomiphene citrate, letrozole, and their combination for ovulation induction in PCOS. Subsequent to that, the PPCCOS-II (Legro et al., 2014) Engl J Med trial definitively compared letrozole and clomiphene as first-line in PCOS. What was the primary outcome difference?
A 26-year-old with PCOS undergoing IVF is at high risk for ovarian hyperstimulation syndrome (OHSS). A GnRH antagonist protocol is used. To prevent OHSS while completing the IVF cycle, which trigger and luteal support strategy is currently recommended?
Ulipristal acetate (UPA) 30 mg is a selective progesterone receptor modulator used for emergency contraception. A woman takes UPA 90 hours after unprotected intercourse. Which mechanism explains its continued efficacy at this time point compared to levonorgestrel?
A 28-year-old with BMI 38 kg/m² and PCOS is counselled about combined oral contraceptive pills (COCPs) for cycle regulation. The primary concern regarding efficacy in this context relates to which pharmacokinetic principle?
A 27-year-old woman with PCOS (Rotterdam criteria: oligomenorrhoea, polycystic ovaries on USS, biochemical hyperandrogenism) has BMI 32 kg/m² and is planning pregnancy. She fails to conceive after 6 months of lifestyle modification. The ESHRE 2023 PCOS guidelines recommend which agent as first-line ovulation induction?
In the investigation of male factor infertility, a semen analysis shows: volume 2 mL, sperm concentration 4 million/mL, total motility 30% (progressive motility 20%), normal forms 3% (strict Kruger criteria). According to WHO 2021 reference values, which specific parameter(s) are below the lower reference limits?
A 35-year-old woman who is 5 days postcoital requests emergency contraception. She had unprotected intercourse 5 days ago. What is the most effective emergency contraception option available at this time point?
A 25-year-old woman with PCOS is started on a combined oral contraceptive pill (COCP) for cycle regulation and hyperandrogenism. She asks about the mechanism by which COCPs reduce free androgen levels in PCOS. Which mechanism is MOST important?
The Rotterdam 2003 PCOS diagnostic criteria require 2 of 3 features. A 26-year-old woman has regular cycles, mild hirsutism (Ferriman-Gallwey score 9), and polycystic ovarian morphology (PCOM) on ultrasound (18 follicles per ovary). Which additional criterion, if absent, would still allow a Rotterdam diagnosis?
In the OHSS (ovarian hyperstimulation syndrome) risk stratification, which serum marker on the day of hCG trigger most reliably predicts severe OHSS development in an IVF cycle?
A 32-year-old woman with BMI 32 requests a subdermal progestogen implant (etonogestrel, Nexplanon). She takes enzyme-inducing medication (rifampicin). Which statement about efficacy and management is correct per UKMEC 2016 guidance?
The PPCOS II trial (2012) compared letrozole versus clomiphene citrate for ovulation induction in infertile women with PCOS. Its principal finding was:
A 25-year-old woman with PCOS (Rotterdam criteria: oligo-ovulation, polycystic ovarian morphology, biochemical hyperandrogenism) fails to ovulate on clomiphene citrate 150 mg for 3 cycles. According to current ESHRE/ASRM 2023 guidelines, which is the FIRST-LINE next step?
A 30-year-old woman initiates combined oral contraceptive pill (COCP). Which mechanism is responsible for the PRIMARY contraceptive action of combined oral contraceptives?
The IUCD/LNG-IUS inserted within 120 hours of unprotected intercourse is used as emergency contraception. Which mechanism accounts for the higher efficacy of copper IUCD over levonorgestrel (Plan B) as emergency contraception?
A 28-year-old with unexplained infertility for 2 years undergoes IVF. On day 3 of stimulation, her AFC (antral follicle count) was 4 and AMH was 0.8 ng/mL. She develops only 3 follicles on day 8. This represents which ovarian response category per POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) classification?
According to the Rotterdam 2003 criteria, diagnosis of PCOS requires 2 of 3 features. In a 25-year-old woman with regular cycles (28–30 days), clinical hyperandrogenism (hirsutism, acne), and polycystic ovarian morphology on ultrasound (PCOM), the correct diagnosis is:
In the PPCOSII trial comparing letrozole versus clomiphene citrate as first-line ovulation induction in anovulatory PCOS, letrozole demonstrated superior outcomes due to its mechanism of action. The mechanism of letrozole's superiority over clomiphene is:
The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) releases 20 μg/day of levonorgestrel. Its primary contraceptive mechanism is:
A 36-year-old woman with WHO Medical Eligibility Criteria Category 4 conditions for combined oral contraceptives seeks contraception. Which combination of conditions represents absolute contraindications (WHO MEC 4) to COCs?
The Rotterdam 2003 criteria for PCOS require at least 2 of 3 features: oligo/anovulation, clinical/biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Which polycystic ovarian morphology (PCOM) threshold was updated by the international evidence-based guideline 2018?
A woman with PCOS and BMI 32 kg/m² undergoes ovulation induction with letrozole. She fails to ovulate after 5 days letrozole 2.5 mg. The next step in management per current guidelines is:
A 28-year-old woman uses the levonorgestrel-releasing IUS (Mirena, 52 mg) for contraception. Which mechanism accounts for its primary contraceptive efficacy?
The PCOSACT trial (Legro et al., NEJM 2014) directly compared letrozole versus clomiphene for ovulation induction in PCOS. What was the primary outcome result?
A 28-year-old woman with PCOS undergoes ovulation induction with letrozole. Despite 5 days of letrozole 5 mg (days 3–7), follicular monitoring at day 12 shows 3 dominant follicles (22 mm, 20 mm, 18 mm). What is the MOST appropriate clinical decision?
A couple is investigated for infertility. The male partner's semen analysis shows: volume 2.5 mL, pH 7.5, concentration 8 × 10^6/mL, total motility 42%, progressive motility 25%, normal morphology 2% (strict Kruger criteria), WBC 0.4 × 10^6/mL. Which WHO 2021 criteria define this sample as abnormal, and what is the MOST important parameter for outcome?
A 32-year-old nulliparous woman requests a copper IUD for emergency contraception 4.5 days after unprotected intercourse. She is confirmed to be HIV-negative and has no history of STIs. Which statement BEST reflects current WHO Medical Eligibility Criteria (MEC) and effectiveness data?
In a patient with PCOS undergoing IVF, a GnRH agonist trigger rather than hCG trigger is planned to prevent OHSS. The patient has a day-3 AMH of 14.2 ng/mL and AFC of 28. After GnRH agonist trigger, what is the MOST critical immediate intervention to maintain corpus luteum function and prevent luteal phase deficiency?
A 29-year-old woman is started on etonogestrel implant (Nexplanon) for contraception. She reports irregular bleeding at 3 months — light but daily spotting. The mechanism by which the etonogestrel implant primarily achieves contraception is:
A 28-year-old woman presents with infertility, oligomenorrhoea, moderate hirsutism, and acne. Serum LH:FSH ratio is 3:1, fasting insulin is elevated, AMH is 8.2 ng/mL, and ultrasound shows 14 follicles per ovary, each 2–9 mm. She desires pregnancy. The first-line ovulation induction agent is:
A 32-year-old woman underwent IVF with oocyte retrieval 5 days ago. She now presents with abdominal distension, nausea, shortness of breath, and oliguria. Ultrasound shows bilateral enlarged ovaries (each 8 cm) with massive ascites. Haematocrit is 48%, creatinine 1.3 mg/dL. This is classified as:
A 24-year-old woman on combined oral contraceptive pills (COCPs) for 2 years misses 3 consecutive pills in week 2 of her pill pack. The most appropriate advice is:
A 35-year-old parous woman with dysmenorrhea and menorrhagia requests a long-acting reversible contraceptive that also treats her menstrual symptoms. The most appropriate device is:
A 30-year-old presents with primary infertility of 3 years. Hysterosalpingography shows bilateral tubal occlusion at the cornual end. Semen analysis is normal. Her next best investigation to assess cornual tubal status before surgery is:
A 28-year-old woman with PCOS undergoes IVF. After oocyte retrieval, she develops abdominal distension, nausea, and shortness of breath. Ultrasound shows bilateral ovarian enlargement to 12 cm with free peritoneal fluid. Serum albumin is 2.8 g/dL and haematocrit is 46%. She is classified as having severe OHSS. The MOST important initial management priority is:
The Rotterdam consensus criteria (2003) for PCOS diagnosis require at least 2 of 3 features. A 24-year-old woman has regular menstrual cycles every 28–30 days, no clinical or biochemical hyperandrogenism, but ultrasound shows 14 follicles of 2–9 mm in the right ovary and 10 in the left (total 24 follicles). Does she meet PCOS criteria?
A 35-year-old woman with hypertension and a BMI of 32 kg/m² requests reliable contraception. She is a non-smoker. She has completed her family. She has no personal or family history of VTE. The MOST appropriate long-acting reversible contraceptive (LARC) is:
A couple has been investigated for infertility. Post-coital test (PCT) shows < 5 motile sperm per high-power field in cervical mucus taken at mid-cycle. Semen analysis is normal. The next MOST appropriate investigation is:
According to the Rotterdam 2003 criteria for PCOS diagnosis, a minimum of how many of the three criteria must be present, and what are those three criteria?
A 28-year-old woman with PCOS and BMI 32 kg/m² is initiating clomiphene citrate for ovulation induction. She has been on metformin for 6 months. Which intervention, when added to clomiphene, has demonstrated improved live birth rates in a Cochrane review?
A 24-year-old woman requests an intrauterine device for contraception. She had a chlamydia infection treated 2 years ago, is currently in a mutually monogamous relationship, and her last Pap smear was normal. Which IUD-related guidance is MOST appropriate?
The LEGRO trial (2014, NEJM) compared letrozole versus clomiphene citrate in PCOS-related infertility. The primary outcome of live birth rate was:
Which progesterone-only contraceptive method works PRIMARILY by thickening cervical mucus rather than inhibiting ovulation?
A 28-year-old woman with PCOS and a BMI of 32 kg/m² has oligomenorrhea and anovulatory infertility. AMH is 8.2 ng/mL, antral follicle count is 18 per ovary. Clomiphene citrate 150 mg for 5 cycles failed to achieve ovulation. The next most appropriate intervention is:
A 35-year-old woman with known Factor V Leiden heterozygosity and a past history of DVT wants reliable long-term contraception. She is breastfeeding her 6-week-old infant. The most appropriate contraceptive option is:
Rotterdam criteria (2003) require at least 2 of 3 features for PCOS diagnosis: oligo/anovulation, clinical/biochemical hyperandrogenism, and polycystic ovarian morphology (PCOM) on ultrasound. PCOM is defined on transvaginal ultrasound as:
A couple has been trying to conceive for 2 years without success. Semen analysis reveals: volume 2.5 mL, concentration 8 million/mL, motility 35% progressive, normal morphology 2% (Kruger strict criteria). This pattern is best described as:
The EMBRACE study assessed genetic testing in BRCA mutation carriers. For a woman with a BRCA1 germline mutation who has completed childbearing, current guidelines recommend risk-reducing salpingo-oophorectomy at what age?
The Rotterdam 2003 consensus criteria for PCOS require 2 of 3 features. Which phenotype of PCOS by Rotterdam criteria is associated with the MILDEST metabolic risk?
In controlled ovarian stimulation for IVF, the OHSS prevention strategy of triggering with GnRH agonist (instead of hCG) is applicable in which protocol?
A woman with known etonogestrel implant (Nexplanon) in place for 2 years presents with an unintended pregnancy. Which mechanism most likely explains the failure?
In the ORACLE trial, which antibiotic regimen given to women with preterm premature rupture of membranes (PPROM) was associated with an increase in childhood cerebral palsy at 7-year follow-up?
A 28-year-old woman with PCOS undergoes IVF with controlled ovarian hyperstimulation. On day 10 of stimulation her estradiol is 5,200 pg/mL and ultrasound shows 22 follicles ≥10 mm. She is at high risk for OHSS. The trigger shot used to reduce OHSS risk in an antagonist protocol while achieving final oocyte maturation is:
A couple has unexplained infertility for 2 years. Semen analysis: volume 2.5 mL, count 18 million/mL, total motility 40%, morphology 3% normal forms (strict Kruger criteria). The morphology result:
A 32-year-old woman requests emergency contraception (EC) 60 hours after unprotected intercourse. She has a BMI of 32 kg/m². The MOST effective non-surgical EC option at this time-point is:
The ESHRE/ASRM Rotterdam diagnostic criteria for PCOS require 2 of 3 features. Which of the following is NOT one of the Rotterdam criteria?
In a patient undergoing IVF-ET, the luteal phase is supported primarily because:
A 28-year-old woman with PCOS undergoes ovulation induction with clomiphene citrate 100 mg for 5 days. Follicle tracking shows no dominant follicle 18 mm or greater on day 16. She is diagnosed with clomiphene resistance. The NEXT most appropriate intervention is:
A 32-year-old woman requests a copper intrauterine device (Cu-IUD). She had an uncomplicated delivery 6 weeks ago. She is breastfeeding and has no history of STIs. What is the WHO Medical Eligibility Criteria category for Cu-IUD insertion at 6 weeks postpartum?
The landmark PCOS ovulation induction trial (Legro et al., NEJM 2014) compared clomiphene with letrozole in anovulatory PCOS women. The primary outcome was live birth rate. Which finding was reported?
An otherwise healthy 22-year-old woman requests the levonorgestrel emergency contraceptive pill (1.5 mg single dose). She had unprotected intercourse 72 hours ago. She weighs 80 kg. Which statement about efficacy at this weight is most accurate?
A 29-year-old woman with PCOS and anovulatory infertility fails to ovulate on clomiphene 150 mg × 3 cycles. Letrozole was not tried. She is now counselled regarding laparoscopic ovarian drilling (LOD). Which statement about LOD is MOST accurate?
The PPCOSII trial (Legro et al., NEJM 2014) compared letrozole versus clomiphene citrate as first-line ovulation induction in women with PCOS. The primary finding that changed clinical practice was:
A 22-year-old woman presents requesting emergency contraception 72 hours after unprotected intercourse. She is breastfeeding an 8-week-old infant. Which emergency contraceptive is MOST appropriate?
In the Rotterdam 2003 PCOS diagnostic criteria, which two of the following three features are required (plus exclusion of other disorders) for PCOS diagnosis?
A 27-year-old woman with PCOS and anovulatory infertility has failed 3 cycles of clomiphene citrate (150 mg). Her BMI is 28 kg/m². Serum AMH is 8 ng/mL. What is the MOST appropriate next intervention?
The Rotterdam criteria (2003) for PCOS require 2 of 3 features. A woman has oligomenorrhoea and PCO morphology on ultrasound but no clinical or biochemical hyperandrogenism. According to Rotterdam criteria, she:
A 36-year-old woman on combined oral contraceptives (COC) develops sudden unilateral severe headache with contralateral arm weakness. She smokes 15 cigarettes/day. On examination she has BP 145/90 mmHg. What is the MOST appropriate action?
Which mechanism distinguishes the levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) from the copper IUD as a contraceptive?
The PPCOSII (Pregnancy in Polycystic Ovary Syndrome II) trial compared letrozole versus clomiphene citrate for ovulation induction. Its key finding was:
In a woman with PCOS planning conception, which Rotterdam criterion combination predicts the BEST response to clomiphene citrate ovulation induction?
The failure rate of combined oral contraceptive pills is commonly reported as 0.3% with perfect use and approximately 9% with typical use. The mechanism by which COCPs provide their PRIMARY contraceptive effect is:
A 28-year-old with migraine WITH aura requests combined oral contraceptive pills for contraception. The appropriate advice is:
Regarding the levonorgestrel intrauterine system (LNG-IUS, Mirena), which statement about its mechanism of action is MOST accurate?
A woman with PCOS and BMI 32 kg/m² undergoes ovulation induction with clomiphene citrate for 6 cycles without conception. Her husband's semen analysis is normal. The next most appropriate step is:
The Rotterdam criteria for PCOS diagnosis require at least 2 of 3 features. A woman has oligo/anovulation and polycystic ovarian morphology on ultrasound (≥20 follicles 2–9 mm per ovary) but no clinical or biochemical hyperandrogenism. She:
A 32-year-old woman requests emergency contraception 72 hours after unprotected intercourse. She has no contraindications. The most effective single-dose oral emergency contraceptive available in this timeframe is:
A couple has unexplained infertility for 2 years. The woman is 34 years old. Post-coital test is satisfactory, HSG and laparoscopy are normal, and semen analysis is normal. The most appropriate next management step is:
The Rotterdam criteria (2003) for PCOS require 2 of 3 features. Which of the following correctly describes the ultrasound criterion?
A 34-year-old woman with PCOS and anovulatory infertility fails to ovulate after 6 cycles of clomiphene citrate 150 mg. She is BMI 29 kg/m². The NEXT recommended ovulation induction strategy according to current guidelines is:
The MIRENA intrauterine system releases levonorgestrel at 20 mcg/day and is licensed for which of the following durations in the UK/India for contraception?
In hysteroscopic assessment of the uterine cavity during infertility workup, an arcuate uterus is distinguished from a subseptate uterus by which feature?
According to the PPCOS II trial, which agent is superior to clomiphene citrate as first-line ovulation induction in obese women with PCOS?
Emergency contraception with ulipristal acetate (UPA, EllaOne) has which advantage over levonorgestrel (Plan B)?
In a patient with unexplained infertility, the FASTT trial compared clomiphene-IUI, FSH-IUI, and immediate IVF. What was the primary conclusion for treatment sequencing?
Regarding in vitro fertilization (IVF) complications, ovarian hyperstimulation syndrome (OHSS) severe form is characterized by which finding?
Rotterdam 2003 criteria for PCOS require 2 of 3 features. A 22-year-old woman has polycystic ovarian morphology on ultrasound (≥20 follicles per ovary on 2D ultrasound) and elevated testosterone but regular menstrual cycles. Does she fulfill Rotterdam criteria for PCOS?
In IVF, which pharmacological protocol is used to prevent a premature LH surge during controlled ovarian hyperstimulation using a GnRH antagonist?
A 19-year-old sexually active woman requests emergency contraception 52 hours after unprotected intercourse. She has no contraindications. The MOST effective oral emergency contraceptive option available is:
Laparoscopic ovarian drilling (LOD) for PCOS-associated anovulatory infertility is thought to work by which mechanism?
According to the Rotterdam 2003 consensus criteria, which TWO of the following three features must be present for a diagnosis of PCOS?
A 32-year-old woman with PCOS undergoing ovarian stimulation for IVF develops abdominal distension, nausea, and shortness of breath 5 days after oocyte retrieval. Her oestradiol on trigger day was 4200 pg/mL and 18 follicles were retrieved. The most life-threatening complication to anticipate is:
A 34-year-old woman with unexplained infertility has undergone 3 cycles of IUI without success. She is now offered IVF. The main advantage of IVF over IUI in this indication is:
A 20-year-old woman requests emergency contraception 72 hours after unprotected intercourse. Which method provides the highest efficacy at this time point?
The ORACLE trial evaluated the use of antibiotics in preterm prelabour rupture of membranes (PPROM). Which antibiotic combination was found to be harmful and should be avoided in PPROM?
A 26-year-old woman with PCOS and infertility is started on clomiphene citrate. She does not ovulate after three cycles with the maximum dose. The MOST appropriate next pharmacological step before considering ART is:
The levonorgestrel-releasing intrauterine system (Mirena LNG-IUS, 52 mg) primarily prevents pregnancy by which mechanism?
The 2023 revised Rotterdam consensus criteria for PCOS diagnosis require at least 2 of 3 features. Which of the following best describes the current ultrasound threshold for polycystic ovarian morphology (PCOM)?
A 30-year-old woman undergoes controlled ovarian hyperstimulation for IVF. On day 10 of stimulation, her serum oestradiol is 6500 pg/mL, and ultrasound shows 18 follicles ≥12 mm bilaterally with bilateral enlarged ovaries (8 cm each). She has mild abdominal discomfort and bloating. This represents which grade of ovarian hyperstimulation syndrome (OHSS)?
Emergency contraception with the copper intrauterine device (Cu-IUD) can be inserted up to how many days after unprotected intercourse, and its failure rate is approximately:
A 26-year-old woman with PCOS is undergoing IVF. She develops abdominal distension, nausea, and dyspnea 5 days after oocyte retrieval. Ultrasound shows bilateral ovarian enlargement to 10 cm with ascites. Her hematocrit is 48%. The MOST important immediate intervention is:
The Rotterdam criteria for PCOS require the presence of at least 2 of 3 features. A 22-year-old woman has regular cycles, clinical hyperandrogenism (acne, hirsutism), and polycystic ovarian morphology on ultrasound. She meets:
A 28-year-old woman with PCOS is treated with clomiphene citrate 100 mg for ovulation induction. She fails to ovulate. The NEXT most appropriate pharmacological step is:
A 32-year-old woman requests emergency contraception 60 hours after unprotected intercourse. She has no contraindications. The MOST effective method available is:
Hysteroscopic findings in Asherman syndrome show intrauterine adhesions. The MODIFIED American Fertility Society (mAFS) classification grades adhesions based on which parameters?
A couple undergoes IVF. Sperm analysis shows total motile count of 0.8 million/mL. The MOST appropriate ART technique is:
Anti-Müllerian hormone (AMH) in the context of ovarian reserve testing — which of the following statements is CORRECT?
WHO 2021 semen analysis reference values: which of the following correctly states the lower reference limit for TOTAL motility (progressive + non-progressive)?
A 28-year-old woman with PCOS undergoes ovulation induction with clomiphene citrate. After 3 failed cycles with maximum dose, she is started on gonadotrophins. Ultrasound monitoring shows 4 follicles ≥18 mm. What is the most appropriate management to avoid ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy?
Rotterdam criteria for PCOS require two of three features. A 26-year-old woman has oligomenorrhoea and ultrasound showing polycystic ovarian morphology (PCOM) but normal androgens. She has PCOS by Rotterdam criteria. Which additional investigation is most important before starting metformin?
A 32-year-old woman with a BMI of 38 kg/m² requests hormonal contraception. She has no other medical conditions. Which combined oral contraceptive pill-related risk is most relevant in her case?
A copper IUD is placed for emergency contraception in a 24-year-old woman who had unprotected intercourse 4 days ago. She subsequently requests long-term contraception and wants to keep the device. What is the minimum follow-up period before confirming successful emergency contraception with copper IUD?
A 30-year-old woman undergoes diagnostic laparoscopy for unexplained infertility. Bilateral tubes are patent on chromotubation. The uterine cavity appears normal on hysteroscopy. Semen analysis is normal. She has been trying to conceive for 3 years. What is the most evidence-based next step?
The 2023 revised international PCOS diagnostic criteria (International evidence-based PCOS guideline) now requires which of the following for diagnosis in adults?
The TOGGLE trial evaluated letrozole versus clomiphene as first-line ovulation induction in PCOS. Which is the MOST accurate conclusion from this evidence?
A woman using a copper intrauterine device (Cu-IUD) as emergency contraception presents 4 days after unprotected intercourse. Which mechanism primarily accounts for its >99% effectiveness in this setting?
In women with PCOS undergoing IVF who are at high risk of ovarian hyperstimulation syndrome (OHSS), which antagonist-protocol trigger modification is MOST effective in preventing severe OHSS while maintaining reasonable oocyte yield?
A couple has been investigated for infertility. The husband's semen analysis shows total progressive motility 28% (normal ≥ 32%), total motile count adequate, morphology 3% (Kruger strict criteria, normal ≥ 4%). This pattern is BEST described as:
A 26-year-old woman with a history of deep vein thrombosis requests contraception. She is a non-smoker. Which of the following methods is MOST appropriate?
A 30-year-old woman presents with a 3-year history of secondary infertility. Hysterosalpingography shows bilateral tubal occlusion at the cornual end. Semen analysis of her partner is normal. The MOST likely cause of this finding is:
A 28-year-old woman presents requesting emergency contraception. She had unprotected intercourse 60 hours ago. She is not currently taking any regular contraception. The MOST effective pharmacological option available to her at this time point is:
A 32-year-old woman is being evaluated for infertility. Her day 3 FSH is 18 IU/L, LH is 7 IU/L, and anti-Müllerian hormone (AMH) is 0.4 ng/mL. Antral follicle count on ultrasound is 3. These findings are MOST consistent with:
A copper intrauterine device (Cu-IUD) is inserted in a 25-year-old nulliparous woman for long-term contraception. She returns 2 months later with a positive pregnancy test. Ultrasound confirms an intrauterine pregnancy at 7 weeks with the IUD strings visible. She wishes to continue the pregnancy. The MOST appropriate immediate management is:
A 34-year-old man is investigated for azoospermia. His FSH is 32 IU/L (markedly elevated) and testicular volume is 6 mL bilaterally (normal >15 mL). LH is also elevated and testosterone is low. Testicular biopsy shows complete absence of germ cells with only Sertoli cells lining the seminiferous tubules (Sertoli-cell-only syndrome). The prognosis for fertility with these findings is:
In IVF, controlled ovarian hyperstimulation (COH) with gonadotrophins triggers with a GnRH agonist (leuprolide acetate trigger) is preferred over hCG trigger in which clinical situation?
Testicular sperm aspiration (TESA) vs testicular sperm extraction (TESE) — TESE is preferred in which condition?
A 34-year-old woman with diminished ovarian reserve (AMH 0.3 ng/mL, AFC 3) undergoes IVF with minimal stimulation protocol (natural modified IVF). She is counselled about live birth rates. Which statement most accurately reflects the evidence regarding IVF in poor ovarian response (DOR)?
An IUD (levonorgestrel-releasing intrauterine system, LNG-IUS 52 mg) is inserted in a 32-year-old nulliparous woman with dysmenorrhoea and menorrhagia. Six months later, she presents with lower abdominal pain and irregular spotting. Ultrasound shows the IUD is in the lower uterine segment with the stem partially protruding through the internal os. This is best described as:
In IVF, ovarian hyperstimulation syndrome (OHSS) prevention in a high-risk patient (PCO morphology, AMH 7 ng/mL, >20 antral follicles) is best achieved by which strategy?
A couple's infertility workup reveals: male partner semen analysis — total motility 25%, normal morphology 2% (Kruger strict criteria). The female has patent bilateral tubes and normal ovarian reserve. What is the BEST treatment approach?
Emergency contraception with ulipristal acetate (UPA, 30 mg) is effective up to how many hours after unprotected intercourse, and what is its primary mechanism?
A 30-year-old woman with PCOS and BMI 35 kg/m² is started on metformin 1500 mg/day. What is the EVIDENCE-BASED indication for metformin in PCOS management per the ESHRE 2023 international guideline?
A 35-year-old woman with unexplained infertility for 3 years is considering IVF. Regarding ovarian reserve testing, which combination of tests provides the best prediction of ovarian response to controlled ovarian hyperstimulation?
The levonorgestrel intrauterine system (LNG-IUS, e.g., Mirena) primarily prevents pregnancy by which mechanism?
A 38-year-old woman with migraine with aura wants contraception. She is a non-smoker with BP 130/84 mmHg and BMI 26. Which is the SAFEST contraceptive option for her?

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