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WorksheetsFertility - OBGYN wk 9
Total questions: 120
Worksheet time: 2hrs 37mins
Normal fertility percentage per cycle
50%
60%
90%
20-22%
Normal fertility after 3 cycles
50%
60%
80%
90%
Normal fertility after 6 months
50%
60%
80%
90%
Normal fertility within 12 months
50%
60%
80%
90%
Normal fertility within 18 months
20%
50%
90%
10%
What is the most important factor affecting a women's ability to conceive and have a health child?
Egg count
Age
Weight
Race
As women age their fertility (a)
A woman's fertility starts to decline in early 30s, but rapidly declines at what age?
31
32
34
35
A 40 year old women has a ___% of becoming pregnant in any month
1
5
3
2
Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after __ months of unprotected sexual intercourse
12
18
6
9
Infertility is defined by the Inability to conceive within (a) months with
regular coitus (or within 6 months for > 35 y.o.)
In North America, what percentage of females age 15-45 suffer from infertility?
10-20
8-15
9-11
5-10
What is most important for investigation of infertility in women?
(a)
For women ___ menstrual abnormalities, hx of pelvic diseases, surgeries, (cause for an earlier initial investigation)
>35yrs
<35yrs
BOTH women and men are (a) responsible for infertility
The remaining combination of female and male factors affecting infertility account for what percentage?
40%
20%
30%
50%
Cervical, endometrial, uterine, tubal, ovulatory, peritoneal
(a)
What are the two most common uterine causes that lead to infertility?
Large submucosal fibroids
Leimyomas
Cervical polyps
Endometrial polyps
Male factors: Low sperm count
(a)
Male factors: decreased sperm motility (ability to swim)
(a)
Male factors: Percentage of normal forms
(a)
Obstruction of spermatic ducts, scrotal varicoceles
(a)
Which structure to provide nonhostile environment to harbor sperm with glands that secrete mucus and crypts that hold sperm
(a)
US iz used to evaluate ___ and ___
(a)
What is used to evaluate Internal Os diameter?
(a)
A diameter of ___ by HSG indicates cervical stenosis
>1mm
<2mm
<1mm
>2mm
When we evaluate cervical mucus, we observe = (a)
also known as fibrosity, is a biomedical rheology term which refers to the stringy or stretchy property found to varying degrees in mucus, saliva, albumen and similar viscoelastic fluids
(a)
The clear slippery elastic consistency characteristic of cervical mucus during ovulation mimics that of a __
Slime
Uncooked egg white
Snail mucus
None of the above
It is a valuable sign of the peak fertile period of menstrual cycle
(a)
What is the average length that cervical mucus strands reach before breaking?
1cm
2cm
8cm
6cm
1
(a)
2
(a)
3
(a)
1
(a)
2
(a)
3
(a)
This shows
(a)
represents a uterine malformation where the uterus is present as a paired organ when the embryogenetic fusion of the Müllerian ducts fails to occur
(a)
What variation of uterine development occurs as a result of the failure of embryogenetic fusion of mullerian ducts?
Bicornuate uterus
Uterus didelphys
Cervical atresia
Seubseptate uterus
As a result, there is a double uterus with two separate cervices, and rarely a double vagina as well
(a)
Is didelphys uterus commonly associated with fertility problems?
Yes
No
A unicornuate uterus is rare and only occurs in __% of women?
1
2
3
4
This shows a (a) uterus
This image shows a (a) uterus
This image shows (a) uterus
This image shows (a) uterus w pregnancy in only one uterus
This image is shows:
(a)
Lack of progesterone in luteal phase =“ (a) ”
Endo ____ than expected (may be associated with infertility and early pregnancy loss)
Thinner
Thicker
What is the central threshold of endometrium thickness for achieving pregnancy?
1mm
5mm
6mm
7mm
What is important to evaluate in when considering embryo transfer?
Cervix
Endometrial thickness
Ovaries
All of above
Intrauterine adhesions (several D&C, severe infections) => linear strands on US
(a)
– broad base
– more isoechoic to myometrium
– circumferential flow around them
(a)
– Narrow base attachment to endo (a stalk)
– Hyperechoic
– Vascular pedicle feeding them
(a)
This shows a (a) fibroid with SIS
This shows
(a)
This shows (a) with SIS
What is associated with 50% reduction in pregnancy rate and doubling of spontaneous miscarriage rate?
Pyosalpinx
Hematosalpinx
Hydrosalpinx
What is assessed by injecting saline into tube and looking for spillage of fluid into cul-de-sac or by using contrast to evaluate for spillage
Tubal patency
Tubal clearness
Tubal twisted
Tubal mucus
Because of expense of contrast imaging- start with saline injection (10-30 cc of sterile saline)
True
False
If no spillage noted and patient complains of pain during injection, tube may be (a)
When evaluated, (a) are assessed for spillage of saline or air around ovary, or into posterior cul-de-sac
(a) can obstruct a fallopian tube
insufflation of tube with carbon dioxide gas
(a)
catheter, contrast, fluoroscopic imaging
(a)
This image shows
(a)
Dominant follicle grows at a rate of __ to __ mm a day
2-3
1-2
4-5
1-3
When follicle reaches ___ mm, it will rupture and ovulation will occur
22
30
10
55
Rupture may be associated with an increase OR decrease in size
True
False
This image shows a (a) follicle in the ovary
PCOS is a (a) disorder that inhibits the release of FSH
With PCOS, FSH levels are ___ or within the lower follicular range
Low
Medium
High
Altered sex steroid production, metabolic disfunction, and obesity may all contribute to the changes in LH secretion pattern
(a)
Are LH levels low or elevated in regards to PCOS?
Low
Elevated
The exact cause of PCOS is unknown
True
False
Do follicles develop normally in a patient with PCOS?
Yes
No
Immature follicles will continue to produce estrogen in PCOS, which causes:
Thickened endo
Thin endo
Irregular bleeding
Normal bleeding
PCOS inhibits (a) function and prevents normal ovulation
When pituitary gland produces more LH than FSH, follicles will remain in a (a) state
An excess in which hormone causes the ovaries to overproduce androgens?
LH
FSH
LH and FSH
PCOS is a diagnostic triad of:
Oligoovulation
Hyperandrogenism
Oligmenorrhea
Polycystic ovaries
infrequent or irregularovulation= cycles of ≥36 days or <8 cycles a year
(a)
Excessive levels of androgens --> Hirsutism
(a)
Sonographically appears as a round ovary, 12 or more follicles 2-9mm, and a "string of pearls"
(a)
Each of these show
(a)
Peritoneal factors may be a cause for as many as __% of infertility cases
25
34
78
20
Peritoneal factors are __ and __
(a)
bands of scar tissue that can obstruct fimbriated end of fallopian tube
(a)
Sometimes fluid will collect in between adhesions, resulting in (a)
Ovarian Induction Therapy refers to treatment in which ovarian stimulation achieved in controlled setting
True
False
If serum Estradiol (a) and large ovarian cyst present, oral contraceptives may be indicated to suppress follicular activity before starting ovarian stimulation therapy
Optimal time to assess for intracavitary masses (polyp, fibroid), since lining of uterus is usually at its thinnest during this (a) . phase
Ovulation induction involves taking medication to induce ovulation by encouraging eggs to develop in the ovaries and be released, increasing the chance of conception through timed intercourse or artificial insemination
True
False
Ovarian induction is usually accomplished by administering __ or __
(a)
Once therapy started, ultrasound used to monitor number and size of follicles in days __ to __ (follicular phase) of menstrual cycle
1-5
8-14
9-10
15-20
Correct measurement of follicles important because human chorionic gonadotropin (hCG), substitute for LH, may need to be given intramuscularly to trigger
ovulation
True
False
Optimal mean measurement of mature follicle is between __ and __mm
10-15
17-30
16-20
14-18
During this time ultrasound can be correlated with serum (a) levels if follicular growth corresponds with adequate E2 production
This image shows enlargement of multiple ovarian (a)
Normal endometrial response associated with ovarian stimulation is increasing thickness from 2 to 3 mm to ___
10-20mm
4-7mm
12-14mm
15-30mm
It’s a method of fertilizing human oocyte outside body
(a)
1)extracting mature oocytes
2) retrieving a sperm sample
manually combining the oocytes and sperm in a laboratory dish
4) resulting embryo(s) then transferred to the uterus
(a)
This image shows the process of (a)
Regarding IVF, instead of evaluating for two optimal follicles, (a)
follicles are identified before triggering evaluation
Once the oocytes are retrieved, they are fertilized in a dish and incubated for a few days before embryo transfer into the uterus
True
False
Is embryo transfer with IVF done with assistance of transabdominal or transvaginal ultrasound:
Transabdominal
Transvaginal
Optimal placement of the embryos is considered to be within ___ cm of the apex of the fundus
1
2
3
4
Technique used to treat male factor infertility
(a)
With intrauterine insemination, catheter containing sperm placed into
(a)
Referred to as artificial insemination using donor sperm or Therapeutic Donor Insemination (TDI)
(a)
1. Ovarian Hyperstimulation syndrome (OHSS)
2. Multiple gestations
3. Ectopic pregnancy
These are all complications associated with (a)
is syndrome that presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites, pleural effusions
(a)
Often seen in patients who have undergone ovulation induction after administration of follicle-stimulating hormone or GnRH analogue followed by hCG
(a)
This image shows (a)
What percentage of patients who undergo IVF may experience multiple gestations?
10
20
30
40
Concern with multiple gestations that if there are three or more fetuses, increased risk of fetal and/or neonatal morbidity and mortality
True
False
(a) is a pregnancy implanted OUTSIDE of the uterus
(a) is an ectopic pregnancy which coexists with a intrauterine pregnancy
This image shows an (a) pregnancy -- an intrauterine twin pregnancy is occurring alongside this one
