Review Practice Exercise 1

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Practice Exercise 1

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Total Questions : 6

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Question 1:

Which hormone is primarily responsible for stimulating follicular development in the female reproductive system?

A. Luteinizing hormone (LH) B. Follicle-stimulating hormone (FSH) C. Gonadotropin-releasing hormone (GnRH) D. Progesterone

Answer and Explanation

Choice A:

LH is responsible for triggering ovulation and supporting the formation of the corpus luteum, not the initial development of follicles. It acts later in the cycle, peaking around day 14 to induce rupture of the mature follicle. It does not initiate follicular development.

Choice B:

FSH is secreted by the anterior pituitary and directly stimulates growth and maturation of ovarian follicles. It acts on granulosa cells, promoting estrogen synthesis and follicular expansion during the early follicular phase of the menstrual cycle. Rising estrogen levels then provide feedback for LH surge and ovulation.Rationale for incorrect answers

Choice C:

GnRH is produced by the hypothalamus and regulates the release of both FSH and LH from the anterior pituitary. While it is essential for initiating the hormonal cascade, it does not directly stimulate ovarian follicle development. It functions upstream in the hormonal hierarchy.

Choice D:

Progesterone is secreted primarily by the corpus luteum after ovulation and is involved in preparing the endometrium for potential implantation. It inhibits FSH and LH through negative feedback and is not involved in stimulating follicular growth, but rather in the luteal phase.

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Question 2:

A nurse is assessing a patient with suspected infertility. What is the definition of primary infertility?

A. Inability to conceive after a previous pregnancy B. Inability to conceive after one year of unprotected intercourse C. Inability to carry a pregnancy to term D. Inability to conceive due to male factor issues

Answer and Explanation

Choice A:

This defines secondary infertility, not primary. Secondary infertility occurs when a couple has previously achieved a pregnancy but is now unable to conceive again despite 12 months of unprotected intercourse. The term primary infertility specifically refers to couples who have never achieved pregnancy.

Choice B:

Primary infertility is defined scientifically as the inability to conceive after 12 consecutive months of regular, unprotected sexual intercourse. This is the international standard set by the WHO and CDC for couples with no previous pregnancies. The definition excludes secondary infertility, miscarriage, or male factor causes unless specified.Rationale for incorrect answers

Choice C:

The inability to carry a pregnancy to term relates to recurrent pregnancy loss or miscarriage, not infertility. Infertility refers to the failure to achieve conception, while pregnancy loss is a separate reproductive issue, often involving different investigations and management approaches.

Choice D:

Male factor infertility is a cause of infertility, not a definition. While male factors contribute to about 40–50% of infertility cases, the term "primary infertility" does not specify the source (male or female), only the condition of never having conceived.

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Question 3:

A 32-year-old female presents to the clinic reporting inability to conceive after 18 months of regular, unprotected sexual intercourse. Her menstrual cycles are irregular, occurring every 45-60 days. She also reports increased facial hair and acne. Which of the following conditions is most likely contributing to her infertility?

A. Hypothalamic-Pituitary Dysfunction B. Premature Ovarian Insufficiency C. Polycystic Ovary Syndrome (PCOS) D. Endometriosis

Answer and Explanation

Choice A:

Hypothalamic-pituitary dysfunction usually presents with hypogonadotropic hypogonadism—low FSH and LH—and is often triggered by stress, weight loss, or excessive exercise. These patients typically have absent rather than irregular menses, and do not display signs of androgen excess like hirsutism or acne.

Choice B:

Premature ovarian insufficiency presents with menopause before age 40, usually with elevated FSH >25 mIU/mL and amenorrhea or oligomenorrhea. It is not typically associated with hyperandrogenism, and patients may have hot flashes or night sweats. The presence of androgenic symptoms makes PCOS more likely.

Choice C:

PCOS is the most likely diagnosis in a woman with infertility, irregular cycles (45–60 days), hirsutism, and acne—all signs of hyperandrogenism and anovulation. The chronic anovulation prevents regular follicular maturation and ovulation, leading to infertility. The history fits the classic diagnostic criteria (Rotterdam criteria) for PCOS.Rationale for incorrect answers

Choice D:

Endometriosis commonly presents with chronic pelvic pain, dyspareunia, and dysmenorrhea, rather than androgenic symptoms or cycle lengths of 45–60 days. While it can cause infertility due to pelvic adhesions and inflammation, it does not typically feature hirsutism or acne.

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Question 4:

Which of the following are causes of female infertility? Select all that apply.

A. Polycystic ovary syndrome B. Varicocele C. Endometriosis D. Hypogonadism E. Uterine fibroids

Answer and Explanation

Choice A:

PCOS is a leading cause of female infertility due to chronic anovulation. Women present with irregular menses, elevated androgens, and disrupted follicular maturation. The hormonal imbalance interferes with ovulation and conception.

Choice B:

Varicocele is a dilation of the pampiniform plexus in the scrotum and is a male factor infertility cause. It impairs testicular thermoregulation and sperm quality but does not apply to female infertility.

Choice C:

Endometriosis causes infertility through pelvic adhesions, inflammation, and distorted anatomy that impair oocyte pickup and tubal transport. It may also create an inhospitable peritoneal environment for fertilization or implantation.

Choice D:

Hypogonadism is a general term indicating reduced gonadal function. In females, primary hypogonadism (e.g., Turner syndrome) can cause infertility, but the term is more commonly associated with male infertility due to low testosterone. The question focuses on common female causes, making this option inapplicable without specifying female context.

Choice E:

Uterine fibroids (especially submucosal or intramural types) can distort the uterine cavity, interfere with implantation, or cause early pregnancy loss. They are a structural cause of infertility in women.Rationale for incorrect answers

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Question 5:

Which of the following are common causes of ovulatory dysfunction in females? Select all that apply.

A. Polycystic Ovary Syndrome (PCOS) B. Hypothalamic-Pituitary Dysfunction C. Pelvic Inflammatory Disease (PID) D. Premature Ovarian Insufficiency (POI) E. Uterine Fibroids

Answer and Explanation

Choice A:

PCOS is the most common cause of chronic anovulation. It is associated with hyperandrogenism, insulin resistance, and elevated LH:FSH ratio (>2:1), which disrupt follicular maturation and prevent ovulation.

Choice B:

Hypothalamic-pituitary dysfunction results in decreased GnRH secretion, leading to low or inappropriately normal FSH and LH, and subsequently insufficient ovarian stimulation. Common causes include stress, excessive exercise, and eating disorders.

Choice C:

PID causes infertility primarily by damaging the fallopian tubes through infection-induced scarring. It is not a direct cause of ovulatory dysfunction because it does not affect the hypothalamic-pituitary-ovarian axis or folliculogenesis.

Choice D:

Premature ovarian insufficiency involves early depletion of ovarian follicles before age 40. It presents with elevated FSH (>25 mIU/mL), low estradiol (<30 pg/mL), and amenorrhea or oligomenorrhea, causing loss of ovulatory cycles.Rationale for incorrect answers

Choice E:

Uterine fibroids interfere with implantation or cause mechanical disruption of the uterine cavity but do not affect ovulation. They are structural causes of infertility rather than hormonal or ovulatory.

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Question 6:

Which of the following diagnostic tests are used to evaluate female infertility? Select all that apply.

A. Hysterosalpingogram B. Semen analysis C. Anti-Müllerian hormone (AMH) level D. Scrotal ultrasound E. Laparoscopy

Answer and Explanation

Choice A:

Hysterosalpingogram is used to evaluate uterine cavity anatomy and fallopian tube patency by injecting contrast under fluoroscopy. It helps detect tubal obstruction, adhesions, and uterine anomalies, making it a core test in female infertility assessment.

Choice B:

Semen analysis is the primary test for male infertility and assesses sperm concentration, motility, and morphology. It is not used to evaluate female infertility, though it is essential in a comprehensive infertility evaluation of the couple.

Choice C:

Anti-Müllerian hormone reflects the quantity of antral follicles and is used to assess ovarian reserve. High AMH levels (>4.5 ng/mL) may indicate PCOS, while low levels (<1.0 ng/mL) suggest diminished ovarian reserve. It is cycle-independent and highly reliable.

Choice D:

Scrotal ultrasound is used to evaluate male reproductive anatomy, particularly for detecting varicocele, testicular masses, or structural abnormalities. It plays no role in diagnosing female infertility.

Choice E:

Laparoscopy allows direct visualization of pelvic organs and is considered the gold standard for diagnosing endometriosis, pelvic adhesions, and tubal disease. It is both diagnostic and therapeutic in managing structural causes of infertility.Rationale for incorrect answers

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Practice Exercise 1

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