Review Practice Exercise 2

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Practice Exercise 2

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Total Questions : 3

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Question 1:

Which diagnostic procedure is considered the gold standard for directly visualizing the pelvic organs and diagnosing endometriosis in a female patient with infertility?

A. Hysterosalpingogram (HSG) B. Transvaginal Ultrasound C. Laparoscopy D. Sonohysterography (SIS)

Answer and Explanation

Choice A:

HSG evaluates the uterine cavity and tubal patency using contrast dye under fluoroscopy. It does not allow visualization of peritoneal or ovarian implants and cannot confirm endometriosis.

Choice B:

Transvaginal ultrasound is useful for identifying ovarian endometriomas (chocolate cysts) but cannot detect superficial peritoneal implants or adhesions. It is not diagnostic for endometriosis unless a mass is present.

Choice C:

Laparoscopy is the gold standard because it allows direct visualization of pelvic structures and biopsy of suspected endometrial implants. It can assess extent and severity of disease, detect adhesions, and facilitate surgical treatment during the same procedure.Rationale for incorrect answers

Choice D:

Sonohysterography (SIS) is used to assess the uterine cavity using saline infusion and ultrasound. It detects polyps and fibroids but does not visualize the peritoneum or diagnose endometriosis.

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Question 2:

What is the minimum sperm count considered normal in a semen analysis?

A. 5 million/mL B. 10 million/mL C. 15 million/mL

Answer and Explanation

Choice A:

A concentration of 5 million/mL is well below the WHO cutoff and is classified as moderate to severe oligozoospermia. Fertility is typically impaired at this level, and further investigation is required.

Choice B:

While higher than 5 million/mL, 10 million/mL is still below the normal reference range. This value may result in reduced fertility and is not considered normal by WHO standards.

Choice C:

The WHO 2021 criteria define the minimum normal sperm concentration as 15 million/mL. This threshold reflects the lowest 5th percentile of fertile men and is used globally in fertility assessments. Below this level, the probability of spontaneous conception declines significantly.Rationale for incorrect answers

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Question 3:

Which of the following parameters are typically assessed in a routine semen analysis? Select all that apply.

A. Sperm concentration B. Sperm motility C. Sperm morphology D. Semen pH E. Serum testosterone levels

Answer and Explanation

Choice A:

Sperm concentration, measured in millions per milliliter, assesses the density of sperm in the ejaculate. A normal value is ≥15 million/mL. Low concentration indicates oligozoospermia and may affect fertility.

Choice B:

Sperm motility evaluates the percentage of moving sperm and their ability to move progressively toward the egg. Total motility should be ≥40%, with progressive motility ≥32%. Poor motility (asthenozoospermia) reduces fertilization capability.

Choice C:

Sperm morphology is assessed under strict Kruger criteria, with ≥4% normal forms considered acceptable. Abnormal shapes can impair the ability to fertilize an egg.

Choice D:

Semen pH assesses the acidity or alkalinity of the ejaculate. Normal pH ranges from 7.2–8.0. Deviations may indicate infection (alkaline) or ejaculatory duct obstruction (acidic).Rationale for incorrect answers

Choice E:

Serum testosterone is a hormonal parameter and not part of a routine semen analysis. It is measured separately when evaluating endocrine causes of male infertility, especially in cases of low libido, erectile dysfunction, or signs of hypogonadism.

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Practice Exercise 2

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