DHA Reproductive Medicine & Infertility exam questions

6 worked Reproductive Medicine & Infertility practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Anovulation, PCOS and Ovulation Induction

   Using a transvaginal transducer with a frequency of 8 MHz or higher in an adult, which finding meets the 2023 guideline threshold for polycystic ovarian morphology?

   1. A20 or more follicles per ovary
   2. B12 or more follicles per ovary
   3. COvarian volume of 6 mL or more
   4. DA dominant follicle above 10 mm
   Show answer and explanation

   Correct answer: A. 20 or more follicles per ovary

   The 2023 guideline defines PCOM as a follicle number per ovary of 20 or more and/or an ovarian volume of 10 mL or more in either ovary. The older threshold of 12 follicles applied to lower-resolution equipment.

   Reference: International Evidence-based Guideline for the Assessment and Management of PCOS 2023

2. Question 2 · Assisted Reproductive Technology

   An IVF patient receives an hCG trigger at 22:00 on Monday. When should oocyte retrieval be scheduled?

   1. AWednesday, 08:00 to 10:00
   2. BTuesday, 10:00 to 12:00
   3. CTuesday, 20:00 to 22:00
   4. DThursday, 08:00 to 10:00
   Show answer and explanation

   Correct answer: A. Wednesday, 08:00 to 10:00

   Retrieval is timed 34 to 36 hours after the trigger, just before expected ovulation, which falls between 08:00 and 10:00 on Wednesday. Earlier retrieval yields immature oocytes, and later retrieval risks ovulation before collection.

   Reference: Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th ed.

3. Question 3 · Assisted Reproductive Technology

   A 30-year-old woman in her first IVF cycle has two good-quality blastocysts. Which transfer policy is most appropriate?

   1. ATransfer both if she requests twins
   2. BTransfer both blastocysts together
   3. CFreeze both and transfer neither
   4. DTransfer one and freeze the other
   Show answer and explanation

   Correct answer: D. Transfer one and freeze the other

   Elective single embryo transfer in good-prognosis patients gives a similar cumulative live birth rate while greatly reducing twin pregnancy and its maternal and neonatal risks. Double transfer mainly increases multiple pregnancy.

   Reference: ASRM Practice Committee: Guidance on the Limits to the Number of Embryos to Transfer 2021

4. Question 4 · Endometriosis, Uterine Factors and Recurrent Pregnancy Loss

   A 36-year-old woman with a 3 cm asymptomatic ovarian endometrioma and low AMH is about to start IVF. Ultrasound features are typical and benign. What is the most appropriate management?

   1. ALaparoscopic cystectomy before IVF
   2. BProceed with IVF without cystectomy
   3. CSix months of GnRH agonist before IVF
   4. DUltrasound-guided sclerotherapy before IVF
   Show answer and explanation

   Correct answer: B. Proceed with IVF without cystectomy

   Surgery for endometrioma before ART does not improve live birth rates and can further reduce ovarian reserve, particularly when AMH is already low. Surgery is considered for pain, suspicious features or access problems.

   Reference: ESHRE Guideline: Endometriosis 2022

5. Question 5 · Endometriosis, Uterine Factors and Recurrent Pregnancy Loss

   A woman with three consecutive first-trimester losses has persistently positive lupus anticoagulant 12 weeks apart. What treatment is recommended in her next pregnancy?

   1. AIntravenous immunoglobulin infusions
   2. BPrednisolone from conception
   3. CAspirin plus prophylactic heparin
   4. DVaginal progesterone from conception
   Show answer and explanation

   Correct answer: C. Aspirin plus prophylactic heparin

   Women with recurrent loss and antiphospholipid syndrome are offered low-dose aspirin plus prophylactic heparin, which improves live birth rates. Steroids and immunoglobulin are not recommended.

   Reference: ESHRE Guideline: Recurrent Pregnancy Loss 2022

6. Question 6 · Female Infertility Evaluation

   A 31-year-old woman has 6 months of amenorrhoea and FSH levels of 48 and 52 IU/L measured 5 weeks apart. Pregnancy test is negative. Which investigations are recommended to find the cause?

   1. AKaryotype and FMR1 premutation
   2. BPelvic MRI and serum CA-125
   3. COvarian biopsy and serum AMH
   4. DProlactin and pituitary MRI
   Show answer and explanation

   Correct answer: A. Karyotype and FMR1 premutation

   Two raised FSH levels more than 4 weeks apart with amenorrhoea before age 40 confirm premature ovarian insufficiency. Recommended aetiological tests include karyotype, FMR1 premutation and adrenal antibodies. Ovarian biopsy is not recommended, and pituitary imaging is for low-gonadotropin states.

   Reference: ESHRE Guideline: Management of Women with Premature Ovarian Insufficiency 2016