Reproductive Medicine & Infertility Prometric exam questions with answers

1. Question 1Anovulation, PCOS and Ovulation Inductionmedium

   A woman with PCOS who failed oral ovulation induction starts gonadotropins. Why is a low-dose step-up protocol preferred?

   1. ATo shorten the duration of stimulation
   2. BTo promote monofollicular development
   3. CTo avoid the need for ultrasound monitoring
   4. DTo increase the number of mature follicles
   Show answer and explanation▾

   Answer: B. To promote monofollicular development

   Women with PCOS are very sensitive to FSH, so a low starting dose with small increments aims for a single dominant follicle, limiting OHSS and multiple pregnancy. It usually lengthens stimulation and still requires ultrasound monitoring.

2. Question 2Assisted Reproductive Technologyhard

   A 26-year-old woman with PCOS has 28 follicles above 10 mm on a GnRH antagonist protocol. Which trigger strategy best reduces her risk of OHSS?

   1. AGnRH agonist trigger with freeze-all
   2. BStandard dose hCG with fresh transfer
   3. CDouble dose hCG trigger
   4. DCoasting for 5 days then hCG
   Show answer and explanation▾

   Answer: A. GnRH agonist trigger with freeze-all

   A GnRH agonist trigger produces a short endogenous LH surge and nearly eliminates early OHSS, and freezing all embryos avoids late OHSS from pregnancy hCG. It works only when the pituitary is not down-regulated, as in an antagonist cycle.

3. Question 3Complications of ARTmedium

   Five days after oocyte retrieval, a woman has abdominal distension, ascites on ultrasound, haematocrit 0.47 and reduced urine output. What is the most appropriate management?

   1. AGive a high-dose diuretic to clear the ascites
   2. BDischarge with oral analgesia and review in a week
   3. CAdmit with fluid balance monitoring and thromboprophylaxis
   4. DStart nonsteroidal anti-inflammatory drugs
   Show answer and explanation▾

   Answer: C. Admit with fluid balance monitoring and thromboprophylaxis

   Haemoconcentration, oliguria and ascites indicate severe OHSS, which needs admission, fluid balance charting, thromboprophylaxis and paracentesis if required. Diuretics worsen intravascular depletion, and NSAIDs may impair renal function.

4. Question 4Embryology Laboratory, Cryopreservation and PGTmedium

   Oocytes are checked 17 hours after ICSI. One shows three pronuclei. How should this zygote be managed?

   1. ATransfer it with another embryo
   2. BCulture and transfer as normal
   3. CFreeze it for a later transfer
   4. DDo not use it for transfer
   Show answer and explanation▾

   Answer: D. Do not use it for transfer

   Normal fertilisation shows two pronuclei and two polar bodies at about 16 to 18 hours; three pronuclei indicate abnormal fertilisation with a high risk of triploidy. Such zygotes are not used for transfer.

5. Question 5Female Infertility Evaluationeasy

   A hysterosalpingogram is planned for a woman with regular cycles. When in the cycle should it be performed?

   1. AAfter menses end and before ovulation
   2. BDuring active menstrual bleeding
   3. CIn the mid-luteal phase
   4. DOn the day of the expected period
   Show answer and explanation▾

   Answer: A. After menses end and before ovulation

   HSG is done in the early follicular phase after bleeding stops and before ovulation to avoid irradiating a possible early pregnancy and to reduce the risk of intravasation. Luteal-phase testing risks exposing an unrecognised pregnancy.

6. Question 6Embryology Laboratory, Cryopreservation and PGTmedium

   A 34-year-old woman chooses elective oocyte cryopreservation. Which method gives the best post-thaw survival of mature oocytes?

   1. AStorage at minus 80 degrees Celsius
   2. BSlow programmable freezing
   3. CVitrification
   4. DFreezing without cryoprotectant
   Show answer and explanation▾

   Answer: C. Vitrification

   Vitrification uses high cryoprotectant concentrations and ultra-rapid cooling to avoid ice crystal formation and gives higher oocyte survival than slow freezing. Storage must be in liquid nitrogen, not a minus 80 freezer.

7. Question 7Male Infertility and Andrologyhard

   A man with non-obstructive azoospermia is found to have a complete AZFa deletion of the Y chromosome. What is the most accurate counselling regarding surgical sperm retrieval?

   1. ARetrieval depends only on serum FSH
   2. BRetrieval succeeds in about half of men
   3. CRetrieval succeeds in most men
   4. DRetrieval is virtually never successful
   Show answer and explanation▾

   Answer: D. Retrieval is virtually never successful

   Complete AZFa or AZFb deletions are associated with a near-zero chance of finding sperm, so testicular sperm extraction is not advised. Men with AZFc deletions often have sperm retrievable, which is the most tempting confusion.

8. Question 8Reproductive Physiology and Endocrinologyeasy

   Which hormone, produced by Sertoli cells, provides negative feedback mainly on pituitary FSH secretion?

   1. AActivin A
   2. BTestosterone
   3. CAnti-Mullerian hormone
   4. DInhibin B
   Show answer and explanation▾

   Answer: D. Inhibin B

   Inhibin B from Sertoli cells selectively suppresses FSH and is a marker of spermatogenic activity. Testosterone from Leydig cells mainly feeds back on LH and GnRH, and activin stimulates rather than inhibits FSH.

9. Question 9Female Infertility Evaluationmedium

   A woman about to start IVF has a large unilateral hydrosalpinx visible on ultrasound. What is the most appropriate management before embryo transfer?

   1. AProceed with IVF and give prophylactic antibiotics
   2. BLaparoscopic salpingectomy or proximal tubal occlusion
   3. CUltrasound-guided aspiration at each cycle
   4. DSalpingostomy to restore tubal patency
   Show answer and explanation▾

   Answer: B. Laparoscopic salpingectomy or proximal tubal occlusion

   Hydrosalpinx fluid reduces implantation, and salpingectomy or proximal occlusion before IVF improves pregnancy and live birth rates. Antibiotics alone do not remove the toxic fluid, and salpingostomy is not the treatment of choice when IVF is planned.

10. Question 10Female Infertility Evaluationmedium

    A woman is scheduled for hysterosalpingography as part of a fertility work-up. What should be done beforehand to reduce infective risk?

    1. APerform a high vaginal swab for Candida
    2. BGive routine antifungal prophylaxis
    3. CScreen for Chlamydia trachomatis
    4. DCheck serum CA-125
    Show answer and explanation▾

    Answer: C. Screen for Chlamydia trachomatis

    Before uterine instrumentation, women should be screened for Chlamydia trachomatis or given prophylactic antibiotics if screening has not been done, to prevent pelvic infection. Candida and CA-125 testing do not reduce this risk.

11. Question 11Male Infertility and Andrologymedium

    A semen analysis shows volume 2.0 mL, sperm concentration 12 million/mL, total motility 50%, progressive motility 35% and normal forms 5%. Using WHO 2021 lower reference limits, which parameter is abnormal?

    1. ASperm concentration
    2. BSemen volume
    3. CProgressive motility
    4. DNormal morphology
    Show answer and explanation▾

    Answer: A. Sperm concentration

    The WHO 2021 lower reference limit for concentration is 16 million/mL, so 12 million/mL is low. The limits for volume (1.4 mL), progressive motility (30%) and normal forms (4%) are all met.

12. Question 12Male Infertility and Andrologymedium

    A 28-year-old azoospermic man has small firm testes, raised FSH and LH and a 47,XXY karyotype. Which option offers the best chance of genetic parenthood?

    1. ATestosterone replacement therapy
    2. BMicrodissection TESE with ICSI
    3. CClomiphene for 12 months
    4. DVaricocele repair
    Show answer and explanation▾

    Answer: B. Microdissection TESE with ICSI

    Foci of spermatogenesis exist in many men with Klinefelter syndrome, and micro-TESE with ICSI can achieve pregnancy. Exogenous testosterone suppresses spermatogenesis and should be avoided when fertility is desired.

13. Question 13Male Infertility and Andrologymedium

    A 29-year-old bodybuilder has azoospermia, small testes, and suppressed FSH and LH. He admits to injecting testosterone for 2 years. What is the most appropriate first step?

    1. AArrange testicular sperm extraction now
    2. BStop androgens and repeat semen analysis
    3. CContinue testosterone and add clomiphene
    4. DRefer for donor sperm insemination
    Show answer and explanation▾

    Answer: B. Stop androgens and repeat semen analysis

    Exogenous androgens suppress gonadotropins and spermatogenesis, which usually recovers over months after stopping. Surgical retrieval or donor sperm is premature before recovery has been allowed.

14. Question 14Reproductive Physiology and Endocrinologymedium

    A 30-year-old woman with regular 35-day cycles is being investigated for subfertility. On which cycle day should serum progesterone be measured to confirm ovulation?

    1. ADay 28
    2. BDay 14
    3. CDay 21
    4. DDay 35
    Show answer and explanation▾

    Answer: A. Day 28

    Mid-luteal progesterone should be measured about 7 days before the expected period, which is day 28 in a 35-day cycle. A day 21 test is only correct for a 28-day cycle and would give a falsely low result here.

15. Question 15Reproductive Physiology and Endocrinologymedium

    A woman with oligomenorrhoea and galactorrhoea has a prolactin of 2,500 mIU/L and a 6 mm pituitary microadenoma. She wants to conceive. What is the first-line treatment?

    1. APituitary radiotherapy
    2. BTranssphenoidal surgery
    3. CLetrozole
    4. DCabergoline
    Show answer and explanation▾

    Answer: D. Cabergoline

    A dopamine agonist, preferably cabergoline, normalises prolactin and restores ovulation in most microprolactinomas. Surgery is reserved for intolerance or resistance, and letrozole does not correct the underlying cause.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.