Govt. Exams
Entrance Exams
In unexplained infertility, IVF allows multiple sperm-egg interactions and can overcome subtle defects in gamete interaction that cannot be detected by standard testing.
Cystic fibrosis typically results in congenital bilateral absence of vas deferens (CBAVD), leading to azoospermia with normal seminal fluid parameters (obstructive azoospermia).
IVF is the gold standard for endometriosis-related infertility as it bypasses tubal and peritoneal factors. IUI has lower success rates in endometriosis. GIFT is rarely used now.
Elevated basal FSH (>10 IU/L on day 3) indicates reduced ovarian reserve, meaning fewer eggs remain in the ovaries, affecting fertility prognosis.
# Diagnosis of Vaginal Bleeding in Third Trimester with Previous Cesarean Deliveries
This clinical scenario involves a pregnant woman at 32 weeks gestation with vaginal bleeding and a significant obstetric history of three prior cesarean deliveries—key risk factors that guide differential diagnosis.
Step 1: Analyze the Clinical Presentation
Third trimester vaginal bleeding (after 20 weeks) narrows the differential to three main conditions:
- Placenta previa (painless bleeding)
- Placental abruption (painful bleeding with contractions)
- Placenta accreta/morbidly adherent placenta (usually asymptomatic until delivery)
The patient presents with vaginal bleeding without mention of abdominal pain or contractions, suggesting painless hemorrhage.
Step 2: Evaluate Risk Factors for Placenta Previa
Placenta previa risk increases with:
- Advanced maternal age (\(\geq 35\) years) ✓
- Multiple previous cesarean deliveries ✓
- Multiparity ✓
- Uterine scar tissue from prior procedures
This patient has multiple strong risk factors for placenta previa.
Step 3: Distinguish from Other Conditions
The absence of pain and the classic risk factors point away from abruption and accreta.
Step 4: Clinical Diagnosis
Placenta previa—where the placenta partially or completely covers the internal cervical os—is the most common cause of painless third-trimester bleeding and is strongly associated with maternal age, multiparity, and prior uterine surgery.
Answer: Placenta previa (Option B)
The combination of painless vaginal bleeding at 32 weeks, advanced maternal age (35 years), and three previous cesarean deliveries makes placenta previa the most likely diagnosis. Confirmation requires transvaginal ultrasound to visualize placental location.
Oocytes arrest in prophase I during fetal development and remain in this arrested state (dictyotene). First meiotic division completes just before ovulation, producing secondary oocyte and polar body.
Low testosterone with erectile dysfunction requires assessment of LH and FSH. If LH/FSH are low, it indicates secondary hypogonadism (pituitary/hypothalamic origin).
GnRH agonists cause initial stimulation followed by desensitization, suppressing endogenous LH and FSH to prevent premature ovulation during controlled ovarian hyperstimulation.
HSG is the first-line radiological investigation for assessing tubal patency and uterine cavity in suspected secondary infertility after normal male factor evaluation.
Elevated FSH with irregular cycles indicates diminished ovarian reserve characteristic of POI. PCOS typically shows normal or low FSH with hyperandrogenism.
