MEDICAL ENTRANCE

XII
Reproductive Health
 REPRODUCTIVE HEALTH

INDEX

CONTENTS

THEORY .............................................................................. Page 1 - 17

EXERCISE–1 ...................................................................... Page 18 - 24
EXERCISE–2 ...................................................................... Page 25 - 30
EXERCISE–3 ...................................................................... Page 31 - 32
Quick Review Table ............................................................. Page 33

MEDICAL ENTRANCE
XII
Reproductive Health
 Reproductive Health
Syllabus
Reproductive health: Need for reproductive health and prevention of sexually transmitted
diseases (STD); Birth control-Need and Methods, Contraception and Medical Termination of
Pregnancy (MTP); Amniocentesis; Infertility and assisted reproductive technologies – IVF,
ZIFT, GIFT (Elementary idea for general awareness).

Chapter Index

Reproduction Health  Infertility

 Reproductive Health – Problems and  Assisted Reproductive Technologies
strategies (ART)
 Human Population Growth  Some Important Definitions
 Methods of Birth Control  Summary
 Sexually Transmitted Diseases

REPRODUCTIVE HEALTH
 According to World Health Organisation (WHO), reproductive health means a total well-being
in all aspects of reproduction, i.e., physical, emotional, social and behavioural.
 Thus, a society with people who have physically and functionally normal reproductive organs
and normal emotional and behavioural interactions among them in all sex-related aspects might
be called reproductively healthy.

REPRODUCTIVE HEALTH -PROBLEMS AND STRATEGIES

Problems and strategies of reproductive health in human beings are explained as follows.
(i) Over population :
 Main problem of India is its excess population which is directly connected with reproductive
health.
 To achieve total reproductive health, some plans and programmes were started.
 Family planning programme was initiated in 1951 and was periodically assessed.
 These programmes were popularly named Reproductive and Child Health-care (RCH).
 The major tasks carried out under these programmes are to provide facilities and support for
building up a reproductive healthy society.
(ii) Awareness about reproduction :
 Audio-visual and print media, governmental and non-governmental agencies are doing good
job to create awareness among people about reproduction in humans.
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 Parents, close relatives, friends and teachers also have a major role in giving the above
information.
(iii) Sex Education :
 Sex education in schools should also be introduced and encouraged to provide right
information about myths and misconceptions about sex-related aspects.
(iv) Knowledge of growth of reproductive organs and STDs :
 Proper information about reproductive organs, adolescence (period of rapid growth between
childhood and adulthood), safe and hygienic sexual practices, sexually transmitted diseases
(STDs), e.g., AIDS etc., would help to lead a reproductive healthy life.
(v) Birth control devices and care of mother and child (Prenatal, Natal and Post-natal Care) :
 Fertile couples and people of marriageable age group should know about available birth
control devices, care of pregnant mothers, postnatal (after birth) care of the mother and child,
importance of breast feeding, equal importance for the male and female child, etc.
(vi) Prevention of sex abuse and sex related crime:
 Awareness of problems due to uncontrolled population growth, social evils like sex abuse and
sex-related crimes, etc. need to be created so that people should think and take up necessary
steps to prevent them and thereby build up a reproductively healthy society.
(vii) lnformation about reproduction related problems:
 For successful action plans to attain reproductive health, requires good infrastructural facilities,
professional expert knowledge and material support.
 These are necessary to provide medical help and care for reproduction related problems like
menstrual problems, infertility, pregnancy, delivery, contraception, abortions, sexually
transmitted diseases (STDs).
 Implementation of better techniques and new strategies are also required to provide better care
and help to people for reproductive health.
(viii) Amniocentesis -Meaning and Use:
 Amniocentesis is a foetal sex determination
and disorder test based on the chromosomal
pattern in the amniotic fluid surrounding the
developing embryo.
Procedure:
 Amniotic fluid contains cells from the skin of
the foetus and other sources.
 These cells can be used to determine the sex
of the infant, to identify some abnormalities
in the number of chromosomes and to detect
certain biochemicals and enzymatic
abnormalities.
 If it is established that the child is likely to
suffer from a serious incurable congenital defect, the mother should get the foetus aborted.
 Misuse of Amniocentesis: It is being used to kill the normal female foetus. Female foeticide is
illegal.
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 (ix) Research in reproductive health area:
 It should be encouraged and supported to find out new methods.
 "Saheli" a new oral contraceptive for the females was developed by our scientists at Central
Drug Research Institute (CDRI) in Lucknow, India.
(x) Medical facilities :
 Better awareness about sex related problems, prenatal care of mother, medically assisted
deliveries and post-natal care of mother and infant, decrease maternal and infant mortality.
Small families, better detection and cure of sexually transmitted diseases (STDs) and increased
medical facilities for sex-related problems, etc. indicate improved reproductive health of male
and female individuals and children.

Measures to control Over Population

1. Education:
 People, particularly those in the reproductive age group, should be educated about the
advantages of a small family.
 Mass media and educational institutions can play an important role in this campaign.
 Posters showing a happy couple and two children with a slogan "Hum Do Humare Do" should
be displayed.
 Many couples even adopted "one child norm".
2. Marriageable Age :
 Raising of the age of marriage is more effective means to control the population (now
marriageable age of female is 18 years and that of male is 21 years).
3. Incentives: Couples with small families should be given incentives.
4. Family planning: There are many birth control measures which can check birth rate.

POPULATION EXPLOSION AND BIRTH CONTROL

Rapid increase in population over relatively short period is called population explosion.
 Census gives information about the number of individuals present in a given region at a given
time.
World Population 1900 2 billion
2000 6 billion
Indian Population 1947 350 million
2000 1 billion
It means every sixth person in the world is an Indian.
 The time required for a population to double itself is called the doubling time.
 The present growth rate of approximately 1.6 percent per year for India is smaller than the
peak of about 2.1 percent per year during 1965-1970.
 Population growth rate is indicated by (i) the annual average growth rate and (ii) the
doubling time.
 Growth rate depends on birth (fertility) rate, death (mortality) rate migration and age sex ratio.
 The major reasons for this growth are :
(i) A rapid decline in death rate
(ii) A decline in maternal mortality rate (MMR)
(iii) A decline in infant mortality rate (IMR)
(iv) Increase in the number of people reaching reproducible age

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BIRTH CONTROL
 Is the process to prevent conception or pregnancy without interfering the reproductive health of
the individuals.
 Characteristics of an ideal contraceptive are: (i) User friendly, i.e., comfortable and easy to use.
(ii) Without side effects. (iii) Reversible. (iv) Completely effective against pregnancy.
 There are several methods of contraception-natural or traditional, barriers, IUDs, oral
contraceptives, injectables, implants and surgical methods.
 Couple protection is the process of bringing eligible couples under family planning measures.
In India, it is over 55% at present and is voluntary in nature.
 In 2004, there were 60·79 lakh IUD insertions, 48·74 lakh sterilisations, 249·9 lakh condom
users and 87·54 lakh oral pill users.

Conceptual Questions
Q.1 Which was the first country in the developing world to initiate 'Family planning programmes'?
Q.2 When were family planning programmes initiated?
Q.3 Which conditions have an explosive impact on the growth of population?
Q.4 What are the suggested reasons for population explosion?
Ans. Q.1. India, Q.2. In 1951, Q.3. Increased health facilities with better living conditions,
Q.4. (i) Rapid decline in death rate, (ii) Decline in maternal mortality rate, (iii) Decline in
infant mortality rate

METHODS OF BIRTH CONTROL

1. Natural Methods:
 These are the methods which do not require any device or medicine so no side effects but
chances of failure are very high.
 Natural methods are of three kinds-safe period, withdrawal and breast feeding.
(i) Safe period (Rhythm Method) :
 Ovulation occurs roughly about the middle of menstrual cycle.
 Fertility period is upto 48 hours after ovulation, when fertilization can occur.
 Avoiding sex during the fertility period will naturally prevent conception.
 Ovulation period can be known by the rise in body temperature by about 1º F, cervical mucus
is slippery and can be drawn into a thread (Spinnbarkeit test) when stretched between two
fingers.
 Period prior to ovulation is safe.
 Period after fourth day of rise in body temperature (or last positive Spinnbarkeit test) is also
considered safe.
 It is however, always better to avoid sex from day 10-17 of the menstrual cycle.
(ii) Withdrawal Method (Coitus Intruptus) :
 The method is based on withdrawal of penis from the vagina before ejaculation.

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  This method has high failure rate due to pre-ejaculatory release of sperms or failure to
withdraw penis from the vagina before ejaculation.
(iii) Lactational Amenorrhoea :
 Just after parturition, there is a phase of amenorrhoea or absence of menstruation.
 It is also the phase of intense lactation.
 Breast feeding the child fully prevents conception.
 The method is, however, effective only upto a maximum period of six months.

Concept Map

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2. Barrier Methods :
 These are mechanical devices which prevent the deposition of sperms into vagina and their
passage into the uterus.
 Further, they can be self inserted by the user in complete privacy.
 The common barrier methods are condoms, diaphragm, fem shield and cervical cap.
(i) Condom:
 It is tubular latex sheath which is rolled over the male
copulatory organ during sex.
 The common brand provided by family welfare services
is Nirodh.
 The device also provides protection against sexually transmitted diseases including AIDS.
(ii) Fem Shield (Female Condom) :
 The device is polyurethane pouch with a ring at either
end.
 The inner ring is smaller and present at the inner closed
end.
 The device covers the external genitalia as well as lines
the vagina.
 Fem shield provides protection from sexually transmitted
diseases also.
(iii) Diaphragm:
 It is a tubular rubber sheath with a flexible metal or spring ring at the margin which is fitted
inside the vagina.
(iv) Cervical Cap:
 It is rubber nipple which is fitted over the cervix and is designed to remain
there by suction.
 The device prevents the entry of sperms into the uterus.
(v) Vault Cap :
 It is hemispheric dome like rubber or plastic cap with a thick rim which is
meant for fitting over the vaginal vault over the cervix.

3. Chemical Methods:
 These are contraceptives which contain spermicidal chemicals.
 The chemical contraceptives are available in the form of creams (e.g., delfen), jelly (perceptin,
volpar paste), foam tablets (e.g., aerosol foam, chlorimin T or contab).... etc.
 These commonly contain lactic acid, boric acid, citric acid, zinc sulphate and potassium
permanganate.
 The contraceptives are introduced in vagina prior to sex.
 Sponge (Today) is a foam suppository or tablet containing nonoxynol-9 as spermicide. It kills
the sperm by disrupting the membrane. It is moistened before use to activate the spermicide.
The device also absorbs the male ejaculate.

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4. Intrauterine Devices (IUDs) (Intrauterine Contraceptive Devices or IUCDs) :
 These devices are inserted by doctors or expert nurses
in the uterus through vagina. IUDs affect motility of
sperms within the uterus. These IUDs can be –
(a) Non-medicated (e.g., Lippes loop)
(b) Copper releasing (e.g., CuT, Cu7, Multiload 375) –
The copper ions suppress the motility and fertilization
capacity of sperms.
(c) Hormone releasing (e.g., Progestasert, LNG-20)- The hormone releasing IUDs, in addition,
make the uterus unsuitable for implantation and the cervix hostile to the sperms.
IUDs are ideal contraceptives for the females who want to delay pregnancy and / or space
children. It is one of the most widely accepted methods of contraception in India.

5. Oral Contraceptives (Oral Pills) :

 Are preparations containing either progestin (= progestogen = progesterone) alone or a
combination of progestogen and oestrogen (= estrogen).
 The pills are taken orally for 21 days in a menstrual cycle starting from 5th
day and ending on 25th day.
 However, it is advisable to restart the course after a gap of 7 days
irrespective of the onset or nonset of menstruation during the pill free days.
 When a pill is missed, it should be taken whenever one remembers,
sometimes two at a time.
 This helps in keeping the hormonal level optimum for contraception.
 Hormonal pills act by four ways :
(a) Inhibition of ovulation.
(b) Alternation in uterine endometrium to make it unsuitable for implantation.
(c) Changes in cervical mucus impairing its ability to allow passage and transport of sperms.
(d) Inhibition of motility and secretory activity of fallopian tubes.
 Oral pills are of two types, combined and minipills.
 Combined pills contain both oestrogen and progestin.
 They are synthetic products.
 Oestrogen is an ovulatory, that inhibits FSH production. Progestin is anovulatory that inhibits
LH production.
 It protects the endometrial lining from adverse effect of oestrogen.
 The hormone also changes cervical mucus.
 The most commonly used progestin is levonorgestrel or desogestrel.
 The most common oestrogen is ethinyl oestradiol or menstranol.
 In monophasic combined pill, both oestrogen and progestin are present in nearly the same
amount, e.g., Mala D, Mala L.
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 In multiphasic combined pills, oestrogen is maintained at the same level throughout the 21 day
course (0.03 mg). But the amount of progestin is increased (0.05 mg for first six days, 0.075
for next 5 days and 0.125 mg for last ten days), e.g., triquilar, orthonovum.
 Minipills are progestin pills only (with no estrogen). They are taken daily without break.
 Saheli, a nonsteroidal preparation, is taken once a week after an initial intake of twice a week
dose for 3 months.

6. Injectable Contraceptives (Depo-Provara) :

 Two types of progestin preparations are used singly.
 They are depot-medroxy progesterone acetate (DMPA) 150 mg every three months or 300
mg every six months and norethisterone enanthate (NET EN) 200 mg every two months.
 Cyclofem and mesigna and combined injectable contraceptives which are given once every
month.
 They contain progestin preparation as well as oestradiol.

7. Implants:
 They are hormone containing devices which are implanted
subdermally for providing long term contraception.
 Norplant is progestin only. The device is with six small
permeable capsules (34 mm × 2.4 mm) each with about 36
mg levonorgestrel.
 They are inserted under the skin in a fan shaped manner
inside upper arm or fore arm through a small incision.
 Suturing is not required. Norplant remains effective for about 5 years.
 Implanon is a single rod-like device which is implanted through a wide bored needle. It
contains 3-keto desogestrel. It remains functional for three years.

Average Failure Rate of Various Contraceptive Techniques

Contraceptive method Average failure rate
(Annual pregnancies/100 women)
None 90
Natural (rhythm) methods 20 – 30
Coitus interruptus 23
Chemical contraceptives 20
Barrier methods 10 – 15
Oral contraceptives 2–3
Intrauterine contraceptive device 6
Implanted contraceptives <1

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8. Emergency Contraception :
 It is treatment for unprotected sex, sexual assault, missed pills and other reasons which have
risk of pregnancy.
 The drugs used for treating emergency contraceptions are called morning-after pills.
 They are also available in India under Family Welfare Programme since 2002-2003.
 Two ovral tablets to start and two tablets after 12 hours provide relief.
 Other morning-after pills are noral, norgynon and ovidon.
 An antiprogesterone pill (mifepristone) is a single pill treatment.
 Insertion of IUD within five days of unprotected sex prevents implantation.

9. Surgical Methods of Family Planning :

 They are also called terminal methods of family planning.
 Surgical methods are permanent methods of family planning where there is no need of
replacement or augmentation but the reversibility is poor.
 The methods are operative procedures which block the passage of semen in males and ova in
females.
 The techniques are also called sterilisation procedures.
 They are called vasectomy in males and tubectomy in females.

Vasectomy (L. vas-vessel, ektome-excision) :

 It is a surgical method of sterilisation of
males.
 Vasa deferentia are blocked by cutting and
occluding them so that sperms are unable to
pass down the male reproductive system.
(i) Conventional Vasectomy (Scalpel Surgery) :
 Under local anaesthesia, transverse 1cm
incision is made through the skin of the
scrotum with the help of the scalpel over the
area of vasa deferentia.
 Each vas deferense is exposed and cut.
 The two ends are separated and tied.
 A gap of 1-4cm is must between the two ends
otherwise reunion can occur.
(ii) No-scalpel Vasectomy:
 Here instead of scalpel, a dissecting forceps and a ringed forceps are required.
 The skin is punctured and the vas deferense is taken out.
 It is occluded by removal of 1-2 cm followed by ligation of ends.
 Occlusion can also be achieved by heat and clips.
 Vasectomy is a reversible procedure as the cut ends can be joined together to open to sperm
passage.

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 Tubectomy (L. tubes-pipe, ektome-excision):
 It is a surgical procedure of female
sterilisation where a portion of both the
fallopian tubes is excised or ligated to
block the passage of ovum through them.
 Tubectomy is performed by conventional
transabdominal surgery, conventional
laparotomy and minilaparotomy.
 In surgical procedures, the fallopian tubes
are cut and the cut ends are tied to
prevent reunion.
 The procedure is reversible as the cut
ends can be rejoined.
 In laparoscopic procedure, sterlisation is
achieved by loop development and constricting the basal region of loop with the help of elastic
ring either through a small incision in the abdomen or through vagina.

Difference between Vasectomy and Tubectomy

Vasectomy Tubectomy
1. It is surgical sterlisation technique for the 1. It is surgical sterlisation technique for the
males. females.
2. The two vasa deferentia are interrupted by 2. The two oviducts are interrupted by either
giving cuts. ligation or cuts.
3. Passage of sperms is prevented. 3. Passage of ova is prevented.

Medical Termination of Pregnancy (MTP)

 It is voluntary or intentional abortion induced and performed to end pregnancy before the
completion of full term.
 Worldwide, nearly 20% of the total pregnancies get aborted.
 The number of MTPs is 40-50 million/yr.
 Therefore, MTPs have a significant role in containment of population though they are not
performed for this purpose.
 They are mainly meant for removing unsustainable pregnancies.
 Many countries do not have a law about MTPs because the latter involve emotional, ethical,
religious and social issues.
 However, in India there is a proper act, Medical Termination of pregnancy Act, 1971.
 It is mainly meant for preventing unnatural maternal deaths due to unsafe abortions (8.9% of
the total maternal deaths).
 The act has been amended in 2002.

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  Under this act termination of pregnancy can be done upto 20 weeks, if pregnancy is likely
to produce a congenitally malformed child, is a result of rape and contraceptive failure or is
likely to harm the mother.
 MTP is safe if it is performed upto 12 weeks (first trimester) of pregnancy.
 Misoprostol (prostaglandin) alongwith mifepristone (antiprogesterone) is an effective
combination.
 Vacuum aspiration and surgical procedures are adopted thereafter.
 Second trimester abortions are risky.
 They are generally performed after testing the sex of the baby through amniocentesis or
sonography.
 It has resulted in large scale female foeticide and complications due to unsafe abortions in the
hands of untrained persons.
 To prevent such happening, the government has enacted a law, Pre-natal diagnostic
techniques (Regulation and Prevention of Misuse) Act, 1994 with amendments in 2003.
 It prohibits preconception and prenatal sex determination.

Conceptual Questions

Q.1 Which hormones are present in brith control pills?

Q.2 Name any one injectable contraceptive.
Q.3 Name the ideal contraceptives for a female who wants to delay pregnancy or space children.
Q.4 Which drug is progesterone antagonist and helpful in inducing abortion?
Q.5 Which method is the terminal method of contraception?

Ans. Q.1. Progesterone and oestrogen, Q.2. Depo-provera, Q.3. IUD (Intra Uterine Devices),
Q.4. Mifepristone, Q.5. Surgical method

Self Assessment

Q.1 Which of the following can't be considered as advantage of amniocentesis ?

(1) Prenatal diagnostics
(2) Detection of biochemical abnormalities
(3) Detection of congenital defects
(4) Determination of sex to abort female foetus
Q.2 Population growth rate depends upon
(1) Birth rate (2) Death rate (3) Age-sex ratio (4) All of these
Q.3 Replacement level is the number of children a couple must produce to replace themselves so as
to maintain population at zero growth level. The value of replacement level for developed
countries is
(1) 2.7 (2) 2.1 (3) 1.9 (4) 1.2

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Q.4 Which of the following defines the stage of demographic transition ?
(1) Birth rate is higher than death rate
(2) Death rate is higher than birth rate
(3) Birth rate and death rate are equal
(4) Both (1) & (2)
Q.5 The average number of children that would be borne by a female during her lifetime is called
(1) Natality (2) Birth rate
(3) Population growth rate (4) Total fertility rate
Q.6 Which of the following can be included under natural methods of birth control ?
(1) Rhythm method (2) Coitus interruptus
(3) Lactational amenorrhoea (4) All of these
Q.7 Which of the following contraceptive devices also protect against sexually transmitted
diseases?
(1) Fem shield (2) Sponge (3) IUDs (4) LNG-20
Q.8 Which of the following chemicals can be used under chemical methods for contraception ?
(1) Lactic acid (2) Boric acid (3) Citric acid (4) All of these
Q.9 Which of the following is/are hormone releasing IUDs ?
(1) Progestasert (2) Levonorgestrel (3) Both (1) & (2) (4) Lippe's loop
Q.10 Which of the following can be included under emergency contraception ?
(1) An antiprogesterone pill
(2) Insertion of IUD within 72 hours of unprotected sexual contact
(3) Both (1) & (2)
(4) Vasectomy

Ans. Q.1 (4), Q.2 (4), Q.3 (2), Q.4 (3), Q.5 (4), Q.6 (4), Q.7 (1), Q.8 (4), Q.9 (3), Q.10 (3)

SEXUALLY TRANSMITTED DISEASES

 The general term sexually transmitted disease (STD) is applied to any of the large group of
diseases that can be spread by sexual contact.
 The group includes conditions traditionally specified as venereal diseases (VD), such as
chlamydia, gonorrhea, syphilis, and genital herpes.
 AIDS and hepatitis, which are sexually transmitted diseases and are that also can be contracted
in other ways also.

Some common sexually transmitted diseases (STDs)

Name of sexually Causative organism Symptoms
transmitted disease
Gonorrhea Bacterium -Infects mucous membrane of the urinogenital tract.
(Neisseria gonorrhoae) -Genital discharge, painful urination.
-Children born to infected mothers often suffer eye
infections.

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Syphilis Bacterium -Causes sores and lesions in the genital tract.
(Treponema pallidum) -Burning sensation at the time of urination.
-Later causes sores in mouth.
-Can be deadly if not treated.
Trichomoniasis Trichomonas Protozoa -Vaginal irritation, itching and discharge.
AIDS HIV -Destroys the immune system of body.
(Acquired Immuno (Human Immuno -Persistent cough and fever.
Deficiency Deficiency Virus) -Body gets infected by other diseases like pneumonia,
Syndrome) TB and certain cancers.
-AIDS is a life-threatening disease. At present there is
no cure. However AIDS is preventable from
agrevation.

Conceptual Questions
Q.1 Name the causative organism for syphilis.
Q.2 In which stage of syphilis, chancre is the chief symptom?
Ans. Q.1. Treponema pallidum, Q.2. Primary stage

INFERTILITY
 Infertility (L. in-not, fertilis-fruitful) is failure to conceive even after 1-2 years of regular
unprotected sex.
 The term is not synonym of sterility which means complete inability to produce offspring.
 Infertility can best be defined as relative sterility.
 It is of two types, primary and secondary.
 Primary infertility is the infertility found in patients who have never conceived.
 Secondary infertility is found in patients who have previously connceived.
 Infertility is caused by defects found in males, females as well as both.

Infertility in Males
 Semen of a fertile male is 2.5 to 5 ml per ejaculation with a sperm count of over 200-300
million, mostly motile, having proper fructose content and fluidity which is deposited high in
the vagina.
 Any defect in sperm count, sperm structure, sperm motility of seminal fluid leads of infertility.
 Low sperm count is called oligospermia while near absence of sperms is known as
azoospermia.
 Low sperm motility is called asthenozoospermia while defective sperm morphology is termed
as teratozoospermia.

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 Infertility in Females
 A fertile woman is the one who regularly ovulates once every cycle, passes the egg down the
reproductive tract which develops conditions for smooth passage of sperms and implantation of
fertilised egg.
 The various causes of infertility in females are as follows :
1. Anovulation (nonovulation) and oligoovulation (deficient ovulation).
2. Inadequate growth and functioning of corpus luteum.
3. The ovum is not liberated but remains trapped inside the follicle due to hyperprolactinaemia.
4. Fallopian tube may fail to pick up ovum.
5. Noncanalisation of uterus.
6. Defective uterine endometrium.
7. Fibroid uterus.
8. Defects in cervix.
9. Defective vaginal growth.

ASSISTED REPRODUCTIVE TECHNOLOGIES (ART)

 More than two decades ago, in an experimental procedure called invitro fertilization (IVF),
doctors joined a woman's egg and a man's sperm in a glass dish on the laboratory table.
 For the first time, fertilization happened outside a woman's body. Nine months later, the first
test-tube baby was born.
 Today, assisted reproductive technology (ART) refers not only to IVF but also to several
variations tailored to patient's unique conditions.
 These procedures are usually paired with more conventional therapies, such as fertility drugs,
to increase success rates.
 Almost one out of every three cycles of ART results in the birth of a baby.
 But ART procedures are invasive and expensive.
 Though no long-term health effects have been linked to children born using ART procedures,
most doctors recommend reserving ART as a last resort for having a baby.
 Following is the list of important techniques which could benefit such infertile couples.
IVF & ET
In Vitro Fertilization (IVF) is the fertilization outside the body, in almost similar conditions as
that in the body, which is followed by embryo transfer (ET). In this method, popularly known
as, Test-Tube baby method, the ova from the wife/donor (female) and sperms from the
husband/donor (male) are collected and are induced to form zygote under simulated conditions
in the laboratory. The zygote or early embryos are then transferred into fallopian tube or uterus
to complete its further development.
1. ZIFT
In ZIFT (Zygote Intra Fallopian Transfer) the zygote, formed in vitro, or early embryo up to
8-blastomere, is transferred into fallopian tube.
2. IUT
In IUT (Intra Uterine Transfer) the embryos with more than 8 blastomeres are transferred into
the uterus for further development. The embryos formed by in-vivo fertilization can also be
used for transfer to assist those females who cannot conceive.

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 3. GIFT
The GIFT (Gamete Intra Fallopian Transfer) is the transfer of an ovum collected from a donor
into the fallopian tube of the recipient who can provide suitable environment for fertilization
and further development.
4. ICSI
In ICSI (Intra Cytoplasmic Sperm Injection) is another specialized procedure to form an
embryo in the laboratory in which a sperm is directly injected into the ovum.
5. AI
The AI (Artificial Insemination) is used for the cases of infertility which is either due to
inability of the male partner to inseminate the female, or due to very low sperm counts in the
ejaculate.
In this technique, the semen collected either from the husband or a healthy donor is artificially
introduced either into the vagina or into the uterus (IUI -intra-uterine insemination) of the
female.
ART requires extremely high precision handling by specialized professionals and expensive
instrumentation. The infertility facilities are presently available only in very few centres in the
country.
Obviously their benefits are affordable to only a limited number of people. Emotional,
religious and social factors are also involved in the adoption of these methods.
Adoption
Our law also permits legal adoption. Adoption can benefit not only the people who are looking
for parenthood but also to many orphaned and destitute children in India, who would probably
not survive till maturity, unless taken care of.
 Surrogacy or use of a gestational carrier: Another woman carries embryo or a donor embryo
to term.

Conceptual Questions
Q.1 What is azoospermia?
Q.2 Which drugs suppress spermatogenesis?
Q.3 Expand IVF.

Ans. Q.1. Near absence of sperms in semen,

Q.2. Cytotoxic, antidepressant and anticonvulsant drugs,
Q.3. In vitro fertilization

Concept Builder

Conventional Methods of Contraception: Rhythm method, spermicides, vaginal diaphragms

and condoms.
Gossypol : It is a yellow pigment (C30H30O8) present in cotton seed taken orally (10-20 mg)
daily for 3 months and thereafter twice weekly (20 mg) inhibits spermatogenesis.

Reproductive Health || 15
Saheli : (Centchroman) is nonsteroidal drug taken orally twice a week for three months and
then once a week is a potent contraceptive which prevents implantation but does not inhibit
ovulation. It is a research product of Central Drug Research Institute, Lucknow.
IVE-ET — In vitro fertilisation and embryo transfer
GIFT — Gamete intra-fallopian transfer
ZIFT — Zygote intra-fallopian transfer
lUI — Intrauterine insemination
POST — Peritoneal oocyte and sperm transfer
SUZI — Subzonal insemination
ICSI — Intra-cytoplasmic sperm injection
TESE — Testicular sperm extraction
MESA — Microsurgical epididymal sperm aspiration

Reproductive Health || 16
 SUMMARY
 Reproductive health refers to total well-being of reproduction.
 India was the first nation to initiate action plans at national level to attain reproductively
healthy society.
 Sex related awareness and education is the primary step of reproductive health.
 Pre-natal, natal and post-natal care is another important aspect of the reproductive and child
health care.
 Improved reproductive health in our country is indicated by :
(i) Reduced maternal and infant mortality rate.
(ii) Early detection and cure of STDs.
(iii) Assistance to infertile couples ........ etc.
 Simultaneously population explosion necessitated intense propagation of contraceptive
methods. They are :
(i) Natural methods
(ii) Barrier methods
(iii) IUDs
(iv) Pills
(v) Injectibles
(vi) Implants
(vii) Surgical methods
Contraceptives are not regular requirements for reproductive health but are used to avoid
pregnancy or to delay or space pregnancies.
 MTP is legalised in India. MTP is done under following conditions :
(i) Rape
(ii) When the continuation of pregnancy could be harmful.
 Inability to conceive or produce children even after 2 years of unprotected sexual cohabitation
is called infertility.
 Infertility can be solved by IVF-ET that gives birth to test-tube baby.

Chap-26_ Reproductive Health || 17

 EXERCISE – 1

Section – A
Q.1 'Norplant' is the new form of birth control and it
(1) Allows ovulation but doesn't allow fertilization
(2) Makes the cervical mucus thin making sperm entry into the uterus difficult
(3) Has progestin as the active ingredient
(4) Is effective for a maximum of one year
Q.2 Which of the following is not included under barrier methods of birth control?
(1) Vaginal pouch (2) Diaphragm (3) Cervical cap (4) Implant
Q.3 Sexually transmitted diseases can get transmitted easily during use of
(1) Diaphragm (2) Cervical cap (3) Birth control pills (4) All of these
Q.4 The diaphragm is rubber dome shaped structure and stops the sperms from entering into
(1) Vestibule (2) Vagina (3) Cervix (4) Both (1) & (2)
Q.5 Among the following methods which one has the highest failure rate?
(1) Diaphragm with spermicide (2) Condom
(3) Intrauterine device (4) Rhythm method
Q.6 In case of a person suffering from syphilis, the chancre formation occurs during
(1) Primary stage (2) Secondary stage (3) Tertiary stage (4) Neurosyphilis stage
Q.7 The 'symptomless' period or latent period in case of syphilis may last for
(1) 1-5 weeks (2) 6-24 weeks (3) 4-12 weeks (4) 20 years
Q.8 Which of the following STD and its causative agent is not correctly matched?
(1) Genital warts : Haemophilus ducrei
(2) Syphilis : Treponema pallidum
(3) Genital herpes : Type II Herpes simplex virus (HSV-2)
(4) Trichomoniasis : Trichomonas vaginalis
Q.9 India was amongst the first countries in the world to initiate action plans and programs at a
national level to attain reproductive health. These programs called as 'family planning' were
initiated in ____ year in India
(1) 1951 (2) 1976 (3) 1901 (4) 1987
Q.10 All the following are uses of amniocentesis, but one is misuse. Which one is misuse?
(1) The centres for genetic counselling offer amniocentesis on request to women for
chromosome analysis
(2) This technique has been developed for detecting foetal abnormalities by analysing
chromosomal defects
(3) It is used to study metabolic defects of foetus like PKU (phenyl ketonuria)
(4) It is done to examine the sex of the foetus leading to increasing female foeticides
Q.11 Which of the following is world's first non-hormonal oral contraceptive pill for females,
developed by scientists at Central Drug Research Institute (CDRI) in Lucknow, India?
(1) Mala-D (2) Saheli (3) MORNING (4) PoP

Chap-26_ Reproductive Health || 18

Q.12 Which of the following is hormone releasing IUD?
(1) Cu-T (2) LNG-20 (3) Multiload 375 (4) Implant
Q.13 Contraceptive pills are very effective with lesser side effects and are well accepted by the
female. They work by
(1) Inhibiting ovulation
(2) Inhibiting implantation
(3) They alter the quality of cervical mucous to prevent retard the entry of sperms
(4) All of these
Q.14 Which of the following is a once a week pill with very few side effects and high contraceptive
value?
(1) Mala-D (2) Saheli (3) Depo-provera (4) Norplant
Q.15 A sterlisation technique in females which blocks gamete transport and thereby prevent
conception is
(1) Vasectomy (2) Copper-T (3) Condom (4) Tubectomy
Q.16 Surrogate mother is
(1) Mother without lactation
(2) Future mother with embryo implanted from another
(3) Carrying several embryos
(4) Artificially inseminated female
Q.17 The latest technique to produce a child is GIFT. The full form is
(1) Gametic internal fertilization and transfer
(2) Gametic intra fallopian transfer
(3) Gametic inter fallopian transfer
(4) General internal fallopian transfer
Q.18 Test tube baby is the one
(1) Who is reared on artificial medium outside the womb
(2) Growth of human baby inside the fallopian tube instead in uterus
(3) Ova from wife/donor (female) and sperms from husband/donor (male) and are induced to
form zygote by (IVF) and then implanted in female
(4) Baby born after artificial insemination
Q.19 Which of the following is the most appropriate statement of Infertility?
(1) Couple is unable to produce children inspite of unprotected sexual co-habitation
(2) Infertility is defined as the inability to produce a viable offspring and is always due to
defects/ abnormalities in the female partner
(3) Infertility, is due to immature sex organs
(4) Infertility cannot be helped by ART
Q.20 Which of the following STDs cannot be treated with antibiotics?
A. Gonorrhoea B. Syphilis C. Chlamydia D. Genital herpes
(1) D only (2) B and D (3) C and D (4) C only

Reproductive Health || 19
Q.21 At what stage of the ovarian cycle are mammalian eggs most likely to become fertilized?
(1) At the beginning of proliferative phase (2) Immediately after ovulation
(3) During the middle of the secretory phase (4) During the menstrual phase
Q.22 World Population Day is
(1) 11th July (2) 21st September (3) 7th April (4) 1st July
Q.23 MTPs are considered relatively safe up to ___ of pregnancy
(1) 12 weeks (2) 20 weeks (3) 25 weeks (4) 18 weeks
Q.24 Most of the sexually transmitted diseases are completely curable if detected early and treated
properly, except
(1) Hepatitis-B (2) Genital herpes (3) HIV infections (4) All of these
Q.25 Which of the following causative agents of STDs can cross the placenta?
(1) Hepatitis-B (2) HIV (3) Syphilis (4) All of these
Q.26 Which of the following methods of birth control can cause excessive menstrual bleeding and
pain?
(1) Condom (2) Cervical cap (3) Oral contraceptive (4) Intrauterine device
Q.27 Which of the following is one of the safest method of birth control?
(1) The rhythm method (2) Sterilization techniques
(3) Use of physical barriers (4) Termination of unwanted pregnancy
Q.28 Tubectomy is to prevent :
(1) coitus (2) fertilization (3) egg formation (4) embryonic development
Q.29 Preventive birth control measure is :
(1) MTP (2) Test tube babies
(3) Preventing union of sperm of ovum (4) Preventing sperms from entering uterus
Q.30 Which of the following method of birth control is effective, easy to use and less-expensive?
(1) IUD (2) Condom (3) Implant (4) Diaphragm
Q.31 Progesterone level falls during :
(1) lactation (2) gestation (3) menopause (4) menstruation
Q.32 Each primary oocyte on meiosis produces :
(1) one ovum (2) two ova (3) four ova (4) three ova
Q.33 In oogenesis, haploid egg is fertilized by sperm at which stage?
(1) Ovum (2) Oogonium (3) Primary oocyte (4) Secondary oocyte
st
Q.34 1 polar body is formed at which stage of oogenesis?
(1) 1st meiosis (2) 2nd mitosis (3) 1st mitosis (4) differentiation
Q.35 Vitallogenesis occurs during the formation of :
(1) ootid in the Fallopian tube (2) oogonial cell in the Graafian follicle
(3) secondary oocyte in the Fallopian tube (4) primary oocyte in the Graafian follicle
Q.36 Foetal ejection reflex in human female is induced by :
(1) release of oxytocin from pituitary (2) fully developed foetus and placenta
(3) differentiation of mammary glands (4) pressure exerted by amniotic fluid

Reproductive Health || 20
Q.37 Sertoli cells are found in :
(1) ovaries and secrete progesterone
(2) adrenal cortex and secrete adrenaline
(3) pancreas and secrete cholecystokinin
(4) seminiferous tubules and provide nutrition to germ cells
Q.38 The second maturation division of the mammalian ovum occurs:
(1) Shortly after ovulation before the ovum makes entry into the Fallopian tube
(2) After the ovum has been penetrated by a sperm
(3) Until the nucleus of the sperm has fused with that of the ovum
(4) In the Graafian follicle following the first maturation division
Q.39 Which one of the following statements about human sperm is correct?
(1) Acrosome has a conical pointed structure used for piercing and penetrating the egg,
resulting in fertilization
(2) The sperm lysins in the acrosome dissolve the egg envelope facilitating fertilization
(3) Acrosome serves as a sensory structure leading the sperm towards the ovum
(4) Acrosome serves no particular function
Q.40 The part of Fallopian tube closest to the ovary is :
(1) Cervix (2) Isthmus (3) Ampulla (4) Infundibulum
Q.41 In vitro fertilization is a technique that involves transfer of which one of the following into the
Fallopian tube?
(1) Either zygote or early embryo upto 8 cell stage
(2) Embryo only, upto 8 cell stage
(3) Embryo of 32 cell stage
(4) Zygote only
Q.42 In human female the blastocyst :
(1) forms placenta even before implantation
(2) gets implanted into uterus 3 days after ovulation
(3) gets nutrition from uterine endometrial secretion only after implantation
(4) gets implanted in endometrium by trophoblast cells
Q.43 Which of the following induces parturition?
(1) GH (2) TSH (3) Oxytocin (4) Vasopressin
Q.44 The first movements of the foetus and appearance of hair on its head are usually observed
during which month of pregnancy?
(1) Fourth month (2) Fifth month (3) Sixth month (4) Third month

Section – B
Q.1 Which of the following statement is not true w.r.t. tubectomy or tubal ligation?
(1) It is more difficult than vasectomy and is even more difficult to reverse
(2) No ovulation occurs, hence no fertilization is possible
(3) It involves ligation of both fallopian tubes
(4) The failure rate of this approach is almost zero percent

Reproductive Health || 21
Q.2 Which of the following hormone/s is/are maintained at high level during hormonal method of
birth control?
(1) FSH (2) LH (3) Progesterone (4) Both (1) & (2)
Q.3 In injectable form of the hormone based contraceptive is
(1) Norplant (2) Depo-provera (3) Mala-D (4) Saheli
Q.4 In the rhythm method of birth control, the couple refrains from intercourse
(1) One day before and after ovulation (2) Two days before and after ovulation
(3) Three days before and after ovulation (4) One week before and after ovulation
Q.5 Which of the following method is used during abortion?
(1) Vacuum aspiration (2) Infusion of a saline solution
(3) Scraping (4) All of these
Q.6 Action of which of the following hormone is blocked during use of RU 486 (mifepristone)?
(1) FSH (2) LH (3) Progesterone (4) hCG
Q.7 Which of the following STD is not caused by a bacterium?
(1) Chlamydia (2) Gonorrhea (3) Syphilis (4) Genital Herpes
Q.8 Which of the following can 't be taken as the symptom of a female suffering from gonorrhea?
(1) Inflammation of urethera with painful urination
(2) Discharge of pus from vagina
(3) Inflammation of uterine tubes
(4) Peritonitis or inflammation of the peritoneum
Q.9 Which of the following stage of syphilis is characterised by a skin rash, fever and aches in the
joints and muscles?
(1) Primary stage (2) Secondary stage (3) Tertiary stage (4) Neurosyphilis stage
Q.10 Which of the following cells are infected in a person suffering from AIDS?
(1) CD4 receptor cells (2) CD8 receptor cells
(3) Macrophages (4) Germ cells
Q.11 Use of which of the following contraceptive device has increased in recent years due to its
additional benefit of protecting the user from contracting STDs and AIDS?
(1) Coitus interrupts (2) IUDs (Intra-Uterine-Devices)
(3) Condoms (4) Vasectomy
Q.12 Which of the following have been found to be very effective as emergency contraceptives as
they could be used to avoid possible pregnancy due to rape if given within 72 hours?
A. Administration of progestogens B. Progestogen-estrogen combination
C. IUDs D. Condoms
(1) D only (2) A and B (3) A, B and C (4) A, B, C and D
Q.13 All the following statements about ZIFT are correct, but one is wrong. Which one is wrong?
(1) It is zygote intra fallopian transfer (ZIFT)
(2) Zygote is transferred into the fallopian tube after IVF
(3) Early embryos upto 8 blastomeres can also be transferred into the fallopian tubes
(4) Embryos with more than 8 blastomeres are also transferred into the fallopian tubes

Reproductive Health || 22
Q.14 If a person is suffering with severe male infertility, in which the ejaculate contains very few
sperm (oligozoospermia) or even no live sperm (azoospermia), can be overcome by_______.
This should offer couples an alternative to using donor sperm
(1) GIFT (2) ZIFT (3) ICSI (4) IVF
Q.15 Which of the following sexually transmitted diseases is caused by a protozoan?
(1) Gonorrhoea (2) Trichomoniasis (3) Chlamydiasis (4) Syphilis
Q.16 Which of the following contraceptive is an injectable form of the 'birth control pill hormones'
that prevent ovulation?
(1) Norplant (2) Depo-Provera (3) Saheli (4) Mala-D
Q.17 Which of the following STDs is caused by the human papilloma virus (HPV) and are
transmitted through intimate contact with infected person?
(1) Genital herpes (2) Genital warts (3) AIDS (4) Chlamydia
Q.18 Norplant is
(1) A kind of plant (2) A fertilizer factory
(3) A contraceptive (4) A power generation plant
Q.19 Which of the following is an important detection technique for syphilis?
(1) Gram staining of the discharge (2) Nucleic acid hybridisation, PCR
(3) Antibody detection e.g., VDRL (4) Microscopic examination of culture
Q.20 Which of the following virus has ds-DNA as the genetic material and is transmitted mainly by
sexual contact?
(1) Hepatitis-A (2) Hepatitis-B (3) Hepatitis-C (4) All of these
Q.21 Which of the following drug is progesterone antagonist and acts as an abortion drug?
(1) Saheli (2) Mifepristone (3) Mala-N (4) Depo-provera
Q.22 An important function of progesterone is :
A. Prepare uterus for pregnancy B. implantation of embryo
C. maintenance of pregnancy D. stimulate ADH
Codes :
(1) A and B are correct (2) B and D are correct
(3) A and C are correct (4) A, B and C are correct
Q.23 Correctly matched pairs are :
A. Clitoris – Erectile body in female homologous to glans panis of male
B. Sexual intercourse – Coitus
C. Colostrum – Secretion found in seminal fluid
D. Areola – Pigmented circular area around the nipple
Codes :
(1) A and B are correct (2) B and D are correct
(3) A and C are correct (4) A, B and C are correct
Q.24 Utrerine endometrium, uterine glands and connective tissue are broken during menstrual phase.
That is due to :
(1) lack of estrogen (2) lack of progesterone
(3) over secretion of FSH (4) over production of progesterone
Reproductive Health || 23
Q.25 Menstrual cycle is controlled by :
A. Estrogen and progesterone of ovary B. FSH of pituitary
C. FSH and LH of pituitary D. Oxytocin hormone
Codes :
(1) A and B are correct (2) B and D are correct
(3) A and C are correct (4) A, B and C are correct
Q.26 Which hormone level reaches its peak during luteal phase of menstrual cycle?
(1) Estrogen (2) Progesterone
(3) Luteinizing hromone (4) Follicle stimulating hormone
Q.27 The 32 cells stage of the human embryo is :
(1) smaller than the fertilized egg (2) same size as the fertilized egg
(3) two times of the size of the fertilized egg (4) four times the size of the fertilized egg
Q.28 Which one of the following is the correct matching of the events occurring during menstrual
cycle?
(1) Menstruation : Breakdown of myometrium and ovum not fertilized.
(2) Ovulation : LH and FSH attain peak level and sharp fall in the secretion of
progesterone.
(3) Proliferative : Rapid regeneration of myometrium and maturation of Graafian
phase follicle.
(4) Development of : Secretory phase and increased secretion of progesterone.
corpus luteum

Answer Key

Section–A
Q.1 3 Q.2 4 Q.3 4 Q.4 3 Q.5 4 Q.6 1 Q.7 4
Q.8 1 Q.9 1 Q.10 4 Q.11 2 Q.12 2 Q.13 4 Q.14 2
Q.15 4 Q.16 2 Q.17 2 Q.18 3 Q.19 1 Q.20 1 Q.21 2
Q.22 1 Q.23 1 Q.24 4 Q.25 4 Q.26 4 Q.27 2 Q.28 2
Q.29 3 Q.30 2 Q.31 3 Q.32 1 Q.33 4 Q.34 1 Q.35 4
Q.36 2 Q.37 4 Q.38 2 Q.39 2 Q.40 4 Q.41 1 Q.42 4
Q.43 3 Q.44 2
Section–B
Q.1 2 Q.2 3 Q.3 2 Q.4 3 Q.5 4 Q.6 3 Q.7 4
Q.8 1 Q.9 2 Q.10 1 Q.11 3 Q.12 3 Q.13 4 Q.14 3
Q.15 2 Q.16 2 Q.17 2 Q.18 3 Q.19 3 Q.20 2 Q.21 2
Q.22 4 Q.23 2 Q.24 2 Q.25 4 Q.26 2 Q.27 2 Q.28 4

Reproductive Health || 24
EXERCISE – 2 Previous Years Questions

Q.1 Which of the following statements is correct with reference to a test tube baby? [AIPMT 1994]
(1) fertilization of the egg is completed outside the body; the fertilized egg is then placed in the
womb of the mother where the gestation is completed
(2) fertilization of the egg is completed in the female genital tract. It is then taken out and
grown in a large test tube
(3) a prematurely born baby is reared in an incubator
(4) fertilization of the egg and growth of the embryo is completed in a large test tube.
Q.2 The test tube baby means [AIPMT 1996]
(1) fertilization and development both in uterus
(2) fertilization in vitro and then transplantation in uterus
(3) a baby grown in test tube
(4) fertilized and developed embryo in test tube.
Q.3 What is the work of copper-T? [AIPMT 2000]
(1) to inhibit ovulation (2) to inhibit fertilization
(3) to inhibit implantation of blastocyst (4) to inhibit gametogenesis
Q.4 What is the work of progesterone which is present in oral contraceptive pills? [AIPMT 2000]
(1) to inhibit ovulation
(2) to check oogenesis
(3) to check entry of sperms into cervix and to make them inactive
(4) to check sexual behaviour.
Q.5 Which is showing accurate pairing? [AIPMT 2000]
(1) syphilis -Treponema pallidum (2) AIDS -Bacillus conjugalis
(3) gonorrhoea -Leishmania donovani (4) typhoid -Mycobacterium leprae.
Q.6 Test tube baby means a baby born when [AIPMT 2003]
(1) it is developed in a test tube
(2) it is developed through tissue culture method
(3) the ovum is fertilized externally and thereafter implanted in the uterus
(4) it develops from a nonfertilized uterus
Q.7 Given below are four methods (A-D) and their modes of action (a-d) in achieving
contraception. Select their correct matching from the four options that follow [AIPMT 2008]
Method Mode of Action
A. The pill (i) Prevents sperms reaching cervix
B. Condom (ii) Prevents implantation
C. Vasectomy (iii) Prevents ovulation
D. Copper-T (iv) Semen contains no sperms
(1) A -(iii), B -(iv), C -(i), D -(ii) (2) A -(ii), B -(iii), C -(i), D -(iv)
(3) A -(iii), B -(i), C -(iv), D -(ii) (4) A -(iv), B -(i), C -(ii), D -(iii)

Reproductive Health || 25
Q.8 Consider the statements given below regarding contraception and answer as directed there after
A. medical termination of pregnancy (MTP) during first trimester is generally safe
B. generally chances of conception are nil until mother breast-feeds the infant upto two years
C. intrauterine devices like copper-Tare effective contraceptives
D. contraception pills may be taken upto one week after coitus to prevent conception.
Which two of the above statements are correct? [AIPMT 2008]
(1) A, C (2) A, B (3) B, C (4) C, D
Q.9 Amniocentesis is [AIIMS 2000]
(1) digestion of amino acid (2) conversion of glucose to amino acids
(3) taking out of cells near the foetus (4) killing of child before birth.
Q.10 What is function of copper-T ? [BHU 2002]
(1) checks mutation (2) stops zygote formation
(3) stops fertilization (4) stops obiliteration of blastocoel
Q.11 AIDS disease was first reported in [DPMT 1993]
(1) Russia (2) USA (3) Germany (4) France
Q.12 Tubectomy prevents pregnancy by [DPMT 2000]
(1) preventing fertilization (2) preventing ovulation
(3) altering FSH levels in ovary (4) altering LH levels in ovary
Q.13 Progesterone pill helps in preventing pregnancy by not allowing [DPMT 2003]
(1) ova formation (2) fertilization (3) implantation (4) none of these
Q.14 Oral contraceptive pills function by [DPMT 2008]
(1) inhibiting ovulation
(2) stimulating ovulation
(3) stimulating the motility and secretory activity of oviduct
(4) none of the above
Q.15 The most important component of oral contraceptive pills is [UPCPMT 1999]
(1) progesterone-estrogen (2) growth honnone
(3) thyroxine (4) luteinizing hormone
Q.16 Amniocentesis is a technique to [UPCPMT 2009]
(1) detennine any disease in heart
(2) detennine any hereditary disease in the embryo
(3) know about the disease of brain
(4) grow cell on culture medium.
Q.17 Which of the following is a technique of direct introduction of gametes into the oviduct?
[Manipal 2004]
(1) MTS (2) ET (3) IVF (4) POST
Q.18 Syphilis is caused by [Manipal 2004]
(1) Treponema pallidum (2) Plasmodium
(3) Neisseria gonorrhea (4) Entamoeba histolytica.

Reproductive Health || 26
Q.19 Gonorrhoea is caused by [Manipal 2005]
(1) Treponema pallidum (2) Entamoeba gingivalis
(3) Mycobacterium leprae (4) Neisseria gonorrhiae.
Q.20 Which is non-invasive technique of genetic counselling? [AMU 1996]
(1) amniocentesis (2) chorionic biopsy
(3) foetal blood sampling (4) ultrasonography.
Q.21 Which one of the following organisms, cause syphilis? [AMU 1999]
(1) Neisseria gonorrhoae (2) Treponema pallidum
(3) Pasteurella pestis (4) Clostridium botulinum.
Q.22 The common means of transmission of AIDS is [AMU 2001]
(1) sexual intercourse (2) blood transfusion (3) placental transfer (4) all of these
Q.23 AIDS is transmitted [AMU 2003]
(1) sexually (2) parenterally (3) vertically (4) all of these
Q.24 Which is the causal agent for syphilis? [AMU 2004]
(1) Haemophilus durei (2) Treponema pallidum
(3) Chlamydia trachomatis (4) all of the above
Q.25 Component of oral pills is - [AFMC 2009]
(1) progesterone (2) oxytocin (3) relaxin (4) none of these
Q.26 Contraceptive oral pills help birth control by [Karnataka 1997]
(1) preventing ovulation (2) killing the sperms
(3) forming barriers between sperms-ova (4) killing the ova
Q.27 GIFT involves transfer of [Karnataka 1997]
(1) a mixture of sperms and ova into the uterus
(2) embryo into the uterus
(3) a mixture of sperms and ova into the Fallopian tube
(4) zygote into the Fallopian tube
Q.28 In the production of test tube babies [Karnataka 2002]
(1) fertilization and foetus formation is external
(2) fertilization and foetus formation is internal
(3) fertilization is internal and foetus formation is external
(4) fertilization is external and foetus formation is internal
Q.29 The first case of IVF-ET technique success, was reported by [Karnataka 2003]
(1) Louis Joy Brown and Banting Best (2) Patrick Steptoe and Robert Edwards
(3) Robert Steptoe and Gilbert Brown (4) Baylis and Starling Taylor.
Q.30 Which of the following is a mechanical barrier used in birth control? [Karnataka 2004]
(1) loop (2) dalcon shield (3) copper-T (4) diaphragm
Q.31 Which of the following birth control measure can be considered as the safest?
[Karnataka 2006]
(1) the rhythm method (2) the use of physical barriers
(3) termination of unwanted pregnancy (4) sterilization techniques.

Reproductive Health || 27
Q.32 A sexually transmitted disease symptomised by the development of chancre on the genitals is
caused by the infection of [Karnataka 2008]
(1) Treponema pallidum (2) Neisseria gonorrhoeae
(3) human immuno deficiency virus (4) hepatitis B virus.
Q.33 Surgical removal of vas deferens is called [J & K 2001]
(1) tubectomy (2) vasectomy (3) vasectolysis (4) none of these
Q.34 Amniocentesis is a technique used to [J & K 2003]
(1) detennine errors in amino acid metabolism in embryo
(2) pin point specific cardiac ailmcnts in embryo
(3) detcnninc any hereditary genetic abnonnality in embryo
(4) all of the above
Q.35 Oral contraceptives are prescribed in females to check [J & K 2004]
(1) entry of spenns in vagina (2) implantation
(3) ovulation (4) fertilization
Q.36 Which one of following diseases is a sexually transmitted disease? [J & K 2004]
(1) cancer (2) syphilis (3) diphtheria (4) myocarditis
Q.37 The status of the foetus for genetic counselling can be determined by [J & K 2006]
(1) aminocentesis (2) amniocentesis (3) aminoacidopathy (4) foetocentesis.
Q.38 The tests, which is misused for identification for an unborn baby is [J & K 2007]
(1) clotting test (2) amniocentesis (3) erythroblastosis (4) angiogram
Q.39 Amniocentesis detects [Punjab 2000]
(1) defonnity in brain (2) deformity in heart (3) hereditary disease (4) all of these
Q.40 Which of the following is a method of birth control? [Punjab 2007]
(1) IUD (2) GIFT (3) HTF (4) IVF-ET
Q.41 Tubectomy [AMU 1994]
(1) Prevents implantation (2) Prevents foetal deve lopment
(3) Prevents fertilization (4) All above
Q.42 The present population of the world is about [CBSE 1997]
(1) 500 million (2) 100 million (3) 15 Billion (4) 6 billion
Q.43 GIFT is [MAHE 2002]
(1) Embryo implantation after in vivo fertilization
(2) Spenn injection for in vivo fertilization
(3) Embryo implantation after in vitro fertilization
(4) Egg implantation for in vitro fertilization
Q.44 Copper-T acts by [Karala 2001]
(1) Suppression of fertilization by fanning a membrane
(2) Disturbing the site of implantation of blastocyst
(3) Acting as a harrier
(4) None of these

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Q.45 Each couple should produce only two children which will help in [AMU 1998]
(1) Checking pollution (2) Stablising the ecosystem
(3) Fertility of soil (4) Improving food-Web
Q.46 Amniocentesis has helped [Haryana 1998]
(1) The childless couples
(2) Antifemale demographic snow ball to set in motion
(3) In establishment of Biological superiority of female
(4) In waste of money
Q.47 The technique which makes use of amniotic fluid for the detection of prenatal disorder is called
as: [MP 1993]
(1) Laparoscopy (2) Amniocemesis (3) Endoscopy (4) Ultrasound
Q.48 In vitro fertilization is a technique that involves transfer of which one of the following into the
fallopian tube? [CBSE 2010]
(1) Zygote only
(2) Embryo only, upto 8 cell stage
(3) Either zygote or early embryo upto 8 cell stage
(4) Embryo of 32 cell stage
Q.49 The permissible use of the technique amniocentesis is for :
(1) detecting any genetic abnormality
(2) detecting sex of the unbom foetus
(3) artificial insemination
(4) transfer of embryo into the uterus of a surrogate mother
Q.50 Cu ions released from copper- releasing Intra Uterine Devices (IUDs); [CBSE 2010]
(1) prevent ovulation (2) make uterus unsuitable for implantation
(3) increase phagocytosis of sperms (4) suppress sperm motility
Q.51 Which of the following cannot be considered as assisted reproductive technology
[HPPMT 2010]
(1) In vitro fertilization (IVF) (2) Medical termination of pregnancy (MTP)
(3) Gamete intrafallopian transfer (GIFT) (4) Intracytoplasmic sperm injection (ICSI)
Q.52 What is the figure given below showing in particular ? [AIPMT PRE 2012]

(1) Uterine cancer (2) Tubectomy (3) Vasectomy (4) Ovarian cancer
Q.53 The Test-tube Baby Programme employs which one of the following techniques?
[AIPMT PRE 2012]
(1) Intra uterine insemination (IUI) (2) Gamete intra fallopian transfer (GIFT)
(3) Zygote intra fallopian transfer (ZIFT) (4) Intra cytoplasmic sperm injection (ICSI)

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Q.54 Identify the human developmental stage shown below as well as the related right place of its
occurrence in a normal pregnant woman, and select the right option for the two together.
[AIPMT Mains 2012]
Options :
Developmental Stage Site of occurance
(1) Late morula Middle part of fallopian tube
(2) Blastula End part of fallopian tube
(3) Blastocyst Uterine wall
(4) 8-celled morula Starting point of fallopian tube
Q.55 Assisted reproductive technology, IVF involves transfer of: [AIPMT 2014]
(1) Zygote into the uterus.
(2) Embryo with 16 blastomeres into the fallopian tube.
(3) Ovum into the fallopian tube.
(4) Zygote into the fallopian tube.
Q.56 Tubectomy is a method of sterilization in which: [AIPMT 2014]
(1) small part of vas deferens is removed or tied up.
(2) uterus is removed surgically
(3) small part of the fallopian tube is removed or tied up.
(4) ovaries are removed surgically.
Q.57 Which of the following is a hormone releasing Intra Uterine Device (IUD)? [AIPMT 2014]
(1) Cervical cap (2) Vault (3) Multiload 375 (4) LNG-20

Answer Key

Q.1 1 Q.2 2 Q.3 2 Q.4 1 Q.7 1 Q.8 3 Q.7 3

Q.8 1 Q.9 3 Q.10 3 Q.11 2 Q.12 1 Q.13 1 Q.14 1
Q.15 1 Q.16 2 Q.17 3 Q.18 1 Q.19 4 Q.20 4 Q.21 2
Q.22 4 Q.23 4 Q.24 2 Q.25 1 Q.26 1 Q.27 3 Q.28 4
Q.29 2 Q.30 4 Q.31 4 Q.32 1 Q.33 2 Q.34 3 Q.35 3
Q.36 2 Q.37 2 Q.38 2 Q.39 4 Q.40 1 Q.41 3 Q.42 4
Q.43 2 Q.44 2 Q.45 2 Q.46 2 Q.47 2 Q.48 3 Q.49 1
Q.50 4 Q.51 2 Q.52 2 Q.53 3 Q.54 3 Q.55 4 Q.56 3
Q.57 4

Reproductive Health || 30
EXERCISE – 3 AIIMS Speical Questions
INSTRUCTIONS
In the following questions, a statement of assertion (A) is followed by a statement of reason
(R).
(1) If both Assertion & Reason are true and the reason is the correct explanation of the assertion,
then mark (1).
(2) If both Assertion & Reason are true but the reason is not the correct explanation of the
assertion, then mark (2).
(3) If Assertion is true statement but Reason is false, then mark (3).
(4) If both Assertion and Reason are false statements, then mark (4).
Q.1 A : Population of India crossed one billion in May 2000.
R : It is the result of rapid decline in death rate, maternal mortality rate (MMR) and infant
mortality rate (IMR) as well as an increase in number of people in reproducible age.
Q.2 A : Intrauterine devices (IUDs) are very effective contraceptive method.
R : IUDs don't allow sperms to enter uterus.
Q.3 A : Surgical method blocks gamete transport & thereby prevents conception.
R : Surgical method used in the male for this purpose is called vasectomy.
Q.4 A : Saheli -the new oral contraceptive for the female contains a non-steroidal preparation.
R : It is 'once a week' pill with very few side effects and high contraceptive value.
Q.5 A : In test-tube baby programme, ova from wife/donor (female) and sperms from the husband/
donor (male) are collected and are induced to form zygote under simulated conditions in
laboratory.
R : Embryos with more than 8 blastomeres are then transferred to fallopian tube (ZIFT) to
complete its further development.
Q.6 A : Surgical methods of contraception are practiced to space the successive two conceptions.
R : During surgical methods ovaries from females or testes from males are removed.
Q.7 A : Natural methods are based on menstrual cycle and the life of sperms.
R : Natural methods often fail to contracept.
Q.8 A : Sexually transmitted diseases get transmitted from the infected to the normal person, only
during sexual contact.
R : All sexually transmitted diseases can be cured by antibiotics.
Q.9 A : In 1900 world population was 2000 million.
R : Indian population crossed 2000 million mark in May 2000.
Q.10 A : Marriageable age of Indian female and male is 18 and 21 years respectively.
R : Under normal condition a girl-child will release around 450 ova in her life time.
Q.11 A : HIV infected person may die without symptoms.
R : HIV is a dangerous bacterium.
Q.12 A : IVF-ET leads to a test-tube baby.
R : Durga is the first Indian test-tube baby.

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Q.13 A : One in every six persons in the world is an Indian.
R : In India, there are more females than males.
Q.14 A : In India, IUDs like placement of copper-T is one of the most widely accepted methods of
contraception.
R : Sterilisation procedure in the male is called vasectomy.
Q.15 A : Sex education in schools is not necessary.
R : Sex education may increase certain myths and mis-conceptions in the students.
Q.16 A : Now a days, there are less childless couples.
R : A number of measures are now available by which even infertile couples can have child.
Q.17 A : Over population causes a number of socio-economic problems.
R : A number of bacterial and viral diseases have been controlled.

Answer Key

Q.1 1 Q.2 3 Q.3 2 Q.4 2 Q.5 3 Q.6 4 Q.7 1

Q.8 4 Q.9 3 Q.10 2 Q.11 3 Q.12 1 Q.13 3 Q.14 2
Q.15 4 Q.16 1 Q.17

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 Bansal Quick Review Table
Instruction to fill
(A) Write down the Question Number you are unable to solve in column A below, by Pen.
(B) After discussing the Questions written in column A with faculties, strike off them in the
manner so that you can see at the time of Revision also, to solve these questions again.
(C) Write down the Question Number you feel are important or good in the column B.

Exercise No. Column A Column B

Question I am unable to solve in
Good/Important questions
first attempt

Exercise – 1(a)

Exercise – 1(b)

Exercise – 2

Exercise – 3

Other Exercise

Advantages
1. It is advised to the students that they should prepare a question bank for the revision as it is
very difficult to solve all the questions at the time of revision.
2. Using above index you can prepare and maintain the questions for your revision.

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