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Male factor infertility — MCCQE Part 1 MCQ

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ModerateInfertilityMale factor infertilityMCCQE Part 1

34-year-old couple presents with inability to conceive after 14 months. The female partner has regular cycles and semen analysis shows low concentration and motility. Which of the following is the most appropriate next step?

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Correct answer: D — Repeat semen analysis and refer for male-factor infertility evaluation

Repeat semen analysis and refer for male-factor infertility evaluation is best because abnormal semen analysis is central and should be confirmed. Discharge without pregnancy-specific safety-netting is suboptimal because pregnancy-related bleeding, pain or hypertension can deteriorate quickly; Perform a digital vaginal examination before excluding placenta previa or instability is suboptimal because digital examination can precipitate haemorrhage when placenta previa is possible; Use a medication contraindicated in pregnancy as first-line therapy is suboptimal because maternal treatment must account for fetal safety and gestational age; Delay obstetric or gynaecologic consultation despite red flags is suboptimal because specialist involvement is needed when maternal or fetal risk is present. Infertility evaluation should include both partners from the outset.

Reference: Canadian Urological Association infertility guidance