Infertility: hypogonadotropic amenorrhoea: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Infertility: hypogonadotropic amenorrhoea

Sample item

A marathon runner has amenorrhoea with low FSH, low LH, low oestradiol and a normal prolactin and TSH. She wishes to conceive. Which treatment will induce ovulation?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Pulsatile GnRH or gonadotropins (FSH with LH activity)

In hypothalamic amenorrhoea, endogenous oestradiol is too low for clomiphene to act, as it depends on an intact feedback loop. Pulsatile GnRH or gonadotropin therapy induces follicular growth, and lifestyle changes with weight regain and reduced exercise may restore function. Bromocriptine is for hyperprolactinaemia.

Option by option

  • A. Bromocriptine

    Bromocriptine treats raised prolactin.

  • B. Metformin alone

    Metformin helps PCOS, not hypothalamic amenorrhoea.

  • C. Clomiphene citrate alone

    Clomiphene needs normal oestrogen feedback and is ineffective here.

  • D. Pulsatile GnRH or gonadotropins (FSH with LH activity) (correct)

    Correct. Gonadotropins or pulsatile GnRH replace the missing stimulus.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Pulsatile GnRH or gonadotropins (FSH with LH activity). In hypothalamic amenorrhoea, endogenous oestradiol is too low for clomiphene to act, as it depends on an intact feedback loop.

Why is "Bromocriptine" not the answer?

Bromocriptine treats raised prolactin.

Why is "Metformin alone" not the answer?

Metformin helps PCOS, not hypothalamic amenorrhoea.

Why is "Clomiphene citrate alone" not the answer?

Clomiphene needs normal oestrogen feedback and is ineffective here.

What concept does this question test?

It tests Infertility: hypogonadotropic amenorrhoea in OBG. Pulsatile GnRH or gonadotropin therapy induces follicular growth, and lifestyle changes with weight regain and reduced exercise may restore function. Bromocriptine is for hyperprolactinaemia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Infertility: hypogonadotropic amenorrhoea?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.