Page 1 of 169
ESHRE-EBCOG EFRM [European Fellowship in
Reproductive Medicine ACTUAL EXAM COMPLETE 400
QUESTIONS AND VERIFIED SOLUTIONS LATEST UPDATE
THIS YEAR
European Fellowship in Reproductive Medicine (EFRM), candidates must master the complex
endocrinology of the Hypothalamic-Pituitary-Ovarian (HPO) axis, the mechanics of Assisted
Reproductive Technology (ART), and the latest ESHRE guidelines.
Exam Coverage Areas
• Reproductive Endocrinology: Menstrual cycle dynamics, HPO axis, and steroidogenesis.
• Infertility Management: PCOS, endometriosis, tubal factor, and male infertility.
• Assisted Reproduction: Controlled ovarian hyperstimulation (COH), embryology, and lab
techniques.
• Reproductive Surgery: Hysteroscopy, laparoscopy, and fertility preservation.
• Ethics and Legal: European regulations and ESHRE/EBCOG position statements.
• Basic Reproductive Science: Gametogenesis, fertilization, and early embryo
development.
• Clinical Endocrinology: Disorders of the HPO axis, PCOS, and thyroid dysfunction.
• Andrology: Semen analysis interpretation, male factor infertility, and sperm retrieval.
• IVF & Laboratory: Stimulation protocols, OHSS prevention, and PGT.
• Surgery & Ethics: Minimal access surgery and European legal frameworks.
Batch 1: Questions 1–100
1. Which enzyme is responsible for the conversion of testosterone to dihydrotestosterone
(DHT) in peripheral tissues?
• A) Aromatase
,Page 2 of 169
• B) 5-alpha-reductase
• C) 17-beta-HSD
• D) Desmolase
• Answer: B
• Rationale: 5-alpha-reductase is essential for the development of male external genitalia
and the prostate by converting testosterone to the more potent DHT.
2. In the "Two-Cell, Two-Gonadotropin" theory, what is the primary role of the Granulosa
cell?
• A) Synthesis of cholesterol
• B) Synthesis of androgens under LH stimulation
• C) Aromatization of androgens to estrogens under FSH stimulation
• D) Production of progesterone only
• Answer: C
• Rationale: Granulosa cells lack the enzyme $17\alpha$-hydroxylase and cannot produce
androgens; they rely on theca cells to provide the substrate for estrogen production.
3. What is the characteristic karyotype of Klinefelter Syndrome?
• A) 45, X
• B) 47, XXY
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• C) 47, XYY
• D) 46, XX/XY mosaic
• Answer: B
• Rationale: Klinefelter Syndrome is the most common genetic cause of male infertility,
characterized by primary hypogonadism and azoospermia.
4. According to ESHRE guidelines, what is the recommended first-line treatment for ovulation
induction in women with PCOS?
• A) Clomiphene citrate
• B) Letrozole
• C) Metformin
• D) Gonadotropins
• Answer: B
• Rationale: The 2023 International Evidence-based Guideline (endorsed by ESHRE)
recommends Letrozole as first-line due to higher live birth rates compared to
Clomiphene.
5. At which stage of meiosis is the primary oocyte arrested at birth?
• A) Prophase I (Diplotene stage)
• B) Metaphase I
, Page 4 of 169
• C) Prophase II
• Answer: A
• Rationale: Oocytes remain in the Dictyate (Diplotene) stage of Prophase I until the LH
surge occurs prior to ovulation.
6. Which hormone is considered the most sensitive marker for Premature Ovarian
Insufficiency (POI)?
• A) LH
• B) FSH
• C) Estradiol
• D) Prolactin
• Answer: B
• Rationale: POI is clinically diagnosed by elevated FSH levels (usually >25 IU/L on two
occasions) in women under age 40.
7. "Capacitation" of sperm naturally occurs in which location?
• A) The epididymis
• B) The vas deferens
• C) The female reproductive tract
• D) The seminal vesicles
ESHRE-EBCOG EFRM [European Fellowship in
Reproductive Medicine ACTUAL EXAM COMPLETE 400
QUESTIONS AND VERIFIED SOLUTIONS LATEST UPDATE
THIS YEAR
European Fellowship in Reproductive Medicine (EFRM), candidates must master the complex
endocrinology of the Hypothalamic-Pituitary-Ovarian (HPO) axis, the mechanics of Assisted
Reproductive Technology (ART), and the latest ESHRE guidelines.
Exam Coverage Areas
• Reproductive Endocrinology: Menstrual cycle dynamics, HPO axis, and steroidogenesis.
• Infertility Management: PCOS, endometriosis, tubal factor, and male infertility.
• Assisted Reproduction: Controlled ovarian hyperstimulation (COH), embryology, and lab
techniques.
• Reproductive Surgery: Hysteroscopy, laparoscopy, and fertility preservation.
• Ethics and Legal: European regulations and ESHRE/EBCOG position statements.
• Basic Reproductive Science: Gametogenesis, fertilization, and early embryo
development.
• Clinical Endocrinology: Disorders of the HPO axis, PCOS, and thyroid dysfunction.
• Andrology: Semen analysis interpretation, male factor infertility, and sperm retrieval.
• IVF & Laboratory: Stimulation protocols, OHSS prevention, and PGT.
• Surgery & Ethics: Minimal access surgery and European legal frameworks.
Batch 1: Questions 1–100
1. Which enzyme is responsible for the conversion of testosterone to dihydrotestosterone
(DHT) in peripheral tissues?
• A) Aromatase
,Page 2 of 169
• B) 5-alpha-reductase
• C) 17-beta-HSD
• D) Desmolase
• Answer: B
• Rationale: 5-alpha-reductase is essential for the development of male external genitalia
and the prostate by converting testosterone to the more potent DHT.
2. In the "Two-Cell, Two-Gonadotropin" theory, what is the primary role of the Granulosa
cell?
• A) Synthesis of cholesterol
• B) Synthesis of androgens under LH stimulation
• C) Aromatization of androgens to estrogens under FSH stimulation
• D) Production of progesterone only
• Answer: C
• Rationale: Granulosa cells lack the enzyme $17\alpha$-hydroxylase and cannot produce
androgens; they rely on theca cells to provide the substrate for estrogen production.
3. What is the characteristic karyotype of Klinefelter Syndrome?
• A) 45, X
• B) 47, XXY
,Page 3 of 169
• C) 47, XYY
• D) 46, XX/XY mosaic
• Answer: B
• Rationale: Klinefelter Syndrome is the most common genetic cause of male infertility,
characterized by primary hypogonadism and azoospermia.
4. According to ESHRE guidelines, what is the recommended first-line treatment for ovulation
induction in women with PCOS?
• A) Clomiphene citrate
• B) Letrozole
• C) Metformin
• D) Gonadotropins
• Answer: B
• Rationale: The 2023 International Evidence-based Guideline (endorsed by ESHRE)
recommends Letrozole as first-line due to higher live birth rates compared to
Clomiphene.
5. At which stage of meiosis is the primary oocyte arrested at birth?
• A) Prophase I (Diplotene stage)
• B) Metaphase I
, Page 4 of 169
• C) Prophase II
• Answer: A
• Rationale: Oocytes remain in the Dictyate (Diplotene) stage of Prophase I until the LH
surge occurs prior to ovulation.
6. Which hormone is considered the most sensitive marker for Premature Ovarian
Insufficiency (POI)?
• A) LH
• B) FSH
• C) Estradiol
• D) Prolactin
• Answer: B
• Rationale: POI is clinically diagnosed by elevated FSH levels (usually >25 IU/L on two
occasions) in women under age 40.
7. "Capacitation" of sperm naturally occurs in which location?
• A) The epididymis
• B) The vas deferens
• C) The female reproductive tract
• D) The seminal vesicles
