1. A 35-year-old woman with a history of endometriosis

and infertility is undergoing in vitro fertilization (IVF)

treatment. She receives daily injections of gonadotropins to

stimulate ovarian follicle development. On day 10 of her

cycle, she undergoes transvaginal ultrasound to assess the

number and size of the follicles. The ultrasound reveals that

she has 12 follicles, ranging from 15 to 20 mm in diameter.

What is the most appropriate next step in her treatment?

A) Continue gonadotropin injections until the follicles

reach 25 mm in diameter.

B) Administer human chorionic gonadotropin (hCG)

injection to trigger ovulation and schedule oocyte retrieval.

C) Reduce the dose of gonadotropins to prevent ovarian

hyperstimulation syndrome (OHSS).

D) Cancel the cycle and start a new one with a lower dose

of gonadotropins.

Answer: B) Administer human chorionic gonadotropin

(hCG) injection to trigger ovulation and schedule oocyte

retrieval.

Rationale: The optimal size of the follicles for IVF is

between 18 and 22 mm in diameter. When the majority of

the follicles reach this size, hCG injection is given to

induce final maturation and ovulation of the oocytes.

Oocyte retrieval is performed 34 to 36 hours after hCG

injection. Continuing gonadotropin injections or reducing

the dose may compromise the quality and quantity of the

oocytes. Cancelling the cycle is not necessary unless there

are signs of OHSS or other complications.