Reproductive Health — Class 12 Biology practice questions

Question 1

Read the following passage carefully and answer the questions that follow:

Dr. Priya, a gynaecologist working at a rural health centre in Rajasthan, encounters four patients in a single day:

Patient A: A 28-year-old woman who delivered her second child 3 months ago and is exclusively breastfeeding. She asks whether she needs additional contraception.

Patient B: A 19-year-old unmarried woman who reports unprotected intercourse 48 hours ago and is anxious about an unwanted pregnancy. She has no known medical conditions.

Patient C: A 32-year-old woman diagnosed with Chlamydia trachomatis infection. She is asymptomatic and is worried about long-term consequences if she leaves it untreated.

Patient D: A 25-year-old woman with a history of two consecutive tubular blockages who wishes to conceive. Her husband has normal semen parameters.

(i) Dr. Priya advises Patient A that she may currently be protected from pregnancy due to a natural physiological phenomenon. Name this phenomenon, state its basis, and mention its limitation. (1 mark)

(ii) Which medically acceptable option can Dr. Priya offer Patient B to prevent pregnancy after unprotected intercourse? State the mechanism by which it prevents pregnancy and the time window within which it must be used. (1 mark)

(iii) Name the infection affecting Patient C. State any TWO serious complications that may develop in this female patient if the infection is left untreated. (1 mark)

(iv) Which Assisted Reproductive Technology (ART) would be most appropriate for Patient D, and why? Name the specific step that distinguishes this ART from IVF-ET. (1 mark)

Accepted Answer

MARKING SCHEME — 4 marks (1 mark per sub-part)

(i) Phenomenon: Lactational Amenorrhoea (LAM) [½ mark]

Basis: During intense and exclusive breastfeeding, suckling stimulates continuous prolactin secretion from the anterior pituitary → prolactin inhibits GnRH release from hypothalamus → FSH and LH are suppressed → no follicular development → no ovulation → no menstruation (amenorrhoea). Since ovulation is absent, the woman is naturally protected from pregnancy. [½ mark]

Limitation: This protection is effective ONLY up to 6 months after parturition AND only if the woman is exclusively breastfeeding (no supplementary feeding). After 6 months or if breastfeeding becomes irregular, ovulation may resume, making this method unreliable. [Award ½ if limitation is correctly stated; full 1 mark if basis AND limitation both given]

(Award full 1 mark for: correct name + correct hormonal/ovulation basis + correct limitation)

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(ii) Option: Emergency Contraceptive Pills (ECPs) — e.g., levonorgestrel (Progestin-only pill) or combined oestrogen–progestin pills [½ mark]

Mechanism: ECPs prevent pregnancy primarily by:
• Inhibiting or delaying ovulation (if taken before LH surge)
• Preventing fertilisation
• May prevent implantation of the zygote in the uterine endometrium
(Any ONE mechanism acceptable for marks)

Time window: Must be taken within 72 hours (3 days) of unprotected intercourse for maximum efficacy. [½ mark]

(Award full 1 mark for: correct name of ECP + any one correct mechanism + correct 72-hour window)

Note: MTP is NOT applicable here as fertilisation may not have occurred yet; ECPs are the medically appropriate option.

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(iii) Infection: Chlamydiasis — caused by Chlamydia trachomatis (an STI / Sexually Transmitted Infection) [No separate mark for name as it is given in passage]

TWO serious complications in an untreated female:
1. Pelvic Inflammatory Disease (PID) — spread of infection to uterus, fallopian tubes, and ovaries → chronic pelvic pain and inflammation [½ mark]
2. Blockage/scarring of fallopian tubes → tubal (ectopic) pregnancy or infertility (inability to conceive) [½ mark]

Other acceptable complications (award if biologically correct):
• Increased risk of cervical cancer
• Neonatal conjunctivitis / pneumonia if infection is transmitted to newborn during delivery

(Award 1 mark for any TWO correct, distinct complications; ½ mark for any ONE)

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(iv) Most appropriate ART: GIFT — Gamete Intra-Fallopian Transfer [½ mark]

Reason: GIFT is NOT appropriate here because Patient D has BILATERAL TUBULAR BLOCKAGE — she cannot use GIFT (which requires at least one functional fallopian tube for gamete/zygote transport).

Therefore, the correct ART for Patient D is: IVF-ET (In Vitro Fertilisation — Embryo Transfer), also called 'Test Tube Baby' technique. [½ mark]

Rationale: In IVF-ET, fertilisation occurs OUTSIDE the body (in vitro) → embryo cultured to 8-cell stage → transferred directly into the uterus (ET), BYPASSING the blocked fallopian tubes entirely.

Distinguishing step compared to GIFT/ZIFT: Fertilisation occurs outside the body (in vitro) in a laboratory, not inside the fallopian tube — the embryo is then transferred to the uterus, not the tube.

(Award full 1 mark for: correct ART = IVF-ET + correct reason linking bilateral tubal blockage to bypassing tubes + the distinguishing feature that fertilisation is in vitro)

[Examiner note: If a student writes ZIFT, award ½ mark only — ZIFT transfers a zygote to the tube, still requiring a functional tube; IVF-ET with uterine transfer is the definitive answer for bilateral blockage.]

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FULL MARK SUMMARY:
(i) LAM + basis + limitation = 1 mark
(ii) ECP + mechanism + 72-hour window = 1 mark
(iii) Any two correct complications = 1 mark
(iv) IVF-ET + correct reason + distinguishing step = 1 mark
TOTAL = 4 marks

Question 2

Read the following passage carefully and answer the questions that follow:

Rahul and Priya are a married couple with two children. They have decided that they do not want any more children. Their doctor discussed several contraceptive options with them. Priya is currently breastfeeding their 4-month-old baby and has not resumed her menstrual cycle since delivery. Their doctor first explained that Priya's current physiological state itself offers some protection against pregnancy. The doctor then outlined additional options: (i) Priya could use a copper-releasing intrauterine device (IUD), or (ii) Rahul could undergo a minor surgical procedure for a permanent solution. The doctor also mentioned that if they ever needed emergency contraception, a pill is available but must be taken within 72 hours.

(a) The doctor told Priya that her current condition provides natural protection against pregnancy for up to 6 months. Name this phenomenon and explain the hormonal mechanism responsible for it. (2 marks)

(b) Name ONE copper-releasing IUD mentioned in the NCERT textbook and state TWO mechanisms by which copper-releasing IUDs prevent pregnancy. (1 mark)

(c) Name the surgical procedure recommended for Rahul and identify the specific anatomical structure on which this procedure is performed. (1 mark)

Accepted Answer

MARKING SCHEME — Total: 4 marks

─────────────────────────────────────
(a) Phenomenon + Hormonal Mechanism [2 marks]
─────────────────────────────────────

• Name of phenomenon: Lactational Amenorrhoea (LAM) [½ mark]
  – Definition: The absence of menstruation (and hence ovulation) during the period of intense / full breastfeeding after delivery. [½ mark]

• Hormonal mechanism: [1 mark]
  – Intense suckling by the infant → stimulates secretion of PROLACTIN from the anterior pituitary.
  – High prolactin levels → inhibit secretion of GnRH (Gonadotropin-Releasing Hormone) from the hypothalamus.
  – Reduced GnRH → suppresses release of FSH and LH from the anterior pituitary.
  – Without FSH/LH → no follicular development → no ovulation → no menstrual cycle (amenorrhoea).
  – Therefore, no egg is released and pregnancy cannot occur.

[Award 1 mark for correctly identifying: suckling → prolactin → inhibits GnRH/gonadotropins → no ovulation. Any 2 correct linked steps = 1 mark]

• Effective as contraception only up to 6 months after delivery, provided the mother is exclusively breastfeeding. [This is the context clue from the passage — confirms the 6-month window]

─────────────────────────────────────
(b) Name of IUD + TWO mechanisms [1 mark]
─────────────────────────────────────

• Name (any ONE): CuT / Multiload-375 / Cu7  [½ mark]
  (NCERT-listed copper-releasing IUDs)

• Mechanisms (any TWO — award ½ mark for the pair): [½ mark]
  1. Cu²⁺ ions released → are SPERMICIDAL — suppress sperm motility and fertilising capacity of sperms.
  2. Increase phagocytosis of sperms within the uterus.
  3. Make the uterine environment hostile/non-receptive to implantation (alter uterine physiology).
  [Any 2 correct mechanisms = ½ mark]

─────────────────────────────────────
(c) Surgical procedure for Rahul [1 mark]
─────────────────────────────────────

• Name of procedure: VASECTOMY [½ mark]

• Structure on which it is performed: VAS DEFERENS (sperm duct) [½ mark]
  – A small portion of the vas deferens is cut and tied (ligated) through a small incision in the scrotum.
  – This prevents the passage of sperms, making the male permanently sterile.

─────────────────────────────────────
SUMMARY OF VALUE POINTS:
─────────────────────────────────────
(a) → Lactational amenorrhoea [½] + definition/statement [½] + mechanism: suckling→prolactin→↓GnRH→↓FSH/LH→no ovulation [1]
(b) → Any one IUD name [½] + any two mechanisms [½]
(c) → Vasectomy [½] + vas deferens [½]

NOTE FOR EXAMINER:
• If a student writes 'tubectomy' for part (c), award 0 — tubectomy is for females (fallopian tubes); question specifies Rahul (male).
• For part (a), accept 'no ovulation during breastfeeding' as partial credit for the phenomenon if the term 'lactational amenorrhoea' is not written, but deduct ½ mark for missing the specific term.
• Emergency contraceptive pill (i-pill / 'morning-after pill') mentioned in the passage is not directly asked — no marks deducted if students discuss it, but it earns no extra credit.

Question 3

Read the following passage carefully and answer the questions that follow:

Dr. Priya, a gynaecologist at a rural health centre, counselled four women (A, B, C, D) who visited for family planning advice. She explained various contraceptive methods and drew a diagram of the female reproductive system to show where each method acts.

Woman A was advised a copper-releasing intrauterine device. Woman B was prescribed oral contraceptive pills containing synthetic estrogen and progesterone. Woman C, who had completed her family, opted for a permanent method involving surgical ligation of fallopian tubes. Woman D chose a non-medicated barrier method.

Dr. Priya also drew the following diagram of the female reproductive system and marked the sites of action of the above methods:

[Refer to diagram drawn in answer]

(i) Identify the contraceptive methods used by Women A, B, C, and D. (1 mark)
(ii) State the primary mechanism by which the contraceptive pill (used by Woman B) prevents pregnancy. (1 mark)
(iii) Draw a labelled diagram of the female reproductive system and mark (with arrows) the site of action of the methods used by Women A, C, and D. (2 marks)

Accepted Answer

MARKING SCHEME — CASE STUDY (4 marks)

─────────────────────────────────────
(i) Identification of contraceptive methods (1 mark)
─────────────────────────────────────
Award 1 mark for all four correctly identified (½ mark if only two or three are correct — examiner discretion; full 1 mark for all four):

• Woman A → Cu-T (Copper-T) / copper-releasing IUD
• Woman B → Oral contraceptive pills (OCPs) / combined pill
• Woman C → Tubectomy / tubal ligation / female sterilisation
• Woman D → Diaphragm / cervical cap / male/female condom (any non-medicated barrier method)

(1 mark)

─────────────────────────────────────
(ii) Mechanism of action of oral contraceptive pill (1 mark)
─────────────────────────────────────
Oral contraceptive pills contain synthetic estrogen and progesterone.
They inhibit ovulation by suppressing the release of FSH (Follicle Stimulating Hormone) and LH (Luteinising Hormone) from the anterior pituitary, thereby preventing follicular development and ovulation.

[Acceptable alternatives: 'suppress LH surge preventing ovulation' / 'alter cervical mucus making it hostile to sperm' / 'alter endometrium preventing implantation' — any one mechanism accepted]

(1 mark)

─────────────────────────────────────
(iii) Labelled diagram of female reproductive system with sites of action (2 marks)
─────────────────────────────────────
Mark allocation:
• Correct, labelled diagram of female reproductive system = 1 mark
• Correct marking of all three sites of action (A, C, D) with arrows = 1 mark

DIAGRAM (draw in answer book):

Fallopian tube (oviduct)
        /                        \
 Fimbriae                    Uterus
    |                        /      \
    |                  Cervix        \
    |                    |            \
    ↑ Site C:          Site D:        Site A:
  Tubectomy         Diaphragm/       Cu-T placed
 (ligation of      Condom acts      inside uterine
 fallopian tube)   at vaginal/      cavity
                   cervical
                   opening

FULL LABELLED DIAGRAM TO DRAW:

┌─────────────────────────────────────────┐
│                                         │
│   Ovary ── Fallopian tube ── Uterus     │
│     │           │              │        │
│     │     ←Site C→             │        │
│     │    (Tubectomy:           │        │
│     │    tube ligated)    ←Site A→      │
│     │                    (Cu-T in       │
│     │                    uterine        │
│     │                    cavity)        │
│     │                         │        │
│     │                       Cervix      │
│     │                         │        │
│     │                    ←Site D→       │
│     │                  (Diaphragm at    │
│     │                   cervical        │
│     │                   opening)        │
│     │                         │        │
│     │                       Vagina      │
└─────────────────────────────────────────┘

Mandatory labels on diagram:
1. Ovary
2. Fallopian tube / Oviduct
3. Uterus
4. Cervix
5. Vagina
6. Arrow at fallopian tube → 'Site C: Tubectomy'
7. Arrow inside uterus → 'Site A: Cu-T (IUD)'
8. Arrow at cervix/vaginal opening → 'Site D: Diaphragm'

Note to examiner: Award 1 mark for a recognisable, labelled diagram of the female reproductive system (minimum labels: ovary, fallopian tube, uterus, cervix/vagina). Award the second mark only if all three sites (A, C, D) are correctly indicated with arrows or labels on the diagram.

(1 + 1 = 2 marks)

─────────────────────────────────────
TOTAL: 4 marks (1 + 1 + 2)
─────────────────────────────────────

Question 4

Read the following passage carefully and answer the questions that follow:

Rohini, a 28-year-old married woman, visited a family planning clinic with her husband. She informed the doctor that they already have two children and do not wish to have more. The doctor explained several options: (i) Rohini could use a copper-releasing IUD (CuT), (ii) her husband could use condoms, (iii) Rohini could opt for surgical sterilisation (tubectomy), or (iv) they could rely on periodic abstinence. The doctor also mentioned that in case of accidental pregnancy, Medical Termination of Pregnancy (MTP) is legally available in India under certain conditions. The doctor emphasised that sexually transmitted infections (STIs) can be prevented only by some of these methods, not all.

(a) State ONE mechanism by which copper-releasing IUDs (e.g., CuT) prevent pregnancy. Also name ONE non-medicated IUD. (1 mark)

(b) Among all the options mentioned above, identify which ONE method ALSO provides protection against STIs, and give a reason for your answer. (1 mark)

(c) Rohini accidentally becomes pregnant. State the legal gestational limit (in weeks) up to which MTP can be performed in India (as per the amended MTP Act), and give ONE valid medical reason that would justify performing MTP. (1 mark)

(d) The doctor advises Rohini that tubectomy is a permanent method. Explain what tubectomy involves and why it is considered a terminal/permanent method of contraception. (1 mark)

Accepted Answer

MARKING SCHEME — Total: 4 marks (1 mark each sub-part)

─────────────────────────────────────────
(a) Mechanism of Cu-releasing IUDs + non-medicated IUD example [1 mark]
─────────────────────────────────────────
Mechanism (½ mark): Copper ions (Cu²⁺) released by CuT are spermicidal — they suppress sperm motility and fertilising capacity of sperms, thereby preventing fertilisation.
[Also accept: Cu ions increase phagocytosis of sperms in the uterus / make the uterine environment hostile for fertilisation.]

Non-medicated IUD (½ mark): Lippes loop
[Also accept: Stainless steel ring]

─────────────────────────────────────────
(b) Method providing STI protection + reason [1 mark]
─────────────────────────────────────────
Method (½ mark): Condom (barrier method)

Reason (½ mark): Condoms create a physical barrier between partners, preventing contact with infected body fluids (semen, vaginal secretions), thereby blocking transmission of STI-causing pathogens such as HIV, Neisseria gonorrhoeae, etc.
• CuT, tubectomy, and periodic abstinence do NOT provide STI protection because they do not prevent skin/fluid contact between partners.

─────────────────────────────────────────
(c) Legal gestational limit for MTP + one valid reason [1 mark]
─────────────────────────────────────────
Legal limit (½ mark): Up to 20 weeks under normal circumstances; up to 24 weeks with special conditions (as per MTP Act 1971, amended 2021).
[Award ½ mark if student writes 'up to 20 weeks'; full ½ mark for mentioning both limits.]

One valid medical reason (½ mark): Any ONE of the following:
• Failure of contraceptive method (accidental pregnancy)
• Foetal abnormality / genetic disorder detected in foetus
• Rape / sexual assault leading to pregnancy
• Continuation of pregnancy posing risk to the physical or mental health of the mother

─────────────────────────────────────────
(d) Tubectomy — procedure + why permanent [1 mark]
─────────────────────────────────────────
Procedure (½ mark): In tubectomy, the fallopian tubes of the woman are cut, tied, or ligated (surgical sterilisation). This prevents the ovum from travelling from the ovary to the uterus.

Why permanent (½ mark): Because the continuity of the fallopian tubes is permanently disrupted — sperms and egg can no longer meet, making fertilisation impossible. Reversal is very difficult; hence it is considered a terminal method.

─────────────────────────────────────────
EXAMINER'S NOTE:
• Award marks for conceptually correct answers even if exact NCERT wording is not used.
• Do not penalise for spelling of scientific terms if the meaning is clear.
• For (c), accept 'first trimester' (up to 12 weeks) as relatively safe if student justifies; however, the legally correct limit as per MTP Act (amended 2021) must reference 20/24 weeks for full marks.

Question 5

Meera and Arjun are a married couple in their late twenties living in a rural district of Rajasthan. Meera has recently delivered her second child and is exclusively breastfeeding the newborn. Their local health worker visits and discusses various family planning options with them. Arjun is willing to consider a permanent surgical option, while Meera wishes to know about a non-hormonal temporary device that can be placed by a doctor. The health worker also mentions that a new once-a-week oral pill is available, but clarifies it is not suitable for Meera right now.

(a) Meera is exclusively breastfeeding her newborn. Name the natural contraceptive phenomenon she is currently experiencing and explain its hormonal mechanism. (1 mark)
(b) Name the permanent surgical contraceptive method suitable for Arjun. Describe the procedure and explain why it is considered highly effective yet reversibility is limited. (2 marks)
(c) Name the non-hormonal intrauterine device (IUD) the health worker is referring to and explain TWO mechanisms by which it prevents pregnancy. (1 mark)
(d) The health worker mentioned a once-a-week oral pill that is non-steroidal. Name this pill and identify the institution that developed it. Why would it be unsuitable for Meera at this stage? (1 mark)

Accepted Answer

COMPLETE MODEL ANSWER — Reproductive Health (5 Marks)

─────────────────────────────────────────
(a) Lactational Amenorrhoea (LAM) — 1 mark
─────────────────────────────────────────

The natural contraceptive phenomenon Meera is currently experiencing is Lactational Amenorrhoea (LAM). During exclusive and frequent breastfeeding, the suckling reflex stimulates high prolactin secretion from the anterior pituitary, which suppresses GnRH release from the hypothalamus, thereby inhibiting FSH and LH secretion; in the absence of these gonadotropins, ovulation does not occur, providing natural contraceptive protection for up to 6 months post-delivery.

(Name + hormonal mechanism together = 1 mark)

─────────────────────────────────────────
(b) Vasectomy — 2 marks
─────────────────────────────────────────

Name: Vasectomy (male sterilisation)

Procedure (1 mark):
A small incision (or needle puncture in no-scalpel vasectomy) is made in the scrotum. The vas deferens (ductus deferens) on each side is located, and a small segment is cut and the cut ends are ligated (tied), cauterised, or sealed. This physically blocks the passage of spermatozoa from the testes to the urethra, so the ejaculate contains no sperms and fertilisation cannot occur. The hormonal function of the testes (testosterone production) remains completely unaffected.

Why highly effective yet reversibility is limited (1 mark):
Vasectomy is highly effective because the sperm transport pathway is physically and permanently interrupted with no scope for user error. Reversibility is limited because, although surgical reanastomosis (vasovasostomy) is technically possible, the body may develop anti-sperm antibodies after vasectomy and scar tissue formation at the cut site makes successful reconnection difficult; hence it is considered a permanent method.

─────────────────────────────────────────
(c) Non-hormonal IUD — CuT (Copper-T) — 1 mark
─────────────────────────────────────────

Name: CuT (Copper-T) / Copper-releasing IUD (e.g., CuT-380A)

The entire sub-part (name + two mechanisms) earns 1 mark as a single value point:
Copper ions (Cu²⁺) released by the device are spermicidal — they suppress sperm motility and fertilising capacity; additionally, the IUD makes the uterine environment hostile to implantation by causing a local inflammatory reaction in the endometrium, thereby preventing the blastocyst from implanting even if fertilisation were to occur.

(Name + any two mechanisms combined = 1 mark)

─────────────────────────────────────────
(d) Once-a-week non-steroidal oral pill — 1 mark
─────────────────────────────────────────

Name of pill: Saheli (generic name: Centchroman / Ormeloxifene)

Developing institution: CDRI — Central Drug Research Institute, Lucknow (India)

Why unsuitable for Meera at this stage: Saheli is unsuitable for Meera because she is exclusively breastfeeding her newborn; the drug (Centchroman) can pass into breast milk and may adversely affect the newborn. Additionally, Meera is already experiencing lactational amenorrhoea, which provides natural contraceptive cover, making additional pharmacological contraception unnecessary at this stage.

(Name + institution + reason for unsuitability = 1 mark as a combined value point)

Question 6

Riya, a 28-year-old woman, visits a gynaecologist for family planning advice. She has one child (delivered normally 8 months ago) and is currently breastfeeding. She is concerned about hormonal side effects and wants to understand all available options. The doctor explains: (i) her current physiological state itself offers temporary protection, (ii) a hormonal device that can be placed inside the uterus, and (iii) a non-hormonal barrier method. Later, Riya's 19-year-old unmarried sister arrives seeking emergency contraception after unprotected intercourse 36 hours ago.

(a) Name the natural contraceptive mechanism protecting Riya currently. Explain its biological basis with the hormonal pathway involved. (2 marks)
(b) Name the hormonal intrauterine device mentioned by the doctor. How does it differ from a copper-releasing IUD in its mode of action? (1 mark)
(c) What emergency contraceptive option is available to Riya's sister? State one concern associated with its regular use. (1 mark)
(d) The gynaecologist also discusses Medical Termination of Pregnancy (MTP). State any ONE legal condition under which MTP is permitted in India and mention the legal time limit as per the amended MTP Act. (1 mark)

Accepted Answer

CBSE MARKING SCHEME — LA 5 Marks

──────────────────────────────────────
(a) Lactational Amenorrhoea — biological basis and hormonal pathway [2 marks]
──────────────────────────────────────
• The natural contraceptive mechanism is Lactational Amenorrhoea (LAM). [½ mark]

• Definition: The absence of menstruation (and therefore ovulation) during intense / full breastfeeding, up to 6 months after delivery. [½ mark]

• Hormonal pathway (complete chain for full credit):
  Suckling by infant
  ↓
  Stimulates hypothalamus → releases Prolactin-Releasing Factor (PRF)
  ↓
  Anterior pituitary secretes PROLACTIN in large amounts
  ↓
  High prolactin INHIBITS GnRH (Gonadotropin-Releasing Hormone) secretion by hypothalamus
  ↓
  GnRH suppression → reduced FSH and LH secretion
  ↓
  No follicular development → no ovulation → no menstruation [1 mark]

• Key condition: Protection is effective ONLY if the mother is fully / exclusively breastfeeding AND the child is less than 6 months old. [included in 1-mark point above]

──────────────────────────────────────
(b) Hormonal IUD vs Copper-releasing IUD — name and difference in mode of action [1 mark]
──────────────────────────────────────
• Hormonal IUD: Levonorgestrel-releasing IUS (e.g., LNG-IUS / Mirena / Progestasert). [½ mark]

• Difference in mode of action:

| Feature | Copper-releasing IUD (e.g., CuT, Multiload-375) | Hormonal IUD (e.g., Progestasert / LNG-IUS) |
|---|---|---|
| Active agent | Copper ions (Cu²⁺) | Progestogen (levonorgestrel) |
| Primary mechanism | Cu²⁺ ions are spermicidal; increase phagocytosis of sperm; make uterine environment hostile | Thickens cervical mucus (blocks sperm entry); suppresses endometrial growth; may partially suppress ovulation |
| Hormonal effect | None (non-hormonal) | Yes — local and mild systemic progestogenic effect |

[½ mark for correct difference — any ONE distinguishing mechanism is acceptable]

──────────────────────────────────────
(c) Emergency contraception for Riya's sister + concern [1 mark]
──────────────────────────────────────
• Emergency contraceptive available: Emergency Contraceptive Pills (ECPs) — e.g., 'i-pill' or 'unwanted 72' containing high-dose levonorgestrel (progestogen), OR combined estrogen-progestogen pills (Yuzpe regimen). [½ mark]
  — Must be taken within 72 hours (ideally within 36–48 hours) of unprotected intercourse.

• One concern associated with regular / repeated use:
  Regular use of ECPs is NOT recommended as a routine contraceptive method because: (i) high hormone doses disrupt the normal hormonal cycle, (ii) may cause menstrual irregularities and nausea, and (iii) it is significantly less effective than regular contraception — intended only for emergency / occasional use. [½ mark]

──────────────────────────────────────
(d) MTP — one legal condition + time limit [1 mark]
──────────────────────────────────────
• MTP (Medical Termination of Pregnancy) is LEGAL in India under the MTP Act, 1971 (amended 2021).

• Legal time limit: Up to 20 weeks of gestation (with one registered medical practitioner's opinion); up to 24 weeks in special circumstances (e.g., rape survivors, minors, differently-abled women — requires two registered practitioners' opinion). [½ mark]

• Any ONE legal condition under which MTP is permitted (any one of the following earns the mark):
  (i) Contraceptive failure in a married or unmarried woman.
  (ii) Pregnancy resulting from rape or sexual assault.
  (iii) Risk to the physical or mental health of the mother.
  (iv) Substantial risk that the child, if born, would suffer from serious physical or mental abnormalities (foetal abnormalities detected by prenatal diagnosis). [½ mark]

• Note for examiner: MTP should NOT be misused for sex-selective abortion — this is illegal under PCPNDT Act, 1994.

──────────────────────────────────────
MARK SUMMARY
──────────────────────────────────────
(a) Lactational amenorrhoea: name ½ + hormonal pathway (prolactin → GnRH suppression → no ovulation) 1 + condition ½ = 2 marks
(b) Name of hormonal IUD ½ + correct difference in mechanism ½ = 1 mark
(c) Name of ECP ½ + one concern ½ = 1 mark
(d) Time limit ½ + one legal condition ½ = 1 mark
TOTAL = 5 marks

Question 7

A 28-year-old woman who has recently delivered a baby is exclusively breastfeeding her infant. Her doctor advises her that she is naturally protected from pregnancy for up to 6 months after delivery, provided she continues full breastfeeding. Which of the following CORRECTLY explains the biological basis of this protection?

(A) Prolactin suppresses GnRH → inhibits FSH and LH → no follicle development → no ovulation
(B) Oxytocin released during suckling directly inhibits the corpus luteum → progesterone falls → no implantation
(C) High oestrogen levels during lactation suppress the hypothalamus → no LH surge → amenorrhoea
(D) Colostrum contains antibodies that block FSH receptors on ovarian follicles → ovulation is prevented

Accepted Answer

Correct answer: (A)

Lactational Amenorrhoea — Biological Mechanism:

• During intense, exclusive breastfeeding, the suckling stimulus triggers continuous secretion of PROLACTIN from the anterior pituitary.
• High prolactin levels suppress the secretion of GnRH (Gonadotropin-Releasing Hormone) from the hypothalamus.
• Reduced GnRH → reduced FSH and LH secretion from anterior pituitary.
• Without adequate FSH: no follicular development in the ovary.
• Without LH surge: no ovulation occurs.
• Result: no menstruation (amenorrhoea) → this is called LACTATIONAL AMENORRHOEA (LAM).
• Effective as a natural contraceptive method up to 6 months post-delivery, provided the mother is exclusively breastfeeding.

Why other options are INCORRECT:
• (B) Oxytocin is involved in milk let-down (ejection reflex) and uterine contractions during parturition — it does NOT directly inhibit the corpus luteum.
• (C) Oestrogen levels are actually LOW during lactation (not high); it is prolactin (not oestrogen) that mediates the contraceptive effect.
• (D) Colostrum contains maternal immunoglobulins (IgA) that protect the newborn — there is no mechanism by which colostrum blocks FSH receptors on ovarian follicles.

[1 mark for choosing option A]

Question 8

Medical Termination of Pregnancy (MTP) is legally permitted in India under the MTP Act. Up to how many weeks of pregnancy is MTP generally permitted?

Accepted Answer

Correct answer: (B) Up to 20 weeks

MTP (Medical Termination of Pregnancy) is legal in India under the MTP Act, 1971 (amended 2021). It is generally permitted up to 20 weeks of pregnancy (extendable to 24 weeks in special conditions such as rape, contraceptive failure, or foetal abnormalities, with approval of a medical board).

Question 9

Assertion (A): A lactating mother who exclusively breastfeeds her newborn for the first six months after delivery is unlikely to conceive during this period, even without using any other contraceptive method.
Reason (R): Intense suckling by the infant stimulates prolactin secretion, which suppresses GnRH release from the hypothalamus, thereby inhibiting ovulation.

Accepted Answer

Correct option: (A) Both A and R are true, and R is the correct explanation of A.

Explanation:
• Assertion is TRUE: The phenomenon is called Lactational Amenorrhoea (LAM). During intense and exclusive breastfeeding (up to 6 months post-partum), menstruation does not occur and ovulation is inhibited — making pregnancy highly unlikely during this window.
• Reason is TRUE and correctly explains A:
  – The suckling stimulus → signals anterior pituitary → prolactin secretion rises.
  – High prolactin → suppresses hypothalamic GnRH release → FSH and LH levels fall → follicle development and ovulation do NOT occur.
  – No ovulation → no corpus luteum → no progesterone surge → no endometrial preparation → amenorrhoea.
• R directly causes the physiological basis of A; hence R is the correct explanation of A.

Note: This method is effective ONLY when breastfeeding is exclusive (no supplementary feeding) and continuous, and only up to 6 months after delivery.

Question 10

Assertion (A): Copper-releasing IUDs such as CuT and Multiload-375 are more effective as contraceptives than non-medicated IUDs like Lippes loop.
Reason (R): Copper ions released from Cu-IUDs are spermicidal in nature and also increase phagocytosis of sperms inside the uterus.

Accepted Answer

Correct option: (A) Both A and R are true, and R is the correct explanation of A.

Explanation:
• Assertion is TRUE: Cu-releasing IUDs (CuT 380A, Multiload-375) have higher contraceptive efficacy than non-medicated IUDs (Lippes loop) because they have an additional spermicidal mechanism beyond the physical barrier/inflammatory reaction.
• Reason is TRUE and CORRECTLY explains A: Cu²⁺ ions released continuously suppress sperm motility and fertilising capacity; they also enhance phagocytosis of sperms within the uterine cavity, making Cu-IUDs more effective than non-medicated IUDs.
• Hence both A and R are true AND R is the correct explanation of A → Option (A).

Question 11

A 28-year-old woman who delivered a healthy baby three months ago is exclusively breastfeeding her child. Her gynaecologist tells her she need not use any additional contraceptive method for the time being. (i) Name the natural contraceptive phenomenon the doctor is referring to. (ii) State the hormonal mechanism by which this phenomenon prevents pregnancy.

Accepted Answer

(i) Lactational Amenorrhoea (LAM) — the absence of menstruation (and hence ovulation) during intense/exclusive breastfeeding, effective up to 6 months after delivery. [1 mark]

(ii) Hormonal mechanism: Suckling stimulus → prolactin secretion from anterior pituitary → prolactin inhibits GnRH (Gonadotropin-releasing hormone) release from hypothalamus → suppressed FSH and LH levels → follicle does not develop → no ovulation → no menstruation → pregnancy not possible. [1 mark]

(Note: Both parts must be answered for full 2 marks. ½ mark may be awarded if only the name or only a partial mechanism is given.)

Question 12

A married couple visits a fertility clinic. The doctor informs them that the wife has both fallopian tubes blocked but her ovaries and uterus are functioning normally. The doctor recommends an ART procedure that involves fertilisation outside the body followed by transfer of the embryo into the uterus. (i) Name the ART procedure recommended. (ii) At what stage is the embryo transferred into the uterus in this procedure?

Accepted Answer

(i) The ART procedure recommended is IVF-ET (In Vitro Fertilisation and Embryo Transfer), commonly known as the 'test tube baby' programme. ½ + ½ mark
• In IVF-ET, the egg is fertilised by sperm outside the body (in vitro) in a laboratory setting.
• It is specifically indicated when fallopian tubes are blocked or damaged, as fertilisation cannot occur naturally in the tubes.

(ii) The embryo is transferred into the uterus at the 8-celled stage (or up to the blastocyst stage). ½ + ½ mark
• If transfer is into the fallopian tube (ZIFT — Zygote Intra Fallopian Transfer), it is done at the zygote or early cleavage stage; however, since tubes are blocked in this patient, transfer is into the uterus (IVF-ET) at the 8-celled stage.

[Award 1 mark for correct name of procedure + 1 mark for correct embryo stage at transfer]

Question 13

What is Lactational Amenorrhoea? State the mechanism by which it acts as a natural method of contraception.

Accepted Answer

Lactational Amenorrhoea: Absence of menstruation (and hence ovulation) during the period of intense breastfeeding after delivery — effective as a natural contraceptive method up to 6 months post-partum. [1 mark]

Mechanism: Suckling by the infant → stimulates prolactin secretion from anterior pituitary → prolactin inhibits GnRH (Gonadotropin Releasing Hormone) release → suppresses FSH and LH → ovulation does not occur → no pregnancy. [1 mark]

Question 14

Name any two sexually transmitted infections (STIs) caused by bacteria. State one preventive measure effective against both.

Accepted Answer

Any TWO bacterial STIs (½ mark each):
• Gonorrhoea — caused by Neisseria gonorrhoeae
• Syphilis — caused by Treponema pallidum
• Chlamydiasis — caused by Chlamydia trachomatis (most common STI)

(Award ½ + ½ for any two correct names; organism name not mandatory for the mark)

One preventive measure effective against both (1 mark):
• Use of barrier contraceptives (condoms / male or female condom) during sexual intercourse — condoms form a physical barrier that prevents contact with infected secretions/skin, thereby preventing transmission of the pathogen.

(Accept also: avoiding multiple sexual partners / avoiding unprotected sex with unknown partners)

Total: ½ + ½ + 1 = 2 marks

Question 15

Name any three Sexually Transmitted Infections (STIs), giving the causative organism for each. Also state any two measures to prevent the spread of STIs.

Accepted Answer

**Three STIs with causative organisms:** (any 3 × ½ mark = 1½ marks)

| STI | Causative Organism | Type |
|---|---|---|
| Gonorrhoea | *Neisseria gonorrhoeae* | Bacterium |
| Syphilis | *Treponema pallidum* | Bacterium |
| Chlamydiasis | *Chlamydia trachomatis* | Bacterium |
| Genital herpes | *Herpes simplex virus* (HSV-2) | Virus |
| AIDS | HIV (Human Immunodeficiency Virus) | Virus |
| Hepatitis-B | Hepatitis B virus (HBV) | Virus |
| Genital warts | Human Papillomavirus (HPV) | Virus |

*(Award ½ mark for correct STI name + ½ mark for correct causative organism = 1 mark per pair; any 3 pairs required for full 1½ marks)*

---

**Two preventive measures against STIs:** (any 2 × ¾ mark = 1½ marks)

1. **Use of barrier contraceptives** — condoms (male/female) during sexual intercourse prevent direct contact with infected secretions/fluids.
2. **Avoid sexual contact with unknown/multiple partners** — restricting sexual contact to a single, uninfected partner greatly reduces risk.
3. **Early diagnosis and treatment** — regular screening and prompt treatment of STIs prevents further transmission.
4. **Vaccination** — where available (e.g., Hepatitis-B vaccine, HPV vaccine) provides protection.
5. **Avoid sharing needles/syringes** — prevents blood-borne STIs such as HIV and Hepatitis-B.

*(Any two clearly stated preventive measures, ¾ mark each)*

---

**Marking Summary:**
- 3 STIs named with correct causative organisms = **1½ marks** (½ per pair)
- 2 preventive measures = **1½ marks** (¾ per measure)
- **Total = 3 marks**

Question 16

Meera, a 28-year-old woman, recently delivered her second child and is breastfeeding exclusively. Her doctor advises her that she currently has natural protection against pregnancy and does not need any additional contraceptive method for up to 6 months post-delivery, provided certain conditions are met.

(i) Name the natural phenomenon the doctor is referring to and state the hormonal basis for this protection. (1 mark)
(ii) Meera's neighbour, who is not breastfeeding, wishes to use a copper-releasing IUD (CuT). Explain TWO mechanisms by which CuT prevents pregnancy. (2 marks)

Accepted Answer

**Answer:**

**(i) Lactational Amenorrhoea — 1 mark**

The phenomenon is **Lactational Amenorrhoea (LAM)**.

**Hormonal basis:**
Intense and exclusive breastfeeding → suckling stimulus → sustained secretion of **prolactin** from the anterior pituitary → prolactin inhibits the release of **GnRH** (Gonadotropin-releasing hormone) → suppression of **FSH and LH** → no follicle development → **no ovulation** → no menstruation (amenorrhoea).

*(Award 1 mark for correct name + any valid hormonal explanation; accept either prolactin suppressing GnRH or directly suppressing FSH/LH.)*

---

**(ii) Two mechanisms by which CuT (copper-releasing IUD) prevents pregnancy — 2 marks (1 mark each)**

1. **Suppression of sperm motility and fertilising capacity:** Cu²⁺ ions released continuously in the uterine environment are toxic to spermatozoa. They interfere with sperm enzyme activity and membrane function, thereby reducing sperm motility and their ability to fertilise the egg.

2. **Making the uterine environment hostile for implantation:** The presence of the device and the Cu²⁺ ions creates a local inflammatory/aseptic reaction in the uterine endometrium, making it unsuitable for implantation of the blastocyst even if fertilisation were to occur.

*(Award 1 mark for each correct mechanism stated clearly. Both mechanisms must be distinct — do not award both marks if only sperm motility is described twice.)*

---

**Marking Summary:**
| Part | Value Points | Marks |
|------|-------------|-------|
| (i) | Name: Lactational Amenorrhoea | ½ |
| (i) | Hormonal basis: prolactin → suppresses GnRH/FSH/LH → no ovulation | ½ |
| (ii) | Mechanism 1: Cu²⁺ ions suppress sperm motility/fertilising capacity | 1 |
| (ii) | Mechanism 2: Hostile uterine environment / prevents implantation | 1 |
| **Total** | | **3** |

Question 17

Distinguish between IVF-ET and GIFT as Assisted Reproductive Technologies (ART). For each, state (i) the stage/material transferred, (ii) the site of transfer, and (iii) the specific indication/condition for which it is recommended. (3 marks)

Accepted Answer

IVF-ET vs GIFT — Comparison (3 marks)

| Feature | IVF-ET (In Vitro Fertilisation – Embryo Transfer) | GIFT (Gamete Intra-Fallopian Transfer) |
|---|---|---|
| Stage / material transferred | Embryo (zygote allowed to develop to 8-cell stage in vitro before transfer) | Unfertilised female gamete (ovum) along with donor sperm — fertilisation occurs inside the body |
| Site of transfer | Uterus (intra-uterine transfer — IUT) if ≤8-cell stage; or Fallopian tube (ZIFT — Zygote Intra-Fallopian Transfer) if zygote stage | Fallopian tube (ampullary region) |
| Specific indication | Women with BLOCKED or damaged Fallopian tubes / couples where natural fertilisation has repeatedly failed | Women who have AT LEAST ONE functional, patent Fallopian tube (tube must be capable of supporting fertilisation and early development) |

Key value points for full marks:
• IVF-ET: fertilisation occurs OUTSIDE the body (in vitro, literally 'in glass') → embryo transferred to uterus. (1 mark)
• GIFT: gametes (ovum + sperm) transferred to the Fallopian tube → fertilisation occurs IN VIVO (inside the body). (1 mark)
• Correct indication for each — blocked tubes for IVF-ET; functional tube required for GIFT. (1 mark)

Note: ZIFT (Zygote Intra-Fallopian Transfer) is a variant of IVF-ET where the zygote (not the 8-cell embryo) is transferred to the Fallopian tube. Credit this if mentioned correctly.

Question 18

Seema, a 32-year-old woman, was diagnosed with complete bilateral blockage of her fallopian tubes due to a past pelvic infection. Her husband has normal semen parameters. Their doctor explained that assisted reproductive technology (ART) would be necessary for them to have a biological child, but cautioned that the specific technique chosen must match their clinical condition.

(a) Which ONE ART technique is most appropriate for Seema? Give ONE reason for your choice. (1 mark)
(b) Why would GIFT be contraindicated in Seema's case? (1 mark)
(c) After the chosen ART procedure, at what stage of development is the embryo typically transferred to the uterus, and why is this stage preferred over an earlier stage? (1 mark)

Accepted Answer

(a) Most appropriate ART technique: IVF-ET (In Vitro Fertilisation – Embryo Transfer) / Test-tube baby technique. [½ mark]
Reason: In IVF-ET, fertilisation occurs outside the body (in vitro) in a culture medium, completely bypassing the fallopian tubes. Since Seema's tubes are bilaterally blocked, the sperm and egg cannot meet naturally in the tube — IVF-ET allows fertilisation to occur externally and the embryo is transferred directly to the uterus. [½ mark]

(b) GIFT (Gamete Intra-Fallopian Transfer) involves transferring the collected oocyte and sperm directly into the fallopian tube, where fertilisation occurs naturally inside the tube. Since Seema has complete bilateral blockage of both fallopian tubes, the gametes cannot be introduced into a functional tube, making GIFT contraindicated / impossible in her case. [1 mark]

(c) The embryo is transferred to the uterus at the 8-celled stage (or up to the blastocyst stage). [½ mark]
Reason: Embryos with more than 8 cells (or at blastocyst stage) have a higher implantation success rate because the cells have undergone sufficient differentiation and compaction, making the embryo more competent to implant into the uterine endometrium than a 2- or 4-celled embryo. [½ mark]

[Examiner note: Award full marks if student states 'blastocyst stage' for part (c) with a valid reason related to implantation competence. For part (a), accept 'IVF' or 'IVF-ET' or 'test-tube baby technique' — all are equivalent. Do NOT accept ZIFT as the answer to part (a) without justification, as ZIFT transfers the zygote to the tube and would also be contraindicated; however, if a student mentions ZIFT with transfer to uterus instead of tube, award ½ mark only.]

Question 19

Assisted Reproductive Technologies (ART) offer hope to infertile couples. With reference to ART, answer the following:
(i) Name the ART procedure that is most suitable for a woman with at least one functional fallopian tube. Give one reason for your answer.
(ii) Distinguish between ZIFT and IVF-ET on the basis of the site of transfer.
(iii) State one reason why ICSI is preferred over conventional IVF in cases of very low sperm count.

Accepted Answer

**Answer (3 marks — 1 + 1 + 1)**

**(i) GIFT — Gamete Intra Fallopian Transfer** *(1 mark)*

- GIFT is the most suitable ART for a woman with at least one functional (patent) fallopian tube.
- **Reason:** In GIFT, the collected oocyte (gamete) from the female donor/wife and the processed sperms are transferred directly into the fallopian tube. The tube must be functional because fertilisation occurs naturally *within* the tube (not outside in the laboratory), and the fertilised egg must travel down to the uterus for implantation.

**(ii) ZIFT vs IVF-ET — site of transfer** *(1 mark)*

| ART Procedure | Site of Transfer |
|---|---|
| **ZIFT** (Zygote Intra Fallopian Transfer) | Zygote (or early embryo up to 8 cells) is transferred into the **fallopian tube** |
| **IVF-ET** (In Vitro Fertilisation – Embryo Transfer) | Embryo (with more than 8 cells) is transferred into the **uterus** |

- In both cases, fertilisation occurs *outside* the body (in vitro), but the site of transfer differs — fallopian tube in ZIFT, uterus in IVF-ET.

**(iii) Reason for preference of ICSI over conventional IVF in very low sperm count** *(1 mark)*

- In **ICSI (Intra Cytoplasmic Sperm Injection)**, a *single sperm* is directly injected into the cytoplasm of the egg (oocyte) in the laboratory.
- In conventional IVF, thousands of sperms are mixed with the egg and fertilisation depends on the sperm reaching the egg on its own.
- Therefore, when sperm count is very low (oligospermia) or sperm motility is severely reduced, ICSI is preferred because fertilisation can be achieved with just **one viable sperm**, bypassing the need for sperm to independently penetrate the egg.

Question 20

A newly married couple visited a family planning clinic. The wife has a history of recurrent pelvic inflammatory disease (PID) and her doctor has advised against the use of any intra-uterine device (IUD). The husband is unwilling to undergo any surgical procedure. The couple does not wish to conceive for the next 3 years.

(i) Suggest ONE most appropriate hormonal contraceptive method for this couple. Name the hormones it contains.
(ii) State the TWO principal mechanisms by which this method prevents pregnancy.
(iii) Identify ONE limitation of this method that the couple should be informed about.

Accepted Answer

MARKING SCHEME (Total: 3 marks)

(i) Suggested method and hormones — 1 mark

Most appropriate method: Combined Oral Contraceptive Pill (OCP) / 'the Pill'
• It is suitable because: IUDs are contraindicated (PID history) and surgical methods are refused.
• Hormones contained: Synthetic oestrogen AND synthetic progesterone (progestogen/progestin).
  — Examples of pills: Saheli (non-steroidal / centchroman — contains ormeloxifene, a SERM; accept this if mentioned as an alternative)
  — For full mark: must name BOTH hormones (oestrogen + progesterone/progestin) OR correctly name Saheli with its active ingredient.

Award 1 mark for correct method name + hormones.

(ii) Two principal mechanisms — 1 mark (½ + ½)

The combined OCP prevents pregnancy by:
• Mechanism 1: Inhibition of ovulation — synthetic oestrogen and progesterone suppress the mid-cycle LH surge (and FSH surge), thereby preventing the release of the ovum from the Graafian follicle. (½ mark)
• Mechanism 2: Changes in cervical mucus — progesterone makes cervical mucus thick and viscous, which prevents sperm penetration into the uterus / fallopian tube. (½ mark)

[Alternate acceptable mechanism for ½ mark: Alteration of endometrial lining — progestin makes the endometrium unsuitable/hostile for implantation of the blastocyst.]

Award ½ mark per correct mechanism; maximum 1 mark for any two correct mechanisms.

(iii) One limitation — 1 mark

Accept ANY ONE of the following (1 mark):
• Provides NO protection against Sexually Transmitted Infections (STIs) / HIV / AIDS — unlike barrier methods such as condoms.
• Must be taken DAILY at the same time; missing a dose reduces effectiveness significantly.
• Associated with side effects such as nausea, weight gain, irregular bleeding, or increased risk of thromboembolism in susceptible individuals.
• Not suitable for women who are breastfeeding (oestrogen-containing pills suppress lactation / reduce milk production) — relevant in a different scenario but valid biological limitation.

Note to examiner: Do NOT deduct marks if the student suggests Saheli (centchroman) instead of combined OCP, provided the answer is internally consistent throughout parts (i), (ii), and (iii).

Reproductive Health: Class 12 Biology Practice Questions

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