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Exam Review

Key Facts: C-RHI Exam

125

Total Questions

100 scored + 25 pretest

2 hrs

Time Limit

NCC

25%

Largest Domain Weight

Pathophysiology, Evaluation, Diagnosis

Multi

Eligibility

RN, APRN, midwife, PA

$210

Exam Fee

NCC

Test ctr

Delivery

PSI test center only

The C-RHI (Reproductive Health and Infertility) exam is administered by NCC and is open to a multidisciplinary group including RNs, APRNs (NP/CNS/CNM), certified midwives, and PAs with no minimum practice-experience requirement. The exam consists of 125 multiple-choice questions (100 scored, 25 pretest) with a 2-hour time limit. Pathophysiology, Evaluation and Diagnosis is the largest domain at 25%, with ART close behind at 24%. Test-center only.

Sample C-RHI Practice Questions

Try these sample questions to review concepts for the C-RHI exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1Per ASRM definitions, infertility in a couple where the female partner is under 35 years old is defined as the inability to conceive after how many months of regular, unprotected intercourse?

A.6 months

B.12 months

C.18 months

D.24 months

Explanation: ASRM defines infertility in women under 35 as failure to achieve pregnancy after 12 months of regular, unprotected intercourse. For women 35 or older, evaluation is recommended after 6 months because of age-related decline in fecundity and ovarian reserve. Earlier evaluation is appropriate when known risk factors exist (oligomenorrhea, prior pelvic surgery, known male factor).

2Ovulation typically occurs approximately how many hours after the onset of the luteinizing hormone (LH) surge?

A.6-12 hours

B.24-36 hours

C.48-60 hours

D.72-96 hours

Explanation: Ovulation typically occurs 24-36 hours after the onset of the LH surge and approximately 10-12 hours after the LH peak. This timing is the basis for ovulation predictor kits and for scheduling intrauterine insemination (IUI) the day after a positive LH kit result.

3A 34-year-old presents for fertility counseling. Which serum marker drawn on cycle day 3 is the MOST direct biochemical reflection of the antral follicle pool and ovarian reserve?

A.Follicle-stimulating hormone (FSH)

B.Luteinizing hormone (LH)

C.Anti-Mullerian hormone (AMH)

D.Estradiol (E2)

Explanation: Anti-Mullerian hormone is produced by granulosa cells of preantral and small antral follicles and reflects the size of the remaining ovarian follicle pool. Unlike FSH, AMH varies minimally across the menstrual cycle and is not significantly suppressed by hormonal contraception in the long term, making it the most direct biochemical marker of ovarian reserve.

4During transvaginal ultrasound assessment, the antral follicle count (AFC) is performed by counting follicles in both ovaries within which size range?

A.1-1.9 mm

B.2-10 mm

C.11-17 mm

D.18-24 mm

Explanation: Antral follicle count is the sum of follicles measuring 2-10 mm in both ovaries, ideally measured in the early follicular phase. AFC correlates with the recruitable cohort and predicts ovarian response to stimulation. Together with AMH, it is a primary measure of ovarian reserve.

5The implantation window in a natural cycle generally occurs during which interval after ovulation?

A.1-3 days post-ovulation

B.6-10 days post-ovulation

C.12-14 days post-ovulation

D.16-18 days post-ovulation

Explanation: The implantation window opens approximately 6 days after ovulation and closes around day 10, corresponding to cycle days 20-24 in a typical 28-day cycle. During this period the endometrium expresses pinopodes and integrins that permit blastocyst attachment. This window underlies the timing of frozen embryo transfer with progesterone exposure.

6Which finding on a basic semen analysis is consistent with the WHO 2021 (6th edition) lower reference limit for sperm concentration?

A.5 million/mL

B.10 million/mL

C.16 million/mL

D.40 million/mL

Explanation: The WHO 2021 (6th edition) lower reference limit for sperm concentration is 16 million/mL, with a total count threshold of 39 million per ejaculate. Values below this define oligozoospermia and warrant repeat testing and andrology referral. Reference limits represent the 5th percentile of fertile men, not absolute fertility cutoffs.

7A male patient is instructed to provide a semen specimen for analysis. Which abstinence interval is appropriate to ensure result validity per WHO recommendations?

A.12-24 hours

B.2-7 days

C.10-14 days

D.21-28 days

Explanation: WHO guidelines recommend 2-7 days of sexual abstinence prior to semen collection. Shorter intervals reduce volume and total count; longer intervals can decrease motility and increase abnormal forms. Documenting the abstinence interval is essential for accurate interpretation.

8A nurse is reviewing infectious disease screening required by the FDA before donor sperm or oocyte tissue can be used. Which testing panel is required for anonymous gamete donors per 21 CFR 1271?

A.Only HIV antibody and hepatitis B surface antigen

B.Comprehensive donor eligibility testing including HIV, HBV, HCV, syphilis, HTLV, CMV, and Zika

C.Only a urine sexually transmitted infection panel

D.No infectious disease testing is required for directed donors

Explanation: 21 CFR 1271 (Subpart C) requires donor eligibility determination including testing for HIV-1/2, hepatitis B (HBsAg and anti-HBc), hepatitis C, syphilis (Treponema pallidum), HTLV-I/II, CMV, and Zika using FDA-licensed assays. Donors must also undergo a relevant medical history review. Directed donors may be exempt from some requirements but still must be tested.

9Which of the following lifestyle factors has been shown to most significantly reduce female fecundity and is a routine focus of preconception counseling?

A.Moderate caffeine intake (less than 200 mg/day)

B.Cigarette smoking

C.Daily multivitamin use

D.Moderate aerobic exercise

Explanation: Cigarette smoking accelerates oocyte loss, decreases ovarian reserve, increases time to conception, and reduces IVF success. Smoking cessation is a high-yield preconception intervention. Caffeine under 200 mg, daily prenatal vitamins, and moderate exercise are not associated with reduced fecundity.

10A 28-year-old patient with a BMI of 36 kg/m^2 and oligomenorrhea asks how her weight affects fertility. Which counseling point is most accurate?

A.Weight has no impact on ovulation in young patients

B.Even modest weight loss of 5-10% of body weight can restore ovulation in many patients with weight-related anovulation

C.Bariatric surgery is the first-line intervention for all patients with BMI over 35

D.Caloric restriction below 1000 kcal/day is recommended for fertility patients

Explanation: In patients with anovulation related to obesity, particularly PCOS phenotypes, a 5-10% loss of body weight can restore ovulatory cycles, improve insulin sensitivity, and increase pregnancy rates without ART. Lifestyle modification is first-line. Severe caloric restriction is harmful, and bariatric surgery is reserved for select cases after lifestyle and medical management fail.

About the C-RHI Exam

Multidisciplinary subspecialty certification for clinicians providing reproductive endocrinology and infertility (REI) care. The C-RHI validates expertise in reproductive anatomy and physiology, infertility workup and diagnosis, non-ART treatments (ovulation induction, IUI, surgery), assisted reproductive technologies (IVF, ICSI, PGT, fertility preservation), and reproductive health treatment including transgender care, contraception, and third-party reproduction.

Exam sponsor: NCC. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

125 questions

Time Limit

2 hours

Passing Score

Pass/Fail (scaled)

Exam / Certification Fees

$210

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Official sources

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

20%

General Assessment, Reproductive Anatomy and Physiology

History/screening, menstrual cycle, ovarian reserve, baseline labs and imaging, donor screening

25%

Pathophysiology, Evaluation and Diagnosis

PCOS, POI, endometriosis, fibroids, male factor, RPL, unexplained infertility

12%

Non-ART Treatment and Complications

Lifestyle, ovulation induction, IUI, sperm preparation, reproductive surgeries

24%

Assisted Reproductive Technologies (ART)

IVF protocols, OHSS, ICSI, PGT, embryo grading, FET, fertility preservation, FDA tissue rules

19%

Reproductive Health Treatment and Complications

Endocrine tx, ectopic, multiple gestation, transgender care, contraception, third-party reproduction, ethics

Preparing for the C-RHI Exam

What You Need to Know

Passing score: Pass/Fail (scaled)
Exam length: 125 questions
Time limit: 2 hours
Exam / certification fees: $210 Official sources

Using Our Practice Resources

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
Use our AI tutor for tough concepts

C-RHI: Suggested Study Strategy

1Focus heaviest on Pathophysiology/Evaluation/Diagnosis (25%) and ART (24%) — together these are nearly half the exam

2Master IVF stimulation protocols (long agonist vs antagonist), trigger options (hCG vs agonist), and OHSS prevention/grading

3Know ovarian reserve markers (AMH, day-3 FSH, AFC) and their interpretation in workup of female infertility

4Understand PGT types (PGT-A aneuploidy, PGT-M monogenic, PGT-SR structural) and their indications

5Complete at least 100 practice questions before scheduling your exam

Frequently Asked Questions

Who can sit for the C-RHI exam?

C-RHI is a multidisciplinary REI clinician credential open to registered nurses, advanced practice registered nurses (NP, CNS, CNM), certified midwives, and physician assistants. There is no minimum practice-experience requirement, making it accessible for clinicians newer to fertility care. The exam is offered at PSI test centers (no remote proctoring).

What is the most heavily weighted C-RHI domain?

Pathophysiology, Evaluation and Diagnosis carries the largest weight at 25%, followed closely by Assisted Reproductive Technologies at 24%. The pathophysiology domain covers ovulatory disorders (PCOS, hypothalamic amenorrhea, POI), tubal/uterine factors (endometriosis, fibroids, Asherman), male factor (Klinefelter, Kallmann, CBAVD), recurrent pregnancy loss, and unexplained infertility.

What ART content is on the C-RHI exam?

The ART domain (24%) covers IVF stimulation protocols (long agonist, antagonist, microdose flare), OHSS prevention and grading, ICSI and surgical sperm retrieval (MESA/PESA), preimplantation genetic testing (PGT-A, PGT-M, PGT-SR, mosaicism), embryo grading, vitrification, fresh and frozen embryo transfer, fertility preservation (oncofertility), and FDA tissue regulations.

Is the C-RHI exam offered remotely?

No. C-RHI is currently test-center only — there is no remote proctoring option. Candidates schedule their exam at a PSI test center through the link on the NCC credential page. Plan ahead since test-center availability varies by region.

How should I study for the C-RHI exam?

Plan for 40-60 hours of study over 6-10 weeks. Focus heaviest on the two largest domains — Pathophysiology/Evaluation/Diagnosis (25%) and ART (24%) — which together are nearly half the exam. Master IVF stimulation protocols, OHSS recognition and management, and the major infertility diagnoses. Use the NCC C-RHI candidate guide as your blueprint.

Free Practice Questions for C-RHI

C-RHI Reproductive Health and Infertility

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