A 30-year-old nulliparous woman has had dysmenorrhea and dyspareunia for 4 years. Laparoscopy reveals deposits on the uterosacral ligaments, ovarian endometrioma (4 cm) on the right, and bilateral tubal disease with partial obstruction. She desires future fertility. What is the MOST appropriate management?
- A Laparoscopic cystectomy of endometrioma, adhesiolysis, and proceed to IVF ✓
- B Medical suppression with GnRH agonist for 6 months then attempt conception
- C Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy
- D Combined oral contraceptive pill for pain and repeat laparoscopy in 1 year
Correct answer: A. Laparoscopic cystectomy of endometrioma, adhesiolysis, and proceed to IVF
Explanation
In a fertility-seeking patient with stage III-IV endometriosis and associated tubal pathology, laparoscopic surgical treatment (cystectomy and adhesiolysis) improves access for egg retrieval and IVF outcomes. Excision of endometrioma rather than drainage alone reduces recurrence. Given bilateral tubal disease limiting natural conception, IVF is appropriate after surgical treatment. GnRH agonist medical therapy does not improve fertility outcomes and delays conception.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.