A 29-year-old woman presents with secondary infertility for 2 years. She has dysmenorrhoea, deep dyspareunia, and a fixed retroverted uterus on examination. Transvaginal ultrasound shows a 4 cm unilateral endometrioma. What is the most appropriate first-line treatment to improve fertility?
- A Expectant management with timed intercourse for 6 months
- B In vitro fertilization with embryo transfer ✓
- C Controlled ovarian stimulation with intrauterine insemination
- D Surgical cystectomy of the endometrioma
Correct answer: B. In vitro fertilization with embryo transfer
Explanation
For stage III-IV endometriosis with an endometrioma, IVF-ET is the most effective first-line treatment to achieve pregnancy. Surgical cystectomy may reduce ovarian reserve and does not consistently improve spontaneous pregnancy rates compared with expectant management. COH/IUI has limited efficacy in moderate-severe endometriosis. The NICE guidelines and ESHRE guidelines recommend IVF as the primary fertility treatment in this setting.
Reference: ESHRE Guideline on Endometriosis, 2022 ed.
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Written and medically reviewed by the StethoPrep medical team.