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Endometriosis-associated subfertility — DRCOG MCQ

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HardSubfertilityEndometriosis-associated subfertilityDRCOG

A 32-year-old woman has 18 months of subfertility, severe dysmenorrhoea and deep dyspareunia. Transvaginal ultrasound shows a 5 cm endometrioma. Her partner's semen analysis is normal. When should this patient be referred?

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Correct answer: C — Refer to a fertility or endometriosis specialist service

Subfertility with significant endometriosis symptoms and an endometrioma warrants specialist referral for fertility-sensitive management. Hormonal suppression can improve pain but prevents conception while used, so it is not suitable when actively trying without specialist planning. Endometriomas can be associated with reduced ovarian reserve and surgical decisions require expertise. Cervical cautery is unrelated.

Reference: NICE NG73; NICE CG156