A 32-year-old woman presents to our office regarding difficulty conceiving. She and her partner have been attempting conception for 13 months. The patient reports regular every 28-day painful menstrual cycles since menarche at age 13. She reports her cycles have become more painful. Usually, her dysmenorrhea is relieved with nonsteroidal anti-inflammatory medications. However, while still happening occasionally, she is more frequently absent from work during menses due to pain. She denies a history of sexually transmitted infections and prior pelvic surgery. Her partner has no children. The referring provider initiated an evaluation and sent you results of a normal semen analysis demonstrating normal morphology, hysterosalpingogram demonstrating bilateral tubal patency and normal endometrial morphology, and day 21 progesterone consistent with ovulation. Pelvic ultrasonography showed a 6.8 cm retroverted uterus with a 3.4 cm left complex ovarian cyst with a “ground glass” background and one thin septation suggestive of an endometrioma cyst. The patient previously used barrier contraception and withdrawal. She used oral contraceptives for a brief interval, but discontinued them due to side effects. Read more