A 34-yrs-old woman is trying for a pregnancy for 3 years. On p/V these is a nodular, tender uterosacral ligament, a retroveed but normal-sized uterus, and a right adnexal mass. A recent pelvic ultrasound reveals a 6-cm right complex ovarian mass. Her CA-125 is elevated. What is the initial next step in management?

The most likely diagnosis here is an endometrioma of the right ovary. Because this patient has been attempting to get pregnant, conservative surgery to remove the endometrioma while preserving ovarian tissue and to ablate any endometriotic implants may improve her chances. Medical therapy with a GnRH agonist may treat her symptoms, but it will not treat the ovarian cyst or help her get pregnant. CA-125 can be elevated with endometriosis and is not specific to endometriosis alone