Review Question - QID 108684

A 32-year-old G1P0010 woman presents to her gynecologist for secondary infertility after a first-trimester spontaneous abortion 4 years ago. No testing was performed on either the patient or the products of conception at that time. Afterward, the patient used a combined oral contraceptive for pregnancy prevention but discontinued it 2 years ago in order to conceive again. She and her husband have been having unprotected intercourse regularly since then without achieving pregnancy. The patient currently has periods every 28-30 days with moderate flow. Since discontinuing the oral contraceptive, she has had “excruciating” periods with severe cramping for up to 10 days each cycle. In addition, she has noticed occasional pain with defecation and dyspareunia with deep penetration. She denies any urinary symptoms, fatigue, or weight gain. The patient has a past medical history of hypothyroidism on levothyroxine and is a freelance painter. She endorses occasional alcohol use and has smoked 1 pack of cigarettes per day for the last 15 years. Her husband has no past medical history. Her temperature is 98.6°F (37°C), blood pressure is 117/74 mmHg, pulse is 93/min, and respirations are 12/min. Labs drawn on day 3 of the patient’s cycle are shown below:

Follicle stimulating hormone: 5.1 mIU/mL
Estradiol: 30 pg/mL
Anti-Mullerian hormone (AMH): 2.7 ng/mL
Thyroid stimulating hormone: 1.4 µIU/mL

Pelvic ultrasound is shown in Figure A. Which of the following is the next most appropriate step in order to improve this patient’s chances of conceiving?