A 38-year-old woman with a 5-year history of secondary infertility undergoes diagnostic laparoscopy, which reveals stage III endometriosis with adhesions and a 3 cm endometrioma on the left ovary. Her husband's semen analysis is normal. After surgical excision of the endometrioma and adhesiolysis, the couple attempts natural conception for 12 months without success. Repeat semen analysis remains normal. Transvaginal ultrasound shows no recurrent endometrioma. What is the most appropriate next step in management?
A 32-year-old woman with a 3-year history of primary infertility presents to the fertility clinic. Her husband's semen analysis is normal. Hysterosalpingography shows patent fallopian tubes bilaterally. Transvaginal ultrasound reveals multiple small follicles (2–8 mm) in both ovaries with a total antral follicle count of 28. Serum FSH on day 3 is 8.2 mIU/mL, LH 7.1 mIU/mL, and testosterone 0.8 ng/mL. She has irregular menses (cycle length 35–45 days), mild hirsutism, and BMI 28 kg/m². What is the most appropriate first-line management for this couple?
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