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This is the case of a young woman diagnosed with endometriosis, first operated in 2020 . Five years later, she presents with bilateral endometriomas and a pain score of 10 out of 10. Now married and planning fertility, she also has hematosalpinx, a condition where blood collects in the fallopian tubes, further complicating her chances of conception. Although the cysts are relatively small (2 cm and 3.8 cm), the severity of pain and the presence of hematosalpinx make this a clear surgical indication. What makes this case critical is that her first surgery was not performed by a specialist, which often leads to incomplete treatment. This time, the goal is comprehensive care — to relieve her pain, preserve her ovarian reserve, and optimise her fertility outcomes through expert surgical intervention. Endometriosis requires specialised attention. Timely decisions can protect both reproductive health and long-term quality of life. Follow For More! #Endometriosis #Endometrioma #ChronicPelvicPain #EndometriosisTreatment #EndometriosisSurgery #GynaecologicSurgery #EndometriosisIndia #DrJayMehta {endometriosis, endometriosis surgery, fertility specialist, chocolate cyst, pelvic pain, gynecologist India, female infertility, fertility doctor, AMH preservation, laparoscopic surgery}