<prompt> 30 years old female presents with chronic cyclical abdominal pain. Pain is increased during the 5 days of menstrual cycle. Patient is married for 2 years and has not conceived till now. What is the most appropriate next step in management?UltrasonographyTest for male infertilityCT Scan of abdomen with contrastTest for urine infection  <response>: Ans. is a i.e., Ultrasonography o According the clinical scenario of chronic cyclical abdominal pain with infertility the most probable clinical diagnosis is endometriosis and the most logical next step in management of this patient is to investigate the patient with ultrasonography for definitive diagnosis of endometriorsis.Fernisle Infertility : Causes, investigations andmanagementAetiologyInvestigationsManagementTubal causeo Hysterosalpingography or sonosalpingogoraphyo Falloscopyo Salpingographyo Laparoscopic chemotubationo Adhesiolysis Lap.o Tuboplastyo Hysteroscopic cannulation and balloonoplasty o If failed or not feasibleOvulationo Ovulation monitoring by ultrasound BBT, BBI EB for tuberculosisIVF Gif o Clomiphene, letrozoleAbnormalFailedHormonal studyFSH, LH, GnRHo FSH, LH, Prolactino E2, P levelPositive, No responseo Thyroid and diabetes ResponseIf failed IVF Donor eggAdoptionOther causesUltrasound, MRI, SSG, hysteroscopyTreat the causeo This above table is important to decide the clinical next step in answering the questions like the one given aboveo Clinical suspicion of endometriosis with infertility will come under the other causes as per the cable and thus Ultrasound is the best next step in management of such patient. 