A 32-year-old woman, gravida 2 para 1, at 18 weeks gestation comes to the office for her first prenatal visit. She has noticed new
facial hair and acne over the past few weeks. The patient has had no vaginal bleeding or abdominal pain Some mild nausea earlier
in the pregnancy has resolved. The patient has had no vomiting and is eating 5 small meals a day Her prepregnancy BMI was 24
kg/m2 and she has gained 2.3 kg (5 lb} over the past 2 months. Examination shows acne on her chest and back and coarse hair in
the distribution of the upper lip, chin, periareolar area, chest, and lower abdomen. The uterus is nontender and fundal height is 2 cm
below the umbilicus. Ultrasonogram shows an intrauterine gestation consistent with dates and bilateral 7-cm solid masses in the
ovaries. Which of the following is the best next step in management of this patient?
- 0 A Clomiphene therapy
- Q B. Diagnostic laparoscopy with ovarian biopsy
- O C. Exploratory laparotomy with oophorectomy
- O D. Observation and expectant management
- 0 E. Suction evacuation of the uterus
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