A 28-year-old female invo...

I am currently managing a case of a 28-year-old female involving a primigravida at 11 weeks of gestation, presenting with a 9.5cm × 5.8cm subserosal fibroid and a 7.5cm × 5.6cm endometrioma on the left ovary. The patient is experiencing severe abdominal pain on alternating days despite treatment with Isoxsuprine, Susten, Duphaston, and Folcure5D. I seek guidance regarding the appropriate timing for intervention, considering whether surgical removal of the endometrioma should occur at 16 or 18 weeks gestation due to the severity of her symptoms or if conservative management should be continued.