A 25 – years old married infeile woman having regular menstruation, fever, lower abdominal pain and dysmenorrhoea present herself at the OPD. On examination, there are bilateral soft tender masses of 3cm diameter in both fornices and uterus is of normal size. The most likely diagnosis is :

**Core Concept**
The patient's symptoms and physical examination findings suggest a diagnosis related to pelvic inflammatory disease (PID) or a gynecological condition involving the ovaries. The presence of bilateral soft tender masses in the fornices, along with fever and lower abdominal pain, points towards an infectious or inflammatory process.

**Why the Correct Answer is Right**
The correct diagnosis is likely **Ectopic Pregnancy**. Although the patient is married and infertile, the presence of bilateral adnexal masses and lower abdominal pain could be indicative of an ectopic pregnancy. The patient's regular menstruation and normal-sized uterus do not rule out ectopic pregnancy, as this condition can still occur in women with a history of infertility. The bilateral adnexal masses may represent the ectopic gestational sacs.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is likely incorrect as it does not specifically address the patient's symptoms and physical examination findings.
**Option B:** While PID could be a consideration, the presence of bilateral adnexal masses and lower abdominal pain makes PID less likely.
**Option C:** This option is incorrect as it does not take into account the patient's symptoms and physical examination findings.

**Clinical Pearl / High-Yield Fact**
In a woman of reproductive age presenting with lower abdominal pain and adnexal masses, ectopic pregnancy should be considered in the differential diagnosis, even if the patient has a history of infertility.

**Correct Answer:** D. Ectopic Pregnancy

✓ Correct Answer: B. Tubo - ovarian masses