Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery

Abstract

Background:The endometriosis fertility index (EFI) has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer (IVF-ET) is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates (PRs), and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET.Methods:This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score ≥5 were divided into non-IVF-ET group (n = 209) and IVE-ET group (n = 98) to compare the cumulative PRs. Cumulative PRs’ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model.Results:Significant differences in spontaneous PRs among different EFI scores were identified (χ2 = 29.945, P < 0.05). The least function score was proved to be the most important factor for EFI (χ2 = 6.931, P < 0.05) staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone (χ2 = 4.160, P = 0.041).Conclusions:The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.

Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?

“…However, the EFI is a predictive tool rather than a therapeutic decision-making tool and clinical interpretation to determine the best approach for post-operative fertility is ambiguous [12]. In the literature, the decisional threshold indicating a good likelihood of spontaneous pregnancy is generally taken to be 5 [13][14][15]. However, the current interest is to determine the role of the EFI in the post-operative management of patients with endometriois-related infertility: i.e., spontaneous conception or assisted reproductive technology (ART) and the optimal time frame for each.…”

The Impact of Laparoscopic Treated Endometrioma on the Live Birth Rate in IVF/ICSI Cycles Compared with Unexplained Infertility: A Prospective Randomized Study

“…EFI is used to predict fertility sequentially to surgery. Regarding the women who underwent surgery, a follow-up assessment of EFI ≥5-12 months postoperatively was indicated the implementation of IVF-ET procedure [27].…”

Methods to Improve the Treatment Outcomes for Infertility Associated with Endometriomas

“…После повторных операций беременность наступила у 5 (35,7%) из 14 участниц группы 1, тогда как в группе женщин, которых вели в соответствии с разработанным нами подходом, таких случаев было только 3 (10%) (p = 0,031). [2,7,10]. В настоящее время многие исследователи полагают, что к вопросу о хирургическом лечении ЭКЯ малого размера следует подходить очень внимательно.…”

“…По современным представлениям, эндометриоз -это хроническое доброкачественное эстроген-зависимое заболевание, при котором за пределами полости матки происходит доброкачественное разрастание ткани, по морфологическим и функциональным свойствам подобной эндометрию. Распространенность данного заболевания составляет 5-10% [1][2][3]. У 44% женщин, страдающих эндометриозом, выявляются эндометриоидные кисты яичников (ЭКЯ), которые нередко сочетаются с трубным бесплодием [4,5].…”