Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis

Abstract

BackgroundEndometriosis is a common disease. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis.Methods199 women with endometriosis receiving IVF treatment after surgery were analysis. The EFI score and r-AFS classification in their ability to predict these IVF outcomes were compared in the same population. ROC curves were used to analyse the predictive values of the EFI and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and the Youden’s index.ResultsThe Area Under the Curve (AUC) of the EFI score (AUC = 0.641, Standard Error(SE) = 0.039, P = 0.001, 95% CI = 0.564-0.717, cut-off score = 6) was significantly larger than that of the r-AFS classification (AUC = 0.445, SE = 0.041, P = 0.184, and 95% CI = 0.364-0.526). The antral follicle count, oestradiol level on day of hCG, number of oocytes retrieved, number of oocytes fertilised, and number of cleaved embryos in the greater than or equal to 6 EFI score group was greater than that of the lower than or equal to 5 EFI score group, and the dose of gonadotropin of the greater than or equal to 6 EFI score group were less than that in the lower than or equal to 5 EFI score group. Implantation rate, clinical pregnancy rate, and cumulative pregnancy rate in the greater than or equal to 6 EFI score group were higher than in the lower than or equal to 5 EFI score group.ConclusionsIt suggests that the EFI has more predictive power for IVF outcomes in endometriosis patients than the r-AFS classification. The clinical pregnancy rate was higher in patients with EFI greater than or equal to 6 score than with EFI lower than or equal to 5 score.

External Validation of the Endometriosis Fertility Index (EFI) for Predicting Spontaneous Pregnancy after Surgery: Further Considerations on Its Validity

“…It should be considered that in our study ART was offered only after 1 year of childbearing time and the disease might have progressed in the meantime. On the other hand, similar findings were obtained by Wang et al [21] that offered an ART cycle 6 months after the laparoscopic treatment supporting the idea that this aspect is probably not critical for the general validity of the score. Therefore, this information allows the possibility of providing a more complete counseling at the time of decision making.…”

“…The best cut-point for pregnancy based on sensitivity and specificity was 5.5. This result, obtained on a small number of patients, has been recently confirmed by Wang et al [21]. This study was conducted on 199 women with endometriosis who received IVF treatment after surgery demonstrating that EFI score was a predictive tool of IVF outcomes.…”

The Endometriosis Fertility Index Is Useful for Predicting the Ability to Conceive without Assisted Reproductive Technology Treatment after Laparoscopic Surgery, Regardless of Endometriosis

“…However, it has limited ability for predicting a successful pregnancy after surgery [11]. Opoien et al [15] reported on the r-ASRM classification of endometriosis and the pregnancy rate with ART due to tubal factors.…”

“…Recently, the relationship between EFI and ART outcomes was reported [11]. EFI was suggested to have greater predictive power than the r-ASRM for a successful pregnancy with ART in endometriosis patients [12].…”

Clinical management of endometriosis‐associated infertility

“…Wang et al [53] were the first to compare the predictive value of the EFI score with the r-ASRM classification in the same population of women with endometriosis who had received IVF treatment. They suggested that neither the future of pregnancy nor IVF outcome could be predicted by r-ASRM classification.…”