Use of the Endometriosis Fertility Index to Predict Natural Pregnancy after Endometriosis Surgery: A Single-Center Study

Kim, Jeong Sook; Lee, Chung Won; Yun, Ji Hye; Lee, Jae Hoon; Yun, Bo Hyun; Park, Joo Hyun; Seo, Seok Kyo; Cho, SiHyun; Choi, Young Sik; Lee, Byung Seok

doi:10.1159/000493264

Cited by 13 publications

(9 citation statements)

References 33 publications

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“…The EFI, a 10-point scoring system grouped into five categories of risk, has been assessed in 12 studies and one review. It has been mainly assessed for its intended purpose, being prediction of the probability of natural conception after surgery [53][54][55][56][57][58][59][60][61][62][63][64]. Interestingly, in some of these studies an evaluation of the prognostic value of the different factors included in the EFI score was also performed.…”

Section: Replication Validation and Clinical Value Of Published Systemsmentioning

confidence: 99%

Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification

Vermeulen

Abrão

Einarsson

et al. 2021

Journal of Minimally Invasive Gynecology

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Objective: In the field of endometriosis, several classification, staging and reporting systems have been developed. Which endometriosis classification, staging and reporting systems have been published and validated for use in clinical practice? Data sources: A systematic PUBMED literature search was performed. Data were extracted and summarized. Methods of study selection: na Tabulation, integration and results: Twenty-two endometriosis classification, staging and reporting systems have been published between 1973 and 2021, each developed for specific, and different, purposes. There still is no international agreement on how to describe the disease. Studies evaluating the different systems are summarized showing a discrepancy between the intended and the evaluated purpose, and a general lack of validation data confirming a correlation with pain symptoms or quality of life for any of the current systems. A few studies confirm the value of the ENZIAN system for surgical description of deep endometriosis. With regards to infertility, the endometriosis fertility index has been confirmed valid for its intended purpose. Conclusion: Of the 22 endometriosis classification, staging and reporting systems identified in this historical overview, only a few have been evaluated for the purpose for which they were developed. The literature search was limited to PUBMED. Unpublished classification, staging or reporting systems, or those published in books were not considered. It can be concluded that there is no international agreement on how to describe endometriosis or how to classify it, and that most classification/staging systems show no or very little correlation with patient outcomes.

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Section: Replication Validation and Clinical Value Of Published Systemsmentioning

confidence: 99%

Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification

Vermeulen

Abrão

Einarsson

et al. 2021

Journal of Minimally Invasive Gynecology

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“…Endometriosis is one of the major causes of infertility, affecting 10% of women in reproductive age and about 50% of women with infertility [1][2][3]. Surgical treatment of endometriosis via laparoscopy can improve non-assisted reproductive technologies (ART) fecundity overall [4][5][6][7][8] The EFI staging system has consistently shown an acceptable predictive accuracy in different external validations [15][16][17][18][19][20][21][22][23][24][25][26][27], with the area under the receiver operating characteristic curve (ROC) ranging from 0.65 to 0.75. However, in these validation studies, the patient classification depending on the cumulative pregnancy rate was less accurate among those with lower EFI scores [16,20,22].…”

Section: Introductionmentioning

confidence: 99%

“…However, in these validation studies, the patient classification depending on the cumulative pregnancy rate was less accurate among those with lower EFI scores [16,20,22]. Other studies used the ROC to obtain the optimal threshold that maximized the Youden index but ignored the duration between surgery and subsequent pregnancy [20,23,25,26]. Meanwhile, whether the EFI can also be used to predict the rate of live birth remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification

Fan

Kang

et al. 2020

Preprint

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Backround: The EFI, which was previously developed and validated externally, has shown predictive accuracy of non-ART pregnancy following surgery in infertile women with endometriosis. But up to now it was less accurate among the patients with lower scores based on the classification of the original literature. In addition, so far the only study has reported a strong association between the EFI and the live birth. However, the analysis of that study was done in women undergoing surgery rather than in those who had conceived post-operatively. Methods: 501 infertile women undergoing laparoscopic treatment of endometriosis were recruited and followed up for post-operative pregnancy outcomes. The associations of EFI with non-ART pregnancy and with live birth were investigated with survival analysis and the Cochrane-Armitage test. The optimal cut-offs for EFI were determined using the Maximally Selected Rank Statistics (Maxstat). Result(s): The follow-up rate was 92.4% with a mean duration of 38.5 months (range: 14.4-67.4 months). A total of 270 women (58.3%) conceived without ART, 187 (69.3%) had a live birth. A statistically significant association of EFI with non-ART pregnancy rate was observed (hazard ratio: 1.29, 95% confidence interval: 1.19-1.36; 95% confidence interval: 0.57-0.65). The Maxstat method suggested optimal EFI strata of 4, 6 and 8. The cumulative non-ART pregnancy rates 3 years after surgery were 15.0%, 47.1%, 67.6% and 73.6% for EFI scores of 0-4, 5-6, 7-8 and 9-10, respectively (Log-rank p < 0.001). No statistical differences were seen in the live birth rates and the time to pregnancy in the four EFI groups. Conclusion: The EFI is predictive of post-operative non-ART pregnancy but not live birth among non-ART pregnancies. ART might be advisable to women with an EFI score <4 immediately after surgery and to women who have not achieved non-ART pregnancy after 12 months despite a high EFI.

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“…18,19,21 However, this was not the case in our data and another two studies in Asian populations. 23,24 The accuracy of EFI score is also adversely affected by the subjectivity of different surgeons and the interactions between its variables. For example, LF score is greatly affected by r-AFS lesion score and total r-AFS score.…”

Section: Discussionmentioning

confidence: 99%

“…17-19, 21, 22 However, the predictive efficiency of LF score did not appear as robust in two Asian cohorts. 23,24 Similarly, other variables in EFI also failed to predict the non-ART pregnancy rate after surgery in certain conditions. 19,21,[23][24][25] Therefore, it is necessary to modify the original EFI to make it suitable to the Asian.…”

Section: Introductionmentioning

confidence: 99%

Modified endometriosis fertility index Is more accurate to predict the non-ART pregnancy rate following surgery: a cohort of Chinese women

Fan¹,

Kang²,

et al.

Authorea

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Objective: To examine whether a modified endometriosis fertility index (EFI) can better predict the rate of pregnancy without assisted reproductive technologies (ART) after laparoscopic surgery in infertile women with endometriosis. Design: Retrospective cohort study. Setting: A university medical center. Population: 564 infertile patients who received laparoscopic surgery for endometriosis. Methods: 472 patients were used to modify the EFI based on new, optimal cutoffs for its predictor variables. The predictive accuracy of the modified EFI was examined in the other 92 patients. Main outcome measures: post-surgical non-ART pregnancy. Results: Among the patients for the EFI modification, the multivariable Cox regression results showed that historical factors were more contribution in predicting non-ART pregnancy rate than surgical factors both in modified EFI (C-index: historical factors 0.617 vs surgical factors 0.558) and the original EFI (C-index: historical factors 0.600 vs surgical factors 0.549). No significant relationship between the prior pregnancy and post-operative non-ART pregnancy rates was detected by both modified EFI and original EFI (P=0.530 and 0.802, respectively). In the patients for assessing the modified EFI, the predictive accuracy of two modified EFI models (C-index: 0.627 and 0.632, respectively) for non-ART pregnancy rates were superior to that of the original EFI (C-index: 0.602). Conclusions: A modified EFI based on population-specific optimal cutoffs and weight might be more suitable for estimating the rate of non-ART pregnancy after laparoscopic surgery in infertile women with endometriosis. Funding: This study received no external funding.

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Use of the Endometriosis Fertility Index to Predict Natural Pregnancy after Endometriosis Surgery: A Single-Center Study

Cited by 13 publications

References 33 publications

Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification

Endometriosis Classification, Staging and Reporting Systems: A Review on the Road to a Universally Accepted Endometriosis Classification

Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification

Modified endometriosis fertility index Is more accurate to predict the non-ART pregnancy rate following surgery: a cohort of Chinese women

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