Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery

Abstract 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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Role of endometriosis fertility index system in predicting non-IVF conception in patients with surgically documented endometriosis

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192431 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2363

Author(s):

Fessy Louis T. ◽

Deepa Naveen ◽

Ramesh P. ◽

Parasuram Gopinath ◽

Gopinathan K. K.

Keyword(s):

Sensitivity Analysis ◽

Pregnancy Rate ◽

Good Prognosis ◽

Poor Correlation ◽

Retrospective Data ◽

Reasonable Accuracy ◽

Clinical Tool ◽

Fertility Index ◽

Endometriosis Surgery

Background: Endometriosis still remains an enigmatic disease. There are important reasons to stage endometriosis and to prognosticate the chances of pregnancy after a surgical management. The currently used revised AFS system has poor correlation with pregnancy rate. A scoring system-Endometriosis fertility index (EFI) to prognosticate the outcome was proposed few years back. The objective was to assess the usefulness of the EFI system in predicting pregnancy in patients with surgically documented endometriosis who attempt Non-IVF conception.Methods: Retrospective data was collected from 77 subjects with endometriosis who underwent laparoscopy and had documented least function (LF) score and EFI score. All were followed up until 12 months for the occurrence of a non IVF pregnancy.Results: Our study showed that the pregnancy rate was clearly higher in those with high EFI scores than those with low scores. A score of less than 4 was associated with significantly lower pregnancy rates than those with score above 5 (n=26, pregnancy rate- 11.54%) vs. (n=51, pregnancy rate 50.1%); p = 0.001)). Similarly, the pregnancy rate was significantly lower in those with LF score 1-3 (21.2%) as opposed to those with higher LF scores (p =0.029). Also, sensitivity analysis showed that higher EFI score was significantly associated with higher LF score (P <0.001).Conclusions: EFI is a useful clinical tool that predicts pregnancy with reasonable accuracy after endometriosis surgery. Its use clearly provides reassurance to those patients with good prognosis.

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Faculty Opinions recommendation of External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717987166.793473950 ◽

2013 ◽

Author(s):

Edgardo Rolla

Keyword(s):

External Validation ◽

Staging System ◽

Fertility Index ◽

Endometriosis Surgery

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

PLoS ONE ◽

10.1371/journal.pone.0251372 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251372

Author(s):

Alexandre Bailleul ◽

Julien Niro ◽

Joseph Du Cheyron ◽

Pierre Panel ◽

Arnaud Fauconnier

Keyword(s):

Pregnancy Rate ◽

Time Frame ◽

Optimal Time ◽

Gray Model ◽

Artificial Reproduction ◽

Subdistribution Hazard ◽

Fertility Management ◽

Fertility Index ◽

Spontaneous Pregnancy ◽

Endometriosis Surgery

Introduction The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. However, the practical use of the EFI to advise patients about postoperative fertility management is unclear. Materials and methods All patients participating in the ENDOQUAL study–a prospective observational bi-center cohort study conducted between 01/2012 and 06/2018–who underwent surgery for infertility were asked to complete a questionnaire collecting time and mode of conception. Statistical analysis was performed with the Fine and Gray model of competing risks and analysis of fertility according to the EFI. Results Of the 234 patients analyzed, 104 (44.4%) conceived postoperatively including 58 (55.8%) spontaneous pregnancies. An EFI of 0–4 for spontaneous pregnancies was associated with a lower cumulative pregnancy incidence compared to an EFI of 5–10 (52 versus 34 pregnancies respectively, Subdistribution Hazard Ratio (SHR) = 0.47; 95% CI [0.2; 1.1]; p = 0.08). An EFI of 0–4 was associated with a higher cumulative pregnancy rate for pregnancies obtained by artificial reproduction technology (ART), compared to an EFI of 5–10 (12 versus 6 pregnancies respectively, SHR = 1.9; CI95% [0.96; 3.8]; p = 0.06). Fecundability decreased from 12 months for EFI 0–4 and from 24 months for EFI 5–10. Conclusion Our analysis suggests that patients with an unfavorable EFI (≤4) have more ART pregnancies than patients with a favorable EFI (≥5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.

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