Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis

Maheux-Lacroix, Sarah; Nesbitt‐Hawes, Erin; Deans, Rebecca; Won, H.; Budden, Aaron; Adamson, David; Abbott, Jason

doi:10.1093/humrep/dex291

Cited by 37 publications

(33 citation statements)

References 41 publications

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“…To our knowledge, this is the first report validating EFI for the prediction of natural conception after surgery in Korean women with endometriosis. The EFI in this study showed a statistically significant correlation with natural pregnancy, similar to that of previous reports [12,14]. Even though our study population was small, only one woman with an EFI value < 4 was able to naturally conceive.…”

Section: Discussion/conclusionsupporting

confidence: 91%

“…However, because EFI was assessed and recorded at the end of surgery in 61 of 68 patients, the effect of retrospective calculation on our results is likely to be minimal. It has also been suggested that EFI scoring has clinically meaningful results and additional potential use in retrospective settings [14,23]. In sensitivity analysis, such variation was marginally affected by the total EFI score [12], but the LF score still has several critical issues, such as intra/inter-observer variation.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Some clinical trials have confirmed the utility of the EFI [12][13][14]. In this study, we evaluated the ability of EFI to predict natural pregnancy in Korean women who underwent endometriosis surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

Yun

et al. 2018

Gynecol Obstet Invest

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Aims: Our objective was to predict natural pregnancy after endometriosis surgery using the endometriosis fertility index (EFI). Methods: A retrospective medical records review was conducted, examining patients surgically treated for endometriosis at a single center in Korea between January 2009 and February 2015. In total, 68 women attempting natural conception were analyzed by assessing age, preoperative serum CA-125, body mass index, revised American Fertility Society (rAFS) stage, EFI, and pregnancy outcome. Kaplan-Meier estimates and log-rank tests were used to generate cumulative natural pregnancy rate curves based on an EFI cut-point. A receiver-operating characteristic (ROC) curve was plotted for EFI. Results: Seventy-seven patients attempted conceptions, resulting in 33 natural and 9 assisted conceptions. Excluding assisted conceptions, the mean EFI scores of 68 women who were not pregnant and pregnant were 5.43 ± 0.36 and 6.88 ± 0.28 respectively. The relation between EFI and natural pregnancy was significant (cumulative overall pregnancy rate, p = 0.006), whereas rAFS stage was not (univariate logistics, p = 0.853). The cut-point for maximum natural pregnancy outcomes was 6 (area under ROC curve = 0.710, 95% CI 0.586–0.835). Conclusion: The EFI is a reliable staging system for predicting natural pregnancy after endometriosis surgery. EFI scores can be used to guide postoperative treatment of women with endometriosis.

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Section: Discussion/conclusionsupporting

confidence: 91%

Section: Discussion/conclusionmentioning

confidence: 99%

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

Kim

Lee

Yun

et al. 2018

Gynecol Obstet Invest

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“…The median time to pregnancy was 12 months (95% CI 7–17 months), with 63% achieved by expectant management post‐operatively and 37% with assistance. In the most recent paper from our unit, we examined the use of the Endometriosis Fertility Index (EFI) only in stages III–IV disease, where there was a 63% live birth rate in an infertile population having surgery for endometriosis and 64% of these women spontaneously conceived. Perhaps the most important aspect of this study was that it tracked pregnancy to five years and showed that for women with an EFI score 9–10 that at one year, expectant management led to a live birth in 46% of women, 58% at two years and 91% at five years, with IVF only increasing this to 95% at five years.…”

Section: Surgery Endometriosis and Infertilitymentioning

confidence: 99%

Surgical treatment is an excellent option for women with endometriosis and infertility

Abbott

2017

Aust NZ J Obst Gynaeco

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K E Y W O R D S endometriosis, infertility, surgery SURGERY IN PREVIOUS UNSUCCESSFUL IVF Surgery is often successful after previous failed IVF cycles and this has been previously reported, with 22/29 (75%) women with endometriosis having multiple failed IVF cycles treated surgically, with 15/22 (68%) pregnant with expectant management. 19This demonstrates that where IVF has been unsuccessful, the role of surgery should still be considered and in fact may be of substantial benefit. CONCLUSIONSSo how do we wrap all this up? It is clear that surgery has a number of advantages for the often symptomatic woman with endometriosis with regards to pain management and reduction in her pelvic symptoms of dyspareunia, dyschesia and non-menstrual pelvic pain is likely to improve pregnancy from expectant management as her quality of life is improved and she is more likely to have regular timed intercourse. It should also be apparent that the first attempt at fertility should be the best and the adage here is that it is better to peek and shriek than peek and poke. If you cannot finish the surgery with removal of disease, then you should not start and refer to a specialist centre which can undertake optimal disease removal with minimal risk and a multidisciplinary team where appropriate. Deeply invasive disease can and has been successfully removed with improvements in fertility as well as the benefits of symptom reduction. Many women, and their families, will want choices in how they may approach future parenthood and that is not always the one-size-fits-all approach of IVF. Certainly it is an option, but an invasive and expensive option, so at least there should be the choice of a second invasive and less expensive option in surgery.

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“…Live births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART. A total of 147 women (63%) had a live birth following surgery, 94 of them (64%) without ART [1]. Women with a high EFI score have excellent fertility prognosis and may be advised to try to become pregnant with timed intercourse compared to women with a low score, for which prompt referral to ART seems more reasonable [1].…”

Section: Introductionmentioning

confidence: 99%

Management of Infertility in Endometriosis by Operative Laparoscopy and Medical Therapy—Practiced at 3 Different Centres, from September 2005 to October 2007

Devabhaktuni¹,

Gogineni²,

Yalamanchi³

et al. 2019

OJOG

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Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis

Abstract: N/A.

Cited by 37 publications

References 41 publications

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

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

Surgical treatment is an excellent option for women with endometriosis and infertility

Management of Infertility in Endometriosis by Operative Laparoscopy and Medical Therapy—Practiced at 3 Different Centres, from September 2005 to October 2007

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