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

Abstract

Background/Aims: The revised American Society for Reproductive Medicine classification of endometriosis has a limited predictive value for pregnancy after surgery. A tool for predicting spontaneous pregnancy or pregnancy following assisted reproduction technology (ART) represents a clinical need. This study aimed to (i) provide an external validation of the EFI score in predicting pregnancy in infertile Italian endometriosis women; (ii) evaluate the predictive value of EFI score on ART outcome for patients who previously attempted to spontaneously conceive after surgery. Methods: In 104 women with endometriosis, EFI score was calculated based on a prospective database data. Cumulative pregnancy rates curves were calculated using Kaplan-Meier (K-M) product limit estimate and log-rank test was used to evaluate differences between EFI groups. A receiver operating characteristic (ROC) curve was plotted for EFI as a predictor of ART outcome. Results: Differences in time to non-ART pregnancy for the six EFI groups were statistically significant (log-rank, p = 1.4 × 10^-4). The area under the curve (AUC) for EFI as ART outcome predictor was 0.75 (95% CI 0.61-0.89, p = 6.2 × 10^-3), while the best cut-point for pregnancy was 5.5. Conclusion: The EFI score is a reliable scoring system to predict non-ART and ART pregnancy outcome after surgery for endometriosis.

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

“…We demonstrated that the EFI scoring system could validly predict natural pregnancy after endometriosis surgery, which is in line with previous studies [13,17]. To our knowledge, this is the first report validating EFI for the prediction of natural conception after surgery in Korean women with endometriosis.…”

“…Patients with severe disease were encouraged to proceed directly to the ART center without attempting natural conception. Such patients were readily excluded, possibly contributing to "active censorship" similar to previous studies [13,17].…”

“…For this reason, a new system was needed to accurately predict pregnancy outcomes after endometriosis surgery. Accordingly, the endometriosis fertility index (EFI) was introduced in 2010 [12,13].…”

Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ?

“…Sa validation interne et externe permet aujourd'hui, à l'issue de la chirurgie, de proposer une prise en charge personnalisé e chez les patientes endomé -triosiques infertiles et opé ré es. Cinq é tudes montrent qu'il existe une association significative entre le score EFI et la probabilité de grossesse spontané e dans les 12 mois [52][53][54][55][56]. Dans la sé rie française portant sur 417 patientes opé ré es [53], les taux de grossesse spontané e ont é té de 42 % et 57 % lorsque le score é tait !…”

“…L'EFI est un outil nouveau et performant, permettant de guider la prise en charge postopé ratoire [52][53][54][55][56]. La prise en compte de la ré serve ovarienne permet d'obtenir un traitement individualisé pour chaque couple [53,118].…”