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

Abstract

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.

Peripheral blood subpopulations of Bregs producing IL‐35 in women with endometriosis

“…2 The latest research on the EFI shows that women with a favorable EFI (already ≥ 5) may attempt spontaneous pregnancy for 24 months prior to referral to ART. 35 Here, we observed an increase in the percentage of immature B-cells expressing IL-35 in the EFI 7-9 group. We did not observe alterations in the frequencies of IL-35-producing B10 and plasmablasts between the EFI 1-6 and EFI 7-9 groups.…”

“…The limit EFI value for predicting a successful pregnancy without ART was 7 2 . The latest research on the EFI shows that women with a favorable EFI (already ≥ 5) may attempt spontaneous pregnancy for 24 months prior to referral to ART 35 . Here, we observed an increase in the percentage of immature B‐cells expressing IL‐35 in the EFI 7–9 group.…”

Pregnancy after laparoscopic surgery for endometriosis: How long should we wait? A retrospective study involving a long‐term follow up at a university endometriosis center

“…It seems that the first 12 months after the operation are an optimal time for pregnancy, which is similar to the findings reported elsewhere. 4 As shown in the patients with rASRM stage I, until 36 months had passed, a pregnancy could be expected, and, in those with rASRM stage II, until 24 months passed, a pregnancy could be expected. In the group of patients with rASRM stages III and IV, no spontaneous pregnancy was reported after the 12th month.…”

Endometriose e seu impacto na infertilidade feminina

“…A endometriose foi a doença mais estudada em ginecologia nos últimos 15 anos, mesmo assim, no Brasil, atinge cerca de 5-15% das mulheres no período reprodutivo (Ferrero et al, 2021). O quadro clínico que é determinado como uma condição estrogênio-dependente pode variar de assintomático ou apresentar os principais sintomas clássicos de endometriose como: dismenorreia, dor pélvica e infertilidade (Bailleul et al, 2021).…”