Endometriosis fertility index at laparoscope: a ray of hope and lots of scope


  • Vemparala Kalabhashini Kavya Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
  • Sindhuja T. Palanisamy Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
  • N. Palaniappan Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India




EFI score, Endometriosis, Infertility, Spontaneous conception, Laparoscopy


Background: Endometriosis fertility index (EFI) is used to predict the fecundity in women with surgically and histologically confirmed endometriosis. Aim of the study is to evaluate the successful spontaneous pregnancy rates in patients with endometriosis after laparoscopic surgery in relation to EFI score.

Methods: Observational cross-sectional study was conducted on 76 patients who desire to conceive with suspected endometriosis related infertility treated by laparoscopic surgery. EFI score was calculated and information on mode of conception (spontaneous or assisted reproductive technology-ART) was collected by contacting the patients.

Results: In women who conceived spontaneously, mean age was 31.33+3.29 years. Factors found to be significant were age (pvalue-0.0001), time to achieve spontaneous pregnancy (median-9 months). Patients with higher EFI score (5-10) has good spontaneous conception rate (96.2%) compared to those with lower EFI score (0-4) that conceived better with ART (60%) women with lower least function score has better outcome for spontaneous pregnancy (p<0.001).

Conclusions: EFI scoring system is effective in predicting postoperative successful spontaneous pregnancy rates in the patients with endometriosis. In our study patients with higher EFI score achieved successful spontaneous pregnancy.


Vesali S, Razavi M, Rezaeinejad M, Maleki-Hajiagha A, Maroufizadeh S. Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis. BJOG. 2020;127(7):800-9.

ACOG. Management of Endometriosis, 2010. Available at: https://www.acog.org/clinical/clinical-guidance/practicebulletin/articles/2010/07/management-of-endometriosis. Accessed on 10 February 2022.

Werner C. Williams gynecology study guide. 4th ed. Endometriosis. 2020: 233-247.

Wang W, Li R, Fang T. Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis. Reprod Biol Endocrinol. 2013;11:112.

Li X, Zeng C, Zhou YF, Yang HX, Shang J, Zhu SN et al. Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery. Chin Med J (Engl). 2017;130(16):1932-7.

Adamson GD. Endometriosis classification: an update. Curr Opin Obstet Gynecol. 2011;23(4):213-20.

Missmer SA, Hankinson SE, Spiegelman D, Barbieri RL, Marshall LM, Hunter DJ. Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol. 2004;160(8):784-96.

Bailleul A, Niro J, Du Cheyron J, Panel P, Fauconnier A. Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame? PLoS One. 2021;16(5):e0251372.

Adamson GD. Endometriosis Fertility Index: is it better than the present staging systems? Curr Opin Obstet Gynecol. 2013;25(3):186-92.

Tomassetti C, Geysenbergh B, Meuleman C, Timmerman D, Fieuws S, D'Hooghe T. External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod. 2013;28(5):1280-8.

Maheux-Lacroix S, Nesbitt-Hawes E, Deans R. Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis. Hum Reprod. 2017;32(11):2243-9.






Original Research Articles