DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20192431

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

Fessy Louis T., Deepa Naveen, Ramesh P., Parasuram Gopinath, Gopinathan K. K.

Abstract


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.


Keywords


Endometriosis fertility index, Laparoscopy, Least function score, Prognosis, Staging

Full Text:

PDF

References


American Fertility Society. Classification of endometriosis. Fertil Steril. 1979;32:633-4.

Guzick DS, Bross Ds, Rock JA. Assessing the efficacy of American fertility society classification of endometriosis. Fertil Steril. 1982;38:171-6.

Adamson GD, Frison L, Lamb EJ. Endometriosis studies of method for the design of a surgical staging system. Fertil Steril. 1982;38:659-66.

Buttram V. Revised Evolution of Revised American Fertility society classification of endometriosis. Fertil Steril. 1985;43:347-50.

American Fertility society Revised American Fertility society classification of endometriosis. Fertil Steril. 1985;43:351-2.

Stripling MC, Martin DC, Chatman DL, Zwaag RV, Poston WM. Subtle appearance of Pelvic endometriosis. Fertil Steril. 1988;49:427.

Candian GB, Vercellini P, Fedele L. Laparoscopic ovarian puncture for correct staging of endometriosis. Fertil Steril. 1990;53:994-7.

Vercellini P, Vendola N, Bocciolone L, Rogarinelli SG, Candiani GB. Reliability of visual diagnosis of ovarian endometriosis. Fertil Steril. 1991;56:1198-2000.

Canis M, Bouquet De, Jolinieres J, Wattiez A, Pouly JL, Mage G, et al. Classification of endometriosis. Baillieres Clin Obstet Gynaecol. 1993;7:759-74.

Hornstein MD, Gleason RE, ORAV J, Haas ST, Friedman AJ, Rein MS, et al. The reproducibility of the revised American Fertility society classification of endometriosis. Fertil Steril. 1993;59:1015-21.

Rock JA. The reproducibility of the revised American Fertility society classification of endometriosis. Fertil Steril. 1995;63:1108-10.

Wiegerinck MA, Van Dop PA, Brosens JA. The stage of peritoneal endometriosis by type of active lesion in addition to the revised American Fertility Society classification. Fertil Steril. 1993;60:461-4.

Adamson GD, Hurd SJ, Pasta DJ, Rodriguez BD. Laparoscopic endometriosis treatment. Fertil Steril. 1993;59:35-44.

Guzick DS, Silliman NP, Adamson GD, Buttram C, Canis M, Malinak LR, et al. Prediction of pregnancy in infertile women based on the American society for Reproductive Medicine’s revised classification of endometriosis. Fertil Steril. 1997;67:822.

Adamson GD, Pasta DJ. Endometriosis Fertility Index: the new validated -Endometriosis staging system. Fertil Steril. 2009;94:1609-15.