Endometriosis Fertility Index Anticipates Pregnancy in Women with Endometriosis

Endometriosis fertility index (EFI) is a reliable substitute for the revised American Fertility Society (rAFS) classification system when it comes to predicting pregnancy in a women with endometriosis post-surgery.

Key Points

Highlights:

• Li et al. analyze endometriosis fertility index (EFI) as a diagnostic tool for determining fertility in women with endometriosis who has undergone surgery.
• The researchers also sought to determine the factors that have the most impact on EFI.
• The final goal of this paper is to determine viable treatment options for those suffering from endometriosis related infertility.

Importance:

• Women with endometriosis are often affected during their reproductive years. Subsequently, many of these women are unable to conceive. Understanding everything about the link between endometriosis and infertility will lead to better treatments and therapies, which will allow women with the disease the opportunity to live the life they desire.

What’s done here?

• 345 women with endometriosis related infertility were recruited for this study. These women had normal ovulation and one viable tool. Additionally, their partner’s semen was tested for viability as well. Women were excluded if they had uterine fibroids, adenomyosis/uterine malformations, and reproductive system abnormalities.
• All the participants underwent surgery to remove all visible foci of endometriosis.
• Following the surgery, the participants were asked to actively try and conceive naturally or with the help of in vitro fertilization and embryo transfer (IVF-ET).
• After some time the women were contacted and asked whether they are pregnant. Pregnancy was determined using ultrasound and serum β‑human chorionic gonadotropin.
• EFI, rAFS and least function scores were collected for all patients. The researchers also took note of endometriotic implants and adhesions.
• The participants who conceived naturally were split into groups based on their EFI scores. Participants with EFI scores greater than or equal to 5 were divided into two groups: natural conception or IVF-ET conception.
• Statistical analysis of the data consists of using:
  • The Kaplan-Meier product limit estimate to determine cumulative pregnancy rates (PRs).
  • The log-rank test was used for survival analysis.
  • The Cox regression model was used to determine what factors most impacted the EFI score.

Key results:

• The results of the study helped confirm a finding from previous studies: laparoscopy can help raise PRs.
• Compared to rAFS, EFI is a better system for predicting PRs. The reliability of this system was confirmed by the differences in PRs seen among the various EFI scores.
• Least function score is the factor that has the greatest impact on EFI score.
• Women who underwent surgery 12 months prior and have an EFI scores greater than or equal to 5 would see better PRs if they utilize IVF-ET.

Limitations of the study:

• This study utilized participants from one geographical area, which means that the results may not be applicable on a global level.

Lay Summary

Women are often afflicted by endometriosis during their reproductive years and can be faced with the prospect of infertility. These women also undergo treatments and procedures that can further affect their fertility. Consequently, in 2010, Adamson and Pasta came up with a system for predicting pregnancy after surgery. This scoring system is known as the endometriosis fertility index (EFI). In their paper published in Chinese Medical Journal titled “Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery,” Li et al. assess EFI as a scoring system. They also seek to provide options for treatment.

This study consisted of 345 women who were suffering from endometriosis, infertility, and had undergone a laparoscopic surgery. The participants were then allowed to conceive naturally or with the help of in vitro fertilization and embryo transfer (IVF-ET). Those who conceived naturally were split into groups according to their EFI scores. The participants who had EFI scores greater than or equal to 5 were divided according to their method of conception, natural or IVF-et. The cumulative spontaneous pregnancy rates (PRs) were recorded for all the groups. The data from the groups with EFI scores greater than or equal to 5 was analyzed using the Kaplan-Meier product limit estimate and log-rank test. The Cox regression model was used to identify the factors that ultimately led to pregnancy.

The results show that there is a difference between the spontaneous PRs for the different EFIs, which proves that this is a good system for determining spontaneous PR for an individual with endometriosis who has recently undergone surgery. Furthermore, for women who have undergone surgery 12 months prior and have an EFI score greater than or equal to 5, it is recommended that they consider IVF-ET because it will lead to a more desirable spontaneous PR. The last major finding of the study was that the most important influencer of EFI is the least function score.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28776545