The Endometriosis Fertility index Could Help Better Predict the Chance of Conceiving After Laparoscopy

Using the EFI can ensure only women who are less likely to conceive naturally use assisted reproductive technologies

Key Points

Highlights:

The endometriosis fertility index (EFI) could help better predict a woman’s chance of becoming pregnant following laparoscopic surgery without the need to use assisted reproductive technologies.

Importance:

The EFI could be used to ensure that only women who are more likely to need assisted reproductive technologies such as IVF, go through the procedure reducing unnecessary distress and costs.

What’s done here?

Researchers from Japan analyzed infertile 133 women who underwent laparoscopic surgery in terms of pregnancy. 

Key results:

• A younger age, shorter duration of infertility, and higher EFI scores were associated with a higher chance of pregnancy without assisted reproductive technologies following laparoscopic surgery.
• An EFI of 8 to 10 was associated with a significantly higher chance of conceiving compared to a score of 7 or below. 
• The duration of natural conception following surgery was not affected by the EFI. 

Limitations of the study:

The study only included 133 women meaning that it had a small sample size. 

Lay Summary

The endometriosis fertility index (EFI) can more reliably predict the chance of a woman getting pregnant following endometriosis surgery compared to the revised-American Society of Reproductive Medicine score, according to a study published in the scientific journal Gynecologic and Obstetric Investigation.

The EFI could, therefore, be used to ensure that only women who are less likely to become pregnant naturally following laparoscopic surgery use assisted reproductive technologies, such as IVF treatment, reducing the number of unnecessary procedures and costs. 

In order to investigate the utility of the EFI in predicting a successful pregnancy without assisted reproductive technologies, a team of researchers led by Dr. R. Sugiyama at the Sugiyama Clinic in Tokyo, Japan analyzed 133 women who underwent laparoscopic surgery between July 2011 and December 2012. 

A total of 55 women out of the 133 (41.3%) became naturally pregnant following surgery in this period of time.

The researchers calculated the EFI of the women and found that women who became pregnant were younger, had been infertile for a shorter period of time, and had higher EFI scores compared to those who did not become pregnant. 

The researchers also calculated that an EFI score of 7 or above was the cut-off point predicting a successful pregnancy without assisted reproductive technology. In other words, women who had an EFI score between 8 and 10 were significantly more likely to become pregnant naturally than those who had a score of 7 or less. However, the EFI did not affect the time it took to become pregnant after laparoscopic surgery.

The authors concluded that the EFI has a greater power to predict a successful pregnancy compared to the revised-American Society of Reproductive Medicine score. This was independent of whether or not the women had endometriosis. 

The EFI uses a combination of surgical and histological factors to predict a woman’s chance of becoming pregnant. It contains all the components of the revised-American Society of Reproductive Medicine score but also includes a detailed evaluation of the fallopian tubes (connecting the ovaries to the uterus), fimbriae (or fingerlike projections found at the end of the fallopian tubes), and ovaries, and accounts for any fallopian tube dysfunction after surgery. It can more reliably predict a successful pregnancy. 

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28873380