Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification

Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research article Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification Jiaying Fan, Kang Qin, Kuanrong Li, Xiaojun Li, Abraham N Morse, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-26020/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Backround: The EFI, which was previously developed and validated externally, has shown predictive accuracy of non-ART pregnancy following surgery in infertile women with endometriosis. But up to now it was less accurate among the patients with lower scores based on the classification of the original literature. In addition, so far the only study has reported a strong association between the EFI and the live birth. However, the analysis of that study was done in women undergoing surgery rather than in those who had conceived post-operatively. Methods: 501 infertile women undergoing laparoscopic treatment of endometriosis were recruited and followed up for post-operative pregnancy outcomes. The associations of EFI with non-ART pregnancy and with live birth were investigated with survival analysis and the Cochrane-Armitage test. The optimal cut-offs for EFI were determined using the Maximally Selected Rank Statistics (Maxstat). Result(s): The follow-up rate was 92.4% with a mean duration of 38.5 months (range: 14.4-67.4 months). A total of 270 women (58.3%) conceived without ART, 187 (69.3%) had a live birth. A statistically significant association of EFI with non-ART pregnancy rate was observed (hazard ratio: 1.29, 95% confidence interval: 1.19-1.36; 95% confidence interval: 0.57-0.65). The Maxstat method suggested optimal EFI strata of 4, 6 and 8. The cumulative non-ART pregnancy rates 3 years after surgery were 15.0%, 47.1%, 67.6% and 73.6% for EFI scores of 0-4, 5-6, 7-8 and 9-10, respectively (Log-rank p < 0.001). No statistical differences were seen in the live birth rates and the time to pregnancy in the four EFI groups. Conclusion: The EFI is predictive of post-operative non-ART pregnancy but not live birth among non-ART pregnancies. ART might be advisable to women with an EFI score <4 immediately after surgery and to women who have not achieved non-ART pregnancy after 12 months despite a high EFI. Maternal & Fetal Medicine Endometriosis fertility index pregnancy live birth time-to-pregnancy laparoscopy Figures Figure 1 Figure 2 Full Text Supplementary Files SupplementalFigures.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-26020","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":539985,"identity":"fc2a524c-8a26-427e-8449-699b42e2c022","order_by":1,"name":"Jiaying Fan","email":"","orcid":"","institution":"Jinan University First Affiliated Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiaying","middleName":"","lastName":"Fan","suffix":""},{"id":539986,"identity":"b7aa8b03-545d-41a6-8ca7-b45fddc89c27","order_by":2,"name":"Kang Qin","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kang","middleName":"","lastName":"Qin","suffix":""},{"id":539987,"identity":"de06cb38-16fb-43c3-a4d5-33c4aca69de9","order_by":3,"name":"Kuanrong Li","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Kuanrong","middleName":"","lastName":"Li","suffix":""},{"id":539988,"identity":"d6be641a-9e8e-43aa-9f33-88798f9df9c8","order_by":4,"name":"Xiaojun Li","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaojun","middleName":"","lastName":"Li","suffix":""},{"id":539989,"identity":"1fce71f2-fa4e-4a4c-96f1-02950e0ffa62","order_by":5,"name":"Abraham N Morse","email":"","orcid":"","institution":"Tufts University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Abraham","middleName":"N","lastName":"Morse","suffix":""},{"id":539990,"identity":"3869c99b-ce90-4b7a-949a-ccb5c068ac93","order_by":6,"name":"Jingying Xie","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Jingying","middleName":"","lastName":"Xie","suffix":""},{"id":539991,"identity":"228a8a88-2297-46cb-8c32-4660a3d38542","order_by":7,"name":"Huiying Liang","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Huiying","middleName":"","lastName":"Liang","suffix":""},{"id":539992,"identity":"dfa1e6cd-8dc0-48b0-be6e-097771826cbe","order_by":8,"name":"Yan Yang","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Yang","suffix":""},{"id":539993,"identity":"d6a28141-c6d8-476d-9608-4b9b926677ac","order_by":9,"name":"Yunsheng Liao","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yunsheng","middleName":"","lastName":"Liao","suffix":""},{"id":539994,"identity":"b9e74c3d-0381-4f07-9fe1-28f79538e473","order_by":10,"name":"huishu Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIiWNgGAWjYBACPmYGNgYGA4YEBvYGIrWwwbXwHCBWCxgxALVIJBCrhZ3H7DFPQV2ewc3n1yR+5tgx8Esfv0DAYTzmxjwGh4sNbueUSfZuS2aQ7MspIKTFTJrH4EDihts5abcZtx1gMDjDg9+JUC11iRtuniFNC3Pihhvsx6Ba2A8Q0MJWJjnH4HDizDM57D+BfuGR7OHBq4OBn//wNok3f+oS+44ff2zwc5udHD8P+wP8ehCAxwBMwhjEALjhxNsyCkbBKBgFIwMAAOo8P4DIqhBFAAAAAElFTkSuQmCC","orcid":"","institution":"none","correspondingAuthor":true,"prefix":"","firstName":"huishu","middleName":"","lastName":"Liu","suffix":""},{"id":539995,"identity":"b452f724-a7f5-4f09-9cea-3c1239ba8412","order_by":11,"name":"Qingfeng Li","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Qingfeng","middleName":"","lastName":"Li","suffix":""}],"badges":[],"createdAt":"2020-04-29 05:48:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-26020/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-26020/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":1056679,"identity":"1dd228d4-a10b-40d5-a1e5-0e36fed9b2ec","added_by":"auto","created_at":"2020-05-08 14:30:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76901,"visible":true,"origin":"","legend":"Kaplan-Meier estimated cumulative non-ART pregnancy rate by the original\nsix EFI groups (a) and the optimal four EFI groups (b). EFI, Endometriosis Fertility Index.","description":"","filename":"fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1/fig1.png"},{"id":1056681,"identity":"1d6fb4cd-7ec1-48b6-8ca1-6c1192fb7247","added_by":"auto","created_at":"2020-05-08 14:30:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30960,"visible":true,"origin":"","legend":"Box plot of the time to pregnancy of women with different EFI score. EFI, Endometriosis Fertility Index.","description":"","filename":"ig2.png","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1/ig2.png"},{"id":1056682,"identity":"58cb7ff6-301a-410c-9055-c776609d1eb8","added_by":"auto","created_at":"2020-05-08 14:30:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2838415,"visible":true,"origin":"","legend":"","description":"","filename":"manuscipt.pdf","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1_stamped.pdf"},{"id":1056680,"identity":"c613f83b-da64-4e77-9243-5860a46fb0bd","added_by":"auto","created_at":"2020-05-08 14:30:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2808731,"visible":true,"origin":"","legend":"","description":"","filename":"manuscipt.pdf","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1/manuscipt.pdf"},{"id":13502203,"identity":"e7982af8-383d-4e2c-bfb5-d61815a2c922","added_by":"auto","created_at":"2021-09-16 23:13:45","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2887175,"visible":true,"origin":"","legend":"","description":"","filename":"manuscipt.pdf","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1_covered.pdf"},{"id":1056678,"identity":"ad24cb36-4819-4413-82db-a4f4d7a2a4e6","added_by":"auto","created_at":"2020-05-08 14:30:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":1453029,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalFigures.pdf","url":"https://assets-eu.researchsquare.com/files/rs-26020/v1/SupplementalFigures.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eUse of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"\u003cp\u003eThis preprint is available for \u003ca href='/article/rs-26020/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis fertility index, pregnancy, live birth, time-to-pregnancy, laparoscopy","lastPublishedDoi":"10.21203/rs.3.rs-26020/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-26020/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackround: The EFI, which was previously developed\u0026nbsp;and validated externally, has shown predictive accuracy of non-ART pregnancy following surgery in infertile\u0026nbsp;women with endometriosis. But up to now it was less accurate among the patients with lower scores based on the classification\u0026nbsp;of the original literature. In addition, so far the only study has reported a strong association between the EFI and the live birth. However, the analysis of that study was done in women undergoing surgery rather than in those who had conceived post-operatively. \u003c/p\u003e\u003cp\u003eMethods:\u0026nbsp;501 infertile women undergoing laparoscopic treatment of endometriosis were recruited and followed up for post-operative pregnancy\u0026nbsp;outcomes. The associations of EFI with non-ART pregnancy and with live birth were investigated\u0026nbsp;with survival analysis and the Cochrane-Armitage test. The optimal cut-offs for EFI were determined using the Maximally Selected Rank Statistics (Maxstat). \u003c/p\u003e\u003cp\u003eResult(s): The follow-up rate was 92.4% with a mean duration of 38.5 months (range: 14.4-67.4 months). A total of 270 women (58.3%) conceived without ART, 187 (69.3%) had a live birth.\u0026nbsp;A statistically significant association of EFI with non-ART pregnancy rate was observed (hazard ratio: 1.29, 95% confidence interval: 1.19-1.36; 95% confidence interval: 0.57-0.65).\u0026nbsp;The Maxstat method suggested optimal EFI strata of 4, 6 and 8. The cumulative non-ART pregnancy rates 3 years after surgery were\u0026nbsp;15.0%, 47.1%, 67.6%\u0026nbsp;and 73.6%\u0026nbsp;for EFI scores of\u0026nbsp;0-4, 5-6,\u0026nbsp;7-8\u0026nbsp;and 9-10, respectively (Log-rank p \u0026lt; 0.001). No statistical differences were seen in the live birth rates and the time to pregnancy in the four EFI groups. \u003c/p\u003e\u003cp\u003eConclusion:\u0026nbsp;The EFI is predictive of\u0026nbsp;post-operative non-ART pregnancy but not live birth among non-ART pregnancies.\u0026nbsp;ART might be advisable to women with an EFI score \u0026lt;4 immediately after surgery and to women who have not achieved non-ART pregnancy after 12 months despite a high EFI.\u003c/p\u003e","manuscriptTitle":"Use of endometriosis fertility index to predict non-ART pregnancy and live birth after endometriosis surgery based on optimal stratification","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-05-08 14:30:22","doi":"10.21203/rs.3.rs-26020/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"98c4c69b-74ea-414e-8c89-90f2808f46c8","owner":[],"postedDate":"May 8th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":96032,"name":"Maternal \u0026 Fetal Medicine"}],"tags":[],"updatedAt":"2020-09-23T20:22:55+00:00","versionOfRecord":[],"versionCreatedAt":"2020-05-08 14:30:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-26020","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-26020","identity":"rs-26020","version":["v1"]},"buildId":"2u56kwukJI3zHK-uzyFNs","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}