Predictive value of endometriosis fertility index in natural pregnancy outcome of patients with endometriosis and endometrial polyps after hysteroscopy combined with laparoscopic surgery

Objective To investigate the relationship of endometrial polyps (EPs) and endometriosis (EMS), and evaluate the predictive value of EMS fertility index (EFI) for women’s fertility with EMS combined with EPs. Methods A total of 248 infertile patients with EMS and EPs who underwent laparoscopic and hysteroscopic surgery were analyzed. The patients were divided into EPs group and non-EPs group. Then the pregnancy outcome was compared between the two groups. Results The incidence of EPs was 42.3%. The incidence of EPs in patients with moderate to severe EMS (stages III-IV) was slightly higher than that in mild patients (stages I-II), but there was no significant difference between the two groups (P>0.05). The higher the EFI score, the lower the proportion of patients with EPs in the same EFI score, the difference was statistically significant (P=0.000). The natural pregnancy rate (37.1%) and the live birth rate (27.6%) were lower in the EPs group than in the non-EPs group (57.3%, P=0.002; 48.3%, P=0.001). At the same EFI score, the pregnancy rate of the EPs group was lower than that of the non-EPs group, but there was no statistical difference (P>0.05). Within the EPs group and non-EPs group, the spontaneous pregnancy rate increased with increasing EFI score, the difference was statistically significant (P=0.00). Most of the patients got pregnant within 2 years after operation (96.7%). The EPs group had 35 pregnancies within 1 year, accounting for 89.7% of the total number of pregnancies, which was higher than that in the non-EPs group of 73.1%, the difference was statistically significant (P=0.038). Conclusion There was a higher incidence of EPs among infertile patients with EMS. Hysteroscopy combined with laparoscopic surgery can significantly improve fertility for patients with EMS and EPs. The best time for pregnancy was within 2 years after surgery. The value of EFI score for predicting pregnancy rate for women with EMS and EPs remains to be discussed. Key words: Endometriosis (EMS); Endometrial polyps (EPs); Infertility; Laparoscopy; Endometriosis fertility index (EFI)