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

Fessy Louis T., Deepa Naveen, Pooja Ramesh, Parasuram Gopinath, K. K. Gopinathan
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(6) , pp. 2363 · doi:10.18203/2320-1770.ijrcog20192431 · W2946842522
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-07 ⓘ

This study found that the Endometriosis Fertility Index (EFI) score accurately predicts non-IVF conception rates in patients undergoing endometriosis surgery, with higher EFI scores correlating to significantly higher pregnancy rates.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective study evaluated 77 participants with surgically documented endometriosis who underwent laparoscopy with documented least function (LF) scores and endometriosis fertility index (EFI) scores, and were followed for up to 12 months to assess non-IVF pregnancy outcomes. Pregnancy rates were higher in those with higher EFI scores, with EFI 5 (11.54% vs 50.1%; p=0.001), and pregnancy rates were also lower among LF scores 1–3 (21.2%) versus higher LF scores (p=0.029); sensitivity analysis additionally showed higher EFI associated with higher LF score (P<0.001). The paper’s main limitation is its retrospective design and the reliance on prognostic scoring derived from surgical documentation, without prospective validation. This paper is centrally about endometriosis — it assesses whether the EFI system predicts non-IVF conception after endometriosis surgery in surgically documented patients.

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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.
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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. Metrics

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.

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