Magnetic Resonance Imaging as a Non-Surgical Predictor of Endometriosis Fertility Index Surgical Factors

Hisanori Komatsu, Mitsuo Uchida, Yuko Hasegawa, Yumiko Tsukui, Mio Kobayashi, Hikaru Hiraishi, Yoshikazu Kitahara, Akira Iwase
Journal of Obstetrics and Gynaecology Research · 2026 · vol. 52(4) , pp. e70275 · doi:10.1111/jog.70275 · PMID:41956902
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Abnormal follicle location on preoperative MRI correlated with lower endometriosis fertility index surgical factor scores, suggesting MRI can non-invasively predict these surgical factors.

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

This retrospective study evaluated whether preoperative magnetic resonance imaging (MRI) findings could predict the endometriosis fertility index (EFI) surgical factor scores without using operative findings in 34 women (18–43 years) undergoing laparoscopic ovarian cystectomy at Gunma University Hospital (2018–2022). Surgical videos were used to calculate EFI, and logistic regression tested associations between MRI features (ovarian cyst shape, ovarian position, and follicle location) and EFI surgical factor scores. Abnormal follicle location on MRI significantly correlated with lower EFI surgical factor scores, while cyst shape and ovarian position were not significantly associated; the study’s key limitation was its small sample size and that data were not publicly available due to privacy/ethical restrictions. This paper is centrally about endometriosis — it assesses MRI-based prediction of EFI surgical factors for endometriosis-related fertility outcomes.

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Abstract

AIM: Endometriosis affects 6%-10% of women of reproductive age and is associated with chronic pelvic pain, infertility, and impaired quality of life. The endometriosis fertility index (EFI) predicts spontaneous pregnancy postoperatively, but requires operative findings, limiting its use in non-surgical cases. This study evaluated whether magnetic resonance imaging (MRI) could serve as an alternative to EFI. METHODS: This retrospective study included 34 women aged 18-43 years who underwent laparoscopic ovarian cystectomy at Gunma University Hospital (2018-2022). Surgical videos were reviewed to calculate EFI. Preoperative MRI findings were assessed using ovarian cyst shape, ovarian position, and follicle location. MRI indicators were compared with EFI surgical factor scores using logistic regression. RESULTS: The mean EFI was 5.7 ± 1.8. Abnormal follicle location on MRI significantly correlated with lower EFI surgical factor scores (p < 0.05), whereas cyst shape and ovarian position showed no significant associations. Postoperatively, six women conceived spontaneously, and three conceived through assisted reproductive technology (ART). CONCLUSION: Abnormal follicle location may noninvasively predict surgical factors for EFI. Considering that MRI is routinely performed preoperatively in Japan, MRI-based EFI prediction can be used as a supporting finding to assist in determining whether to proceed with ART without surgical intervention.
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Abstract

Aim Endometriosis affects 6%–10% of women of reproductive age and is associated with chronic pelvic pain, infertility, and impaired quality of life. The endometriosis fertility index (EFI) predicts spontaneous pregnancy postoperatively, but requires operative findings, limiting its use in non-surgical cases. This study evaluated whether magnetic resonance imaging (MRI) could serve as an alternative to EFI.

Methods

This retrospective study included 34 women aged 18–43 years who underwent laparoscopic ovarian cystectomy at Gunma University Hospital (2018–2022). Surgical videos were reviewed to calculate EFI. Preoperative MRI findings were assessed using ovarian cyst shape, ovarian position, and follicle location. MRI indicators were compared with EFI surgical factor scores using logistic regression.

Results

The mean EFI was 5.7 ± 1.8. Abnormal follicle location on MRI significantly correlated with lower EFI surgical factor scores (p < 0.05), whereas cyst shape and ovarian position showed no significant associations. Postoperatively, six women conceived spontaneously, and three conceived through assisted reproductive technology (ART).

Conclusion

Abnormal follicle location may noninvasively predict surgical factors for EFI. Considering that MRI is routinely performed preoperatively in Japan, MRI-based EFI prediction can be used as a supporting finding to assist in determining whether to proceed with ART without surgical intervention. Disclosure An earlier version of this article was presented at the following conferences: the 46th Annual Meeting of the Japan Society of Endometriosis, Otsu, Japan, Jan 25–26, 2025. Conflicts of Interest The authors declare no conflicts of interest. Data Availability Statement The data are not publicly accessible due to privacy and ethical restrictions. Although the raw data analyzed in this study have been anonymized, we did not obtain participant consent for public sharing, and ethics committee approval for public disclosure was not granted. However, the corresponding author may provide access to the data upon a reasonable request, subject to the oversight of the ethics committee.

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Condition tags

endometriosischronic_pelvic_paininfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Infertility, Female Infertility, Female Infertility, Female

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