Fragility Index Assessment of Randomised Trials Informing Endometriosis Management Guidance

Yael Yagur, Horesh N, Nir Horesh, Levin G, Gabriel Levin, Meyer R, Raanan Meyer
BJOG: An International Journal of Obstetrics & Gynaecology · 2026 · vol. 133(6) , pp. 1300–1302 · doi:10.1111/1471-0528.70185 · PMID:41689241
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This paper assessed the fragility index of randomized trials included in endometriosis management guidance documents to evaluate the robustness of the evidence supporting these recommendations.

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This paper evaluates the robustness of randomized controlled trial findings that inform endometriosis management guidance by applying a fragility index assessment, comparing how many outcome events would need to change for statistical significance to be lost. It presents fragility index values alongside the number of patients lost to follow-up across medical-intervention RCTs (figure S2) and surgical-intervention RCTs (figure S3). The key caveat explicitly suggested by this approach is that statistical significance in trials may be sensitive to small numbers of events and attrition, so fragility provides a measure of result stability rather than clinical efficacy. This paper is centrally about endometriosis — it assesses the fragility of RCT evidence underlying endometriosis management guidance.

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Yagur, Y., Horesh, N., Levin, G. and Meyer, R. (2026), Fragility Index Assessment of Randomised Trials Informing Endometriosis Management Guidance. BJOG, 133: 1300-1302. https://doi.org/10.1111/1471-0528.70185 Figure S2: Fragility Index values and number of patients lost to follow-up across randomised controlled trials of medical interventions for endometriosis. Figure S3: Fragility Index values and number of patients lost to follow-up across randomised controlled trials of surgical interventions for endometriosis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. References 1M. Hirsch, M. R. Begum, É. Paniz, C. Barker, C. J. Davis, and J. M. N. Duffy, “Diagnosis and Management of Endometriosis: A Systematic Review of International and National Guidelines,” BJOG: An International Journal of Obstetrics & Gynaecology125 (2018): 556–564, https://doi.org/10.1111/1471-0528.14838. 2Y. Cheong, “How Good Are the Current Guidelines on Endometriosis?,” BJOG: An International Journal of Obstetrics & Gynaecology125 (2018): 565, https://doi.org/10.1111/1471-0528.14963. 3M. Walsh, S. K. Srinathan, D. F. McAuley, et al., “The Statistical Significance of Randomized Controlled Trial Results Is Frequently Fragile: A Case for a Fragility Index,” Journal of Clinical Epidemiology67 (2014): 622–628, https://doi.org/10.1016/j.jclinepi.2013.10.019. 5L. Lin, A. Xing, H. Chu, et al., “Assessing the Robustness of Results From Clinical Trials and Meta-Analyses With the Fragility Index,” American Journal of Obstetrics and Gynecology228 (2023): 276–282, https://doi.org/10.1016/j.ajog.2022.08.053. 6E. Pascoal, M. Liu, L. Lin, and L. Luketic, “The Fragility of Statistically Significant Results in Gynaecologic Surgery: A Systematic Review,” Journal of Obstetrics and Gynaecology Canada = Journal d'Obstétrique et Gynécologie du Canada44 (2022): 508–514, https://doi.org/10.1016/j.jogc.2021.11.016. 7N. Horesh, J. Dourado, P. Rogers, et al., “Fragility Index Analysis for Robustness of Evidence in Randomized Controlled Trials in National Comprehensive Cancer Network (NCCN) Guidelines for Rectal Cancer,” International Journal of Cancer157 (2025): 1864–1875, https://doi.org/10.1002/ijc.35521. Total unique accesses to an article’s full text in HTML or PDF/ePDF format.More metric information Scite metrics Explore this article's citation statements on scite.ai Share QR Code Generating QR code QR code copied to clipboard! Something went wrong while generating your QR code. Please try again in a moment. If the issue persists, refresh the page or contact support. Export citation Unable to load citation data. Please try again in a moment. How to cite Elkins, L. J., & Spiegelman, M. (2021). pyUserCalc: A revised Jupyter notebook calculator for uranium-series disequilibria in basalts. Earth and Space Science, 8, e2020EA001619. https://doi.org/10.1029/2020EA001619 How to cite text copied to clipboard! Download Citation If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click on download. This feature enables you to download the bibliographic information (also called citation data, header data, or metadata) for the articles on our site. Citation manager file format Use the dropdown list to choose how to format the bibliographic data you're harvesting. Several citation manager formats are available, including EndNote and BibTex. You can then copy the formatted citation (as displayed) or download it as file, to your device. If the RefWorks format is chosen, the 'Download' button will be replaced with an option to directly export to RefWorks Please check your email for instructions on resetting your password. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. Request Username Can't sign in? Forgot your username? Enter your email address below and we will send you your username If the address matches an existing account you will receive an email with instructions to retrieve your username

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