Use of the endometriosis fertility index in daily practice: A prospective evaluation

Boujenah J, J. Boujenah, Isabelle Cédrin‐Durnerin, Cedrin-Durnerin I, I Cedrin-Durnerin, C. Herbemont, Herbemont C, A Bricou, Alexandre Bricou, Bricou A, Sifer C, C. Sifer, Poncelet C, C. Poncelet
European journal of obstetrics, gynecology, and reproductive biology · 2017 · vol. 219 , pp. 28–34 · doi:10.1016/j.ejogrb.2017.10.001 · PMID:29035799 · W2764118624
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This prospective study evaluated the utility of the Endometriosis Fertility Index in predicting pregnancy outcomes for women undergoing fertility treatments.

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Abstract

ObjectiveTo perform a prospective evaluation of postoperative fertility management using the endometriosis fertility index (EFI).StudyThis prospective non-interventional observational study was performed from January 2013 to February 2016 in a tertiary care university hospital and an assisted reproductive technology (ART) centre. In total, 196 patients underwent laparoscopic surgery for endometriosis-related infertility. Indications for surgery included pelvic pain (dysmenorrhoea, and/or deep dyspareunia), abnormal hysterosalpingogram, and failure to conceive after three or more superovulation cycles with or without intra-uterine insemination. Multidisciplinary fertility management followed the surgical diagnosis and treatment of endometriosis. Three postoperative options were proposed to couples based on the EFI score: EFI score ≤4, ART (Option 1); EFI score 5-6, non-ART management for 4-6 months followed by ART (Option 2); or EFI score ≥7, non-ART management for 6-9 months followed by ART (Option 3). The main outcomes were non-ART pregnancy rates and cumulative pregnancy rates according to EFI score. Univariate and multivariate analyses with backward stepwise logistic regression were used to explain the occurrence of non-ART pregnancy after surgery for women with EFI scores ≥5. Adjustment was made for potential confounding variables that were significant (p<0.05) or tending towards significance (p<0.1) on univariate analysis.ResultsThe cumulative pregnancy rate was 76%. The total number of women and pregnancy rates for Options 1, 2 and 3 were: 26 and 42.3%; 56 and 67.9%; and 114 and 87.7%, respectively. The non-ART pregnancy rates for Options 1, 2 and 3 were 0%, 30.5% and 48.2%, respectively. The ART pregnancy rates for Options 1, 2 and 3 were 50%, 60.6% and 80.3%, respectively. The mean time to conceive for non-ART pregnancies was 4.2 months. The benefit of ART was inversely correlated with the mean EFI score. On multivariate analysis, the EFI score was significantly associated with non-ART pregnancy (odds ratio 1.629, 95% confidence interval 1.235-2.150).ConclusionIn daily prospective practice, the EFI was useful for subsequent postoperative fertility management in infertile patients with endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Infertility, Female Severity of Illness Index Adult Endometriosis Female Humans Infertility, Female Pregnancy Pregnancy Rate Prospective Studies

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