Fertility index after surgical treatment of endometriosis as a predictor of pregnancy

A. A. Ivshin, O. O. Pogodin
In: Meditsinskiy sovet = Medical Council · 2026 · pp. 168–177 · doi:10.21518/ms2025-555 · W7127448867
article OA: diamond CC0
🔓 Open OA copy View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

The Endometriosis Fertility Index (EFI) predicts pregnancy rates after endometriosis surgery better than the rAFS/ASRM classification, guiding individualized fertility management.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-06 ⓘ

The paper studies the prognostic value of the Endometriosis Fertility Index (EFI) after surgical treatment for endometriosis-associated infertility, aiming to develop and justify a clinical decision algorithm for choosing between expectant management, intrauterine insemination, or assisted reproductive technologies. Using a methodical article approach with literature searches in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, Google Scholar, and eLIBRARY.ru, the authors identified 21 studies for qualitative analysis and relied on one published meta-analysis for quantitative synthesis. They report a gradient in pregnancy probability over 36 months: cumulative pregnancy increases from about 10% for EFI 0–2 to about 60–70% for EFI 9–10, with EFI outperforming rAFS/ASRM staging for discrimination (AUC roughly 0.64–0.85; combined about 0.71). A major limitation is that the quantitative conclusions are based on a single included meta-analysis, and the algorithmic proposal is not itself validated within new patient data. This paper is centrally about endometriosis — it focuses on using the EFI to predict pregnancy after endometriosis surgery and to guide post-surgical fertility management choices.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Introduction. Endometriosis is a common pelvic disorder and is frequently associated with infertility. The rAFS/ASRM classification reflects the anatomic extent of disease but has limited ability to predict subsequent pregnancy. Aim. To develop and substantiate a clinical decision algorithm for infertility management (expectant management, intrauterine insemination, and assisted reproductive technologies [ART]) based on contemporary clinical evidence on the development and prognostic value of the Endometriosis Fertility Index (EFI). Materials and methods. This work was designed as a methodological paper with elements of an analytical literature review, drawing on original studies and a published systematic review/meta-analysis on EFI. The search strategy covered PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, Google Scholar, and eLIBRARY.ru (through December 2024). Search terms were: (“Endometriosis Fertility Index” OR EFI OR Adamson) AND endometriosis AND (infertility OR subfertility) AND (laparoscopy OR surgery) AND (pregnancy OR non-ART). A total of 312 records were identified; after removal of 54 duplicates, 258 remained; 48 full-text articles were assessed; 27 were excluded (no EFI and/or outcome data, review/case report, insufficient data); 21 studies were included in the qualitative analysis. Quantitative synthesis: one published meta-analysis was used. Results. EFI demonstrates a prognostic gradient: the cumulative pregnancy rate within 36 months increases from ~10% for EFI 0–2 to ~60–70% for EFI 9–10 and outperforms rAFS/ASRM in outcome discrimination (AUC 0.64–0.85; pooled ~0.71). Conclusions. EFI is a practical tool for fertility stratification after surgical treatment of endometriosis; the proposed algorithm supports individualized selection of management strategies. A total of 18 and 23 sources were used to substantiate the Introduction and Discussion, respectively (39 overall).

My notes (saved in your browser only)

Condition tags

endometriosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (36)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK