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

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 219; pp. 28 - 34
• Main Authors: Boujenah, J., Cedrin-Durnerin, I., Herbemont, C., Bricou, A., Sifer, C., Poncelet, C.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-12-2017
• Subjects: Adult; Endometriosis - complications; Endometriosis fertility index; Female; Fertility management; Humans; Infertility, Female - etiology; Pregnancy; Pregnancy Rate; Prospective Studies; Severity of Illness Index; Spontaneous pregnancy; Surgery; Spontaneous pregnancy; ART; Surgery; Fertility management; Endometriosis fertility index
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2017.10.001

To perform a prospective evaluation of postoperative fertility management using the endometriosis fertility index (EFI).
This 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.
The 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).
In daily prospective practice, the EFI was useful for subsequent postoperative fertility management in infertile patients with endometriosis.