Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis.

Qingxue Zhang,Nengyong Ouyang,Tingfeng Fang,Liangan Wang,Dongzi Yang,Wenjun Wang,Ruiqi Li,Lili Huang

doi:10.1186/1477-7827-11-112

Abstract

BackgroundEndometriosis is a common disease. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis.Methods199 women with endometriosis receiving IVF treatment after surgery were analysis. The EFI score and r-AFS classification in their ability to predict these IVF outcomes were compared in the same population. ROC curves were used to analyse the predictive values of the EFI and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and the Youden’s index.ResultsThe Area Under the Curve (AUC) of the EFI score (AUC = 0.641, Standard Error(SE) = 0.039, P = 0.001, 95% CI = 0.564-0.717, cut-off score = 6) was significantly larger than that of the r-AFS classification (AUC = 0.445, SE = 0.041, P = 0.184, and 95% CI = 0.364-0.526). The antral follicle count, oestradiol level on day of hCG, number of oocytes retrieved, number of oocytes fertilised, and number of cleaved embryos in the greater than or equal to 6 EFI score group was greater than that of the lower than or equal to 5 EFI score group, and the dose of gonadotropin of the greater than or equal to 6 EFI score group were less than that in the lower than or equal to 5 EFI score group. Implantation rate, clinical pregnancy rate, and cumulative pregnancy rate in the greater than or equal to 6 EFI score group were higher than in the lower than or equal to 5 EFI score group.ConclusionsIt suggests that the EFI has more predictive power for IVF outcomes in endometriosis patients than the r-AFS classification. The clinical pregnancy rate was higher in patients with EFI greater than or equal to 6 score than with EFI lower than or equal to 5 score.

Highlights

Adamson and Pasta suggested that the Revised American Fertility Society (r-AFS) classification depends mainly on morphological descriptions [6], whereas Vercellini et al observed no association between the endometriosis stage or lesion type and lesion site and the cumulative probability of pregnancy [7]
ROC curves were used to analyse the predictive values of the endometriosis fertility index (EFI) and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and Youden’s index
Our results show that there was no statistical difference between the implantation rate and the pregnancy rate in patients with different stages of endometriosis, consistent with the above study

Summary

Introduction

The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) [4,5]. The r-AFS classification is used to predict the recurrence potential of endometriosis after surgery. It has limited predictive ability for pregnancy after surgery. Adamson and Pasta suggested that the r-AFS classification depends mainly on morphological descriptions [6], whereas Vercellini et al observed no association between the endometriosis stage or lesion type and lesion site and the cumulative probability of pregnancy [7]

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