Pregnancy rates can be predicted by validated endometriosis fertility index (EFI)

Abstract

Objective: To develop a clinical tool that predicts an infertile endometriosis patient’s probability of pregnancy following surgical staging.Design: Prospectively collected data, prospectively validated EFI.Materials/Methods: Initially, prospectively collected detailed clinical and surgical data on 579 consecutive infertile endometriosis patients were analyzed by sophisticated analysis. Surgical findings that predict pregnancy rates were identified and quantitatively aggregated to develop a “Least Function Score”. This was combined with statistically identified elements of the AFS endometriosis score and historical factors that predicted pregnancy rates to create an Endometriosis Fertility Index (EFI). After developing the EFI, the same data were prospectively collected on 436 additional consecutive patients, the EFI calculated on each patient, and pregnancy rates predicted prospectively. The data were then analyzed to determine the validity of the EFI in predicting pregnancy rates prospectively in these 436 patients. The final EFI and associated pregnancy rates were subsequently derived from the total of 1,015 patients.Results: The EFI ranges from 0 to 10 with 0 representing the poorest prognosis and 10 the best prognosis (Table A). The estimated cumulative percent pregnant based on the EFI score demonstrates the utility of the EFI (Figure). Results of correlation analysis showed a good correlation of predicted and actual outcomes in the prospectively validated patients for all stages of endometriosis. Table AEndometriosis fertility index (EFI).Historical factorsSurgical factorsPointsDescriptionPointsDescription2If age is ≤35 years3If LF score = 7–8 (high score)1If age is 36–39 years2If LF score = 4–6 (moderate score)0If age is ≥40 years0If LF score = 1–3 (low score)2If years infertile is ≤31If AFS endometriosis lesion score <160If years infertile is >30If AFS endometriosis lesion score ≥161If there is a history of prior pregnancy1If AFS total score <710If there is no history of prior pregnancy0If AFS total score ≥71 Open table in a new tab Conclusions: The EFI is a simple, robust and validated clinical tool that predicts pregnancy rates for patients following surgical staging of endometriosis. The EFI is very useful in developing treatment plans in infertile endometriosis patients.Supported By: No support. Objective: To develop a clinical tool that predicts an infertile endometriosis patient’s probability of pregnancy following surgical staging. Design: Prospectively collected data, prospectively validated EFI. Materials/Methods: Initially, prospectively collected detailed clinical and surgical data on 579 consecutive infertile endometriosis patients were analyzed by sophisticated analysis. Surgical findings that predict pregnancy rates were identified and quantitatively aggregated to develop a “Least Function Score”. This was combined with statistically identified elements of the AFS endometriosis score and historical factors that predicted pregnancy rates to create an Endometriosis Fertility Index (EFI). After developing the EFI, the same data were prospectively collected on 436 additional consecutive patients, the EFI calculated on each patient, and pregnancy rates predicted prospectively. The data were then analyzed to determine the validity of the EFI in predicting pregnancy rates prospectively in these 436 patients. The final EFI and associated pregnancy rates were subsequently derived from the total of 1,015 patients. Results: The EFI ranges from 0 to 10 with 0 representing the poorest prognosis and 10 the best prognosis (Table A). The estimated cumulative percent pregnant based on the EFI score demonstrates the utility of the EFI (Figure). Results of correlation analysis showed a good correlation of predicted and actual outcomes in the prospectively validated patients for all stages of endometriosis. Conclusions: The EFI is a simple, robust and validated clinical tool that predicts pregnancy rates for patients following surgical staging of endometriosis. The EFI is very useful in developing treatment plans in infertile endometriosis patients. Supported By: No support.