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The Endometriosis fertility index can accurately predict the possibility
of non-ART conception or the need of ART for achieving pregnancy after surgical
resection of moderate-severe (Stage III–IV) endometriosis reports the results
of study published in Human Reproduction. The study confirmed that adnexal
function is deciding factor in evaluation of fertility prognosis after the
surgery.
There is no
evidence based guidelines about post-surgery fertility management of women who
have undergone surgery for severe endometriosis. Physicians differ in their
approach about the length of conservative treatment and that sometimes add years
and causes unnecessary delays.
The
researchers in this study from Australia, led by Dr. Sarah Maheux-Lacroix of
the Royal Hospital for Women in Randwick, looked into data of 279 women
who had undergone laparoscopic surgery for stage III-IV and were trying to
become pregnant.
Endometriosis fertility index was first published in 2010 and is a robust
tool to predict fertility after surgical staging of endometriosis.
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The EFI is combines
obstetrical and surgical factors to predict a woman’s chance of becoming
pregnant. In addition to all the components of the revised-American Society of
Reproductive Medicine score, it also includes a detailed evaluation of the
fallopian tubes, fimbriae, and ovaries, and accounts for any adnexal dysfunction
after surgery.
The researchers
calculated EFI for all these women based on detailed operative reports and
surgical images plus the obstetric history of women.
The average
follow-up was 4 years during which 147 women (63%) gave birth, of which 94
conceived naturally without ART.
None of the
women with EFI 0-2 conceived, while 91% women with EFI 9-10 had live births in
5 years period after surgery.
Similarly, women
with EFI 0-2 had a success rate of 38% with ART, while those with EFI 9-10 had
a success rate of 71%.
So, low EFI
was significant in predicting failure to conceive (P = 0.003) in
addition to other factors which adversely affected the pregnancy rates like
being older than 40 years (P = 0.027), having uterine fibroids (P = 0.037) and
history of previous resection (P = 0.019) or incomplete resection (P =
0.028).
The only drawback of the study was its retrospective nature.
The
researchers concluded that the tool can be used to predict the fertility
prognosis in women after surgery for endometriosis. Depending on the EFI score,
the obstetrician can advise patients about timed intercourse or refer the patients
for ART, without wasting precious years.
