The impact of endometriosis fertility index in daily practice

Abstract

Introduction. Endometriosis has a current theme today, as its frequency increases with the technical progress and with the improvement of living conditions of the last decades, becoming a medical emergency with sophisticated behavior and serious consequences for women of reproductive age. Aim of the study. To evaluate the postoperative fertility management using the endometriosis fertility index (EFI). Materials and methods. This prospective non-interventional observational study was performed from January 2017 to February 2019 in IMSP SCMNr. 1, an university hospital. In total, 123 patients underwent laparoscopic surgery for endometriosis and infertility. Indications for surgery included pelvic pain (dysmenorrhoea, and/or deep dyspareunia), abnormal hysterosalpingogram, and failure to conceive after three or more ovulation cycles. Multidisciplinary fertility management followed the surgical diagnosis and treatment of endometriosis. Three postoperative groups were established based on the EFI score: EFI score ≤4, ART (Group 1); EFI score 5-6, non-ART management for 4-6 months followed by ART (Group 2); or EFI score ≥7, non-ART management for 6-9 months followed by ART (Group 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. Results. The cumulative pregnancy rate was 72%. The total number of women and pregnancy rates for Group 1, 2 and 3 were: 20 and 16.6 %; 42 and 34.14 %; and 61 and 49,59%, respectively. The non-ART pregnancy rates for Group 1, 2 and 3 were 0%, 29.5% and 48.2%, respectively. The ART pregnancy rates for Goup were 50%, 60.6% and 80.3%, respectively. The mean time to conceive for non-ART pregnancies was 3.8 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 . Conclusions. In daily practice, the EFI represents a useful tool for postoperative fertility management in infertile patients with endometriosis.