Fertility performance and the predictive value of the endometriosis fertility index staging system in women with recurrent endometriosis: A retrospective study

Abstract

This study presents the postoperative pregnancy rate of women with recurrent endometriosis and evaluates the predictive value of the endometriosis fertility index (EFI) for the pregnancy.A total of 107 women who wished to conceive after surgery for recurrent endometriosis from January 2007 to December 2016 were included. The EFI score was calculated postoperatively. The receiver operator characteristic (ROC) curve was plotted to determine the most promising contributor to predicting pregnancy, and Kaplan-Meier (K-M) analysis was used to estimate the cumulative pregnancy rate (CPR).A total of 61 pregnancies were registered in 58 women and the remaining 49 patients failed to become pregnant. The EFI score was strongly associated with the postoperative fertility prognosis. The CPRs during the first 2 and 3 years postoperatively were 51.86% and 66.38%, respectively, and increased to 71.98% within the first 5 years postoperatively in patients with EFI scores ≥5. However, the CPR was 26.00% during the first 2 years after surgery in individuals with EFI scores <5, and there was no increase in the CRP thereafter.Women suffering from recurrent endometriosis still experienced a probability of natural pregnancy, especially patients with EFI scores ≥5. The EFI score had good predictive power for postoperative pregnancy in these patients.

Figure 1

A. AUC of the AFS endometriosis score = .601 (95% CI .49–.71), Std. Error = .06, P = .07; B. AUC of the AFS total score = .60 (95% CI .49–.71), Std. Error = .06, P = .07; C. AUC of the least function score = .665 (95% CI .56–.77), Std. Error = 0.05, P = .003; D. AUC of the endometriosis fertility index (EFI) score = .80 (95% CI 0.72–0.89), Std. Error = 0.04, P < .001. AFS = American Fertility Society, AUC = Area under the curves.

Figure 2

The Kaplan–Meier analysis showed that the cumulative pregnancy rate was statistically significantly different between the EFI ≥ 5 group and the EFI < 5 group (Gehan-Breslow-Wilcoxon test, X² = 8.65, 95% CI 1.57–4.74, P = .003). EFI =Endometriosis fertility index.