Endometriosis Fertility Index for Predicting Pregnancy after Endometriosis Surgery.

The endometriosis fertility index (EFI) has a predictive value for pregnancy after surgery. In vitro fertilization and embryo transfer (IVF-ET) is a good treatment to infertility. This study aimed to provide external validation of EFI, assess the factors affecting the ability of EFI to predict cumulative spontaneous pregnancy rates (PRs), and propose reasonable advice for treatment by evaluating the effect of infertility management combining surgery and IVF-ET. This retrospective study enrolled 345 endometriosis-related infertile women after laparoscopic surgery from January 2012 to January 2016. Among them, 234 patients tried to conceive naturally and were divided into six groups according to their different EFI scores. Of the 345 patients, 307 with an EFI score ≥5 were divided into non-IVF-ET group (n = 209) and IVE-ET group (n = 98) to compare the cumulative PRs. Cumulative PRs’ curves were calculated using the Kaplan-Meier product limit estimate and the differences were evaluated by log-rank test. Independent predictive factors for pregnancy were assessed using the Cox regression model. Significant differences in spontaneous PRs among different EFI scores were identified (χ2 = 29.945, P < 0.05). The least function score was proved to be the most important factor for EFI (χ2 = 6.931, P < 0.05) staging system. In patients with an EFI score ≥5 after 12 months from surgery, the cumulative PRs of those who received both surgery and IVF-ET were much higher than the spontaneous PRs of those who received surgery alone (χ2 = 4.160, P = 0.041). The EFI is a reliable staging system to predict the spontaneous PR of patients. The least function score was the most influential factor to predict the spontaneous PR. Patients with an EFI score ≥5 after 12 months from surgery are recommended to receive IVF-ET to achieve a higher PR.

子宫内膜异位症生育指数（EFI）对手术后的妊娠有预测价值。体外受精 - 胚胎移植（IVF - ET）是治疗不孕症的一种良好方法。本研究旨在对EFI进行外部验证，评估影响EFI预测累计自然妊娠率（PRs）能力的因素，并通过评估手术与IVF - ET联合治疗不孕症的效果为治疗提出合理建议。 这项回顾性研究纳入了2012年1月至2016年1月期间345例腹腔镜手术后与子宫内膜异位症相关的不孕女性。其中，234例患者尝试自然受孕，并根据其不同的EFI评分分为6组。在345例患者中，EFI评分≥5的307例患者被分为非IVF - ET组（n = 209）和IVE - ET组（n = 98）以比较累计妊娠率。使用Kaplan - Meier乘积极限估计法计算累计妊娠率曲线，并通过对数秩检验评估差异。使用Cox回归模型评估妊娠的独立预测因素。 不同EFI评分之间的自然妊娠率存在显著差异（χ² = 29.945，P < 0.05）。最小功能评分被证明是EFI（χ² = 6.931，P < 0.05）分期系统中最重要的因素。在手术后12个月EFI评分≥5的患者中，接受手术和IVF - ET治疗的患者累计妊娠率远高于仅接受手术治疗的患者的自然妊娠率（χ² = 4.160，P = 0.041）。 EFI是一种可靠的分期系统，可用于预测患者的自然妊娠率。最小功能评分是预测自然妊娠率最具影响力的因素。建议手术后12个月EFI评分≥5的患者接受IVF - ET以获得更高的妊娠率。