Objective: To assess predictors of non-IVF live births after surgical management of severe endometriosis and provide external validation of the Endometriosis Fertility Index (EFI).
Design: Prospective observational study of 141 consecutive women who attempted to conceive after undergoing a fertility-preserving laparoscopic excision of stage III-IV endometriosis according to the American Society for Reproductive Medicine (ASRM) classification system (ethics approval ref.:09/120).
Materials and methods: Detailed operative reports and telephone follow-up were used to assess fertility outcomes and EFI score based on women’s age, duration of infertility, previous pregnancy, least adnexal function score, and ASRM endometriosis and total score (maximum=10 points). Cox proportional hazards regression were used to identify predictive factors of live births.
Results: Mean participants’ age was 33 years old with 35% having stage III and 65% stage IV endometriosis. Resection of endometrioma and bowel resection occurred in 47% and 4% of cases, respectively. Fifty-eight percent of participants had previously undergone a laparoscopy and 60% had a history of infertility. Median follow-up was 55 months. Cumulative non-IVF-live-birth rate was 45% and strongly associated with the EFI score (score 9-10: 68%, score 7-8: 54%, score 5-6: 24%, score 3-4: 11%, score 0-2: 0%, p<.001). Other factors positively associated with occurrence of live births were complete resection of disease (HR=2.33, p=.036) and no previous laparoscopy (HR=2.36, p<.001).
Conclusion: EFI is a reliable clinical tool to predict non-IVF conception after laparoscopic removal of severe endometriosis. First surgery and complete resection of endometriosis offer the best chance of success.