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HomeEndometriosisEndometriosis ResearchEstimation of the Endometriosis Fertility Index prior to operative laparoscopy

Estimation of the Endometriosis Fertility Index prior to operative laparoscopy

Endometriosis is still a poorly understood disease. At G.O. Institute we are constantly looking for the most updated information regarding endometriosis treatment. This is a very recent article which we hope will help you understand at least this part of endo treatment.

If this article seems to apply to your situation, please contact us and Dr. Steven Vasilev, our director. Since we are monitoring this research as it gets published, we can apply it to help you beat endo and get your life back.  Dr. Steven Vasilev is an uber expert in robotic endo excision surgery, especially in recurrent or advanced cases.  See the TRANSLATION below for our thoughts.

Hum Reprod. 2020 Dec 26:deaa346. doi: 10.1093/humrep/deaa346. Online ahead of print.


STUDY QUESTION: Can the Endometriosis Fertility Index (EFI) be estimated accurately before surgery?

SUMMARY ANSWER: The EFI can be estimated accurately based on mere clinical/ultrasound information, with some improvement after adding data from diagnostic laparoscopy.

WHAT IS KNOWN ALREADY: The EFI is a validated clinical instrument predicting the probability of pregnancy after endometriosis surgery without the use of ART. Being an end-of-surgery-score, it implies the decision for operative laparoscopy to be made in advance-hence, its role in the pre-surgical decision-making process remains to be established.

STUDY DESIGN, SIZE, DURATION: Single-cohort prospective observational study in 82 patients undergoing complete endometriosis excision (between June and December 2016). Two methods were used to estimate the final EFI: type A based on non-surgical clinical/ultrasound findings only, and type B based on the combination of non-surgical clinical/ultrasound findings and diagnostic laparoscopy data. To calculate EFI type A, an algorithm was created to translate non-surgical clinical/imaging information into rASRM (revised American Society of Reproductive Medicine)-and EFI points. EFI type A and type B estimates were assessed for their clinical and numerical agreement with the final EFI score. Agreement was defined as clinical if EFI scores were within the same range (0-4, 5-6, 7-10), and numerical if their difference was ≤1.

PARTICIPANTS/MATERIALS, SETTING, METHODS: All 82 patients underwent complete laparoscopic CO2-laser excision of any rASRM stage of endometriosis in the Leuven University Fertility Centre (LUFC) of University Hospitals Leuven, a tertiary referral centre for both endometriosis and infertility. An anonymized clinical research file was created. For each patient, three different data sets were created, in order to allow the estimation of the (surgical part) EFI and of the rASRM scores, defined as follows: ‘Estimated type A’ contained only non-surgical clinical/imaging data, ‘Estimated type B’ included type A information plus the information of the diagnostic laparoscopy and ‘Final EFI’ included information of type A, type B and all intra-operative information required to calculate the final EFI. To calculate EFI type A without surgical information, a set of rules was used to translate pre-surgical clinical/imaging information into (rASRM and EFI points). Scoring was done by one person (C.T.), with a time interval of 4 weeks between sessions for each EFI type. Next to the EFI, also rASRM score and stage were calculated.

MAIN RESULTS AND THE ROLE OF CHANCE: Agreement rate between estimated EFI type A and final EFI was high for both the clinical (0.915; 95% CI 0.832-0.965) and numerical definition (0.878; 95% CI 0.787-0.940). Agreement rates between estimated EFI type B and final EFI were even higher (clinical (0.988; 95% CI 0.934-1.000), numerical (0.963; 95% CI 0.897-0.992)).

TRIAL REGISTRATION NUMBER: study registration number at UZ Leuven Clinical Trial Centre: S59221.

PMID:33367865 | DOI:10.1093/humrep/deaa346

C Tomassetti

TRANSLATION: If fertility is the main motivating factor of endo excision surgery for you, then it is crucial to speak with an infertility specialist.  Sometimes that may be a general gynecologist that does a lot of advanced infertility.  But usually it is best to get a consult with a Reproductive Endocrinologist (a subspecialist in ObGyn), who will look at all factors and the probability of getting pregnant and taking a baby home, with and without the use of advanced technologies like IVF (in vitro fertilization).  IVF is extremely expensive for most, so knowing what is possible is crucial in determining when or if to go for surgery.

This book by Dr. Steven Vasilev MD can help women with ovarian cysts, masses and tumors of all types, including endometriosis and endometriomas.  He is a world-renowned expert on this topic.

To discover more about endometriosis and our unique treatment approach, please READ THIS


Dr Steve Vasilev MD
“I help and guide women to defeat gynecologic cancers and advanced pelvic conditions such as endometriosis, using a unique combination of minimally invasive robotic surgery, precision medicine therapies and complementary holistic natural support towards thriving in survivorship." Dr. Vasilev is the only physician quadruple board certified in Ob-Gyn, Gynecologic Oncology and Integrative & Holistic Medicine in the United States. He is an accomplished advanced robotic surgeon and serves as Medical Director of Integrative Medicine and Integrative Gynecologic Oncology at Providence Saint John's Health Center, Professor at John Wayne Cancer Institute in Santa Monica, California and is Clinical Professor at Loma Linda University School of Medicine. He is former faculty and professor at UC Irvine, UCLA, USC and City of Hope. He is an active member of multiple medical societies and has been nationally listed in "Best Doctors" for 18 years.

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