Prediction of reproductive outcomes in patients with deep endometriosis after surgical treatment

Objective. To assess the prognostic significance of the endometriosis fertility index (EFI) for predicting the chances of pregnancy after surgical treatment for infiltrative endometriosis. Materials and methods. This was a prospective cohort study carried out at the Department of Operative Gynecology and General Surgery at the Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia (2018-2020). The study included 99 patients aged from 18 to 40 years with stage III-IV deep infiltrative endometriosis. All patients were divided into two groups: group I included patients who had deep endometriosis with colon lesions (n=63), group II - deep endometriosis without colon lesions (n=36). According to the objectives of the study, all patients were evaluated for the chances of pregnancy using EFI. The EFI parameters are presented in Table 1. Statistical analysis of the obtained data was carried out using the GraphPad Prism 9.0.0.121 software (USA). Results. The median EFI was 6 (3-10) in group I, and it was significantly lower than one in group II, namely, 7.5 (3-10), p=0.0037. There was a significant correlation between the EFI ratio and pregnancy (AUC=0.8049, p=0.0004). EFI was significantly higher in the group of patients who became pregnant compared to patients who did not get pregnant (7 versus 4, p=0.0002). Conclusion. The patients planning pregnancy after surgery for deep infiltrative endometriosis are recommended to determine the EFI index as the most effective prognostic marker of pregnancy after surgery. If the EFI index is less than 5, patients should be recommended to undergo assisted reproduction due to the low probability of spontaneous pregnancy. If the EFI index is equal to or more than 5, patients can be recommended to conceive spontaneously within a period of 18 months after the operation. After 18 months, there is a significant decrease in the chances of spontaneous pregnancy, and therefore patients should be advised to undergo assisted reproduction.

deep endometriosis, colorectal endometriosis, reproductive outcomes, infertility, fertility index