Modified endometriosis fertility index is more accurate to predict the non-ART pregnancy rate following surgery: a cohor
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GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE
Modified endometriosis fertility index is more accurate to predict the non‑ART pregnancy rate following surgery: a cohort of Chinese women Jiaying Fan1 · Kang Qin2 · Kuanrong Li2 · Xiaojun Li2 · Qingsheng Huang2 · Yunsheng Liao1 · Huiying Liang2 · Jingying Xie1 · Yan Yang1 · Qingfeng Li1 Received: 14 June 2020 / Accepted: 2 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objective To examine whether a modified endometriosis fertility index (EFI) can better predict the rate of pregnancy without assisted reproductive technologies (ART) after laparoscopic surgery in infertile Chinese women with endometriosis. Methods 564 infertile women undergoing laparoscopy for endometriosis were retrospectively collected from January 2014 to December 2018. 472 patients were used to modify the EFI based on new, optimal cutoffs for its predictor variables. The predictive accuracy of the modified EFI was examined in the other 92 patients. Results Among the patients for the EFI modification, the multivariable Cox regression results showed that historical factors made more contribution in predicting non-ART pregnancy rate than surgical factors both in modified EFI (C-index: historical factors 0.617 vs surgical factors 0.558) and original EFI (C-index: historical factors 0.600 vs surgical factors 0.549). No significant relationship between the prior pregnancy and post-operative non-ART pregnancy rates was detected by both modified EFI and original EFI (p = 0.530 and 0.802, respectively). To assess the predictive effect of modified EFI, the two versions of modified EFI not only had higher predictive accuracy (C-index: 0.627 and 0.632) for non-ART pregnancy rates than that of the original EFI (C-index: 0.602) in the patients undergoing surgery during 2014–2017, but also higher than that of the original EFI (C-index: 0.638 and 0.612 vs 0.560) in the externally validated population in 2018. Conclusions A modified EFI based on population-specific optimal cutoffs and weights might be more suitable for estimating the rate of non-ART pregnancy after laparoscopic surgery in infertile women with endometriosis. Keywords Endometriosis fertility index · Pregnancy rate · Predicting factors · Model
Introduction
Jiaying Fan and Kang Qin contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00404-020-05871-1) contains supplementary material, which is available to authorized users. * Qingfeng Li [email protected] 1
Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Guangzhou 510120, China
Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
2
Endometriosis, a disease of unknown origin, affects 10% of women of reproductive age and about 50% of infertile women by damaging their pelvic cavity, ovaries and uterus [1, 2]. Th
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