Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
Department of Biostatistics, Peking University First Hospital, Beijing 100034, China.
Chin Med J (Engl). 2017 Aug 20;130(16):1932-1937. doi: 10.4103/0366-6999.211892.
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）对手术后妊娠具有预测价值。体外受精和胚胎移植（IVF-ET）是治疗不孕的一种较好的方法。本研究旨在为 EFI 提供外部验证，评估影响 EFI 预测累积自然妊娠率（PR）能力的因素，并通过评估手术联合 IVF-ET 治疗对不孕管理的影响，为治疗提供合理建议。
本回顾性研究纳入了 2012 年 1 月至 2016 年 1 月腹腔镜手术后的 345 名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，并根据不同的 EFI 评分分为六组。在 345 名患者中，307 名 EFI 评分≥5 分的患者被分为非 IVF-ET 组（n=209）和 IVE-ET 组（n=98），以比较累积 PR。采用 Kaplan-Meier 乘积限估计法计算累积 PR 曲线，并通过对数秩检验评估差异。采用 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差异有统计学意义（χ2=29.945，P<0.05）。最功能评分被证明是 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，接受手术联合 IVF-ET 的患者的累积 PR 明显高于仅接受手术的患者（χ2=4.160，P=0.041）。
EFI 是预测患者自然妊娠率的可靠分期系统。最功能评分是预测自然妊娠率的最具影响力的因素。手术后 12 个月 EFI 评分≥5 的患者建议接受 IVF-ET 以获得更高的 PR。
