Predictive Value Of Endometriosis Fertility Index For Spontaneous Pregnancy In Endometriosis-Associated Infertile Patients With R-AFS Stage ?-?

Objective: To evaluate the predictive value of endometriosis fertility index(EFI)for spontaneous pregnancy after laparoscopy in endometriosis-associated infertile patients with r-AFS stage I-II.Methods: Clinical data of endometriosis-associated infertile patients who underwent laparoscopic surgery from Jan.2013 to June 2015 in Fujian Provincial Maternity and Children's Hospital of Fujian Medical University were retrospectively assessed.EFI score and pregnancy outcome were monitored.Postoperative spontaneous pregnancy rates(PRs)in different periods were analyzed.The relationship between EFI score and postoperative cumulative PR,the factors affecting postoperative PR,and the predictive value of EFI score for the pregnancy within 12 months after surgery were assessed by using SPSS Statistics 23.0.Results:(1)93.4%(253/271)of patients were followed up.The overall postoperative spontaneous PR was 49%(124/253).The postoperative spontaneous PRs were 28.5%(72/253),10.7%(27/253),9.1%(23/253)and 0.8%(2/253)within the first 6 months,7-12 months,13-24 months and 25-36 months respectively.The PR was significant different between the first 6 months and 7-12 months,also the first 12 months and after 12 months(both P<0.001).(2)The postoperative spontaneous PRs were 0,28.6%,41.7%,35.1%,44.7% and 60.0% of EFI score 0-3,4,5,6,7-8 and 9-10 groups respectively(P<0.05).The postoperative PR was positively correlated with EFI score(RR=1.243,P<0.001).(3)The cumulative PR was negatively correlated with age and years of infertile(RR=0.949 ? 0.839 respectively,both P<0.01).Secondary infertile patients had a higher PR than primary infertile ones(55.2% VS 40.9%,P<0.05).There was no significant difference between the cumulative PR of r-AFS stage I and II(P>0.05).(4)ROC curve of postoperative12 months EFI showed that the area under curve(AUC)was 0.619(0.548~0.690,P=0.001),and the critical value of pregnancy predicted by EFI within 12 months postoperative was 7.5,with a sensitivity of 67.7% and a specificity of 48.7%.Conclusions:(1)The optimal timing of spontaneous pregnancy of Endometriosis-Associated Infertile Patients after laparoscopic surgery was that within 12 months.(2)The cumulative PR is positively correlated with EFI score,while negatively correlated with age and years infertile.The cumulative PR of secondary infertility was higher than primary infertility.(3)EFI score predicts spontaneous PR certainly in endometriosis-associated infertile patients with r-AFS stage I-II.For EFI score?8,active spontaneous pregnancy postoperatively was recommended,if there's no pregnant after 12 months,In vitro fertilization and embryo transfer(IVF-ET)is recommended.For those who's age is over 35 years old,or are long time infertile or primary infertility,the time trying pregnancy should be shorten to 6 months.For EFI score<8,IVF-ET is appropriate.For EFI score<4,spontaneous pregnancy is not recommended.