Endometriosis fertility index score maybe more accurate for predicting the outcomes of in vitro fertilisation than r-AFS classification in women with endometriosis

Reproductive Biology and Endocrinology

Dongzi Yang²  Qingxue Zhang²  Liangan Wang³  Nengyong Ouyang²  Lili Huang¹  Tingfeng Fang²  Ruiqi Li²  Wenjun Wang² 

[1] New Hope Fertility Center, Av.De Praia Grande No.409, China Law Building, 3 Andar BC, Macau, P. R. China;Department of Obstetrics & Gynecology, Reproductive medicine centre, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou 510120, P. R. China;Endocrinology division, Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang Xi Road, Guangzhou 510120, P. R. China

关键词: Clinical pregnancy rate;    In vitro fertilization (IVF);    Endometriosis;    Revised American Fertility Society (r-AFS) classification;    Endometriosis fertility index (EFI);   

Others  :  809805
DOI  :  10.1186/1477-7827-11-112

 received in 2013-08-31, accepted in 2013-12-07,  发布年份 2013

【 摘 要 】

Background

Endometriosis is a common disease. The most widely used staging system of endometriosis is the revised American Fertility Society classification (r-AFS classification) which has limited predictive ability for pregnancy after surgery. The endometriosis fertility index (EFI) is used to predict fecundity after endometriosis surgery. This diagnostic accuracy study was designed to compare the predictive value of the EFI with that of the r-AFS classification for IVF outcomes in patients with endometriosis.

Methods

199 women with endometriosis receiving IVF treatment after surgery were analysis. The EFI score and r-AFS classification in their ability to predict these IVF outcomes were compared in the same population. ROC curves were used to analyse the predictive values of the EFI and r-AFS indices for clinical pregnancy, and their accuracies were evaluated by sensitivity, specificity, and the Youden’s index.

Results

The Area Under the Curve (AUC) of the EFI score (AUC = 0.641, Standard Error(SE) = 0.039, P = 0.001, 95% CI = 0.564-0.717, cut-off score = 6) was significantly larger than that of the r-AFS classification (AUC = 0.445, SE = 0.041, P = 0.184, and 95% CI = 0.364-0.526). The antral follicle count, oestradiol level on day of hCG, number of oocytes retrieved, number of oocytes fertilised, and number of cleaved embryos in the greater than or equal to 6 EFI score group was greater than that of the lower than or equal to 5 EFI score group, and the dose of gonadotropin of the greater than or equal to 6 EFI score group were less than that in the lower than or equal to 5 EFI score group. Implantation rate, clinical pregnancy rate, and cumulative pregnancy rate in the greater than or equal to 6 EFI score group were higher than in the lower than or equal to 5 EFI score group.

Conclusions

It suggests that the EFI has more predictive power for IVF outcomes in endometriosis patients than the r-AFS classification. The clinical pregnancy rate was higher in patients with EFI greater than or equal to 6 score than with EFI lower than or equal to 5 score.

【 授权许可】

   
2013 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Giudice LC, Kao LC: Endometriosis. Lancet 2004, 364:1789-1799.
• [2]Hummelshoj L, Prentice A, Groothuis P: Update on endometriosis. Womens Health (Lond Engl) 2006, 2:53-56.
• [3]Counseller VS, Crenshaw Jr JL: A clinical and surgical review of endometriosis. Am J Obstet Gynecol 1951, 62:930-942.
• [4]The American Fertility Society: Revised American Fertility Society classification of endometriosis: 1985. Fertil Steril 1985, 43:351-352.
• [5]Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS, Vemon MW: Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997, 67:817-821.
• [6]Adamson GD: Endometriosis classification: an update. Curr Opin Obstet Gynecol 2011, 23:213-220.
• [7]Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG: Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod 2006, 21:2679-2685.
• [8]Adamson GD, Pasta DJ: Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010, 94:1609-1615.
• [9]Tomassetti C, Geysenbergh B, Meuleman C, Timmerman D, Fieuws S, D'Hooghe T: External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod 2013, 28:1280-1288.
• [10]Organization WHO: WHO laboratory manual for the Examination and processing of human semen. Geneva, Switzerland: WHO Press; 2010:224.
• [11]Tavmergen E, Ulukus M, Goker EN: Long-term use of gonadotropin-releasing hormone analogues before IVF in women with endometriosis. Curr Opin Obstet Gynecol 2007, 19:284-288.
• [12]Somigliana E, Vercellini P, Vigano P, Ragni G, Crosignani PG: Should endometriomas be treated before IVF-ICSI cycles. Hum Reprod Update 2006, 12:57-64.
• [13]Romao GS, Araujo MC, de Melo AS, de Albuquerque Salles Navarro PA, Ferriani RA, Dos RRM: Oocyte diameter as a predictor of fertilization and embryo quality in assisted reproduction cycles. Fertil Steril 2010, 93:621-625.
• [14]Scott L, Alvero R, Leondires M, Miller B: The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum Reprod 2000, 15:2394-2403.
• [15]Chen H, Wang W, Mo Y, Ma Y, Ouyang N, Li R, Mai M, He Y, Bodombossou-Djobo MM, Yang D: Women with high telomerase activity in luteinised granulosa cells have a higher pregnancy rate during in vitro fertilisation treatment. J Assist Reprod Genet 2011, 28:797-807.
• [16]Donner A: Approaches to sample size estimation in the design of clinical trials–a review. Stat Med 1984, 3:199-214.
• [17]Lerman J: Study design in clinical research: sample size estimation and power analysis. Can J Anaesth 1996, 43:184-191.
• [18]Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Moher D, Rennie D, de Vet HC, Lijmer JG: The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Ann Intern Med 2003, 138:W1-12.
• [19]Balaban B, Brison D, Calderón G, Catt J, Conaghan J, Cowan L, Ebner T, Gardner D, Hardarson T, Lundin K, Cristina Magli M, Mortimer D, Mortimer S, Munné S, Royere D, Scott L, Smitz J, Thornhill A, van Blerkom J, Van den Abbeel E: The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod 2011, 26:1270-1283.
• [20]Opoien HK, Fedorcsak P, Omland AK, Abyholm T, Bjercke S, Ertzeid G, Oldereid N, Mellembakken JR, Tanbo T: In vitro fertilization is a successful treatment in endometriosis-associated infertility. Fertil Steril 2012, 97:912-918.
• [21]Fujishita AKKN, Masuzaki HIT: Influence of pelvic endometriosis and ovarian endometrioma on fertility. Gynecol Obstet Invest 2002, 53:40-45.