The predictive value of Endometriosis Fertility Index(EFI) in … · 2015-10-29 · Kaplan- Meier...

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The predictive value of Endometriosis Fertility Index(EFI) in Chinese women with endometriosis-associated infertility treated by laparoscopy Xianghui Zhang, Wei Huang Dept. Obs/Gyn West China Second University, Sichuan University, China [email protected]

Transcript of The predictive value of Endometriosis Fertility Index(EFI) in … · 2015-10-29 · Kaplan- Meier...

Page 1: The predictive value of Endometriosis Fertility Index(EFI) in … · 2015-10-29 · Kaplan- Meier survival analysis about cumulative PR in different time. Discussion Wei et al. J

The predictive value of Endometriosis

Fertility Index(EFI) in Chinese women

with endometriosis-associated infertility

treated by laparoscopy

Xianghui Zhang, Wei Huang Dept. Obs/Gyn

West China Second University, Sichuan University, China [email protected]

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Background

Endometriosis afflict 35~50% women of reproductive age

by the related infertility, chronic pelvic pain and other

physical problems.

Giudice LC, Kao LC. Lancet 2004.

Infertility

Chronic Pain

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Background

Although a definitive mechanism to the causal links

between endometriosis and infertility is still far away from

us.

It is clear that the fecundity does rebound in some degree

after medical management.

Bulletti C. J Assist Reproduct Geneti 2010.

De Ziegler D. Lancet 2010.

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Background

Laparoscopic surgery is a widely used mean to deal with

endometriosis-associated infertility both for mild-moderate

and severe patients.

Raffi F. Eur J Obstet Gynecol Reprod Biol 2014. Marcoux S. New Eng J Med 1997. Somigliana E. Placenta 2011.

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Background

While pregnancy outcome after laparoscopy was not

consistent with the most widely used staging system of

endometriosis, namely revised American Fertility Society

(rAFS) score.

.

Zeng C. Gynecol Obstet Invest 2014. Vercellini P. Hum 2006

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Background

Adamson developed the endometriosis fertility index (EFI ) in

2010, a scoring system consist of historical factors at the time

of surgery, adnexal function after the intervention of surgery

and assessment of endometriosis that was derived from r-

AFS .

Adamson GD. Fertil Steril 2010.

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Endometriosis Fertility Index(EFI) Historical factors Surgical factors

Points Description Points Description

2 If age is ≤35 years 3 If LF score = 7–8 (high score)

1 If age is 36–39 years 2 If LF score = 4–6 (moderate score)

0 If age is ≥40 years 0 If LF score = 1–3 (low score)

2 If years infertile is ≤3 1 If AFS endometriosis lesion score <16

0 If years infertile is >3 0 If AFS endometriosis lesion score ≥16

1 If there is a history of prior pregnancy

1 If AFS total score <71

0 If there is no history of prior pregnancy

0 If AFS total score ≥71

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Background

With the aim to demonstrate the predictive value of EFI

for natural conception after surgery, this retrospective

study was made in Chinese women with endometriosis

associated infertility.

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Methods

The study reviewed infertile women diagnosed of

endometriosis-associated infertility that underwent

laparoscopic treatment from January 2008 to December

2012.

Inclusion criteria

•  Diagnosis is based on visual typical-lesions under laparoscopy;

•  Infertility after more than one year of unprotected intercourse;

•  Male partners with normal semen analysis.

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Methods

Exclusion criteria

•  Ovulation disorders (e.g. PCOS, hyperprolactinemia );

•  Genital tract malformations;

•  Uterine diseases(e.g. adenomyosis, Intrauterine adhesion);

•  Severe systemic disease.

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Follow –up

! outpatient visit, telephone or letter was conducted to

follow-up postoperative outcomes.

! The duration of follow-up was 12~68 months.

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Statistical analysis

! Relevant EFI score and pregnant outcomes were

analyzed by using the SPSS statistical software 21.0.

! The χ2-test and Kaplan-Meier survival analysis were

used for the comparison of cumulative pregnant rate in

different time.

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Results

! A total of 1325 women were eligible for the study.

! 46 patients were excluded because of pregnancy by IVF-ET.

! 228 women were lost to follow up, lost rate was 17.83%.

! 1051 of remaining 1279 patients were successfully followed-

up

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Clinical characteristics of 1051 endometriosis associated infertile women

Age at operation (yr ) 29.81±4.30 (20~46) BMI 20.34±2.57(13.67~33.73) Duration of infertility(yr) 3.04±2.64(1~18) Type of Infertility primary infertility (%) 561(53.38%) secondary infertility(%) 490(46.62%) r-AFS classification stage I (%) 349(33.21%) stage II (%) 266(25.31%) stage IV (%) 248(23.59%) stage V (%) 188(17.89%)

EFI n(%) 10 121(11.51%

) 9 261(24.83%

) 8 228(21.69%

) 7 194(18.45%

) 6 120(11.41%

) 5 67(6.37%) 4 40(3.8%) 3 13(1.23%) 2 7(0.67%) 1 0

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Results

!  505 (48.05%, 505/1051) patients became pregnant naturally

!  13 cases ongoing pregnancies (8 over 12-week pregnancy)

!  60 (5.71%) women suffered from spontaneous abortion or

termination gestation as fetal anomaly.

!  20 (1.9%) patients experienced ectopic pregnancy.

!  The live birth rate was 38.53% (405/1051)

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Results

Estimated cumulative PRs(pregnant rates) at different time by r-AFS staging

The PRs among diffeent r-AFS staging (I-IV) was no significant difference (52.15% I , 47.37% II, 47.58% III, 42.02% IV; P=0.161)

r"AFS& & Cumulative&PRs,&%&(n/total&n)&12months& & & & & & & & & & & & & & & & 24months& & & & & & & & & & & & & & & & 36months& & & & & & & & & & & & & >40months& &

&

&&

&

45.56%(159/349)& & & & & & & & 50.14%(175/349)& & & & & & & & & & & 51.58%(180/349)& & & & & 52.15%(182/349)&37.59%(100/266)& & & & & & & & 43.23%(115/266)& & & & & & & & & & & 46.62%(124/266)& & & & & 47.37%(126/266)&22.18%(55/248)& & & & & & & & & 42.34%(105/248)& & & & & & & & & & & 47.18%(117/248)& & & & & 47.58%(118/248)&28.19%(53/188)& & & & & & & & & 40.96%(77/188)& & & & & & & & & & & & 42.02%(79/188)& & & & & & 42.02%(79/188)&&

!

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Results

Estimated cumulative PRs(pregnant rates) at different time by EFI score.

EFI$ Cumulative$PRs,$%$(n/total$n)$12months$ $ $ $ $ $ $ $ $ $ $ $ $ $ 24months$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ 36months$ $ $ $ $ $ $ $ $ $ $ $ $ >40months$ $

0~2$3$4$5$6$7$8$9$10$

14.29%(1/7)$ $ $ $ $ $ $ $ $ $ 14.29%(1/7)$ $ $ $ $ $ $ $ $ $ $ $ $ 14.29%(1/7)$ $ $ $ $ $ $ $ $ $ $ 14.29%(1/7)$7.69%(1/13)$ $ $ $ $ $ $ $ $ $ 7.69%(1/13)$ $ $ $ $ $ $ $ $ $ $ $ $ 7.69%(1/13)$ $ $ $ $ $ $ $ $ $ $ 7.69%(1/13)$12.50%(5/40)$ $ $ $ $ $ $ $ $ 17.50%(7/40)$ $ $ $ $ $ $ $ $ $ $ $ 20.00%(8/40)$ $ $ $ $ $ $ $ $ $ 22.50%(9/40)$11.94%(8/67)$ $ $ $ $ $ $ $ $ 14.93%(10/67)$ $ $ $ $ $ $ $ $ $ $ 20.90%(14/67)$ $ $ $ $ $ $ $ $ 20.90%(14/67)$25.00%(30/120)$ $ $ $ $ $ 30.00%(36/120)$ $ $ $ $ $ $ $ $ $ 32.50%(39/120)$ $ $ $ $ $ $ $ 33.33%(40/120)$26.80%(52/194)$ $ $ $ $ $ 41.75%(81/194)$ $ $ $ $ $ $ $ $ $ 43.81%(85/194)$ $ $ $ $ $ $ $ 44.85%(87/194)$39.04%(89/228)$ $ $ $ $ $ 50.44%(115/228)$ $ $ $ $ $ $ $ $ 52.63%(120/228)$ $ $ $ $ $ $ 53.07%(121/228)$41.38%(108/261)$ $ $ $ $ 52.11%(136/261)$ $ $ $ $ $ $ $ $ 54.79%(143/261)$ $ $ $ $ $ $ 54.79%(143/261)$60.33%(73/121)$ $ $ $ $ $ 70.25%(85/121)$ $ $ $ $ $ $ $ $ $ 73.55%(89/121)$ $ $ $ $ $ $ $ $ 73.55%(89/121)$

!

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Results

Kaplan- Meier survival analysis about cumulative PR in different time.

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Discussion

Wei et al. J Chin Obs Gyn,2011

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Conclusions

EFI can better predict women’s fecundity in

endometriosis-associated infertile women with

treatment of laparoscopy.