The predictive value of Endometriosis Fertility Index(EFI ...seud- predictive value of Endometriosis...

download The predictive value of Endometriosis Fertility Index(EFI ...seud- predictive value of Endometriosis Fertility Index(EFI) in Chinese women with endometriosis-associated infertility

of 20

  • date post

    07-Apr-2018
  • Category

    Documents

  • view

    216
  • download

    4

Embed Size (px)

Transcript of The predictive value of Endometriosis Fertility Index(EFI ...seud- predictive value of Endometriosis...

  • 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 weihuang64@163.com

  • 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

  • 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.

  • 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.

  • 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

  • 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.

  • Endometriosis Fertility Index(EFI) Historical factors Surgical factors

    Points Description Points Description

    2 If age is 35 years 3 If LF score = 78 (high score)

    1 If age is 3639 years 2 If LF score = 46 (moderate score)

    0 If age is 40 years 0 If LF score = 13 (low score)

    2 If years infertile is 3 1 If AFS endometriosis lesion score 3 0 If AFS endometriosis lesion score 16

    1 If there is a history of prior pregnancy

    1 If AFS total score

  • 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.

  • 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.

  • Methods

    Exclusion criteria

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

    Genital tract malformations;

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

    Severe systemic disease.

  • Follow up

    !outpatient visit, telephone or letter was conducted to follow-up postoperative outcomes.

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

  • Statistical analysis

    !Relevant EFI score and pregnant outcomes were analyzed by using the SPSS statistical software 21.0.

    !The 2-test and Kaplan-Meier survival analysis were

    used for the comparison of cumulative pregnant rate in

    different time.

  • 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

  • Clinical characteristics of 1051 endometriosis associated infertile women

    Age at operation (yr ) 29.814.30 (20~46) BMI 20.342.57(13.67~33.73) Duration of infertility(yr) 3.042.64(1~18) Type of Infertility primary infertility (%) 56153.38% secondary infertility(%) 49046.62% 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

  • 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)

  • 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)&&

    !

  • 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)$

    !

  • Results

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

  • Discussion

    Wei et al. J Chin Obs Gyn,2011

  • Conclusions

    EFI can better predict womens fecundity in

    endometriosis-associated infertile women with

    treatment of laparoscopy.