By I.Soussis  MD

Scientists have expressed their disappointment over the decades, regarding the lack of correlation between the staging of endometriosis and the severity of the clinical symptoms, a woman experiences. In this regard women with severe endometriosis have no pain whatsoever, where as those with slight endometriosis can suffer from severe period pain. The same also applies regarding endometriosis and infertility.

There are a lot of good reasons for having an effective staging protocol of any illness/disorder, especially so of endometriosis. This way, scientists would all speak the same language, the diagnosis would be more reliable, comparing treatments would be easier and the progress of research would be quicker, all of which would greatly benefit the patient.

Adamson and Pesta from the USA  introduced a new diagnostic index in 2010, that is able to predict better the chances of natural conception in women with surgically diagnosed and histologically proven endometriosis.

This endometriosis Fertility Index(EFI) was developed by retrospectively analyzing the data of 579 infertile women with endometriosis, who had undergone laparoscopic staging of the disease. The ovaries, fallopian tubes and fimbria were graded by the surgeon, according to their estimated functional ability. Furthermore, the age of the patient, the duration of infertility in years and the obstetric history were taken into consideration, when creating this new EFI.

Scientists studied prospectively the index in the next 222 women. They reported remarkably good correlation, of the predictive value of the index, for the chance of natural conception and pregnancy  and the clinical results for all stages of endometriosis. Especially women with an EFI score of 9-10, had the highest chance of natural conception. The percentage of pregnancies was 55% in the first year and 74% three years following the laparoscopy. In contrast, only 10% of women with a low EFI score of 0-3, became pregnant.

Adamson stated: “The EFI is a proven simple, reliable clinical tool, that predicts the chances of natural conception in women with endometriosis. It reassures women who have a good prognosis and avoids wasting time in those with a poor prognosis”.

The reliability of the EFI has been reassessed in various studies and different populations.

Wong et al. from China reported on 2013 that the use of the EFI helped to predict better the chances of natural conception, in 199 women with endometriosis, than the older staging system from the American Fertility Society rAFS.

Garaveglia et al. analyzed the reliability of the EFI in 104 Italian women with endometriosis in 2015. The index proved to be a reliable prognostic tool.

Tomasetti et al. studied 233 European women with endometriosis in Belgium in 2013. They found a statistically significant relationship between the EFI and the time it took for a woman to conceive naturally.

Boujenah et al. showed in 2015 in France, that the EFI could reliably predict the natural conception of women with endometriosis. When laparoscopic treatment was used in conjunction with IVF, the percentage of pregnancies within 18 months was 78.8%.

All women undergoing laparoscopy and treatment of endometriosis, should ask their doctor to calculate their EFI.

This way they will posses a reliable tool, to help them decide in an unbiased manner, if they can attempt to conceive naturally or if they should turn to IVF, without wasting any precious time.

this form can be used to calculate EFI. the last chart shows the expected pregnancy rate according to the EFI score. G. David Adamson and J Pasta. Fertil Steril 2010;94:1609-15

this form can be used to calculate EFI. the last chart shows the expected pregnancy rate according to the EFI score. G. David Adamson and J Pasta. Fertil Steril 2010;94:1609-15