Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?

<h4>Introduction</h4>The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. However, the practical use of the EFI to advise patients about postoperative fertility management is...

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Autores principales:	Alexandre Bailleul, Julien Niro, Joseph Du Cheyron, Pierre Panel, Arnaud Fauconnier
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/9dd1296e5f4b4c3bb14ad6cd08313cc2
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spelling	oai:doaj.org-article:9dd1296e5f4b4c3bb14ad6cd08313cc22021-12-02T20:05:40ZInfertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?1932-620310.1371/journal.pone.0251372https://doaj.org/article/9dd1296e5f4b4c3bb14ad6cd08313cc22021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251372https://doaj.org/toc/1932-6203<h4>Introduction</h4>The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. However, the practical use of the EFI to advise patients about postoperative fertility management is unclear.<h4>Materials and methods</h4>All patients participating in the ENDOQUAL study-a prospective observational bi-center cohort study conducted between 01/2012 and 06/2018-who underwent surgery for infertility were asked to complete a questionnaire collecting time and mode of conception. Statistical analysis was performed with the Fine and Gray model of competing risks and analysis of fertility according to the EFI.<h4>Results</h4>Of the 234 patients analyzed, 104 (44.4%) conceived postoperatively including 58 (55.8%) spontaneous pregnancies. An EFI of 0-4 for spontaneous pregnancies was associated with a lower cumulative pregnancy incidence compared to an EFI of 5-10 (52 versus 34 pregnancies respectively, Subdistribution Hazard Ratio (SHR) = 0.47; 95% CI [0.2; 1.1]; p = 0.08). An EFI of 0-4 was associated with a higher cumulative pregnancy rate for pregnancies obtained by artificial reproduction technology (ART), compared to an EFI of 5-10 (12 versus 6 pregnancies respectively, SHR = 1.9; CI95% [0.96; 3.8]; p = 0.06). Fecundability decreased from 12 months for EFI 0-4 and from 24 months for EFI 5-10.<h4>Conclusion</h4>Our analysis suggests that patients with an unfavorable EFI (≤4) have more ART pregnancies than patients with a favorable EFI (≥5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.Alexandre BailleulJulien NiroJoseph Du CheyronPierre PanelArnaud FauconnierPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251372 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Alexandre Bailleul Julien Niro Joseph Du Cheyron Pierre Panel Arnaud Fauconnier Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
description	<h4>Introduction</h4>The Endometriosis Fertility Index (EFI) is a validated score for predicting the postoperative spontaneous pregnancy rate in patients undergoing endometriosis surgery. However, the practical use of the EFI to advise patients about postoperative fertility management is unclear.<h4>Materials and methods</h4>All patients participating in the ENDOQUAL study-a prospective observational bi-center cohort study conducted between 01/2012 and 06/2018-who underwent surgery for infertility were asked to complete a questionnaire collecting time and mode of conception. Statistical analysis was performed with the Fine and Gray model of competing risks and analysis of fertility according to the EFI.<h4>Results</h4>Of the 234 patients analyzed, 104 (44.4%) conceived postoperatively including 58 (55.8%) spontaneous pregnancies. An EFI of 0-4 for spontaneous pregnancies was associated with a lower cumulative pregnancy incidence compared to an EFI of 5-10 (52 versus 34 pregnancies respectively, Subdistribution Hazard Ratio (SHR) = 0.47; 95% CI [0.2; 1.1]; p = 0.08). An EFI of 0-4 was associated with a higher cumulative pregnancy rate for pregnancies obtained by artificial reproduction technology (ART), compared to an EFI of 5-10 (12 versus 6 pregnancies respectively, SHR = 1.9; CI95% [0.96; 3.8]; p = 0.06). Fecundability decreased from 12 months for EFI 0-4 and from 24 months for EFI 5-10.<h4>Conclusion</h4>Our analysis suggests that patients with an unfavorable EFI (≤4) have more ART pregnancies than patients with a favorable EFI (≥5) and should be referred for ART shortly after surgery. Patients with a favorable EFI may attempt spontaneous pregnancy for 24 months before referral.
format	article
author	Alexandre Bailleul Julien Niro Joseph Du Cheyron Pierre Panel Arnaud Fauconnier
author_facet	Alexandre Bailleul Julien Niro Joseph Du Cheyron Pierre Panel Arnaud Fauconnier
author_sort	Alexandre Bailleul
title	Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
title_short	Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
title_full	Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
title_fullStr	Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
title_full_unstemmed	Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?
title_sort	infertility management according to the endometriosis fertility index in patients operated for endometriosis: what is the optimal time frame?
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/9dd1296e5f4b4c3bb14ad6cd08313cc2
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Infertility management according to the Endometriosis Fertility Index in patients operated for endometriosis: What is the optimal time frame?

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