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Modified endometriosis fertility index is more accurate to predict the non-ART pregnancy rate following surgery: a cohort of Chinese women

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To examine whether a modified endometriosis fertility index (EFI) can better predict the rate of pregnancy without assisted reproductive technologies (ART) after laparoscopic surgery in infertile Chinese women with endometriosis.

Methods

564 infertile women undergoing laparoscopy for endometriosis were retrospectively collected from January 2014 to December 2018. 472 patients were used to modify the EFI based on new, optimal cutoffs for its predictor variables. The predictive accuracy of the modified EFI was examined in the other 92 patients.

Results

Among the patients for the EFI modification, the multivariable Cox regression results showed that historical factors made more contribution in predicting non-ART pregnancy rate than surgical factors both in modified EFI (C-index: historical factors 0.617 vs surgical factors 0.558) and original EFI (C-index: historical factors 0.600 vs surgical factors 0.549). No significant relationship between the prior pregnancy and post-operative non-ART pregnancy rates was detected by both modified EFI and original EFI (p = 0.530 and 0.802, respectively). To assess the predictive effect of modified EFI, the two versions of modified EFI not only had higher predictive accuracy (C-index: 0.627 and 0.632) for non-ART pregnancy rates than that of the original EFI (C-index: 0.602) in the patients undergoing surgery during 2014–2017, but also higher than that of the original EFI (C-index: 0.638 and 0.612 vs 0.560) in the externally validated population in 2018.

Conclusions

A modified EFI based on population-specific optimal cutoffs and weights might be more suitable for estimating the rate of non-ART pregnancy after laparoscopic surgery in infertile women with endometriosis.

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Acknowledgements

We warmly thank Ms. Jiexin Zhang and Ms. Tong Wu for performing the post-operative telephone interview.

Funding

This study received no external funding.

Author information

Author notes

  1. Jiaying Fan and Kang Qin contributed equally to this work.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Guangzhou, 510120, China

    Jiaying Fan, Yunsheng Liao, Jingying Xie, Yan Yang & Qingfeng Li

  2. Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China

    Kang Qin, Kuanrong Li, Xiaojun Li, Qingsheng Huang & Huiying Liang

Authors
  1. Jiaying Fan
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  2. Kang Qin
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  3. Kuanrong Li
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  4. Xiaojun Li
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  5. Qingsheng Huang
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  6. Yunsheng Liao
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  8. Jingying Xie
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  9. Yan Yang
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  10. Qingfeng Li
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Contributions

JF, KQ, QL, KL, QH and HL designed the study. XL, YL, JX and YY prepared the data. KQ performed the statistical analysis. JF and KQ drafted the manuscript. QL, KL and ANM reviewed the manuscript and contributed important intellectual inputs. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Qingfeng Li.

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Conflict of interest

All authors declare that they have no competing interests. Completed disclosure of interest forms are available to view online as supporting information.

Ethical approval

This study was approved by the Guangzhou Women and Children’s Medical Center Ethics Committee (No. 2017102709) and written informed consent was obtained from all participants.

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Fan, J., Qin, K., Li, K. et al. Modified endometriosis fertility index is more accurate to predict the non-ART pregnancy rate following surgery: a cohort of Chinese women. Arch Gynecol Obstet 303, 1353–1361 (2021). https://doi.org/10.1007/s00404-020-05871-1

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  • DOI: https://doi.org/10.1007/s00404-020-05871-1

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