Classical studies suggested that 25% to 50% of infertile women have endometriosis and that 30% to 50% of women with endometriosis are infertile 1. Surgery is the only way to be sure you have endometriosis. In women suffering from endometriosis and infertility, the decision as to when and how to perform surgical excision andor fertility treatment is mainly based on clinical guidelines and expert opinions. Several options have been suggested for medical treatment. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this. Unauthorized use or copying without written consent is strictly prohibited. The effect of endometriosis on fertility and infertility background. Fertility physicians of northern california, palo alto and san jose, california objective. Reproducibility of the endometriosis fertility index. A longterm followup study of women with asymptomatic endometriosis diagnosed incidentally at sterilization. Aug 20, 2017 endometriosis fertility index for predicting pregnancy after endometriosis surgery xin li 1, cheng zeng 1, ying. Infertility patients with untreated mild endometriosis conceive on their own at a rate of 2% to 4. In endometriosis, there is a risk of female infertility of up to 30% to 50%.
Treatment for endometriosis related infertility is not consensual. This booklet will describe options for diagnosing and treating pain. Prospective data collection on 579 patients and comprehensive statistical analysis to derive a new staging systemthe endometriosis fertility index efifrom data rather than a priori assumptions, followed by testing the efi prospectively on 222 additional patients for correlation of predicted and actual outcomes. Endometriosis is often seen as a reproductive disease and while endometriosis can impact the ovaries, uterus and fallopian tubes, it can also be found on the bowels, bladder, appendix as well as other organs. For patients with no risk factors, a negative chlamydia antibody test indicates that there is less than a 15% likelihood of tubal pathology. Endometriosis is a disease where tissue, similar to the tissue that lines the uterus, can be found throughout the pelvis. Fertility solutions medical necessity clinical guideline. Endometriosis is a common disease that occurs in 6 to 10% of reproductiveage women 1, 2. All the 60 patients underwent operative laparoscopy for eno dometriosis. In actuality, fertility is essentially eliminated during treatment because all medical treatments for endometriosis inhibit ovulation. This booklet will describe options for diagnosing and treating pain or infertility that may be attributed to endometriosis.
Apr 16, 20 the presently used international classification american fertility society revised in 1985, afsr does not predict the chance of pregnancy. Endometriosis fertility index score maybe more accurate for. Endometriosis fertility index for predicting pregnancy after endometriosis surgery xin li 1, cheng zeng 1, ying. Prospective data collection on 579 patients and comprehensive statistical analysis to derive a new staging systemthe endometriosis fertility index efi from data rather than a priori assumptions, followed by testing the efi prospectively on 222 additional patients for correlation of predicted and actual outcomes. These extrauterine growths can develop on or under the ovaries, the fallopian tubes or the tubes connecting the ovaries to the uterus, outside of the uterus, or in other areas of the abdomen. Tools such as the endometriosis fertility index efi improve the prediction of pregnancy by natural means or with the assistance of ivf, and your doctor will be able to advise which is the best pathway for you. Endometriosis, fertility and pregnancy 100 women with severe endometriosis, all start trying for a baby at the end of one year, 25 will be pregnant. Infertility and endometriosis cohort full text view. Norbert gleicher whether or not socalled mild endometriosis affects fertility has remained controversial. There is a large body of evidence that demonstrates an association between endometriosis and infertility. Norbert gleicher, md, chrs medical director and chief scientist, was the first to report on the possible association of autoimmunity and endometriosis, suggesting that endometriosis, indeed, may be an autoimmune disease. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue.
The role of the endometriosis fertility index efi and. The world endometriosis society wes established a process to bring together representatives of national and international, medical and nonmedical societies, patient organizations and pharmaceutical companies with an interest in endometriosis, aiming to derive a consensus on the classification of endometriosis from a global perspective in. Endometriosis is a disease of the female reproductive system, in which endometrial tissue the tissue that normally lines the uterus starts growing outside of the uterus. Today, the most widely used staging system of endometriosis is the revised american fertility society classification rafs classification 4, 5. It took you years to figure out that your painful periods were the result of endometriosis, a disease that affects more than 7 million women worldwide, according to the endomentriosis association. Even with severe endometriosis, natural conception is still possible. The efi predicts pregnancy rates in endometriosis patients who want to get pregnant following surgical assessment and treatment of. The endometriosis fertility index efi is the first validated scoring system that is predictive of nonassisted reproductive technologies pregnancy following surgical evaluation when the patient has functional gametes and uterus.
Endometriosis is found in 2040% of infertile women, and it is suspected that multiple mechanisms contribute to decreased fertility in these women. This diagnostic accuracy study was designed to compare the. Endometriosis, fertility and pregnancy endometriosis uk. In addition to classifying endometriosis, the documentation of surgical findings, such as in endometriosis fertility index efi, has been found to have a prognostic value in infertile women adamson and pasta, 2010. Endometriosis can influence fertility in several ways.
On the other hand, many women with endometriosis have completely open tubesbut still struggle with fertility. World endometriosis society consensus on the classification. The pregnancy rates achieved by women with minimalmild endometriosis who undergo intrauterine insemination with their partners or a donors sperm are lower than those of women without fertility problems 1,2. The diagnosis of endometriosis is often made clinically based on history, with women reporting dysmenorrhea, pelvic pain, dyspareunia, and fertility issues. Grade or severity of endometriosis endometriosis is classified into minimal, mild, moderate and severe using the american fertility society revised classification of endometriosis afs score. Aug, 2014 impact of endometriosis on fertility the inflammation and irritation caused by the endometriosis can affect fertility. Treatment for endometriosisrelated infertility is not consensual. Endometriosis is a debilitating condition characterized by high recurrence rates.
The efi predicts pregnancy rates in endometriosis patients who want to get pregnant following surgical assessment and treatment of endometriosis, thus enabling the most informed choice from among. Therefore, they should not be used to improve fertility in women with minimalmild endometriosis 8. To develop a clinical tool that predicts pregnancy rates prs in patients with surgically documented. One study found that the success rate of insemination in women with endometriosis is about half of that of other women 3. If you have endometriosis, it may be more difficult for you to become pregnant. World endometriosis research foundation endometriosis. This is microscopic endometriosis, and the reasons for the difficulty with fertility are less well understood. Introduction women with endometriosis may experience infertility, pelvic pain, or both. It is now widely accepted that the immune system, indeed, plays an important role in endometriosis.
Management of infertility in endometriosis by operative. New drugs on the market and in research have pharmacological effects on the endocrine and inflammatory functions. In addition to classifying endometriosis, the documentation of surgical findings, such as in endometriosis fertility index efi, has been found to have a prognostic value in infertile women. Up to 30% to 50% of women with endometriosis may experience infertility. In women with minimalmild endometriosis, hormonal drugs are not an effective treatment for endometriosisrelated infertility, as none of the drugs leads to better pregnancy rates. Fertility in women with minimal endometriosis compared with normal women was assessed by means of a donor insemination program in unstimulated. Typically, endometriosis causes pain and infertility, although 2025% of patients are asymptomatic. Women undergoing laparoscopic resection of any rasrm. Finally, there may be an immunological factor involved in endometriosis. Jul 18, 2019 to evaluate the reproducibility of the endometriosis fertility index efi. Jun 27, 20 many aspects of endometriosis continue to make it an enigmatic medical condition nearly a century after its first description as a specific disease. There are many theories, but no one knows for sure, dr.
These extrauterine growths can develop on or under the ovaries, the fallopian tubes or the tubes connecting the ovaries to. This document is proprietary and confidential to optum 2020. The world endometriosis research foundation werf endometriosis phenome and biobanking harmonisation project ephect is a global initiative involving 34 clinicalacademic and three industrial collaborators from 16 countries, with the mission to develop a consensus on standardization and harmonization of phenotypic surgicalclinical data and. Norbert gleicher discusses endometriosis and how infertility treatments must address conditions caused by endometriosis. Endometriosis a guide for patients revised 2012 a glossary of italicized words is located at the end of this booklet. The endometriosis fertility index efi is a new way to determine your chances of getting pregnant each month. Endometriosis fertility index endometriosis fertility index. The efi is a scientificallyderived, validated and professionally recognized index that enables clinicians to provide better care to their patients. The presently used international classification american fertility society revised in 1985, afsr does not predict the chance of pregnancy. Many aspects of endometriosis continue to make it an enigmatic medical condition nearly a century after its first description as a specific disease. Endometriosis is a very common gynecological condition affecting women in their reproductive years. Welcome to the endometriosis fertility index efi calculator. Anatomical distortions and adhesions the fibrous bands that form. Approximately 25 to 50% of infertile women have endometriosis, and 30 to 50% of women with endometriosis are infertile.
Now all you want to know is how it will affect your chances of. Prospective data collection on 579 patients and comprehensive statistical analysis to derive a new staging systemthe endometriosis fertility index efifrom data rather than a priori assumptions, followed by testing the efi prospectively on 222 additional patients. The main factor affecting fertility is a womans age, as a woman is born with her lifetime supply of eggs to undergo. The endometrium is the tissue that lines the inside of the uterine cavity. The optimal choice of management for endometriosis.
This document is proprietary and confidential to optum2019. Recommendations for the surgical treatment of endometriosis. Adhesiolysis, electr cautery of surface endometriosis of the ovary, enucleation of endometriotic. Article in bulgarian ibrjam i, veleva g, karagjozova g, ivanov s. New scores such as the endometriosis fertility index efi have been proposed to do so, but need to be validated. Clinical performance guideline medical fertility solutions. Endometriosis can be found in up to 50% of infertile women. The endometriosis fertility index is useful for predicting the ability to conceive without assisted reproductive technology treatment after laparoscopic surgery, regardless of endometriosis. Pdf endometriosis fertility index for predicting pregnancy. Inflammation of the fimbria, which pick up the egg and transport it into the fallopian tube, causes swelling and scarring so the egg may not reach its destination.
To evaluate the reproducibility of the endometriosis fertility index efi. Endometriosis affects womens fertility in many ways. The endometriosis fertility index efi is used to predict fecundity after endometriosis surgery. Endometriosis fertility index score maybe more accurate. The most widely used staging system of endometriosis is the revised american fertility society classification rafs classification which has limited predictive ability for pregnancy after surgery. Rrs infertility clinical performance and medical necessity. Jan 22, 2020 endometriosis fertility index for predicting non. A leading cause of infertility, endometriosis has a prevalence of 0.