Fertility index after surgical treatment of endometriosis as a predictor of pregnancy

A. A. Ivshin, O. O. Pogodin
In: Meditsinskiy sovet = Medical Council · 2026 · pp. 168–177 · doi:10.21518/ms2025-555 · W7127448867
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The Endometriosis Fertility Index (EFI) predicts pregnancy rates after endometriosis surgery better than the rAFS/ASRM classification, guiding individualized fertility management.

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The paper studies the prognostic value of the Endometriosis Fertility Index (EFI) after surgical treatment for endometriosis-associated infertility, aiming to develop and justify a clinical decision algorithm for choosing between expectant management, intrauterine insemination, or assisted reproductive technologies. Using a methodical article approach with literature searches in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, Google Scholar, and eLIBRARY.ru, the authors identified 21 studies for qualitative analysis and relied on one published meta-analysis for quantitative synthesis. They report a gradient in pregnancy probability over 36 months: cumulative pregnancy increases from about 10% for EFI 0–2 to about 60–70% for EFI 9–10, with EFI outperforming rAFS/ASRM staging for discrimination (AUC roughly 0.64–0.85; combined about 0.71). A major limitation is that the quantitative conclusions are based on a single included meta-analysis, and the algorithmic proposal is not itself validated within new patient data. This paper is centrally about endometriosis — it focuses on using the EFI to predict pregnancy after endometriosis surgery and to guide post-surgical fertility management choices.

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Abstract

Introduction. Endometriosis is a common pelvic disorder and is frequently associated with infertility. The rAFS/ASRM classification reflects the anatomic extent of disease but has limited ability to predict subsequent pregnancy. Aim. To develop and substantiate a clinical decision algorithm for infertility management (expectant management, intrauterine insemination, and assisted reproductive technologies [ART]) based on contemporary clinical evidence on the development and prognostic value of the Endometriosis Fertility Index (EFI). Materials and methods. This work was designed as a methodological paper with elements of an analytical literature review, drawing on original studies and a published systematic review/meta-analysis on EFI. The search strategy covered PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, Google Scholar, and eLIBRARY.ru (through December 2024). Search terms were: (“Endometriosis Fertility Index” OR EFI OR Adamson) AND endometriosis AND (infertility OR subfertility) AND (laparoscopy OR surgery) AND (pregnancy OR non-ART). A total of 312 records were identified; after removal of 54 duplicates, 258 remained; 48 full-text articles were assessed; 27 were excluded (no EFI and/or outcome data, review/case report, insufficient data); 21 studies were included in the qualitative analysis. Quantitative synthesis: one published meta-analysis was used. Results. EFI demonstrates a prognostic gradient: the cumulative pregnancy rate within 36 months increases from ~10% for EFI 0–2 to ~60–70% for EFI 9–10 and outperforms rAFS/ASRM in outcome discrimination (AUC 0.64–0.85; pooled ~0.71). Conclusions. EFI is a practical tool for fertility stratification after surgical treatment of endometriosis; the proposed algorithm supports individualized selection of management strategies. A total of 18 and 23 sources were used to substantiate the Introduction and Discussion, respectively (39 overall).
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Индекс фертильности после хирургического лечения эндометриоза – предиктор наступления беременности https://doi.org/10.21518/ms2025-555 Аннотация Введение. Эндометриоз – распространенное заболевание органов малого таза, часто ассоциированное с бесплодием. Стадирование rAFS/ASRM отражает анатомическую распространенность процесса, но слабо прогнозирует наступление беременности. Цель. На основе современных клинических данных о разработке и прогностической значимости индекса фертильности при эндометриозе (ИФЭ, Endometriosis Fertility Index, EFI) разработать и обосновать клинический алгоритм выбора тактики лечения бесплодия (выжидательная тактика, внутриматочная инсеминация, ВРТ). Материалы и методы. Работа выполнена как методическая статья с элементами аналитического обзора с опорой на оригинальные исследования и опубликованный систематический обзор/метаанализ по ИФЭ. В стратегию поиска включены информационные ресурсы: PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, Google Scholar, eLIBRARY.ru (по декабрь 2024); ключевые слова: (“Endometriosis Fertility Index” OR EFI OR Adamson) AND endometriosis AND (infertility OR subfertility) AND (laparoscopy OR surgery) AND (pregnancy OR non-ART). Идентифицировано 312 записей; после удаления 54 дубликатов – 258; полнотекстовые – 48; исключено 27 (нет ИФЭ/исхода, обзор/случай, недостаточные данные); включено 21 для качественного анализа. Количественный синтез: использован 1 опубликованный метаанализ. Результаты. ИФЭ формирует градиент прогноза: кумулятивная частота беременности в течение 36 мес. возрастает от ~10% при ИФЭ 0–2 до ~60–70% при ИФЭ 9–10 и превосходит rAFS/ASRM по дискриминации исходов (AUC 0,64–0,85; объединенно ~0,71). Выводы. EFI – практичный инструмент стратификации фертильности после хирургического лечения эндометриоза; предложенный алгоритм поддерживает дифференцированный выбор тактики. Для обоснования разделов «Введение» и «Обсуждение» использовано 18 и 23 источника соответственно (всего 39). Ключевые слова Об авторах А. А. ИвшинРоссия Ившин Александр Анатольевич, к.м.н., доцент, заведующий кафедрой акушерства и гинекологии, дерматовенерологии 185035, Республика Карелия, Петрозаводск, ул. Красноармейская, д. 31 O. O. Погодин Россия Погодин Олег Олегович, врач акушер-гинеколог, заведующий гинекологическим отделением 185002, Республика Карелия, Петрозаводск, ул. Сыктывкарская, д. 9 Список литературы 1. Адамян ЛВ, Мартиросян ЯО, Асатурова АВ. Этиопатогенез эндометриозассоциированного бесплодия (обзор литературы). Проблемы репродукции. 2018;24(2):28–33. https://doi.org/10.17116/repro201824228-33. 2. Чупрынин ВД, Мельников МВ, Буралкина НА, Чурсин ВВ, Вередченко АВ, Бурыкина ПН и др. 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Surgical treatment of endometriosis-associated infertility: Meta-analysis compared with survival analysis. Am J Obstet Gynecol. 1994;171(6):1488–1505. https://doi.org/10.1016/0002-9378(94)90392-1. 39. Boujenah J, Hugues JN, Sifer C, Cedrin-Durnerin I, Bricou A, Poncelet C. Second live birth after undergoing assisted reproductive technology in women operated on for endometriosis. Fertil Steril. 2016;105(1):129–133. https://doi.org/10.1016/j.fertnstert.2015.09.039. Рецензия Для цитирования: Ившин АА, Погодин OO. Индекс фертильности после хирургического лечения эндометриоза – предиктор наступления беременности. Медицинский Совет. 2025;(23):168-177. https://doi.org/10.21518/ms2025-555 For citation: Ivshin AA, Pogodin OO. Fertility index after surgical treatment of endometriosis as a predictor of pregnancy. Meditsinskiy sovet = Medical Council. 2025;(23):168-177. (In Russ.) https://doi.org/10.21518/ms2025-555 JATS XML

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