Predictive factors for spontaneous conception in women with moderate and severe endometriosis following operative laparoscopy: A cohort study

Abstract

Study objective

To externally validate the Endometriosis Fertility Index (EFI) and to assess cumulative spontaneous pregnancy rates in women with moderate to severe endometriosis following fertility-enhancing minimally invasive surgery.

Design

Retrospective cohort study.

Setting

Tertiary-care center for infertility treatment.

Participants

Women diagnosed with r-ASRM Stage III or IV endometriosis following fertility-sparing surgery between June 2013 and July 2023, and who desired for fertility.

Intervention

Minimally invasive laparoscopy.

Measurements and main results

The follow-up rate was 76.3 %, with a median duration of 15 months [Range (1–130 months)]. The mean age of women was 28.5 ± 3.8 years. Women with low EFI scores (0–3) had lower cumulative spontaneous pregnancy rates (11.4 % at six months, 17 % at three years) compared to those with higher EFI scores (7–8), who had significantly higher rates (35 % at six months, 84.5 % after three years) (P < 0.001). A similar trend was observed for overall pregnancy rates. Factors negatively correlated with spontaneous pregnancy included lower least function scores (P < 0.001), increasing maternal age (P = 0.003), rASRM scores of 16–40 vs. ≥ 71 (P < 0.001), lower antral follicle count (P = 0.02), and increasing paternal age (P < 0.001). Cystectomy (P = 0.001) was positively associated with spontaneous pregnancy post-surgery. Among the 518 women identified with moderate and severe endometriosis, 395 were followed up, out of which 370 attempted spontaneous conception for at least six months, resulting in a pregnancy rate of 37.3 % (138/370).

Conclusion

The current study demonstrated that EFI scores correlate with pregnancy rates, validating the scoring system in a South Asian population. Additionally, clinical factors such as low antral follicle count, and advanced paternal age may be considered to make informed clinical decisions post-surgery for women with advanced endometriosis who wish to conceive.