External validation of the Endometriosis Fertility Index in a French population

Objective To show an external validation of the Endometriosis Fertility Index (EFI) and to observe cumulated pregnancy rates after infertility management combining surgery and assisted reproductive technologies (ART). Design Observational study from January 2004 to December 2012. Setting Tertiary-care university hospital and ART center. Patient(s) Four hundred twelve infertile and endometriotic patients after laparoscopic surgery. Intervention(s) Surgical diagnosis and treatment followed by spontaneous fertility or ART management. Main Outcome Measure(s) Spontaneous pregnancy rates and cumulative (spontaneous and ART) pregnancy rates according to the EFI. Result(s) A significant relationship between EFI and spontaneous pregnancy rates was observed at 12 months ( P =.001). The least function score and complete removal of endometriotic lesions and pelvic adhesions were significantly associated with spontaneous pregnancy ( P =.006). Cumulative pregnancy rate at 18 months was 78.8%. ART benefits for pregnancy rates were higher for patients with poor EFI. Conclusion(s) External validation of the EFI in a French population was demonstrated. Combining surgery for endometriosis and ART led to a 78.8% pregnancy rate at 18 months after surgery.