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

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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