Adamson and Pasta propose a new scoring system for endometriosis. They propose an Endometriosis Fertility Index (EFI). The EFI is a combination of surgical factors and historical factors.
- The EFI is a combination of surgical factors and historical factors.
- The EFI adds a surgical score for functional impairment of the pelvic organs after surgery
- The EFI score correlated well with cumulative pregnancy rates
Endometriosis is a disease that can cause infertility and pain (or both). Precisely how it causes infertility is often debated but when the endometriosis distorts the reproductive organs, then it can cause a mechanical dysfunction of ovum pickup or sperm/embryo transportation.
We believe from a variety of sources that the tube captures the egg not by chance but because the open fimbriated end is attracted to the ovary at the time of ovulation. Anything that prevents or interferes with this process can impair fertility. For example, if the ovary is encased in adhesions (scar tissue) like saran wrap, and then the egg will never get into the tube.
Drs. Adamson and Pasta took another look at surgical scoring systems for endometriosis. They propose an Endometriosis Fertility Index (EFI). The EFI is a combination of surgical factors and historical factors. (GD Adamson, M.D. and DJ Pasta, M.S. Fertil Steril® 2010;94:1609–15.)
[ilink url=”http://bit.ly/gvMC9u”]Link to Abstracts[/ilink]
[box type=”info”]The older endometriosis scoring systems, still in use, have a major problem in that they do not predict pregnancy very well. The authors of this study used data from past surgeries to construct a new scoring system that represents the functional impairment of the organs as seen at surgery.[/box]
The surgery scoring system consists of two parts: The Least Function (LF) Score and the American Fertility Society (AFS) Lesion Score.
- The LF score assigned at the completion of surgery is highest for normal function of the tube, fimbria and ovary.
- They suggest that the score assigned to each side (left or right adnexa) should be the lowest of the three assessments because they reasoned; the adnexa function is likely determined by the weakest link.
- The AFS score is assigned using the old criteria but for the EFI only a score of ≥ 16 (requires an endometrioma or cul-de-sac obliteration: severe disease) matters.
They assign a score for several historical facts and combine the historical score with the surgical score into the EFI. Their EFI predicted outcomes using both historical patients and validation patients.
- They devised the scores to utilize easy straight forward clinical surgical findings.
- Scores will vary somewhat between physicians with about 4% higher scores (better fertility rating) and 11% lower scores (worse fertility rating).
- However the EFI score changed by more than 1 point in only 5% of cases.
Outcomes came from non-IVF treatment (both active and expectant management).
- None of the patients underwent IVF treatment.
- Also, women with a significant uterine factor are excluded – however uterine factors are uncommon with endometriosis.