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Validation of the endometriosis fertility index (EFI) in infertile Filipino women with laparoscopically-diagnosed endometriosis: A preliminary study.


Ma. Isadora Margarita Yap-Garcia,
Delfin A. Tan

Related Institution

Department of Obstetrics and Gynecology - St. Luke's Medical Center

Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Reproductive Endocrinology and Infertility
Publication Date
July-December 2012


OBJECTIVE: To validate the EFI, a clinical tool that predicts the possibility of pregnancy in Filipino women with laparoscopically-diagnosed endometriosis-associated infertility.

DESIGN: Retrospective cohort

SETTING: St. Luke's Medical Center

PATIENTS: One hundred twenty-two infertile women with laparoscopically-diagnosed endometriosis.

METHODOLOGY: Subjects were scored using the Endometriosis Fertility Index (EFI). Pregnancy rates were determined separately. Discriminative capacity of the EFI was assessed by Receiver Operator Characteristic (ROC) analysis. Sensitivity, specificity, positive and negative predictive values of the test at different thresholds were determined. Correlation of EFI scores and pregnancy rates was determined by logistic regression analysis.

MAIN OUTCOME MEASURES: EFI scores, pregnancy rates, ROC curve, Area under the curve (AUC), sensitivity, specificity, positive and negative predictive values, Logistic fit of pregnancy VS. EFI scores.

RESULTS: Twenty-two pregnancies occurred during the 12-month period with 13 pregnancies occurring within the first six months. Over-all pregnancy rate was 18.3%. The ROC curve straddled the line and showed an AUC of 67%. The sensitivity and specificity of the EFI for each threshold showed increasing sensitivity with lower scores and higher specificity with higher scores. Positive predictive values (PPV) were low, but Negative predictive values (NPVs) were high. Logistic regression analysis showed a good correlation between EFI scores and pregnancy (P < 0.05).

CONCLUSIONSS: The individual scores correlate well with the chances of pregnancy and the negative predictive value of the test is high. This index is a newly validated, simple clinical tool that can predict pregnancy in infertile women with endometriosis. The discrimination Gapability of the EFI needs further analysis.


1. Fritz, M A, Speroff, L . "Clinical Gynecologic Endocrinology and Infertility, 8th ed." Lippincott Williams and Wilkins, a Wolters Kluwerbusiness , 1221, 2011
2. "The Practice Committee for the American Society of Reproductive Medicine. Endometriosis and Infertility." Fertil Steril 81, 1441-1446, 2004
3. Giudice, L C. "Clinical Practice: Endometriosis." N EnglJ Med 362(25): 2389-2398, 2010
4. Moayeri, S E, Lim, H C, Lathi, R B, Westphal, L M, Milki, A A, Garber, A M. "Laparoscopy in women with unexplained infertility: A cost-effectiveness analysis." Fertil Steril 92, 471-480, 2009
5. Jacobson, T Z, Barlow, D H, Koninckx, P R, Olive, D , Farquhar, C . "Laparoscopic surgery for subfertility associated with endometriosis." Cochrane Database Syst Rev , 4, 2002
6. Marcoux, S , Maheux, R , Berube, S , et, al . "Laparoscopic surgery in infertile women with minimal or mild endometriosis." N Engl J Med 337, 217-222, 1997
7. Porpora, M S, Pultrone, D C, Bellavia, M , et, al . "Reproductive outcomes after laparoscopic treatment of endometriosis." Clin Exp Obstet Gynecol 29(4): 271-273, 2002
8. Inoue, M , Kobayashi, Y , Haond, I , Awaji, H , Fujii, A . "The impact of endometriosis on the reproductive outcome of infertile patients." Am J Obstet Gynecol 167, 278-282, 1992
9. Gupta, S , Goldberg, J M, Aziz, N , et, al . "Pathogenic mechanisms in endometriosis-related infertility." Fertil Steril 80, 247-257, 2008
10. XinGao, , Outley, J , Botteman, M , Spalding, J , Simon, J A, Pashos, C L. "Economic burden of endometriosis." Fertil Steril 86, 1561-1572, 2006
11. Rockets, C P, Rock, J A. "The current staging system for endometriosis: Does it help?" Obstet Gynecol Clin North Am 2003; 30 (1): 115-123. 30(1): 115-123, 2003
12. Schenker, R S. "Endometriosis classification for infertility." Acta Obstet Gynecol Scand 159, 41-44, 1994
13. Hoeger, K M, Guzick, D S. "An update on the classification of endometriosis." Clin Obstet Gynecol 42(3): 611-619, 1999
14. "American Fertility Society. Revised American Fertility Society classification of endometriosis: 1985." Fertil Steril 43, 351-352, 1985
15. Hornstein, M D, Gleason, R E, Orav, J , Haas, S T, Friedman, A J, Rein, M S, Hill, J A, Barbieri, R L. "The reproducibility the revised American Fertility Society classification of endometriosis." Fertil Steril 59, 1015-1021, 1993
16. "American Fertility Society. Classification of endometriosis." Fertil Steril 38, 171-176, 1982
17. "American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine Classification of Endometriosis: 1996." Fertil Steril 67(5): 817-821, 1997
18. Wallach, E E. "Economic burden of endometriosis." Fertil Steril 86, 1561-1571, 2006
19. Adamson, G D, Pasta, D J. "Endometriosis Fertility Index: The new, validated endometriosis staging system." Fertil Steril 94(5): 1609-1615, 2010
20. Tan, D A. "Impact and experience of endometriosis in Asian women. In: Insights of Endometriosis in Asia. Compendium of Expert Opinion on Endometriosis Management." UBM Medica , 5-7, 2012
21. Sangi-Haghpeykar, H , Poindexter, A N. "Epidemiology of endometriosis among parous women." Obstet Gynecol 85, 983-982, 1995
22. Nnoaham, K E, Hummelshoj, L , Kennedy, S , Jenkin, C , Zondervan, K T. "Developing a symptom-based predictor of endometriosis as a clinical screening tool: results of a multiicenter study." Fertil Steril , . Retrieved from: http://2012
23. Mol, BW J, Coppus, S F, Van derVeen, F , Bossuyt, PM M. "Evaluating predictors for the outcome of assisted reproductive technology: ROC-curves are misleading; calibration is not!" Fertil Steril 84, 253-254, 2005

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