Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis.
Adult
Area Under Curve
Endometriosis
/ complications
Female
Fertility
Gynecologic Surgical Procedures
/ adverse effects
Humans
Infertility, Female
/ etiology
Odds Ratio
Postoperative Complications
/ etiology
Postoperative Period
Predictive Value of Tests
Pregnancy
Pregnancy Rate
Prognosis
Risk Assessment
/ methods
Endometriosis Fertility Index
meta-analysis
pregnancy
systematic review
Journal
BJOG : an international journal of obstetrics and gynaecology
ISSN: 1471-0528
Titre abrégé: BJOG
Pays: England
ID NLM: 100935741
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
accepted:
13
01
2020
pubmed:
23
1
2020
medline:
24
6
2020
entrez:
23
1
2020
Statut:
ppublish
Résumé
Results of studies that have assessed the accuracy of the endometriosis Fertility Index (EFI) for predicting non-assisted reproductive technology (ART) pregnancy are inconsistent. We intended to evaluate the accuracy of EFI for the prediction of non-ART pregnancy. Embase, Medline, Scopus and Web of Science were searched up to 5 October 2019. We included studies that used EFI to predict non-ART pregnancy in women with surgically documented endometriosis. A total of 5547 studies were identified, from which we included 17 studies on 4598 women in the meta-analysis. Eight studies were classified as good quality, and the rest were considered to be of fair quality. Only five (29.41%) studies used appropriate approaches to account for potential confounders. Pooled effect sizes with corresponding 95% CI were calculated using random-effects model. The cumulative non-ART pregnancy rate at 36 months was 10% (95% CI: 3, 16%; P < 0.001) for women with an EFI of 0-2, which significantly increased to 69% (95% CI: 58, 79%; P < 0.001) for women with an EFI of 9-10. Compared with women with an EFI of 3-4 (18%, 95% CI: 12, 24%; P < 0.001), the combined cumulative non-ART pregnancy rates were 44% (95% CI: 26, 63%; P < 0.001) for women with an EFT of 5-6 and 55% (95% CI: 47, 64%; P < 0.001) for women with an EFI of 7-8. Paired comparison by the chi-square test showed a significant difference between all categories (P < 0.001). The odds ratio (OR) for EFI was 1.33 (95% CI: 1.17, 1.49, P < 0.001) and the summary area under the curve (AUC) was 72% (95% CI: 65, 80%, P < 0.001). The current findings highlighted the good performance of the EFI score in predicting the non-ART pregnancy rate. However, these findings should be considered with caution because of the substantial heterogeneity between studies. Review findings show the merits of Endometriosis Fertility Index as having a prognostic ability for non-assisted reproductive technology pregnancy.
Sections du résumé
BACKGROUND
Results of studies that have assessed the accuracy of the endometriosis Fertility Index (EFI) for predicting non-assisted reproductive technology (ART) pregnancy are inconsistent.
OBJECTIVE
We intended to evaluate the accuracy of EFI for the prediction of non-ART pregnancy.
SEARCH STRATEGY
Embase, Medline, Scopus and Web of Science were searched up to 5 October 2019.
SELECTION CRITERIA
We included studies that used EFI to predict non-ART pregnancy in women with surgically documented endometriosis.
DATA COLLECTION AND ANALYSIS
A total of 5547 studies were identified, from which we included 17 studies on 4598 women in the meta-analysis. Eight studies were classified as good quality, and the rest were considered to be of fair quality. Only five (29.41%) studies used appropriate approaches to account for potential confounders. Pooled effect sizes with corresponding 95% CI were calculated using random-effects model.
MAIN RESULTS
The cumulative non-ART pregnancy rate at 36 months was 10% (95% CI: 3, 16%; P < 0.001) for women with an EFI of 0-2, which significantly increased to 69% (95% CI: 58, 79%; P < 0.001) for women with an EFI of 9-10. Compared with women with an EFI of 3-4 (18%, 95% CI: 12, 24%; P < 0.001), the combined cumulative non-ART pregnancy rates were 44% (95% CI: 26, 63%; P < 0.001) for women with an EFT of 5-6 and 55% (95% CI: 47, 64%; P < 0.001) for women with an EFI of 7-8. Paired comparison by the chi-square test showed a significant difference between all categories (P < 0.001). The odds ratio (OR) for EFI was 1.33 (95% CI: 1.17, 1.49, P < 0.001) and the summary area under the curve (AUC) was 72% (95% CI: 65, 80%, P < 0.001).
CONCLUSION
The current findings highlighted the good performance of the EFI score in predicting the non-ART pregnancy rate. However, these findings should be considered with caution because of the substantial heterogeneity between studies.
TWEETABLE ABSTRACT
Review findings show the merits of Endometriosis Fertility Index as having a prognostic ability for non-assisted reproductive technology pregnancy.
Identifiants
pubmed: 31967727
doi: 10.1111/1471-0528.16107
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
800-809Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2020 Royal College of Obstetricians and Gynaecologists.
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