- Background: The Endometriosis Fertility Index (EFI) is a score used as a diagnostic tool for identifying the state of fertility in women undergoing surgery for endometriosis. This score goes from 0 (worst prognosis) to 10 (best prognosis). Since it is calculated in the post-operative time, currently it is still difficult to evaluate its role in the non-surgical management of women suffering from endometriosis, even if it is increasing its significance, because of the re-evaluation of surgery in the diagnosis and treatment of infertility associated with the pathology. - Objective: The purpose of this study is to evaluate if the Endometriosis Fertility Index (EFI) can be accurately estimated even before surgery, with non invasive clinical-instrumental investigations in women affected by endometriosis-related infertility, in order to get advantages from non-surgical management of patients. - Materials and methods: In the study, visited patients were selected in the period from January 2019 to June 2023in the “Chronic pelvic pain and endometriosis” clinic at the Gynecological Obstetrics Clinic of the Hospital / University of Padua, using precise inclusion criteria: clinical-instrumental diagnosis of endometriosis, age between 18 e 42, the presence of infertility associated with the disease. The Endometriosis Fertility Index (EFI) was calculated for each patient at three moments: at ultrasound, at diagnostic laparoscopy and at the end of the pelvic reclamation surgery. The various calculated EFIs were subsequently compared in order to evaluate the concordance between the clinical classes of the ultrasound EFI and the post-surgical EFI (primary outcome). Other aspects had been also evaluated: the agreement between the EFI score; the clinical class calculated during ultrasound and during diagnostic laparoscopy; the possible modification of the ultrasound EFI and the laparoscopic EFI and potential therapeutic suggestion. - Results: Ultrasound and laparoscopic EFI scores did not differ statistically from each other (p= 0,961), this was not the same for ultrasound and post-operative EFI scores (p< 0,01). Agreement between ultrasound and laparoscopic EFI clinical classes were high: 100% (6 of 6) for low EFI, 70% (7 of 10) for intermediate EFI and 80% (12 of 15) for the high EFI. - Conclusions: The high concordance demonstrated between ultrasound and laparoscopic EFI scores and clinical classes, suggests that it is not essential to propose surgery for diagnostic purposes only. Furthermore, evaluating the low concordance between the ultrasound and post-operative EFI classes, it is possible to reach the conclusion that clinical-instrumental investigations cannot completely replace surgery in the treatment of endometriosis-related infertility. On the basis of the EFI calculation, however, it is possible to propose the most appropriate therapeutic strategies: patients with intermediate ultrasound EFI can benefit from pelvic reclamation surgery to improve their chance of spontaneous and non-spontaneous conception; patients with low ultrasound EFI, despite the advantages of surgery from the anatomical point of view, do not see improved their chances of conception, for this reason a medically assisted procreation path is directly offered to them. Finally, for patients with a low ultrasound EFI, the operation does not lead to any improvement from the anatomical and clinical point of view, for this reason surgery is not recommended.
- Background: L’Endometriosis Fertility Index (EFI) è uno score utilizzato come strumento diagnostico utile per individuare lo stato della fertilità in donne sottoposte ad intervento chirurgico per endometriosi, potendo assumere un valore da 0 (prognosi peggiore) a 10 (prognosi migliore). Essendo calcolato nel post-operatorio permane ancora oggi la difficoltà nella valutazione del suo ruolo nel management non chirurgico della donna affetta da endometriosi, anche se sta assumendo sempre più importanza vista la rivalutazione della chirurgia nella diagnosi e trattamento dell’infertilità associata alla patologia. - Scopo dello studio: Lo scopo di questo studio è valutare se l’Endometriosis Fertility Index (EFI) possa essere stimato accuratamente anche prima dell’intervento chirurgico mediante indagini clinico-strumentali non invasive in donne affette da infertilità endometriosi-correlata, al fine di trarre beneficio dai vantaggi di un management non chirurgico della paziente. - Materiali e metodi: Sono state selezionate nello studio le pazienti afferite all’ambulatorio “Dolore pelvico cronico ed endometriosi” presso la Clinica Ginecologica Ostetrica dell’Azienda Ospedale – Università di Padova tra Gennaio 2019 e Giugno 2023 utilizzando precisi criteri di inclusione: diagnosi clinico-strumentale di endometriosi, età compresa tra 18 e 42 anni, presenza di infertilità associata alla malattia. Per ogni paziente è stato calcolato l’Endometriosi Fertility Index (EFI) in tre momenti: all’ecografia, alla laparoscopia diagnostica e al termine dell’intervento di bonifica della pelvi. I vari EFI calcolati sono stati successivamente confrontati al fine di valutare la concordanza tra le classi cliniche dell’EFI ecografico e di quello post-chirurgico (outcome primario). Sono stati inoltre valutati altri aspetti quali la concordanza tra il punteggio e la classe clinica EFI calcolati durante l’ecografia e durante la laparoscopia diagnostica e l’eventuale modifica dell’EFI ecografico e dell’EFI post-chirurgico e potenziale suggerimento terapeutico. - Risultati: I punteggi EFI ecografici e laparoscopici non presentano tra loro una differenza statisticamente significativa (p= 0,961), a differenza di quanto emerso tra i punteggi EFI ecografici e post-operatori (p< 0,01). La concordanza tra le classi cliniche EFI ecografiche e laparoscopiche si è dimostrata alta: 100% (6 su 6) in presenza di un EFI basso, 70% (7 su 10) per l’EFI intermedio e dell’80% (12 su 15) per l’EFI elevato. - Conclusioni: L’elevata concordanza dimostratasi tra i punteggi e le classi cliniche EFI ecografiche e laparoscopiche suggerisce che non sia indispensabile proporre l’intervento chirurgico ai soli scopi diagnostici. Valutando inoltre la bassa concordanza tra le classi EFI ecografiche e post-operatorie è possibile giungere alla conclusione che le indagini clinico-strumentali non possano completamente subentrare alla chirurgia nel trattamento dell’infertilità endometriosi-correlata. Sulla base del calcolo dell’EFI è possibile, tuttavia, proporre delle strategie terapeutiche ritenute più opportune: le pazienti con EFI ecografico intermedio possono trarre beneficio dall’intervento di bonifica della pelvi per migliorare la loro possibilità di concepimento spontaneo e non; le pazienti con EFI ecografico basso, nonostante i vantaggi apportati dalla chirurgia dal punto anatomico, non vedono migliorate le proprie chances di concepimento e per questo motivo viene proposto loro direttamente un percorso di procreazione medicalmente assistita. Infine, per le pazienti con un EFI ecografico basso l’intervento non comporta un eventuale miglioramento dal punto di vista anatomico e clinico, pertanto la chirurgia non viene consigliata.
Endometriosis Fertility Index: dalla chirurgia all'ecografia, per un approccio conservativo dell'infertilità endometriosi-correlata.
SCHIESARI, GIULIA
2022/2023
Abstract
- Background: The Endometriosis Fertility Index (EFI) is a score used as a diagnostic tool for identifying the state of fertility in women undergoing surgery for endometriosis. This score goes from 0 (worst prognosis) to 10 (best prognosis). Since it is calculated in the post-operative time, currently it is still difficult to evaluate its role in the non-surgical management of women suffering from endometriosis, even if it is increasing its significance, because of the re-evaluation of surgery in the diagnosis and treatment of infertility associated with the pathology. - Objective: The purpose of this study is to evaluate if the Endometriosis Fertility Index (EFI) can be accurately estimated even before surgery, with non invasive clinical-instrumental investigations in women affected by endometriosis-related infertility, in order to get advantages from non-surgical management of patients. - Materials and methods: In the study, visited patients were selected in the period from January 2019 to June 2023in the “Chronic pelvic pain and endometriosis” clinic at the Gynecological Obstetrics Clinic of the Hospital / University of Padua, using precise inclusion criteria: clinical-instrumental diagnosis of endometriosis, age between 18 e 42, the presence of infertility associated with the disease. The Endometriosis Fertility Index (EFI) was calculated for each patient at three moments: at ultrasound, at diagnostic laparoscopy and at the end of the pelvic reclamation surgery. The various calculated EFIs were subsequently compared in order to evaluate the concordance between the clinical classes of the ultrasound EFI and the post-surgical EFI (primary outcome). Other aspects had been also evaluated: the agreement between the EFI score; the clinical class calculated during ultrasound and during diagnostic laparoscopy; the possible modification of the ultrasound EFI and the laparoscopic EFI and potential therapeutic suggestion. - Results: Ultrasound and laparoscopic EFI scores did not differ statistically from each other (p= 0,961), this was not the same for ultrasound and post-operative EFI scores (p< 0,01). Agreement between ultrasound and laparoscopic EFI clinical classes were high: 100% (6 of 6) for low EFI, 70% (7 of 10) for intermediate EFI and 80% (12 of 15) for the high EFI. - Conclusions: The high concordance demonstrated between ultrasound and laparoscopic EFI scores and clinical classes, suggests that it is not essential to propose surgery for diagnostic purposes only. Furthermore, evaluating the low concordance between the ultrasound and post-operative EFI classes, it is possible to reach the conclusion that clinical-instrumental investigations cannot completely replace surgery in the treatment of endometriosis-related infertility. On the basis of the EFI calculation, however, it is possible to propose the most appropriate therapeutic strategies: patients with intermediate ultrasound EFI can benefit from pelvic reclamation surgery to improve their chance of spontaneous and non-spontaneous conception; patients with low ultrasound EFI, despite the advantages of surgery from the anatomical point of view, do not see improved their chances of conception, for this reason a medically assisted procreation path is directly offered to them. Finally, for patients with a low ultrasound EFI, the operation does not lead to any improvement from the anatomical and clinical point of view, for this reason surgery is not recommended.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/47994