Association of preoperative Enzian score with postoperative fertility in patients with deep pelvic endometriosis

Charlotte Dirou, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France.
Maxime Fondin, Department of Radiology, Rennes University Hospital, France; University 1, Rennes, France.
Estelle Le Pabic, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France.
Gaby Moawad, Department of Obstetrics and Gynecology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20037, USA.
Ludivine Dion, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; Rennes, University 1, IRSET, Rennes, France; University 1, Rennes, France.
Florence Nicolas, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France.
Solène Duros, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France.
Estelle Bauville, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France.
Jean Coiffic, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France.
Anne Cécile Pizzoferrato, INSERM, LTSI - UMR 1099, Rennes, France; University Hospital of Caen, France.
Eugénie Béraud, Department of Radiology, Rennes University Hospital, France.
Jean Levêque, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France.
Vincent Lavoué, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; Rennes, University 1, IRSET, Rennes, France; University 1, Rennes, France.
Krystel Nyangoh Timoh, Department of Obstetrics and Gynecology, Rennes University Hospital, 16 boulevard de Bulgarie, Rennes, France; University 1, Rennes, France. Electronic address: Krystel.nyangoh.timoh@chu-rennes.fr.

Document Type

Journal Article

Publication Date

5-16-2022

Journal

Journal of gynecology obstetrics and human reproduction

Volume

51

Issue

7

DOI

10.1016/j.jogoh.2022.102408

Keywords

Endometriosis; Enzian score; Fertility

Abstract

INTRODUCTION: Endometriosis is a chronic inflammatory disease with a negative impact on fertility. The Enzian classification provides a precise description of deep pelvic endometriotic lesions, especially in the retroperitoneal area, from preoperative pelvic MRI scans. However, it is not known if it is correlated with postoperative fertility. STUDY OBJECTIVE: To determine if there is an association between the preoperative Enzian score and postoperative fertility after deep pelvic endometriosis surgery. DESIGN: We conducted a descriptive, retrospective study using information from the ENDOREN database. SETTING: This was a retrospective study at the Department of Obstetrics and Gynecology at Rennes University Hospital (France) from January 2013 to May 2019 PATIENTS AND INTERVENTIONS: We used information from the ENDOREN database that included all women who underwent surgery for deep endometriosis and wish to conceive. This surgery was intended in a view to achieve a complete removal of endometriosis. MEASUREMENTS: The Enzian score was calculated from preoperative MRI scans, and total, spontaneous, and after In Vitro fertilization (IVF) live births and pregnancies outcomes were collected from the patients'computerized medical records. Univariate and multivariate analysis was performed. RESULTS: Sixty-eight patients were included. The live-birth rate was 35% (24/68). According to the Enzian classification, 25 patients (35%) were classified in compartment A, 64 patients (94%) in compartment B, and 27 (40%) in compartment C. In multivariate analysis, positive predictor of live birth was single Enzian B score (OR=4.7[1.21; 18.81], p = 0.03), negative predictors were uterine adenomyosis and a history of endometriosis surgery. In multivariate analysis, positive predictor of spontaneous live birth was EFI score ≥7 (OR =22.434; CI [1.138; 442.190]). In multivariate analysis, positive predictor was Enzian A score (OR=15.9[2.2; 114.7], p = 0.006), and negative predictors was uterine adenomyosis and Enzian B score (OR=0.01[0; 0.495], p = 0.02) for live birth after IVF. CONCLUSION: The present retrospective study cannot strongly conclude about fertility and correlation with Enzian score because the groups are too small. However, it seems that when solely the compartment B is involved by endometriosis, complete full removal of endometriosis leads to better post-operative live births results. Other studies must be done to determine if Enzian classification based on preoperative pelvic MRI could be clinical value in the decision-making strategy for managing infertile patients with deep pelvic endometriosis.

Department

Obstetrics and Gynecology

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