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

Charlotte Dirou (1) , Maxime Fondin (1) , Estelle Le Pabic (1) , Gaby Moawad (2) , Ludivine Dion (3, 1) , Florence Nicolas (1) , Solène Duros (1) , Estelle Bauville (1) , Jean Coiffic (1) , Anne Cécile Pizzoferrato (4) , Eugénie Béraud (1) , Jean Leveque (1) , Vincent Lavoué (3, 1) , Krystel Nyangoh Timoh (1)

1 Centre Hospitalier Universitaire [Rennes]
2 Washington University School of Medicine in St. Louis
3 Irset - Institut de recherche en santé, environnement et travail
4 LTSI - Laboratoire Traitement du Signal et de l'Image

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.

Mots clés: Endometriosis; Enzian score; Fertility

Domaines: Ingénierie biomédicale; Gynécologie et obstétrique

Charlotte Dirou, Maxime Fondin, Estelle Le Pabic, Gaby Moawad, Ludivine Dion, et al.. Association of preoperative Enzian score with postoperative fertility in patients with deep pelvic endometriosis. Journal of Gynecology Obstetrics and Human Reproduction, 2022, 51 (7), pp.102408. ⟨10.1016/j.jogoh.2022.102408⟩. ⟨hal-03689808⟩