Postoperative fertility counseling

Endometriosis Fertility Index

Explore the 10-point EFI score, see how the historical and surgical components fit together, and connect the result to common fertility planning after endometriosis surgery.

Calculate an example
Medical illustration of reproductive anatomy beside a clinical checklist

Interactive score

Build the EFI from its components

Historical factors
Postoperative least-function score

Score each tube, fimbria, and ovary after surgical treatment: 0 nonfunctional, 1 severe, 2 moderate, 3 mild, 4 normal.

Right side

Left side

rAFS surgical scores

Estimated pregnancy by EFI score

Cumulative non-IVF pregnancy after surgery

Percent pregnant over time

Curves follow the original EFI life-table figure. The highlighted curve updates as the calculated EFI score changes.

EFI 10

Percentages estimate non-IVF pregnancy after endometriosis surgery. The 6-month figures are read from the published curve; the 12-month figures use the published 1-year life-table values.

Clinical interpretation

EFI helps decide how long to try naturally before IVF

EFI 9-10

Strong prognosis

Many clinicians would recommend trying spontaneous conception first if age, ovarian reserve, semen analysis, and tubal status are favorable.

EFI 7-8

Intermediate-to-good prognosis

A trial of natural conception for about 6-12 months after surgery is often reasonable before moving to IVF.

EFI <=6

Lower spontaneous pregnancy rates

IVF is more commonly discussed earlier, especially when other fertility factors reduce the chance of waiting successfully.

EFI 0-3

Very poor natural fertility prognosis

Prompt IVF counseling is usually appropriate because cumulative non-IVF pregnancy rates are low.

Practical cutoff

EFI >=7 supports a trial of spontaneous conception

EFI <=6 often shifts counseling toward earlier IVF, with the inflection point commonly around EFI 5-6.

  • Female age over 35
  • Diminished ovarian reserve
  • Long duration of infertility
  • Male factor infertility
  • Bilateral tubal disease
  • Recurrent endometriomas
  • Prior failed attempts after surgery

EFI is generally interpreted in ranges rather than by one absolute cutoff. A 30-year-old with EFI 6 may still reasonably try naturally; a 39-year-old with EFI 7 may still be counseled toward IVF sooner because time becomes the dominant factor.

The ESHRE endometriosis guideline supports using EFI to counsel patients about postoperative non-ART pregnancy chances after surgical staging, while emphasizing individualized decision-making.

What is counted

The EFI is half history, half surgical function

01

Patient history

Age, duration of infertility, and any prior pregnancy contribute up to 5 points. These factors are known predictors of pregnancy.

02

Least-function score

After surgery, the surgeon scores tube, fimbria, and ovary on each side. The lowest structure score on each side is added, creating a 0-8 least-function score.

03

rAFS context

The AFS endometriosis lesion score and total rAFS score each add one possible point when below the EFI thresholds.

How it is used

After endometriosis surgery, EFI supports timing decisions

  1. At the end of surgeryCalculate postoperative organ function, combine it with age, infertility duration, prior pregnancy, and rAFS scores.
  2. Early post-op counselingA higher EFI can support a period of expectant management or non-IVF treatment; a lower EFI can prompt earlier referral for assisted reproduction.
  3. Ongoing follow-upEFI is interpreted with ovarian reserve, semen analysis, uterine factors, symptoms, patient goals, and time already spent trying.

Clinical guardrails

Use it for the right question

EFI estimates pregnancy prognosis after surgically documented endometriosis in patients attempting non-IVF conception. It is not a pain score, not a diagnosis, and not a substitute for individualized reproductive endocrinology care.