Magnetic Resonance Imaging as a Non‐Surgical Predictor of Endometriosis Fertility Index Surgical Factors

AIM: Endometriosis affects 6%-10% of women of reproductive age and is associated with chronic pelvic pain, infertility, and impaired quality of life. The endometriosis fertility index (EFI) predicts spontaneous pregnancy postoperatively, but requires operative findings, limiting its use in non-surgical cases. This study evaluated whether magnetic resonance imaging (MRI) could serve as an alternative to EFI. METHODS: This retrospective study included 34 women aged 18-43 years who underwent laparoscopic ovarian cystectomy at Gunma University Hospital (2018-2022). Surgical videos were reviewed to calculate EFI. Preoperative MRI findings were assessed using ovarian cyst shape, ovarian position, and follicle location. MRI indicators were compared with EFI surgical factor scores using logistic regression. RESULTS: The mean EFI was 5.7 ± 1.8. Abnormal follicle location on MRI significantly correlated with lower EFI surgical factor scores (p < 0.05), whereas cyst shape and ovarian position showed no significant associations. Postoperatively, six women conceived spontaneously, and three conceived through assisted reproductive technology (ART). CONCLUSION: Abnormal follicle location may noninvasively predict surgical factors for EFI. Considering that MRI is routinely performed preoperatively in Japan, MRI-based EFI prediction can be used as a supporting finding to assist in determining whether to proceed with ART without surgical intervention.