Peritoneal endometriosisLesion depth (superficial or deep) and total diameter
Ovarian endometriosisLesion depth (superficial or deep) and total diameter
Right ovary
Left ovary
Cul-de-sac obliterationExtent of fibrotic obliteration of the pouch of Douglas
Ovarian adhesionsEach ovary scored by adhesion type (filmy or dense) and fraction of ovary enclosed
Right ovary
Left ovary
Fallopian tube adhesionsEach tube scored by adhesion type (filmy or dense) and fraction of tube enclosed
Right tube
Left tube
Single adnexaPoints for the remaining tube and ovary are doubled
Step 1 resultRevised ASRM score and stage
Historical factorsPatient age, duration of infertility, and prior pregnancy — up to 5 points
Least Function (LF) score0 nonfunctional · 4 normal · LF = lowest left + lowest right (0–8)
Rate each structure at the conclusion of surgery. Tap ? for the published description of each level.
Fallopian tube — dysfunction levels
- 4 · Normal
- No injury
- 3 · Mild
- Slight injury to serosa of the fallopian tube
- 2 · Moderate
- Moderate injury to serosa or muscularis of the fallopian tube; moderate limitation in mobility
- 1 · Severe
- Fallopian tube fibrosis or mild/moderate salpingitis isthmica nodosa; severe limitation in mobility
- 0 · Nonfunctional
- Complete tubal obstruction, extensive fibrosis or salpingitis isthmica nodosa
Fimbria — dysfunction levels
- 4 · Normal
- No injury or scarring
- 3 · Mild
- Slight injury to fimbria with minimal scarring
- 2 · Moderate
- Moderate injury to fimbria, with moderate scarring, moderate loss of fimbrial architecture and minimal intrafimbrial fibrosis
- 1 · Severe
- Severe injury to fimbria, with severe scarring, severe loss of fimbrial architecture and moderate intrafimbrial fibrosis
- 0 · Nonfunctional
- Severe injury to fimbria, with extensive scarring, complete loss of fimbrial architecture, complete tubal occlusion or hydrosalpinx
Ovary — dysfunction levels
- 4 · Normal
- No size reduction or surface injury
- 3 · Mild
- Normal or almost normal ovarian size; minimal or mild injury to ovarian serosa
- 2 · Moderate
- Ovarian size reduced by one-third or more; moderate injury to ovarian surface
- 1 · Severe
- Ovarian size reduced by two-thirds or more; severe injury to ovarian surface
- 0 · Nonfunctional
- Ovary absent or completely encased in adhesions
| LF score | Function | EFI points |
|---|---|---|
| 7–8 | High | 3 pts |
| 4–6 | Moderate | 2 pts |
| 0–3 | Low | 0 pts |
AFS score componentsEndometriosis points and rAFS total, carried over from Step 1
Overridden — the EFI below is scored on the values in these boxes, not on Step 1.
Both boxes need a whole number of points, and the pair has to be a score this worksheet could produce — at most 86 endometriosis points, at most 64 adhesion points, so at most 150 in total. The EFI is held at — until they describe a worksheet that could have been filled in.
Estimated pregnancy outcomesCumulative non-ART pregnancy rate after surgery, by EFI score
Sources. Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril 2010;94(5):1609–15 — life-table data, all patients, n = 801. Points are the published 1-, 2- and 3-year figures; the lines between them are drawn, not measured. The merged 7–8 band is the exception the table does not carry: its 1- and 3-year values are read from the Figure 1 chart, and its 2-year value is the midpoint of the tabulated rows for 7 and 8. · Vesali S, Razavi M, Rezaeinejad M, Maleki-Hajiagha A, Maroufizadeh S, Sepidarkish M. Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis. BJOG 2020;127(7):800–9 — pooled 36-month rate, 17 studies, n = 4598.