Clinical predictors of endometriosis in the infertility population: is there a better way to determine who needs a laparoscopy?
OBJECTIVE
Endometriosis is a known contributor to infertility, but the gold standard for its diagnosis is surgical. Therefore, it is important for clinicians to be able to predict which women with infertility are at high risk for endometriosis and thus should be offered laparoscopy. We sought to identify the clinical predictors of endometriosis in the infertility population.


METHODS
We conducted a retrospective review of patients at an academic infertility centre. The primary outcome was identification of endometriosis at laparoscopy, and we used logistic regression to test clinical variables for their ability to predict endometriosis.


RESULTS
Primary infertility, dysmenorrhea, and uterosacral/cul-de-sac nodularity were significant independent predictors of finding endometriosis at laparoscopy. Other clinical variables (including hysterosalpingogram findings) were not independent predictors of endometriosis, and physicians with an endometriosis-focused practice were more likely to diagnose endometriosis at laparoscopy.


CONCLUSIONS
Key predictors of endometriosis in the infertility population are primary infertility, dysmenorrhea, and uterosacral/cul-de-sac nodularity. These results will be used to develop and validate a formal clinical prediction model for endometriosis in infertile women.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Kellie
K
Whitehill
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; British Columbia Women's Centre for Reproductive Health, Vancouver BC.
Paul J
PJ
Yong
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; British Columbia Women's Centre for Reproductive Health, Vancouver BC; Division of Reproductive Endocrinology and Infertility, University of British Columbia, Vancouver BC.
Christina
C
Williams
D000328:Adult; D004412:Dysmenorrhea / Q000209:etiology; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D007247:Infertility, Female / Q000209:etiology*; D010535:Laparoscopy; D016015:Logistic Models; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014599:Uterus / Q000473:pathology