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Interobserver Reproducibility of Two Endometriosis Scoring Systems: A Multicentre Observational Prospective Study.

Gabriella Caron-Racine1, Anne-Marie Bergeron1, Madeleine Lemyre2

  • 1Université Laval, Quebec City, QC.

Journal of Obstetrics and Gynaecology Canada : JOGC = Journal D'Obstetrique Et Gynecologie Du Canada : JOGC
|September 21, 2025
PubMed
Summary
This summary is machine-generated.

The Revised American Society for Reproductive Medicine score (r-ASRM) and Endometriosis Fertility Index (EFI) show high reproducibility between observers in endometriosis surgery. These tools are reliable for communication among healthcare professionals.

Keywords:
endometriosisfemaleinfertilitylaparoscopyobserver variationseverity of illness index

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Area of Science:

  • Reproductive Medicine
  • Surgical Oncology
  • Gynecologic Surgery

Background:

  • Endometriosis diagnosis and staging rely on subjective scoring systems.
  • Accurate staging is crucial for guiding treatment and predicting fertility outcomes.
  • Interobserver variability can impact treatment decisions and research consistency.

Purpose of the Study:

  • To evaluate the interobserver reproducibility of the Revised American Society for Reproductive Medicine (r-ASRM) score.
  • To assess the interobserver reproducibility of the Endometriosis Fertility Index (EFI).
  • To determine the reliability of these scoring systems in women undergoing conservative laparoscopic treatment for endometriosis.

Main Methods:

  • A multicenter cross-sectional cohort study involving 100 women undergoing laparoscopy for endometriosis.
  • Two independent assessors (specialists, fellows, or residents) evaluated r-ASRM stage/score and EFI during surgery.
  • Assessors completed scoring sheets blindly, with consensus reached post-discussion. Reproducibility was measured using Cohen's κ and intraclass correlation coefficients.

Main Results:

  • Strong interobserver agreement was observed for r-ASRM stage.
  • Almost perfect agreement was found for EFI and Least function score categories.
  • Excellent agreement was noted for both r-ASRM and EFI scores, irrespective of assessor expertise or patient history.

Conclusions:

  • The r-ASRM and EFI classifications demonstrate high reproducibility among assessors.
  • These validated tools can enhance communication and consistency among healthcare professionals in managing endometriosis.
  • Further research is needed to address the limitations of these scores in explaining pain symptom variations.