Is there a stage 5 endometriosis?

Canis (1992) suggested using a revised American Fertility
Society (rAFS, 1985) score of >70 as a new stage 5 for

This is also the 4B sub-score of the
Fertility Index (EFI) (Adamson 2010).  The EFI is a clinical
tool used to predict pregnancy rates after endometriosis
surgery.  It is the only system that is predictive of fertility,
but is not a staging system.  The EFI has
6 levels and
uses the 1985 rAFS staging system’s total and
endometriosis sub-total score separately.  

The rAFS (or rASRM) is the staging system most
commonly used in surgical research.  It is useful in
comparing the gross appearance at the beginning of
surgery and is somewhat predictive of surgical difficulty.
But, it is not predictive of fertility, pain, the depth of
infiltration, or the volume of infiltrating endometriosis.

The rAFS has 150 points.  A score of 40 or higher is
rASRM stage 4.  The EFI separates stage 4 into scores for
4A (40 to 70 points) and 4B (71 to 150 points).  Scores of
71 and higher are generally seen only with severe
adhesions. Adhesions, a type of scar tissue, can block the
pathway that the eggs use to get to the tube.  

Adamson GD & Pasta DJ.  Endometriosis fertility index:
the new, validated endometriosis staging system Fertil
Steril 2010;94(5):1609–15

American Fertility Society.  Revised American Fertility
Society classification of endometriosis 1985.  Fertil Steril
43(3):351-352, 1985

American Society for Reproductive Medicine
classification of endometriosis: 1996. Fertil Steril 67(5):
817-21, 1997

Canis M, Pouly JL, Wattiez A, et al. Incidence of bilateral
adnexal disease in severe endometriosis (revised
American Fertility Society [AFS], stage IV): should a
stage V be included in the AFS classification? Fertil Steril
endometriosis, stage 5, what is stage 5