The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies

Abstract

STUDY QUESTIONWhat classification system is more suitable for the accurate, clear, simple and related to the clinical management categorization of female genital anomalies?SUMMARY ANSWERThe new ESHRE/ESGE classification system of female genital anomalies is presented.WHAT IS KNOWN ALREADYCongenital malformations of the female genital tract are common miscellaneous deviations from normal anatomy with health and reproductive consequences. Until now, three systems have been proposed for their categorization but all of them are associated with serious limitations.STUDY DESIGN, SIZE AND DURATIONThe European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) have established a common Working Group, under the name CONUTA (CONgenital UTerine Anomalies), with the goal of developing a new updated classification system. A scientific committee (SC) has been appointed to run the project, looking also for consensus within the scientists working in the field.PARTICIPANTS/MATERIALS, SETTING, METHODSThe new system is designed and developed based on (i) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (ii) consensus measurement among the experts through the use of the DELPHI procedure and (iii) consensus development by the SC, taking into account the results of the DELPHI procedure and the comments of the experts. Almost 90 participants took part in the process of development of the ESHRE/ESGE classification system, contributing with their structured answers and comments.MAIN RESULTS AND THE ROLE OF CHANCEThe ESHRE/ESGE classification system is based on anatomy. Anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance.LIMITATIONS, REASONS FOR CAUTIONThe ESHRE/ESGE classification of female genital anomalies seems to fulfill the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice.WIDER IMPLICATIONS OF THE FINDINGSThe ESHRE/ESGE classification system of female genital anomalies could be used as a starting point for the development of guidelines for their diagnosis and treatment.STUDY FUNDING/COMPETING INTEREST(S)None.

Complex mullarian duct abnormality in a young female: a theraputic dilemma

“…We could not find any class to assign in the present American Fertility Society (AFS) classification, but this anomaly can be assigned to class U IV b C2 V3 of newer consensus classification by ESHRE/ESGE. 5,6 On reviewing the literature, we did not find any similar case reported. we could find one case report with univornuate uterus with cervival dysgenesis.…”

Reply

“…First and foremost, we would like to point out that our study is not a validation of the new European Society of Human Reproduction and Embryology-European Society for Gynaecological Endoscopy (ESHRE-ESGE) 2 over the American Society for Reproductive Medicine (ASRM) 3 classification system. Our objective was only to ascertain the accuracy of three-dimensional ultrasound (3D-US) with respect to this new classification system.…”

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report

“…1A and B). The septum reached the level of the internal cervical os, indicating a complete septate uterus corresponding to class V of the American Society of Reproductive Medicine classification (7) and class U2 of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy classification (8). The patient exhibited hydronephrosis at presentation, indicating disease stage IIIB, according to the uterine cervical cancer staging system of the International Federation of Gynecology and Obstetrics (FIGO) (9).…”