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

Abstract

The new ESHRE/ESGE classification system of female genital anomalies is presented, aiming to provide a more suitable classification system for the accurate, clear, correlated with clinical management and simple categorization of female genital anomalies. Congenital 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. The 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 has been appointed to run the project, looking also for consensus within the scientists working in the field. The new system is designed and developed based on: (1) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (2) consensus measurement among the experts through the use of the DELPHI procedure and (3) consensus development by the scientific committee, 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. The 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. The ESHRE/ESGE classification of female genital anomalies seems to fulfil the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice. The 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.

Reliability of the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy and American Society for Reproductive Medicine classification systems for congenital uterine anomalies detected using three-dimensional ultrasonography

“…This study is the first to estimate the reliability/agreement with regard to the diagnosis of congenital uterine anomalies using the ESHRE-ESGE criteria (24), and to compare it with the reliability/agreement of diagnoses obtained using the ASRM classification supplemented by morphometric criteria (16,21-23, 29, 30, 34, 35).…”

“…The measurements were taken after obtaining a coronal view with visible intramural parts of both Fallopian tubes (16,22,23,29,30). The uterine wall thickness was measured to classify congenital defects according to the ESHRE-ESGE classification (23,24). This was in agreement with the temporary recommendation for the measurement (34,35).…”

“…Therefore, the main objective of this study was to estimate the inter-rater and intrarater reliability of the ESHRE-ESGE classification of common congenital uterine malformations and to compare the results obtained with the reliability of the ASRM classification supplemented with additional morphometric criteria (22)(23)(24). An additional objective of the study was to assess the reliability of the 3D ultrasonographic measurements used to classify the following: internal fundal indentation, and external cleft and uterine wall thickness.…”

“…However, there is no international or interdisciplinary agreement on their application (16,(19)(20)(21)(22)(23), and no quantitative criteria have been formally endorsed by the ASRM. As an alternative to the ASRM classification, the European Society of Human Reproduction and Embryology/ European Society for Gynaecological Endoscopy (ESHRE-ESGE) classification of M€ ullerian anomalies was recently proposed on the basis of the opinions of local experts (24).…”

Aplasia of the uterus and vagina (Mayer-Rokitansky-Kuster-Hauser syndrome) in combination with endometriosis: unresolved aspects of etiopathogenesis (a review)

“…В 2013 г. предложена новая классифика-ция Европейской ассоциации репродуктологов и Ев-ропейской ассоциации гинекологов (ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies). Ученые пришли к единому консенсусу [16], за исключением описания нетипич-ных пороков, отсутствующих в классификации или принадлежащих одновременно более чем к одному классу. Исходя из этого, возникают трудности при постановке правильного диагноза.…”