Is it time to change the ASRM classification for endometriosis lesions? Proposal for a functional FOATIaRVS classification

Abstract

A new FOATIaRVS (Foci-Ovarian endometrioma-Adhesion-Tubal endometriosis-Inflammation-adenomyosis-Recto Vaginal Space) endometriosis classification is proposed to replace the ASRM (American Society Reproductive Medicine) classification. FOATIaRVS is descriptive, complete, precise, simple and easy-to-use. All endometriotic implants are described through the use of a formula. The attribution of coefficients for each endometriotic site is very simple: 0, 1 or 2. A coefficient of 2 is attributed if the lesion is substantial and could cause infertility or pain. The description of the endometriosis covers not only the usual appearance of the implants but also their functional repercussion for tubal and ovarian function. It also includes results of the most recently developed explorations. The formula is clearly of value for providing information on the progression or the regression of each endometriotic site and on the efficacy of the therapy for each location. It has a predictive value and can provide indications for the choice of therapy.

It Is Necessary to Purpose an Add-on to the American Classification of Endometriosis? This Disease Can Be Compared to a Malignant Proliferation While Remaining Benign in Most Cases. EndoGram® Is a New Profile Witness of Its Evolutionary Potential

“…In 1979, the American Fertility Society created the AFS classification (13), followed by a revised form in 1985 (2). In 1996, the committee of the American Society for Reproductive Medicine (ASRM) added to the revised classification a description of peritoneal implants (red, white, and black) (10) (Figure 4) with different grades and defined scores: minimal (scores 1–5), mild (6–15), moderate (16–40), and severe (>40) (Figures 4, 5). However, these scores are arbitrary.…”

“…We know that small, progressive lesions can be much more aggressive in the pelvis and “harmful” to fertility than giant, calm anatomical lesions. Indeed, it is easy to understand why, in the literature, there is so much discordance in treatments and results because the lesions do not have all the same characteristics (10). Adamson and Pasta proposed an index of endometriosis to predict pregnancy rate using IVF program (24).…”

“…Adamson and Pasta proposed an index of endometriosis to predict pregnancy rate using IVF program (24). Finally, Tran and Belaisch (10) developed the FOATI classification in 1991–1992, which became FOATI ARVS (F, foci for superficial implants; O, ovarian endometrioma; A, adhesions; T, lesions of the tubal wall; I, inflammatory appearance; A, adenomyosis; RVS, involvement of the recto vaginal wall) in 2010 after revision (Figure 3). Therein, points are given as 0, 1, and 2, and this classification gives 2 points for functional consequences of lesions (Figure 6).…”

“…It has always been classified by the size of its anatomical lesions—Acosta classification (1), revised by the American fertility society (AFS) (2), and the American society of reproductive medicine (ASRM) classification with a description of the disease at different stages: minimal (score of 1 to 5), mild (3–12), moderate (16 to 40), and severe (>40) (13). If this classification provides a complete repertoire of implants (anatomic) (10), the attribution of points is arbitrary. In fact, the size of the lesions is not synonymous with the difficulty to treat them surgically.…”

“…Thus, attempts to explain their inflammatory side effects have been proposed (14, 15). The French classification nodule, ovaries, adhesions, tube, and inflammation (FOATI) (10) has had the merit of taking this phenomenon into account. In our opinion, we must go much further and propose an amendment in this classification, taking into account the evolution of the lesions and their deep molecular biology because in reality, the lesions are not at the same stage.…”