The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system

Abstract

STUDY QUESTIONHow comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies?SUMMARY ANSWERThe ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system.WHAT IS KNOWN ALREADYUntil now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment.STUDY DESIGN, SIZE AND DURATIONThe CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group.PARTICIPANTS/MATERIALS, SETTING, METHODSAmong the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies.MAIN RESULTS AND THE ROLE OF CHANCEThe congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system.LIMITATIONS, REASONS FOR CAUTIONThe review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare.WIDER IMPLICATIONS OF THE FINDINGSThe comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care a...

Distribution of female genital tract anomalies in two classifications

“…2). Arcuate uterus was categorized as a variant of normal anatomy (U0) in the European classification because this uterine shape no longer exists in the new system [8,10].…”

“…The American classification has been traditionally used in many investigations into Müllerian duct anomalies. Few works have utilized the new European classification and assessed its viability [9,10]. This study was therefore undertaken using both classifications in a wide survey of female genital tract anomalies.…”

Uterus didelphys associated with ovarian endometriosis in an infertile patient

“…Multiple classification systems are used to classify female genital tract anomalies. The classification systems include the following: the American Society of Fertility and Sterility (AFSS); the American Society of Reproductive Medicine (ASRM); the European Society for Human Reproduction and Embryology (ESHRE) and the European Society for Gynecologic Endoscopy (ESGE) 1,9 . Uterus didelphys constitutes 11% of all uterine malformations.…”

A Case of Haematometra Secondary to Cervical Stenosis after Vesicle Vaginal Fistula Surgical Repair

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