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

Grigoris F Grimbizis, Stephan Gordts, Attilio Di Spiezio Sardo, Sara Brucker, Carlo De Angelis, Marco Gergolet, Tin-Chiu Li, Vasilios Tanos, Hans Brölmann, Luca Gianaroli, Rudi Campo, Grigoris F Grimbizis, Stephan Gordts, Attilio Di Spiezio Sardo, Sara Brucker, Carlo De Angelis, Marco Gergolet, Tin-Chiu Li, Vasilios Tanos, Hans Brölmann, Luca Gianaroli, Rudi Campo

Abstract

Study question: What classification system is more suitable for the accurate, clear, simple and related to the clinical management categorization of female genital anomalies?

Summary answer: The new ESHRE/ESGE classification system of female genital anomalies is presented.

What is known already: 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.

Study design, size and duration: 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 (SC) has been appointed to run the project, looking also for consensus within the scientists working in the field.

Participants/materials, setting, methods: The 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 chance: 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.

Limitations, reasons for caution: The 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 findings: 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.

Study funding/competing interest(s): None.

Keywords: anatomy; classification system; female tract.

Figures

Figure 1
Figure 1
Design and running of the project; the stepwise DELPHI consensus method has been used to find the agreement between the experts in the development of the new classification system.
Figure 2
Figure 2
ESHRE/ESGE classification of uterine anomalies: schematic representation (Class U2: internal indentation >50% of the uterine wall thickness and external contour straight or with indentation 50% of the uterine wall thickness, Class U3b: width of the fundal indentation at the midline >150% of the uterine wall thickness).
Figure 3
Figure 3
Scheme for the classification of female genital tract anomalies according to the new ESHRE/ESGE classification system.

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