title: 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: OBJECTIVE
  How 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?
  
  
  CONCLUSIONS
  The 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.
  
  
  BACKGROUND
  Until 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.
  
  
  METHODS
  The 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.
  
  
  METHODS
  Among 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  The 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.
  
  
  CONCLUSIONS
  The 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 and research.
  
  
  BACKGROUND
  None.
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: A
authors: A
authors: Di Spiezio Sardo
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: R
authors: R
authors: Campo
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: S
authors: S
authors: Gordts
authors: Department of Obstetrics and Gynecology, University of Naples 'Federico II', Naples, Italy.
authors: M
authors: M
authors: Spinelli
authors: Department of Obstetrics and Gynecology, University of Salerno, Fisciano (SA), Italy.
authors: C
authors: C
authors: Cosimato
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: V
authors: V
authors: Tanos
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: S
authors: S
authors: Brucker
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: T C
authors: TC
authors: Li
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: M
authors: M
authors: Gergolet
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: C
authors: C
authors: De Angelis
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
authors: L
authors: L
authors: Gianaroli
authors: Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium grigoris.grimbizis@gmail.com grimbi@med.auth.gr.
authors: G
authors: G
authors: Grimbizis
mesh_terms: D002584:Cervix Uteri / Q000002:abnormalities; D000013:Congenital Abnormalities / Q000145:classification* / Q000175:diagnosis*; D005060:Europe; D005260:Female; D005831:Genital Diseases, Female / Q000145:classification* / Q000175:diagnosis*; D006176:Gynecology / Q000592:standards; D006801:Humans; D009095:Mullerian Ducts / Q000002:abnormalities; D012955:Societies, Medical; D016896:Treatment Outcome; D014564:Urogenital Abnormalities / Q000145:classification / Q000175:diagnosis*; D014599:Uterus / Q000002:abnormalities*; D014621:Vagina / Q000002:abnormalities
keywords: ESHRE/ESGE system; Müllerian anomalies; classification; complex anomaly; comprehensiveness