The FIGO ovulatory disorders classification system
The FIGO ovulatory disorders classification system
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the ‘GAIN-FIT-PIE’ mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
anovulation, ovulatory disorders, ovulatory disorders classification, ovulatory dysfunction
2446-2464
Munro, Malcolm G.
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Balen, Adam H.
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Cho, Si Hyun
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Critchley, Hilary O.D.
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Díaz, Ivonne
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Ferriani, Rui
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Henry, Laurie
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Mocanu, Edgar
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van der Spuy, Zephne M.
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Cheong, Ying
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for the FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility
Munro, Malcolm G.
c71a8f85-2935-474e-b252-3f258e5c08e0
Balen, Adam H.
36b47dbf-408c-462f-84a5-2785f554aa21
Cho, Si Hyun
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Critchley, Hilary O.D.
ed3b135e-e838-4f69-ac78-22221c061f9d
Díaz, Ivonne
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Ferriani, Rui
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Henry, Laurie
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Mocanu, Edgar
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van der Spuy, Zephne M.
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Cheong, Ying
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Munro, Malcolm G., Balen, Adam H., Cho, Si Hyun, Critchley, Hilary O.D., Díaz, Ivonne, Ferriani, Rui, Henry, Laurie, Mocanu, Edgar and van der Spuy, Zephne M.
,
for the FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility
(2022)
The FIGO ovulatory disorders classification system.
Human Reproduction, 37 (10), .
(doi:10.1093/humrep/deac180).
Abstract
Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the ‘GAIN-FIT-PIE’ mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.
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deac180
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e-pub ahead of print date: 19 August 2022
Keywords:
anovulation, ovulatory disorders, ovulatory disorders classification, ovulatory dysfunction
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Local EPrints ID: 483201
URI: http://eprints.soton.ac.uk/id/eprint/483201
ISSN: 0268-1161
PURE UUID: 54f014d3-a358-46c5-a311-aeee0d3e9e3d
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Date deposited: 26 Oct 2023 16:36
Last modified: 18 Mar 2024 03:08
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Contributors
Author:
Malcolm G. Munro
Author:
Adam H. Balen
Author:
Si Hyun Cho
Author:
Hilary O.D. Critchley
Author:
Ivonne Díaz
Author:
Rui Ferriani
Author:
Laurie Henry
Author:
Edgar Mocanu
Author:
Zephne M. van der Spuy
Corporate Author: for the FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility
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