anovulation; ovulatory disorders; ovulatory disorders classification; ovulatory dysfunction; Obstetrics and Gynecology; General Medicine
Abstract :
[en] 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 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 manuscript 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.
Disciplines :
Reproductive medicine (gynecology, andrology, obstetrics)
Author, co-author :
Munro, Malcolm G; The University of California, Los Angeles, California, USA
Balen, Adam H; The University of Leeds, Leeds, UK
Cho, SiHyun; Yonsei University, Seoul, South Korea
Critchley, Hilary O D; The University of Edinburgh, Edinburgh, UK
Díaz, Ivonne; Nueva Granada University, Colombia
Ferriani, Rui; The University of São Paolo, Brazil
Henry, Laurie ; Centre Hospitalier Universitaire de Liège - CHU > > Service de gynécologie-obstétrique (CHR)
Mocanu, Edgar; Trinity College, Dublin, Ireland
van der Spuy, Zephne M; The University of Cape Town, Cape Town, South Africa
FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility
Other collaborator :
Nisolle, Michelle ; Université de Liège - ULiège > Département des sciences cliniques > Gynécologie - Obstétrique
Language :
English
Title :
The FIGO ovulatory disorders classification system.
Publication date :
19 August 2022
Journal title :
International Journal of Gynecology and Obstetrics
MGM reports grant funding from AbbVie and Pharmacosmos; consulting fees from Abbvie, Myovant, American Regent, Daiichi Sankyo, Hologic Inc and Pharmacosmos as well as royalty payments from UpToDate. He serves a voluntary role as Chair of the SEUD AUB Task Force, the Past Chair of FIGO's committee on Menstrual Disorders and Related Health Impacts, and Founding and Current Chair of the Women's Health Research Collaborative. AHB reports consulting fees from NovoNordisk and is a member of the WHO's Guideline Development on Infertility and a member of the International PCOS Guideline Group. He is a Trustee of the British Fertility Society and is a Director of Balance Reproductive Health Ltd and Balance Health Ltd. HODC is current Chair, FIGO Committee on Menstrual Disorders and Related Health Impacts. She has received clinical research support for laboratory consumables and staff from Bayer AG (paid to institution) and provides consultancy advice (all paid to institution) for Bayer AG, PregLem SA, Gedeon Richter, Vifor Pharma UK Ltd, AbbVie Inc; Myovant Sciences GmbH. HC has received royalties from UpToDate for articles on abnormal uterine bleeding. The rest of the authors have no conflicts of interest.
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