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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...

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Autores principales: Munro, Malcolm G, Balen, Adam H, Cho, SiHyun, Critchley, Hilary O D, Díaz, Ivonne, Ferriani, Rui, Henry, Laurie, Mocanu, Edgar, van der Spuy, Zephne M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9527465/
https://www.ncbi.nlm.nih.gov/pubmed/35984284
http://dx.doi.org/10.1093/humrep/deac180
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author Munro, Malcolm G
Balen, Adam H
Cho, SiHyun
Critchley, Hilary O D
Díaz, Ivonne
Ferriani, Rui
Henry, Laurie
Mocanu, Edgar
van der Spuy, Zephne M
author_facet Munro, Malcolm G
Balen, Adam H
Cho, SiHyun
Critchley, Hilary O D
Díaz, Ivonne
Ferriani, Rui
Henry, Laurie
Mocanu, Edgar
van der Spuy, Zephne M
author_sort Munro, Malcolm G
collection PubMed
description 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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spelling pubmed-95274652022-10-03 The FIGO Ovulatory Disorders Classification System Munro, Malcolm G Balen, Adam H Cho, SiHyun Critchley, Hilary O D Díaz, Ivonne Ferriani, Rui Henry, Laurie Mocanu, Edgar van der Spuy, Zephne M Hum Reprod Original Articles 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. Oxford University Press 2022-08-19 /pmc/articles/PMC9527465/ /pubmed/35984284 http://dx.doi.org/10.1093/humrep/deac180 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Munro, Malcolm G
Balen, Adam H
Cho, SiHyun
Critchley, Hilary O D
Díaz, Ivonne
Ferriani, Rui
Henry, Laurie
Mocanu, Edgar
van der Spuy, Zephne M
The FIGO Ovulatory Disorders Classification System
title The FIGO Ovulatory Disorders Classification System
title_full The FIGO Ovulatory Disorders Classification System
title_fullStr The FIGO Ovulatory Disorders Classification System
title_full_unstemmed The FIGO Ovulatory Disorders Classification System
title_short The FIGO Ovulatory Disorders Classification System
title_sort figo ovulatory disorders classification system
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9527465/
https://www.ncbi.nlm.nih.gov/pubmed/35984284
http://dx.doi.org/10.1093/humrep/deac180
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