# Critical comparison of American and European classifications of müllerian anomalies: pros and cons

## TL;DR

This paper compares different classification systems for müllerian anomalies to evaluate their strengths and weaknesses in diagnosis and treatment.

## Contribution

The paper provides a critical analysis of American and European classification systems for müllerian anomalies, highlighting areas for improvement.

## Key findings

- The American Fertility Society's 1988 classification was practical but subjective and limited in complex cases.
- The 2013 European classification was more detailed but risked overdiagnosis and included cervical and vaginal anomalies.
- The 2021 American Society for Reproductive Medicine classification aimed to improve accuracy and objectivity.

## Abstract

Müllerian anomalies represent a spectrum of congenital malformations of
the female reproductive tract. Over the decades, various classifications have
been developed to categorize these anomalies. Based on a classification proposed
by Kaufmann and Jarcho in 1946, the classification devised by the American
Fertility Society in 1988 was considered simple and practical; although it faced
criticism for its subjectivity and limitations in classifying complex anomalies,
it was widely adopted. In 2013, the European Society of Human Reproduction and
Embryology and the European Society for Gynaecological Endoscopy introduced a
more detailed classification, which, albeit more complex and with a risk of
overdiagnosis, also included cervical and vaginal anomalies. In 2021, the
American Society for Reproductive Medicine updated the classification with the
aim of simplifying and improving diagnostic accuracy, expanding the categories,
and defining more objective criteria. This new classification seeks to
facilitate communication among professionals and enhance clinical management,
emphasizing the importance of continuous updates to improve reproductive
outcomes and the quality of life for patients affected by these anomalies. This
article aims to discuss the strengths and limitations of each of these
classifications, offering a critical analysis of their impact on the diagnosis
and treatment of müllerian anomalies. It also seeks to highlight aspects
that may be refined in future revisions to achieve greater diagnostic precision
and clinical applicability.