ESHRE–ESGE versus ASRM classification in the diagnosis of septate uterus: a retrospective study
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The European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) system is designed mainly for clinical orientation; its overdiagnosis of septate uteri was confirmed in a general population in comparison to the American Society of Reproductive Medicine (ASRM) supplemental classification proposed by Ludwin. However, the agreement among septate uterus recognition using the ESHRE–ESGE and the supplemental ASRM classifications and the rate of overdiagnosis of septate uterus by ESHRE-ESGE in infertile women remain unclear.
We conducted a retrospective study of 53,540 infertile patients in our reproductive centre from June 2013 to December 2016, to compare septate uterus recognition using three systems. The data were analysed by the ESHRE–ESGE system, the ASRM by Salim and the ASRM by Ludwin separately. The concordance of diagnoses of septate uteri using these three systems was compared.
ESHRE–ESGE classification significantly increased the frequency of septate uteri (11.31%, 6056 vs. 7.20%, 3854 vs. 3.80%, 2034). Good agreement was observed between the ESHRE-ESGE and the ASRM by Salim (k = 0.686, p < 0.001) and between the ASRM by Salim and that by Ludwin (k = 0.671, p < 0.001), while moderate agreement was found between the ESHRE–ESGE and ASRM by Ludwin systems (k = 0.444, p < 0.001). These results suggest that Ludwin’s criteria are the strictest, while the ESHRE–ESGE system is much more relaxed for septate uterus diagnosis.
A risk of overtreatment may also exist in infertile patients when using the ESHRE–ESGE system. Therefore, the ESHRE–ESGE system should be used with caution when guiding hysteroscopic metroplasty in infertile patients.
KeywordsSeptate uterus Infertile Classification system Overdiagnosis Overtreatment
American Fertility Society
American Society of Reproductive Medicine
Vagina, cervix, uterus, adnex-associated malformations
European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy
Body mass index
The authors thank Qingqing Wu and Kailan Xiong for their assistance in collecting and sorting clinical data.
Availability of data and materials
The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request. All data generated or analysed during this study are included in this published article.
YO and YY collected relevant clinical data. YO conducted statistical analyses and drafted the manuscript. FG and G L helped to collect relevant clinical data and have been involved in revising the manuscript. XL conceived of the study, and participated in drafting this manuscript. All authors have read and approved the final manuscript.
This work was funded by the Science and technology project of Health and Family Planning Commission of Hunan Province (No. C20180898) and the CITIC-Xiangya Research Fund (No. KYXM-201703).
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
Consent for publication
The authors report no financial or commercial conflicts of interest.
Ethics approval and consent to participate
This retrospective study was approved by the Institutional Review Board of the Reproductive and Genetic Hospital of Citic-Xiangya.
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