New International Federation of Gynecology and Obstetrics ovulatory disorders classification system 2022. Diagnostic assessment of ovulatory dysfunction

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Abstract

Until recently, researchers and clinicians have used the World Health Organization classification of ovulatory disorders (1973), which was based on the levels of gonadotropins and estrogens in the blood serum (mainly follicle-stimulating hormone) and classified ovulatory disorders depending on the hypothalamic-pituitary-ovarian axis dysfunction levels.

This review article presents a new classification system for ovulation disorders developed by the International Federation of Gynecology and Obstetrics (FIGO) in 2022. The first level of this classification system is based on an anatomical approach (hypothalamus, pituitary gland, ovaries), which is complemented by a separate category for polycystic ovary syndrome. At the second level, each anatomical category is classified according to the putative etiopathogenetic mechanisms underlying ovulation disorders. The third level suggests the presence of specific nosologies, which represent the direct cause of ovulation disorders. This new classification should be used after a preliminary examination that reveals the presence of an ovulation disorder. This review discusses various ovulation disorders and provides tools for their diagnosis in accordance with international guidelines and domestic recommendations.

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About the authors

Yuliya V. Kovalyova

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: yuliya.kovaleva@szgmu.ru
ORCID iD: 0000-0003-2420-692X

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. First and second levels of the International Federation of Gynecology and Obstetrics ovulatory disorders classification system. PCOS, polycystic ovary syndrome

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3. Fig. 2. Ultrasound image of the corpus luteum (author’s observation). Pronounced peripheral vascularization as the “color ring” sign

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4. Fig. 3. Ultrasound image of a luteinized follicle (author’s observation). The wall of the follicle is thickened, there being a slight dispersed echo in its cavity. Color Doppler sonography reveals a scant vascularization along the periphery of the follicle

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5. Fig. 4. Schematic representation of morphologic changes in the ovaries associated with two (a) or three (b) waves of follicle development during the menstrual cycle, and in the case of the luteal out-of-phase event (c)

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