{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T21:14:34Z","timestamp":1793222074679,"version":"4.5.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T00:00:00Z","timestamp":1660867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Intl J Gynecology &amp; Obste"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2009years 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\u2010to\u2010face meetings and five Delphi rounds, the result is a three\u2010level multi\u2010tiered 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\u2010P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians, and trainees using the \u201cGAIN\u2010FIT\u2010PIE\u201d 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.<\/jats:p>","DOI":"10.1002\/ijgo.14331","type":"journal-article","created":{"date-parts":[[2022,8,19]],"date-time":"2022-08-19T07:29:20Z","timestamp":1660894160000},"page":"1-20","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":85,"title":["The FIGO ovulatory disorders classification system"],"prefix":"10.1002","volume":"159","author":[{"given":"Malcolm G.","family":"Munro","sequence":"first","affiliation":[{"name":"The University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam H.","family":"Balen","sequence":"additional","affiliation":[{"name":"The University of Leeds  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SiHyun","family":"Cho","sequence":"additional","affiliation":[{"name":"Yonsei University  Seoul South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilary O. D.","family":"Critchley","sequence":"additional","affiliation":[{"name":"The University of Edinburgh  Edinburgh UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivonne","family":"D\u00edaz","sequence":"additional","affiliation":[{"name":"Nueva Granada University  Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Ferriani","sequence":"additional","affiliation":[{"name":"The University of S\u00e3o Paolo  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurie","family":"Henry","sequence":"additional","affiliation":[{"name":"Centre Hospitalier Universitaire Li\u00e8ge University of Li\u00e8ge  Li\u00e8ge Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgar","family":"Mocanu","sequence":"additional","affiliation":[{"name":"Trinity College  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zephne M.","family":"van der Spuy","sequence":"additional","affiliation":[{"name":"The University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the FIGO Committee on Menstrual Disorders and Related Health Impacts, and FIGO Committee on Reproductive Medicine, Endocrinology, and Infertility","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,19]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmg038"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2018.05.004"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12666"},{"key":"e_1_2_13_5_1","first-page":"1","volume-title":"Agents Stimulating Gonadal Function in the Human","author":"WHO\u2010Scientific\u2010Group","year":"1973"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0134473"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000003271"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dey082"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.738005"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/gme.0b013e31817ee0c2"},{"key":"e_1_2_13_11_1","article-title":"Report of a WHO scientific group","volume":"514","author":"Agents stimulating gonadal function in the human","year":"1976","journal-title":"World Health Organ Tech Rep Ser"},{"key":"e_1_2_13_12_1","unstructured":"National Institute for Health and Care Excellence (NICE).Fertility problems: Assessment and treatment. 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