SPE.
CIAL CONTRIBUTION
FERTILITY AND STERILITY
Copyright" 1979 The American Fertility Society
CLASSIFICATION OF ENDOMETRIOSIS
THE AMERICAN FERTILITY SOCIETY*
Birmingham, Alabama
Many classifications of endometriosis have been
proposed, including those of Acosta et al.,! But-
tram,2 and Kistner et al. 3 Because none of these
has obtained general acceptance, comparison of
reported treatment results has been difficult. Con-
sequently, in July 1978, the president of The
American Fertility Society appointed a committee
to address the problem. The classification submit-
ted is the result of three meetings and numerous
consultations of a committee composed of Doctors
William C. Andrews, S. Jan Behrman, Veasy C.
Buttram, Jr., Melvin R. Cohen, E. Donald Eward,
Howard W. Jones, Jr., Robert W. Kistner, Herbert
H. Thomas, and John C. Weed.
Determination of the stage or degree of
endometriosis involvement is based on a point sys-
tem. Although the distribution of points has been
arbitrarily determined and may require revision
or refinement as knowledge of the· disease in-
creases, the basis of the classification is the natu-
ral progression of the disease with allowances
made for unilateral involvement.
To ensure complete evaluation, inspection ofthe
pelvis in a clockwise or counterclockwise fashion is
encouraged. Number, size, and location
(peritoneum, ovary, or tube) of endometrial im-
*The American Fertility Society, 1608 13th Avenue South,
Birmingham, Ala. 35205.
633
VoL 32, No.6, December 1979
Printed in V.SA.
plants, plaques, or endometriomas are noted. For
example, five separate 0.5-cm endometrial im-
plants in the peritoneum (2.5 cm total) would be
assigned 2 points. (The surface of the uterus should
be considered peritoneum.) Points assigned may
be circled or placed in the left-hand column and
totaled. Aggregation of points indicates stage of
disease (mild, moderate, severe, or extensive).
The presence of endometriosis of the appendix,
cervix, skin, etc., should be recorded. Pathology
observed should be depicted as specifically as pos-
sible on the sketch of pelvic organs, and means of
observation (laparoscopy or laparotomy) should be
noted. .
The classification form (Fig. 1) will be printed in
color; copies may be obtained from The American
Fertility Society office for $4.00/50 copies.
REFERENCES
1. Acosta AA, Buttram VC Jr, Besch PK, Malinak LR,
Franklin RR, Vanderheyden JD: A proposed classification
of pelvic endoemtriosis. Obstet Gynecol 42:19, 1973
2. Buttram VC Jr: An expanded classification of
endometriosis. Fertil Steril 30:240, 1978
3. Kistner RW, Siegler AM, Behrman SJ: Suggested classifi-
cation for endometriosis: relationship to infertility. Fertil
Steril 28:1108, 1977
634 .THE AMEmCAN FERTILITY SOCIETY December .1979

AMERICAN FERTILITY SOCIETY CLASSIFICATION OF ENDOMETRIOSIS

Patient's name _ _ _ _ _ _ _ _ _ _ __

Stage I (Mild) 1-5

Stage II (Moderate) 6-15
Stage III (Severe) 16-30
Stage IV (Extensive) 31-54
Total _ _ _ __

Associated Pathology;

FIG. 1. The classification form.