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

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.