[Classification of endometriosis]

Since 1985 the revised American Fertility Society (r-AFS) classification (renamed later American Society for Reproductive Medicine's classification--ASRM classification) has been a widely accepted system of categorizing the extent of endometriosis. The scoring system gives a detailed description of the location and the severity of the case and correlates to some extent with the degree of pain caused by endometriosis. Based upon collected data the classification was not found sensitive in predicting pregnancy according to the stage and after treatment of the disease. In view of this lack of sensitivity the ASRM has proposed not to change the scoring system, but additional color photographs are provided to assure consistency in describing the appearance of endometriosis. Changes in assessing cul-de-sac obliteration have been suggested to avoid future intra- and interobserver variations. Due to our insufficient understanding of the pathophysiology of endometriosis only a few new biomarkers can be offered for the prediction of fertility and management of pelvic pain. Animal studies and further controlled trials are needed to develop future parameters.