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The FIGO has introduced a consensus-driven, three-level classification system for ovulatory disorders, establishing the HyPO-P and GAIN-FIT-PIE mnemonics to replace outdated 30-year-old WHO guidelines.
Ovulatory disorders—encompassing anovulation (failure to ovulate) and chronic ovulatory dysfunction—are among the key clinical drivers of amenorrhea (primary and secondary), abnormal uterine bleeding, and female infertility. They also represent central features linked with polycystic ovary syndrome (PCOS). For more than three decades, medical practice relied on an outdated classification attributed to the World Health Organization (WHO). Developed in the pre-digital era, that legacy system failed to incorporate thirty years of scientific progress, including breakthrough advancements in high-resolution pelvic imaging, molecular endocrinology, and genetic profiling.
To rectify these longstanding clinical, diagnostic, and educational challenges, the International Federation of Gynecology and Obstetrics (FIGO)—led by its Steering Committee alongside global subspecialty societies, medical journal editors, and lay representatives—executed a multi-year global initiative. Following two international face-to-face consensus meetings and five rounds of a structured Delphi process, FIGO formally released a comprehensive, multi-tiered framework designed to standardize ovulatory dysfunction care worldwide.
The newly developed FIGO classification system comprises three diagnostic levels, combining anatomical localization, etiological factors, and specific diagnostic entities to offer a comprehensive approach to classifying ovulatory disorders.
Overall, the FIGO HyPO-P and GAIN-FIT-PIE classification system offers a comprehensive framework for classifying ovulatory disorders by integrating anatomical and etiological factors. It addresses limitations of the traditional WHO classification and fosters standardized diagnostic terminology across clinical practice and research. Wider adoption may improve diagnostic consistency, patient management, and comparability of research findings. Periodic updates will help ascertain the framework remains aligned with evolving scientific evidence and advances in reproductive medicine.
The International Journal of Gynecology & Obstetrics
The FIGO ovulatory disorders classification system
Malcolm G. Munro et al.
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