Page 13 - World Journal of Laparoscopic Surgery

Role of Laparoscopic Surgery in Endometriosis Associated Infertility—Literature Review

there were inadequacies in staging adhesions and deep the disease progression, impact on future fertility and disease
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endometriosis, it was revised in 1985. But the revised AFS recurrence rate. It has limited clinical relevance in the
showed a very weak relationship between the severity of comparison of populations. This scoring system is prone to
endometriosis and successful pregnancy outcome. Therefore, observational variation which impairs accuracy and
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it was revised again in 1996 and remains the most widely used reproducibility. Most recently Kaloo et al criticized the
one. This classification depends on size, site and depth of lesion revised AFS as a poor indicator of severity as it does not
and point scores were given depending upon severity. Stage I consider bowel adhesions or multifocal nodular disease.
(minimal), Stage II (mild), Stage III (moderate) and Stage IV Currently, therefore, there is no ideal classification of
(severe) (Fig. 1). endometriosis available that predicts fertility outcome or assists
The revised AFS score enables easy and clear in the selection of treatment. An ideal classification would
communication through standardized reporting, but has a reliably correlate disease severity with symptoms and likelihood
number of significant drawbacks. It does not help in the of conception. It might include a biological marker, as well as
comparison of different treatments and is also unable to predict laparoscopic appearance.

*Point assignment changed to 16, **Point assignment doubled
Fig. 1: Shows revised AFS classification 1996. (Revised Endometriosis Classification: 1996, Reproduced with permission from Fertility and
Sterility (1997), Volume 67, Number 5 by Schenken RS, Guzick DS)

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