Hull and Rutherford classification of infertility

Abstract

In 1991, the British Fertility Society commissioned an audit subcommittee to produce an all-encompassing classification system for infertility, which could be used as the basis for national audit. Accurate diagnosis is a basic necessity of good medical practice and determines the selection of appropriate treatment. In addition, assessment of treatment outcome by audit must be related not only to the specific type and severity of the disorder, but also to a number of important compounding variables, such as age of the female partner. Severity is a key factor in the selection of the most appropriate treatment in disorders such as tubal disease and endometriosis; therefore, the classification of these conditions needs to be therapy-oriented, providing a guide to prognosis. The classification system was determined by reference to the best available published data on outcome, in terms of time-specific cumulative pregnancy rates, at the time of preparation, and on information gleaned from surveys of opinion from the members of the British Fertility Society and the British Andrology Society. When used in conjunction with an appropriate computerheld database, codification of data using a classification system provides a powerful tool for clinical audit and research. Such systems allow analysis of the relative effectiveness of different methods of treatment for various patient groups, providing meaningful comparisons among practitioners and hospitals (Jenkins, 1999). A survey published in 2000 of all in vitro fertilization (IVF) centres in the UK indicated overwhelming support for central collection of computerized data by the Human Fertilisation and Embryology Authority (HFEA), which could be extended beyond the limited current dataset if a suitable classification system was available (Keay et al., 2000). This article presents an appendix outlining the classification system as it was first proposed in 1995, so that it may act as a foundation for the future development of an updated classification that could be adopted by the profession.