There are many classification systems for müllerian anomalies. Each suffers from issues that prevent its inclusivity, ease of use, understanding, and correlation to clinical diagnosis and management. The American Fertility Society (AFS) Classification from 1988 has been the most recognized and utilized, its advantages include its simplicity, recognizability, and correlation to clinical pregnancy outcomes. Criticisms have included its focus on uterine anomalies, exclusion of vaginal and cervical anomalies, lack of clear diagnostic criteria, and the lack of ability to classify complex anomalies.
Why MAC2021 Was Created
The ASRM Müllerian Anomaly Classification 2021 (MAC2021) was created with several goals in mind:
MAC2021 Classification Categories
MAC2021 classifies müllerian anomalies into 9 categories based on similar elements in appearance, presentation, and treatment. As müllerian anomalies represent a continuum of development and many have combined elements, some anomalies may appear in more than one category:
Important Features of ASRM MAC2021
Main classification page shows representative anomalies for each category which can be expanded to show more examples
Each category has 5 educational elements:
- Variants screen shows diagrams depict the potential variations for each anomaly within the category, includes section called "also known as" with the preferred terminology identified and other synonyms listed
- Similar to screen shows other anomalies that are similar in presentation, exam, and imaging to help providers refine their differential and arrive at the correct diagnosis
- Presentation screen is divided into 3 sections:
- Symptoms screen shows age at onset and typical symptoms attributed to the disorder
- Examination screen shows key examination findings of the anomaly
- Differential screen shows all other possible differential diagnoses for conditions with similar presentation
- Updated Imaging screen describes the best screening tool, diagnostic strategy, and findings for each anomaly including examples in 3 imaging modalities (not all types of imaging are present for each anomaly)
- MRI
- Ultrasound
- HSG
- Treatment screen is divided into 3 sections:
- Medical section describes options to suppress menstruation to treat pain
- Dilation section describes the process for non-surgical vaginal lengthening procedures (when appropriate)
- Surgical section describes surgical approaches to correct each anomaly, includes links to pertinent surgical videos
Subcategories:
- Key words (with new version)
- Word bank (with new version)
- Patient Education Resources (with new version)
- ICD 10 codes (2027)
- Genetics (2027)
Target Audience
- REIs
- MIGS
- Gynecologic surgeons
- OB/GYN residents/ fellows
- Radiologists
- APP, REI Nurses
- Professional societies, guideline committees, and Training programs
MAVI – AI chatbot
The MAC2021 tool integrates an independent, embedded Gemini-powered interactive AI assistant designed to enhance clinician learning and navigation entirely within the platform. The chatbot enables users to search, filter, consolidate, and summarize content in real time, allowing rapid exploration of classifications, definitions, and key distinctions without leaving the tool. Advanced filtering and contextual prompts will help users synthesize complex information efficiently while preserving accuracy and consistency. Importantly, the AI operates solely on curated, internal content and does not access external resources, ensuring controlled, reliable, and reproducible outputs aligned with the MAC2021 tool.
