Myomas and Adenomyosis: Impact on Reproductive Outcome

Table 1

STEP-w classification for myomas.

Points	Size (cm)	Topography	Extension of the base	Penetration	Lateral wall
0	≤2	Low	≤1/3	0%	+1 point
1	>2–5	Middle	>1/3–2/3	≤50%
2	>5	Upper	>2/3	>50%

According to STEP-w classification system of myomas proposed by Lasmar and colleagues in 2005 [72, 73], the size, the topography, the extension of the base of the submucosal myoma with respect to uterine wall, and the extent of the penetration of the nodule into the myometrium are taken into account in presurgical evaluation of the viability of hysteroscopic treatment. A score of 0 to 9 is applied, assigning submucosal myomas in three groups: Group I (score 0–4): low complexity hysteroscopic myomectomy; Group II (score 5-6): complex hysteroscopic myomectomy consider preparing with GnRH-analogue and/or two-stage surgery; Group III (score 7–9): recommend alternative nonhysteroscopic treatment.