Reply: T?shaped and dysmorphic uterus – misclassifications and low?quality evidence promote unnecessary surgery

The diagnosis of T-shaped uterus is questionable as most the existing definitions are arbitrary and subjective, largely based on expert opinion1. Some classification systems for uterine malformations were developed by researchers or societies with potential commercial bias seem to overestimate their prevalence2. One should also be aware that contractions3 even changes during menstrual cycle might affect features related result in an erroneous a normal dysmorphic (Figure 1). three different subtypes described Alonso Pacheco et al.4 (i.e. T-shaped, Y-shaped I-shaped uterus) regarded normal, arcuate uterus. This subclassification arbitrary, non-reproducible report cases. There no proven association between worse reproductive outcomes5. raises question whether this clinically relevant. If women have similar outcomes those uterus, then what rationale treatment? Evidence regarding benefit intervention suboptimal studies, such uncontrolled pre–post studies favor intervention, risk overestimating its effect. Such low-quality evidence cannot justify expenses risks associated surgery financial burden healthcare systems. A systematic review meta-analysis poor-quality potentially biased studies6 not better than original evidence. authors highlight benefits hysteroscopic metroplasty respect live-birth rate low miscarriage patients presenting primary infertility recurrent miscarriage, discourage expectant management judge being adequate despite absence good-quality support costs possible complications. Clinical decisions always methodologically rigorous randomized controlled trials (RCTs), and, date, effectiveness safety been evaluated RCT. It would surprising if future RCT shows procedures benefit. urgency promote surgical condition only variant uterus1 rather anomaly, judged examiner (subjectivity classification) reassessed after few minutes (waves myometrial contraction3). Advocating proper seems strategy, supported industry, convince new interventions used clinical practice, because they helpful but lucrative. cost office diagnostic hysteroscopy USA about $300, cosmetic average $15007. We echo sentiments Peter Gøtzsche corruption medicine today (https://www.youtube.com/watch?v=GSsvSdk5WSk). declare competing interests.