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Objective: This systematic review and meta-analysis aimed to summarize the available evidence regarding circulating kisspeptin and anti-müllerian hormone (AMH) and the homeostasis model assessment of insulin resistance (HOMA-IR) index in adolescents and women with and without polycystic ovary syndrome (PCOS).Method: We performed a comprehensive literature search in Medline, Embase, Cochrane, Scopus, and Web of Science for studies evaluating circulating kisspeptin levels in women with and without PCOS published until September 24th, 2020. Coprimary outcomes were the HOMA-IR index and AMH. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Random-effects models were used to estimate outcomes, and effects reported as mean difference (MD) or standardized MD (SMD) and their 95% confidence interval (CI). The systematic review and meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO) as number CRD42020205030. Results: We evaluated 18 studies including, 1,282 PCOS cases and 977 controls. Participants with PCOS were younger (MD=-2.38 years, 95%CI -4.32 to -0.44), with higher BMI (MD=1.16, 95% CI 0.54 to 1.78), waist-to-hip ratio (MD=0.04, 95%CI 0.02 to 0.05), circulating kisspeptin (SMD=1.15, 95%CI 0.68 to 1.62), luteinizing hormone (SMD=1.29, 95%CI 0.76 to 1.83), AMH (SMD=0.97, 95%CI 0.60 to 1,34), total testosterone (SMD=2.48, 95%CI 1.73 to 3.23), free testosterone (SMD=1.37, 95%CI 0.56 to 2.17), and dehydroepiandrosterone sulfate (SMD=0.72, 95%CI 0.32 to 1.13) levels, and Ferriman-Galweg score (SMD = 5.08, 95%CI 2.76 to 7.39), and lower sex hormone-binding globulin level (SMD=-1.34, 95%CI -2.15 to -0.52). Besides, participants with PCOS had higher HOMA-IR index (SMD=0.76, 95%CI 0.35 to 1.17), and circulating insulin (SMD=0.75, 95%CI 0.30 to 1.19), leptin (SMD=2.82, 95%CI 1.35 to 4.29), and triglycerides (SMD=2.15, 95%CI 1.08 to 3.23) levels than participants without the syndrome. The meta-regression did not identify significant factors influencing circulating kisspeptin. Conclusion:Patients with PCOS showed higher kisspeptin, LH, insulin, AMH, and androgen levels and HOMA-IR index, and lower sex hormone-binding globulin levels than those without the syndrome.

Aim: To systematically compare sexual function between non-treated women with and without endometriosis. Methods: A systematic review was performed on PubMed/Medline, Scopus, EMBASE, Web of Science and Cochrane Library databases searching studies that analyzed sexual function (assessed with the 19-item Female Sexual Function Index [FSFI]), and dyspareunia, chronic pelvic pain and dysmenorrhea (assessed with a visual analogue scale [VAS]) in women with and with endometriosis. Results: In 4 studies, non-treated women with endometriosis presented a higher risk of female sexual dysfunction (mean total FSFI score 26.55; OR ¼ 2.38; 95% confidence interval [CI] ¼ 1.12, 5.04). Although mean total FSFI scores were not significantly different between women with and without endometriosis (mean difference [MD] ¼ À2.15; 95% CI À4.96, 0.67); all FSFI domain scores were significantly lower in women with endometriosis (n ¼ 4 studies): desire (MD ¼ À0.43; 95% CI À0.57, À0.19); arousal (MD ¼ À0.66; 95% CI À1.15, À0.17); lubrication (MD ¼ À0.41; 95% CI À0.79, À0.02); orgasm (MD ¼ À0.40; 95% CI À0.73, À0.06); satisfaction (MD ¼ À0.45; 95% CI À0.72, À0.18); and pain (MD ¼ À1.03; 95% CI À1.34, À0.72). Women with endometriosis displayed differences (more severity) in terms of VAS scores (2 studies) for dyspareunia (MD ¼ 1.88; 95% CI 0.38, 3.37) and chronic pelvic pain (MD ¼ 2.92; 95% CI 1.26, 4.58); but not for dysmenorrhea. Conclusion: Non-treated women with endometriosis displayed altered sexual function as evidenced by lower scores in all FSFI domains, and severity of dyspareunia and chronic pelvic pain.

Aim This study explored the association between the presence of uterine fibroids (UF), as determined by ultrasound, and preterm birth (PB) risk. Methods Medline, Embase, Cochrane, Scopus and Web of Science databases. Studies reporting women with and without UF demonstrated by an ultrasound exam. The primary outcome was the risk of PB < 37 weeks of gestation in pregnancies with UF diagnosed by an obstetric ultrasound exam. Effects for dichotomous and continuous outcomes are, respectively, reported as risk ratios (RR) or mean differences and their 95% confidence intervals (CI). Results Eighteen studies were included comprising 276 172 pregnancies to whom obstetric ultrasound assessment was performed for the presence/absence of UF. Women with UF were older (mean difference = 2.40 years, 95% CI 0.94–3.85) and were at higher risk of PB before 37 (RR = 1.43, 95% CI 1.27–1.60), 34 (RR = 1.79, 95% CI 1.32–2.42), 32 (RR = 1.94, 95% CI 1.33–2.85) and 28 (RR = 2.17, 95% CI 1.48–3.17) weeks as compared to those without UF (P < 0.01). In addition, women with UF were at higher risk of threatened preterm labor, preterm premature rupture of membranes, fetal malpresentation, placental abruption, lower gestational age and birthweight at delivery and a higher cesarean delivery rate. Conclusion Pregnant women with UF are at increased risk of PB and other adverse obstetric outcomes.

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