The association between the environmental endocrine disruptor bisphenol A and polycystic ovary syndrome: a systematic review and meta-analysis

Objective: To investigate the association between bisphenol A (BPA) and polycystic ovary syndrome (PCOS).Methods: A systematic review and meta-analysis using STATA software for observational studies.Results: Nine studies involving 493 PCOS patients and 440 controls were included in this review. The meta-analysis demonstrated that PCOS patients had significantly higher BPA levels compared with control groups (standardized mean difference (SMD): 2.437, 95% confidence interval (CI): (1.265, 3.609), p<.001). For studies of serum samples detected by enzyme-linked immunosorbent assay (ELISA), subgroup analyses according to ethnicity, body mass index (BMI), sample size, detection method (high-performance liquid chromatography (HPLC) and ELISA), PCOS-to-control ratio and study quality displayed that high BPA levels were significantly associated with Caucasian PCOS patients (SMD: 0.615, 95% CI: (0.308, 0.922), p<.001), high BMI (SMD: 0.512, 95% CI: (0.180, 0.843), p=.002), high quality (SMD: 0.624, 95% CI: (0.391, 0.856), p<.001), and high HOMA-IR (SMD: 0.467, 95% CI: (0.121, 0.813), p=.008).Conclusions: Serum BPA may be positively associated with women with PCOS and BPA might be involved in the insulin-resistance and hyperandrogenism of PCOS. More evidence from high quality studies, advanced detection methods, and larger cohorts for observational trials are needed to further confirm the association between BPA and PCOS.