Lima 2006.

Study characteristics
Patient sampling	Primary objective: to determine FSH, LH, E2, progesterone, and Hi concentrations in serum, PF and FF of women with and without endometriosis Participants: women undergoing laparoscopy for infertility and/or pelvic pain (cases) and tubal sterilisation (controls) Selection criteria: inclusion criteria: secretory cycle phase, no medical treatment for at least three months preceding surgery, absence of other gynaecological diseases, absence of pelvic pain, age between 18 and 40 years Study design: cross‐sectional, two‐gate design, prospective collection of samples
Patient characteristics and setting	Clinical presentation: pelvic pain, infertility (cases); asymptomatic fertile women requesting sterilisation (controls) Age: mean age 33.9 ± 7.8 years (endometriosis group), 36.8 ± 7.4 years (controls) Number of participants enrolled: 49 women Number of participants available for analysis: 49 women (all in luteal cycle phase) Setting: Department of O&G, Hospital das Clinicas, Faculty of Medicine of Ribeirão Preto, University of São Paulo Place of study: São Paulo, Brazil Period of study: 2002‐2004 Language: Portuguese
Index tests	Index test: FSH , LH, E2, progesterone Details of the index test procedure as stated: serum concentrations of FSH, LH, E2 and progesterone were measured using a commercial kit (DPC Imm Sys, California) by chemiluminescence; sample processing described Threshold for positive result: not provided Examiners: no information provided; unclear if blinded to the result of reference standard Interobserver variability: Intra‐ and interassay CV were for FSH 7.9% and 6.5%, for LH 8.8% and 11.3%, for E2 8.4% and 9.3%, for P 5.8% and 10.3%
Target condition and reference standard(s)	Target condition: endometriosis Prevalence of target condition in the sample: n = 28/49 (57%): stage I‐II 18, stage III‐IV 10; controls n = 21 Reference standard: laparoscopy n = 49 (100%) Description of positive case definition by reference standard as reported: visual inspection; staging according to the rASRM classification Examiners: no information provided
Flow and timing	Time interval between index test and reference standard: blood samples were collected before anaesthesia Withdrawals: none
Comparative
Key conclusions by the authors	Ovary dysfunction in women with endometriosis, with reduction on E, P and Hi concentrations, which may contribute to the subfertility often associated with the disease
Conflict of interest	Not reported
Notes	For LH and FSH there was no statistically significant difference between the groups ‐ no data available for meta‐analysis For E2 and progesterone there was statistically significant difference between the groups, but there was insufficient data to construct 2 x 2 tables ‐ not included in this review The data for markers measured in peritoneal fluid are not presented in this review
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	No
Did the study avoid inappropriate exclusions?	Yes
Was a 'two‐gate' design avoided?	No
		High	High
DOMAIN 2: Index Test All tests
Were the index test results interpreted without knowledge of the results of the reference standard?	Unclear
If a threshold was used, was it pre‐specified?	No
Was a cycle phase considered in interpretation of the result of index test?	Yes
		High	Low
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Unclear
Were the reference standard results interpreted without knowledge of the results of the index tests?	Yes
		Unclear	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Yes
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	Yes
		Low