Table 1.

Association of endocrine-disrupting chemicals—bisphenols, parabens and triclosan—with polycystic ovary syndrome in women. Studies included in this systematic review (arranged alphabetically by first author’s last name). Statistically significant differences are presented.

Source	Study Design	Sample of Participants (No. of Women)	Sample Type	Exposure	Main Findings
Akgül et al. (2019), Turkey [84]	Case-control study	95 aged 12–18 years: 62 with PCOS, 33 controls	Blood plasma, urine samples	BPA, phthalates	-Increased urinary BPA levels in PCOS group -Positive correlation of urinary BPA levels with polycystic morphology on ultrasound
Akin et al. (2015), Turkey [85]	Cross-sectional study	173 aged 13–19 years: 112 with PCOS, 61 controls	Blood serum	BPA	-Increased serum BPA levels in PCOS group -Positive correlation of serum BPA with total T and DHEAS in PCOS group
Gu et al. (2019) [86]	Case-control study	123: 40 with PCOS, 83 controls	Urine sample	Organic UV filters, BPA, triclosan	-No association between urinary BPA and TCS and PCOS
Hossein Rashidi et al. (2017), Iran [87]	Case-control study	102: 51 with PCOS, 51 controls	First morning urine sample	BPA	-Higher urinary BPA levels in PCOS group -BPA was significantly associated with PCOS
Jędrzejuk et al. (2019), Poland [88]	Pilot study	63: 27 with PCOS, 36 controls	Blood sample	BPA	-Negative correlation between blood BPA levels and VDBP and SHBG levels in PCOS group -Positive correlation of blood BPA with bilirubin levels in PCOS and study group
Kandaraki et al. (2011), United Kingdom, Greece [89]	Cross-sectional study	171: 71 with PCOS, 100 controls	Blood serum	BPA	-Higher serum BPA levels in PCOS group -Positive correlation of serum BPA with T and A in the total group -Positive correlation of BPA with PCOS in women -Positive correlation of serum BPA with insulin resistance in PCOS group
Konieczna et al. (2018), Poland [90]	Cross-sectional study	186: 106 with PCOS, 80 controls	Blood serum	BPA	-Significantly higher BPA serum levels in PCOS group -Positive correlation of BPA levels with serum total T and FAI in PCOS group
Lazúrová et al. (2021), Slovakia [91]	Case-control study	118: 86 with PCOS, 32 controls	Fasting blood and morning urinary samples	BPA	-Higher urinary BPA levels in PCOS group women -High-BPA PCOS group demonstrated higher serum insulin and HOMA IR, lower serum estrone, estradiol, FSH and FAI comparing to low-BPA PCOS group -Positive correlation of urinary BPA levels with age in PCOS group -Negative correlation of urinary BPA levels with estradiol, T, free-T and FAI in PCOS group
Luo et al. (2020), China [92]	Case-control study	357: 119 with PCOS, 238 controls	Blood plasma	BPA, polybrominated diphenyl ethers, phthalates	-Higher BPA levels in PCOS group -Clearance of BPA, phthalates and androgens is associated with genetic polymorphisms of UGT
Šimková et al. (2020), Czech Republic [93]	Case-control study	39: 19 with PCOS (9 normal-weight, 10 obese), 20 controls	Blood plasma	Parabens, BPA, BPS, BPF, BPAF	-Higher levels of BPA in plasma of PCOS group -Higher levels of plasma BPA, AMH, LH, LH/FSH ratio, T, free T, bioavailable T, A, 7β-OH-epiandrosterone, and cytokines (IL-6, VEGF, PDGF-bb) in normal-weight PCOS women -Positive correlation of BPA with T, SHBG, FSH and LH in healthy controls -No associations of parabens and PCOS in women
Tarantino et al. (2013), Italy [94]	Cross-sectional study	60: 40 with PCOS, 20 controls	Blood serum	BPA	-Higher serum BPA levels associated with higher grades of insulin resistance, hepatic steatosis, FAI, and markers of low-grade chronic inflammation (CRP, IL-6, spleen enlargement) in PCOS group -Spleen size and FAI were the best predictors of BPA
Vagi et al. (2014), USA [95]	Case-control study	102: 52 with PCOS, 50 controls	Blood and urinary samples	Brominated diphenyl ethers, polychlorinated biphenyls, organochlorine pesticides, perfluorinated compounds, phthalates, and BPA	-No association between blood and urinary BPA levels and PCOS in women
Vahedi et al. (2016), Iran [96]	Case-control study	124: 62 with PCOS, 62 controls	Blood serum	BPA	-Higher serum BPA, triglycerides, cholesterol levels and LH/FSH ratio in PCOS group -Lower serum TSH levels in PCOS group
Wang et al. (2017), China [97]	Case-control study	38: 21 with PCOS, 17 controls	Follicular fluid and ovarian granulosa cells	BPA	-Higher BPA levels in the follicular fluid in PCOS group of women -Decreased aromatase expression and estradiol synthesis in cultured granulosa cells after in-vitro BPA exposure in PCOS group of women
Zhou et al. (2016), China [98]	Cross-sectional study	268 infertile women diagnosed with PCOS	Urinary sample	BPA	-Negative association between urinary BPA levels and AFC

Abbreviations: A, androstenedione; AFC, antral follicle count; AMH, anti-Müllerian hormone; BPA, bisphenol A; BPAF, bispheol AF; BPF, bispheol F; BPS, bispheol S; CRP, C-reactive protein; DHEAS, dehydroepiandrosterone sulfate; FAI, free androgen index; FSH, follicle–stimulating hormone; HOMA IR, Homeostatic Model Assessment for Insulin Resistance; IL-6, interleukin 6; LH, luteinizing hormone; PCOS, polycystic ovary syndrome; PDGF-bb, platelet derived growth factor bb; SHBG, sex hormone binding globulin; UGT, uridine diphosphate-glucuronosyl transferase; VDBP, Vitamin D–binding protein; VEGF, vascular endothelial growth factor; T, testosterone; TCS, triclosan; TSH, thyroid–stimulating hormone.