Background: Recent studies indicate that vitamin D impacts male reproductive function, with deficiency linked to infertility. This review evaluates the effect of vitamin D supplementation on male fertility, focusing on total testosterone, free testosterone, the free androgen index (FAI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), sex-hormone-binding globulin (SHBG), and estradiol. Methods: We systematically searched Medline, Web of Science, Cochrane Library, and Scopus from their inception until July 2024 for randomized controlled trials (RCTs) involving adult males. The primary focus of these studies was on reproductive hormone parameters, analyzed using a random-effects meta-analysis and weighted mean difference (WMD). Evidence quality was assessed using ROB2 and GRADE. Meta-regression and dose–response analyses were performed. Results: Seventeen studies met the criteria for quantitative analysis. Vitamin D supplementation significantly increased total testosterone levels (WMD 0.38, 95% CI 0.06–0.70, n = 15, I² = 67.03). However, it had no significant effect on other hormone parameters: free testosterone (WMD 0.00, 95% CI −0.02–0.03, n = 9, I² = 48.12), FSH (WMD −0.02, 95% CI −0.57–0.53, n = 7, I² = 48.72), LH (WMD −0.09, 95% CI −0.30–0.12, n = 8, I² = 0.00), SHBG (WMD 0.73, 95% CI −1.14–2.61, n = 10, I² = 69.05), FAI (WMD −0.92, 95% CI −2.12–0.27, n = 6, I² = 0.00), and estradiol (WMD −0.02, 95% CI −2.95–2.92, n = 5, I² = 20.63). Conclusion: This meta-analysis shows that vitamin D supplementation may increase total testosterone levels in men. However, further well-designed RCTs are needed to determine vitamin D’s effects on other reproductive hormone parameters.

Objective: This study offered an updated meta-analysis of randomized controlled trials (RCTs) that assessed preoperative misoprostol compared to control (matched placebos or no treatment) during abdominal myomectomies. Methods: Six databases underwent screening until 7 April 2024. The risk of bias was assessed using the Cochrane Collaboration tool. The results were presented as mean differences (MDs) or risk ratios (RRs) along with 95% confidence intervals (CIs) using the random-effects model. Results: Sixteen RCTs were analyzed, involving 975 women. The overall quality of the studies was rated as “low” or had “some concerns” of bias in seven and eight RCTs, respectively; one RCT had an overall “high” risk of bias. For primary endpoints, the misoprostol intervention had significantly lower mean intraoperative blood loss (n = 15, MD = −180.2 mL, 95% CI [−224.04, −136.35], p < 0.001), mean hemoglobin drop (n = 13, MD = −0.58 g/dl, 95% CI [−0.82, −0.35], p < 0.001), and rate of perioperative blood transfusion (n = 13, RR = 0.43, 95% CI [0.29, 0.63], p < 0.001) compared to the control intervention. For secondary endpoints, the misoprostol intervention had significantly lower mean hematocrit drop (MD = 2.15, 95% CI −3.34, −0.96], p < 0.001), mean operative time (MD = −12.95 min, 95% CI [−19.89, −6.01], p < 0.001), and mean hospital stay (MD = −0.14 days, 95% CI [−0.25, −0.02], p = 0.02) compared to the control intervention. Nonetheless, no significant change was indicated between both interventions regarding the rate of postoperative fever. Conclusions: During abdominal myomectomy, the administration of preoperative misoprostol was generally safe and yielded statistically significant reductions in intraoperative blood loss, hemoglobin drop, and perioperative blood transfusion.

Background and Objectives: Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with various cardiometabolic risk factors, including insulin resistance, dyslipidemia, hypertension, and obesity, which contribute to an increased risk of cardiovascular diseases. This inaugural systematic review and meta-analysis of randomized controlled trials (RCTs) evaluated the impact of magnesium supplementation on various cardiometabolic risk factors and hormonal parameters in patients with polycystic ovary syndrome (PCOS). Materials and Methods: We systematically searched the MEDLINE, Web of Science, Scopus, and Cochrane databases until 30 March 2024 for studies comparing magnesium supplementation to control in improving cardiometabolic and hormonal factors in PCOS patients. Endpoints were summarized as mean differences (MD) and 95% confidence intervals (CIs) in a random-effects model. Results: The primary search yielded 176 studies. After screening, six studies met our inclusion criteria. Our meta-analysis showed no significant effects of magnesium supplementation on cardiometabolic risk factors and hormonal parameters in patients with PCOS. Conclusions: Magnesium supplementation does not appear to influence the cardiometabolic and hormonal factors in PCOS patients. Further rigorous RCTs are needed to strengthen the evidence and support comprehensive analysis in this area. PROSPERO database (CRD42024526110).

Background: Adverse pregnancy outcomes such as preeclampsia (PE), preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth are major contributors to maternal and neonatal morbidity and mortality. Elevated maternal homocysteine (Hcy) levels, influenced by genetic, dietary, and lifestyle factors, have been increasingly associated with placental dysfunction and adverse pregnancy outcomes. This review aims to evaluate the link between hyperhomocysteinemia and pregnancy complications to inform clinical practice. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Library was conducted up to December 2024. Observational studies assessing maternal Hcy levels in relation to pregnancy complications were included. Heterogeneity was measured using the I² statistic, and a random-effects model using the DerSimonian–Laird method was applied to account for study variability. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. Elevated maternal Hcy was significantly associated with: PE (OR: 2.49; 95% CI: 1.41–4.40; I² = 96.03%; n = 9), preterm birth (OR: 4.01; 95% CI: 1.84–8.72; I² = 91.08%; n = 6), fetal loss (OR: 1.76; 95% CI: 1.22–2.52; I² = 41.47%; n = 6), SGA (OR: 1.69; 95% CI: 1.35–2.11; I² = 0.00%; n = 3), and LBW (OR: 2.46; 95% CI: 1.37–4.43; I² = 77.71%; n = 3). Conclusions: This review highlights a significant association between elevated maternal Hcy levels and various pregnancy complications. However, given the substantial heterogeneity and reliance on observational evidence, these findings should be interpreted with caution. Future well-designed prospective cohort studies with standardized definitions of hyperhomocysteinemia, consistent timing of exposure assessment across pregnancy trimesters, and adjustment for key confounders are needed to better clarify these associations and underlying mechanisms.

Background: Ectopic pregnancy (EP) is a serious condition often treated with methotrexate. Letrozole, a safer aromatase inhibitor, may offer an effective alternative. This study presents a meta-analysis comparing the efficacy and safety of single-agent letrozole versus methotrexate for EP management. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Six sources of information underwent screening until 12 June 2025. Risk of bias and evidence certainty of evidence were assessed. Primary outcome was treatment success rate. Results were presented as mean difference (MD) or risk ratio (RR) along with a 95% confidence interval (CI) using a random-effects model. Results: Six studies (three randomized controlled trials and three nonrandomized prospective cohort studies) comprising seven arms and 260 patients (letrozole = 130, methotrexate = 130) were included. Almost all studies (n = 5) had overall moderate or high risk. Treatment success rates were comparable between groups (n = 7 arms; RR = 1.05; 95% CI: [0.94, 1.17]; p = 0.40). Letrozole was associated with significantly lower β-hCG levels on day 4 (n = 5 arms; MD = −95 mIU/mL; 95% CI: [−189.7, −0.91]; p = 0.048), day 7 (n = 5 arms; MD = −86.24 mIU/mL; 95% CI: [−143.1, −29.36]; p < 0.001), and day 14 (n = 3 arms; MD = −9.15 mIU/mL; 95% CI: [−17.24, −1.06]; p = 0.03); however, the differences were not clinically meaningful. Letrozole showed a better safety profile with higher platelet counts and lower liver enzymes. AMH levels were similar between groups. Most analyses were consistent, though secondary outcomes were less stable. Overall evidence certainty was rated ‘very low’ due to seriousness of risk of bias and imprecision. Conclusions: While letrozole shows comparable efficacy to methotrexate and a potentially better safety profile in the management of EP, the certainty of evidence is ‘very low’ due to risk of bias and imprecision. Therefore, these findings should be interpreted with caution, and further high-quality studies are urgently needed to confirm the results.