Evaluation of tumor necrosis factor alpha serum level in obese and lean women with clomiphene citrate resistant polycystic ovary disease

Abstract

Objective: The aim of this work was to investigate the level of the serum level of tumor necrosis factor alpha (TNF-α) as an inflammatory biomarker in lean and obese women with polycystic ovary disease (PCOD), who are resistant to clomiphene citrate (CCR-PCOD). Patients and design: It is a case controlled study, where one hundred and fifty (n = 150) PCOD women (study group), who are resistant to clomiphene citrate (CCR-PCOD) had been recruited, in addition to one hundred (n = 100) women with PCOD, who are not resistant to clomiphene citrate (NCCR-PCOD) as the first control group, and another one hundred women (n = 100) fertile women with normal reproductive health, as the second control group. All the recruited subjects had been divided into subgroups according to the BMI: One obese group with BMI ⩾ 27, and the second lean group with BMI < 27. TNF-α had been measured in all women groups recruited, in addition to the other essential, basic and PCOD relevant biochemical and hormonal tests. Results: TNF-α level was found to be higher in all PCOD women, either the study or control PCOD groups, than the fertile control group (49.93 ± 3.39 vs. 35.83 ± 2.47 pg/ml, P < 0.001). The level of TNF-α has come highest in the obese clomiphene citrate resistant PCOD women (obese CCR-PCOD), while the lowest has come in the lean PCOD women, who are not resistant to clomiphene citrate (NCCR-PCOD). Free Androgen Index (FAI) and androgenic obesity with higher W/H ratio were clearly going with TNF-α pattern, and have come higher in all PCOD compared to the fertile control group. Insulin Resistance (IR) shows a positive correlation with BMI regardless off PCOD status and androgen level as well. The level of other basic and PCOD relevant hormones like FSH, TSH, and prolactin have never shown statistically significant differences between all the study and control groups, except LH serum level which has shown a non significant higher level in all PCOD women included either resistant to CC or not. Conclusion: TNF-α serum level has come significantly higher in all women with PCOD, especially in those resistant to CC. Androgenic obesity with higher W/H ratio has shown a positive correlation with TNF-α level, which could consider it a good severity index of PCOD status, and an informative predictor of CCR before its use.

Keywords

• Polycystic ovary syndrome
• Clomiphene citrate
• Tumor necrosis factor alfa (TNF-α)
• BMI
• Inflammatory markers
• Insulin resistance and hyperinsulinism