Tumor Necrosis Factor-Alpha (TNF-α) Levels in Women With Polycystic Ovary Syndrome (PCOS): A Systematic Review and Meta-Analysis of Observational Studies.

A single study from China (k = 1) showed a large and highly significant effect (SMD = 1.56, 95% CI = 1.21-1.91) [ 12 ].

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In Iraq (k = 2), the pooled analysis indicated a borderline significant increase in TNF-α (SMD = 0.85, 95% CI = -0.01 to 1.71), but heterogeneity was very high (I2 = 91.3%), limiting interpretability.

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In the lean subgroup, the pooled effect was larger (SMD = 0.97, 95% CI = -0.23 to 2.17; p = 0.11), but the association did not reach statistical significance, likely due to the small number of studies (n = 2) and very high heterogeneity (I2 = 92.2%).

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