Evidence mapPaperPMID 42226212Full record

ArticleBMC women's health2026

Investigation of the effect of TNF-α levels on infertility duration and infertility characteristics in endometriosis patients presenting with infertility complaints.

Gülin Özuyar Şimşek, Özlem Uzunlar, Süleyman Özen, Tuba Çandar, Muzaffer Sancı, Ecem Dilan Duman

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Article in BMC women's health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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6 authors.

Gülin Özuyar ŞimşekDivision of Gynecologic Oncology Surgery, İzmir City Hospital, İzmir, Türkiye. ozuyar92@gmail.com.
Özlem UzunlarDepartment of Obstetrics and Gynecology, Ankara Bilkent City Hospital, Ankara, Türkiye.
Süleyman ÖzenDivision of Gynecologic Oncology Surgery, İzmir City Hospital, İzmir, Türkiye.
Tuba ÇandarDepartment of Medical Biochemistry, Ufuk University, Ankara, Türkiye.
Muzaffer SancıDivision of Gynecologic Oncology Surgery, İzmir City Hospital, İzmir, Türkiye.
Ecem Dilan DumanDepartment of Obstetrics and Gynecology, Private Ortadoğu Hospital, Ankara, Türkiye.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundEndometriosis is a chronic inflammatory disorder frequently associated with infertility. Tumor necrosis factor-alpha (TNF-α) is involved in inflammatory pathways; however, the clinical relevance of serum TNF-α in relation to infertility duration and ovarian reserve remains uncertain.

methodsThis prospective comparative study included 70 infertile women aged 20-37 years: 35 women with clinically and/or radiologically diagnosed endometriosis and 35 age-matched infertile controls with unexplained infertility and no clinical or imaging evidence of endometriosis. Serum TNF-α was measured using enzyme-linked immunosorbent assay. Hormonal parameters, including anti-Müllerian hormone (AMH), were obtained from third-day menstrual-cycle samples retrieved from clinical records. Associations between TNF-α, infertility duration, AMH, and clinical characteristics were evaluated. Exploratory adjusted analyses were performed for log-transformed TNF-α and AMH.

resultsSerum TNF-α levels were higher in the endometriosis group than in controls (median [IQR], 235.49 [124.33-390.31] vs. 64.58 [58.91-76.52] ng/L; p < 0.001). AMH levels were lower in the endometriosis group in unadjusted analysis (2.05 [1.67-3.41] vs. 3.30 [2.26-3.66] ng/mL; p = 0.029). After adjustment for age, BMI, smoking status, and previous surgical history, endometriosis group status remained associated with log-transformed TNF-α (β = 1.386, 95% CI 1.114 to 1.657; p < 0.001), whereas the association with AMH was attenuated (β=-0.824, 95% CI -1.817 to 0.169; p = 0.102). TNF-α was not associated with infertility duration or AMH within the endometriosis group.

conclusionsSerum TNF-α was elevated in infertile women with clinically and/or radiologically diagnosed endometriosis but was not associated with infertility duration, AMH, or selected clinical characteristics. The high discriminatory performance observed in ROC analysis should be interpreted as exploratory because of the modest sample size, clinical/radiologic case definition, potential selection bias, and lack of external validation. Serum TNF-α may reflect systemic inflammatory activity rather than infertility severity or ovarian reserve impairment.

Indexed as

Anti-Mullerian HormoneEndometriosisInfertility, FemaleTumor Necrosis Factor-alphaAdultBiomarkersCase-Control StudiesEnzyme-Linked Immunosorbent AssayFemaleHumansOvarian ReserveProspective StudiesYoung AdultAnti-Mullerian HormoneBiomarkersTumor Necrosis Factor-alphaAMHBiomarkerEndometriosisInfertilityInflammationOvarian reserveTNF-α

Identifiers

PMID42226212
PMCPMC13440169

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