Changes in inflammatory factor levels in follicular fluid of patients with PCOS and their impact on assisted reproductive outcomes: A systematic review and meta-analysis.

This systematic review and meta-analysis examines the association between inflammatory factors in the follicular fluid and assisted reproductive technology (ART) outcomes among women with polycystic ovary syndrome (PCOS). Multiple databases were comprehensively searched, which identified 37 studies, including 24 case-control, 7 cohort, and 6 cross-sectional studies, with a total of 1421 patients with PCOS and 1458 controls. Methodological quality was rated as high in 86.49% (32/37) of included studies. The meta-analysis revealed significantly higher levels of proinflammatory cytokines, including TNF-α (MD = 6.51 [95% CI 4.95-8.07]; P < 0.0001), IL-6 (MD = 7.16 [95% CI 4.19-10.13]; P < 0.0001), IL-18 (MD = 61.27 [95% CI 17.47-105.07]; P = 0.0061), IL-1β (MD = 4.32 [95% CI 0.08-8.55]; P = 0.0456), and IL-8 (MD = 187.77 [95% CI 14.81-360.73]; P = 0.0334), in the follicular fluid of patients with PCOS compared with controls. However, no significant difference was observed in IL-10 levels. Inflammation in the follicular fluid was associated with reductions in oocyte maturation rate, high-quality embryo rate, implantation rate, and clinical pregnancy rate, whereas fertilization rate remained unaffected. These findings suggest that elevated proinflammatory cytokine levels in the follicular fluid of patients with PCOS adversely affect ART outcomes, underscoring the need for further validation in large-scale randomized controlled trials.