Circulating inflammatory markers in polycystic ovary syndrome: a systematic review and metaanalysis

Objective: To perform a review and metaanalysis of the studies evaluating the status of serum inflammatory markers in women with polycystic ovary syndrome (PCOS). Design: Systematic review and metaanalysis of articles published in English before January 2010 and identified using the PubMed search engine. Setting: Academic hospital. Patient(s): Women with PCOS and appropriate controls. Intervention(s): Measurement of serum concentrations of inflammatory markers by high-sensitivity techniques. Main Outcome Measure(s): Metaanalyses of the mean difference in serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations among patients with PCOS and appropriate controls, applying random-effects models to limit interstudy variability, and using appropriate estimates of evidence dissemination bias. Result(s): Metaanalysis of the 31 articles meeting inclusion criteria showed that circulating CRP was 96% higher in women with PCOS compared to controls (95% confidence interval, 71%-122%; z = 7.32) without evidence of dissemination bias (Egger's regression intercept, 0.45; 95% confidence interval, -2.30 to 3.21). These findings persisted after excluding five studies with mismatches in body mass, frequency of obesity, or both, between women with PCOS and controls. Metaanalyses involving 10 studies of IL-6, and nine studies of TNF-a revealed no statistically significant differences between PCOS and controls. Conclusion(s): Women with PCOS exhibit an elevation in circulating CRP that is independent of obesity. This finding corroborates existing molecular evidence of the chronic low-grade inflammation that may underpin the pathogenesis of this disorder. (Fertil Steril (R) 2011;95:1048-58. (C) 2011 by American Society for Reproductive Medicine.)