Synergistic Impact of Follicular TNF-α and Growth Hormone on Oocyte Competence and Pregnancy Success in Assisted Reproduction

Abstract

Background
Inflammatory and endocrine factors play essential roles in regulating ovarian physiology and reproductive outcomes. Tumor necrosis factor-α (TNF-α), a pro-inflammatory cytokine, and growth hormone (GH), a key endocrine regulator, are involved in follicular development, steroidogenesis, and cellular differentiation within the ovary. The aim of this study to evaluate the association of TNF-α and GH levels in serum and follicular fluid with ovarian response, oocyte and embryo characteristics, and pregnancy outcomes in women undergoing ICSF.
Methods
This prospective study included 120 infertile women undergoing ICSI, categorized into poor, normal, and hyper responders. Serum and follicular fluid levels of TNF-α and GH were measured at oocyte retrieval day (ORD) and embryo transfer day (ETD). Associations with hormonal profiles, oocyte characteristics, embryo quality, and pregnancy outcomes were assessed using non-parametric statistical methods.
Results
Both TNF-α and GH levels differed significantly across ovarian response groups (p < 0.001), with higher levels observed in hyper responders. TNF-α demonstrated significant positive correlations with key hormonal parameters and oocyte characteristics, particularly total oocyte count and maturation indices. GH showed similar associations with oocyte quantity and maturity, although follicular fluid GH exhibited negative correlations with MII oocytes.
Despite these biological associations, neither TNF-α nor GH showed consistent relationships with pregnancy outcomes. However, TNF-α demonstrated moderate predictive value, with a cutoff ≤185.32 at ETD yielding an AUC of 0.778, sensitivity of 84.6%, and specificity of 64.7%.
Conclusion
TNF-α and GH are significantly associated with ovarian activity and oocyte development in ICSI patients, reflecting their roles in inflammatory and endocrine regulation of the follicular microenvironment. However, their predictive value for pregnancy outcomes remains limited, suggesting that additional factors contribute to implantation success.