{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:50:32Z","timestamp":1785894632302,"version":"3.56.0"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":65,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endometriosis is a chronic inflammatory disorder frequently associated with infertility. Tumor necrosis factor-alpha (TNF-\u03b1) is involved in inflammatory pathways; however, the clinical relevance of serum TNF-\u03b1 in relation to infertility duration and ovarian reserve remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective comparative study included 70 infertile women aged 20\u201337 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-\u03b1 was measured using enzyme-linked immunosorbent assay. Hormonal parameters, including anti-M\u00fcllerian hormone (AMH), were obtained from third-day menstrual-cycle samples retrieved from clinical records. Associations between TNF-\u03b1, infertility duration, AMH, and clinical characteristics were evaluated. Exploratory adjusted analyses were performed for log-transformed TNF-\u03b1 and AMH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Serum TNF-\u03b1 levels were higher in the endometriosis group than in controls (median [IQR], 235.49 [124.33-390.31] vs. 64.58 [58.91\u201376.52] ng\/L;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). AMH levels were lower in the endometriosis group in unadjusted analysis (2.05 [1.67\u20133.41] vs. 3.30 [2.26\u20133.66] ng\/mL;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). After adjustment for age, BMI, smoking status, and previous surgical history, endometriosis group status remained associated with log-transformed TNF-\u03b1 (\u03b2\u2009=\u20091.386, 95% CI 1.114 to 1.657;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), whereas the association with AMH was attenuated (\u03b2=-0.824, 95% CI -1.817 to 0.169;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.102). TNF-\u03b1 was not associated with infertility duration or AMH within the endometriosis group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Serum TNF-\u03b1 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-\u03b1 may reflect systemic inflammatory activity rather than infertility severity or ovarian reserve impairment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-026-04586-w","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:17:06Z","timestamp":1780319826000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Investigation of the effect of TNF-\u03b1 levels on infertility duration and infertility characteristics in endometriosis patients presenting with infertility complaints"],"prefix":"10.1186","volume":"26","author":[{"given":"G\u00fclin","family":"\u00d6zuyar \u015eim\u015fek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"Uzunlar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00fcleyman","family":"\u00d6zen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuba","family":"\u00c7andar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muzaffer","family":"Sanc\u0131","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ecem Dilan","family":"Duman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"issue":"2","key":"4586_CR1","doi-asserted-by":"publisher","first-page":"hoac009","DOI":"10.1093\/hropen\/hoac009","volume":"2022","author":"CM Becker","year":"2022","unstructured":"Becker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. https:\/\/doi.org\/10.1093\/hropen\/hoac009.","journal-title":"Hum Reprod Open"},{"issue":"10276","key":"4586_CR2","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","volume":"397","author":"HS Taylor","year":"2021","unstructured":"Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839\u201352. https:\/\/doi.org\/10.1016\/S0140-6736(21)00389-5.","journal-title":"Lancet"},{"key":"4586_CR3","doi-asserted-by":"publisher","first-page":"e070750","DOI":"10.1136\/bmj-2022-070750","volume":"379","author":"AW Horne","year":"2022","unstructured":"Horne AW, Missmer SA. Pathophysiology, diagnosis, and management of endometriosis. 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Ethical approval was obtained from the Ankara City Hospital 2nd Clinical Research Ethics Committee (approval no. E2-22-2275; August 17, 2022). Written informed consent was obtained from all participants prior to enrollment.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"396"}}