Moreover, the production of interleukin-1 (IL-1), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) analyzed in this study is also the result of the transition of macrophages from the anti-inflammatory M2 state to the pro-inflammatory M1 state, which is of great importance in women with PCOS, as obesity and IR additionally promote this mechanism [107]. Here, TNF is linked to obesity due to melanocortin 4 receptor deficiency.