TNF and obesity due to melanocortin 4 receptor deficiency: The average rate of obesity in women with PCOS is approximately 49%.[32] Additionally, they also exhibit higher serum concentrations of TNF and C-reactive protein and circulating levels of monocytes and lymphocytes, as well as inflammatory infiltration of ovarian tissue.[33] Elevated insulin levels promote the apoptosis of ovarian granulosa cells, which in turn inhibits ovulation.