Figure 5.

Working model of enhanced cytokine production in the PCOS periovulatory follicle. Cytokines and chemokines are secreted by GCs and are physiological components of the ovulatory response. Elevated local androgens in the PCOS follicle may increase IL6 and CCL20 expression, which can then enhance immune cell activation and recruitment to the area. These recruited immune cells then further contribute to the production of local inflammatory molecules, possibly affecting both angiogenic and steroidogenic pathways. IL8 may be increased by systemic factors associated with elevated body mass index and insulin levels and may also participate in a synergistic-positive feedback loop with immune cells in the production of VEGF and other proangiogenic factors. BM, basement membrane.