Chronology of hemodynamic changes in asymptomatic in vitro fertilization patients and relationship with ovarian steroids and cytokines.
OBJECTIVE
To characterize the chronology of hemodynamic changes in in vitro fertilization (IVF) cycles and its relationship with circulating ovarian steroids, cytokines, and their mediator nitric oxide.


METHODS
Prospective, cross-sectional study.


METHODS
University teaching hospital.


METHODS
Eighty-eight IVF patients.


METHODS
Ovarian stimulation with FSH under pituitary suppression.


METHODS
Circulating levels of estradiol, progesterone, nitrite/nitrate, interleukin-6, vascular endothelial growth factor, tumor necrosis factor alpha, aldosterone, norepinephrine, as well as measurements of plasma renin activity and mean arterial pressure.


RESULTS
The maximal stimulation of the renin-aldosterone and sympathetic nervous systems was seen 7 days after hCG administration, although values still remained elevated over normal control values on day of hCG + 11. Mean arterial pressure in IVF patients remained significantly reduced throughout the luteal phase. Changes in the stimulation of the renin-aldosterone system correlated temporally with progesterone but not estradiol levels. No significant changes were observed in circulating concentrations of cytokines investigated or nitric oxide.


CONCLUSIONS
The circulatory changes and the homeostatic activation of the renin-aldosterone system and sympathetic nervous system that consistently develop in patients undergoing controlled ovarian hyperstimulation for IVF is a feature associated with the luteinization process. These hemodynamic changes occur in the absence of variations in the circulating levels of cytokines potentially involved in ovarian hyperstimulation syndrome.
Manau
Dolors
D
Hospital Clínic , Institut d'Investigacions Biomèdiques August Pi y Sunyer, Faculty of Medicine, University of Barcelona, Spain.
Arroyo
Vicente
V
Jiménez
Wladimiro
W
Fábregues
Francisco
F
Vanrell
Juan A
JA
Balasch
Juan
J
D000328:Adult; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood*; D004958:Estradiol / Q000097:blood*; D005260:Female; D005307:Fertilization in Vitro; D006439:Hemodynamics; D006801:Humans; D009569:Nitric Oxide / Q000097:blood; D010062:Ovulation Induction / Q000379:methods; D011374:Progesterone / Q000097:blood*; D011446:Prospective Studies; D012084:Renin-Angiotensin System; D013564:Sympathetic Nervous System / Q000503:physiopathology
D006063:Chorionic Gonadotropin; D016207:Cytokines; D009569:Nitric Oxide; D011374:Progesterone; D004958:Estradiol