title: Chronology of hemodynamic changes in asymptomatic in vitro fertilization patients and relationship with ovarian steroids and cytokines.
abstract: 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.
authors.affiliation: Hospital Clínic , Institut d'Investigacions Biomèdiques August Pi y Sunyer, Faculty of Medicine, University of Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Manau
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.forename: Wladimiro
authors.initials: W
authors.lastname: Jiménez
authors.forename: Francisco
authors.initials: F
authors.lastname: Fábregues
authors.forename: Juan A
authors.initials: JA
authors.lastname: Vanrell
authors.forename: Juan
authors.initials: J
authors.lastname: Balasch
mesh_terms: 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
chemical_list: D006063:Chorionic Gonadotropin; D016207:Cytokines; D009569:Nitric Oxide; D011374:Progesterone; D004958:Estradiol