The article presents the results of a clinical and instrumental examination of 80 healthy women (average age 32,313,57 years) in order to assess the heart rhythm disturbances after induction of superovulation duringin vitrofertilization. All women were examined twice before and after induction of superovulation during extracorporeal fertilization. Clinical and instrumental examination included: electrocardiography at rest; echocardiography; 24-hour ECG monitoring with heart rate variability analysis; 24-hour blood pressure monitoring. Induction of superovulation is associated with a significant increase in mean daily HR max (р0,01), and consequently with an increase in myocardial oxygen demand. It has been established that induction of superovulation contributes to the development of supraventricular arrhythmias (р0,01) and an increase in episodes of apnea/hypnea (р0,01). Regression analysis revealed predictors of supraventricular arrhythmias after induction of superovulation, including adverse circadian heart rate profile, adverse circadian blood pressure profile, impaired autonomic regulation of heart activity (р0,01). It was shown that the appearance of rhythm disturbances is associated with both the initial functional state of the cardiovascular system and its response to the induction of superovulation. It was established a correlation between the estradiol concentration and the increase of daily average heart rate after induction of superovulation (r=0,30,р0,05), apnea/hypnea index after induction of superovulation (r=0,34,р0,05). Conclusion. Superovulation induction may exacerbate existing chronic cardiovascular diseases. Due to the adverse effect of superovulation induction on the daily heart rate profile, women need to evaluate the functional state of the cardiovascular system duringinvitrofertilization planning. This will prepare the woman for the upcoming procedure and avoid adverse reactions from the cardiovascular system in response to stimulation of superovulationin vitrofertilization.

The purpose of the work to study echocardiographic parameters before and after the induction of superovulation to determine the nature of the effect of extracorporeal fertilization on the functional state of the cardiovascular system in healthy women of reproductive age. Materials and methods. The article presents the results of clinical and instrumental examination of 80 practically healthy women (mean age 32.3 3.5 years). All women were examined twice before and after induction of superovulation during extracorporeal fertilization. Results. It was established that a decrease in the stroke volume of blood (p 0.001) was accompanied by a compensatory increase in heart rate (p 0.001). These changes ensured the stability of the minute blood volume after induction of superovulation (before 51.1 1.1 ml; after 52.1 1.2 ml; p 0.05). After induction of superovulation in women, an increase in the integral systolic index of cardiac remodeling was noted (before 108.7 2.5 units; after 118.5 4.7 units; p 0.001), an indicator of myocardial stress in systole (before 111.5 6.7 dyne/cm2; after 127.3 7.4 dyne/cm2; p 0.001) and the indicator of myocardial stress in diastole (before 139.4 6.8 dyne/cm2; after 165.7 7.9 dyne/cm2; p 0.001). In practically healthy women, after induction of superovulation, the left ventricular ejection fraction increased (before 71.3 4.2%; after 74.8 4.1%; p 0.001). The revealed dynamics is regarded as a response of the myocardium to a change in the hormonal background during superovulation induction. This is evidenced by the correlation between the estradiol level and the left ventricular ejection fraction (r = 0.36; p 0.05). Conclusion. Induction of superovulation does not adversely affect systolic and diastolic function of the left ventricle. However, after these manipulations there is an increase in systolic and diastolic myocardial stress, which reflects myocardial stress in response to hemodynamic changes. Remodeling indices are more informative for evaluating maladaptive and adaptive variants of myocardial changes in healthy women than traditional echocardiographic indicators. In this regard, remodeling indices should be used as additional indicators of the functional state of the heart in women before and after the induction of superovulation in vitro fertilization.

Objective is to study the relationship of hemodynamic, hormonal and metabolic changes with increased blood pressure (BP) in women after the induction of superovulation for extracorporeal fertilization (ECF).Design and methods. We examined 80 women aged from 25 to 38 years (mean age 32,3 ± 3,6 years). All patients underwent ECF at the Center for Reproductive Technologies of the St Petersburg Mariinsky Hospital. Daily monitoring of BP was carried out twice: before the induction of superovulation for ECF and on the first day after this manipulation.Results. After induction of superovulation, an increase in average daily BP ≥ 135/85 mm Hg occurred in 52,5 % of women and an increase in average night BP ≥ 120/70 mm Hg was registered in 13,8 %. In women with initially increased average daily BP, the relative risk of its further increase on the first day after induction of superovulation was 1,46 (95 % confidence interval (CI) 0,79–2,68) compared with women who had normal average daily BP. In women with initially elevated average nightly BP, the relative risk of its further increase after induction of superovulation was 1,16 (95 % CI 1,06–1,27). An increase of BP after induction of superovulation may be associated with age, female factor infertility, the presence of chronic diseases of the genitourinary system in past, changes in the metabolic profile (increase in total cholesterol, urea, creatinine, glucose, estradiol; decreased thyroid-stimulating hormone level), heart rhythm disturbances, episodes of apnea/hypopnea during sleep, increase in heart rate, increased sympathetic activity.Conclusions. Induction of superovulation during in vitro fertilization has an adverse effect on the circadian BP profile. While planning in vitro fertilization, the risk factors for BP increase should be identified and modified. This will help to avoid adverse cardiovascular reactions associated with the procedure. Women with the hypertensive reaction after the induction of superovulation require dynamic BP monitoring.

Обследованы 80 женщин в возрасте от 25 до 38 лет (средний возраст 32,3±3,6 года), которые проходили экстракорпоральное оплодотворение в центре репродуктивных технологий Городской Мариинской больницы. Суточное мониторирование артериального давления (АД) проводилось дважды: перед индукцией суперовуляции при экстракорпоральном оплодотворении и в первые сутки после данной манипуляции. Исследование показало, что в первые сутки после стимуляции суперовуляции у 97,5% женщин наблюдалось повышение среднедневных и/или средненочных показателей АД, из них в 52,5% случаев повышение АД носило патологический характер (≥135/85 мм рт. ст. днем и ≥120/70 мм рт. ст. ночью). При сравнении показателей суточного профиля АД до и после индукции суперовуляции получены данные о том, что в ответ на манипуляцию происходит повышение систолического АД, диастолического АД и среднего АД в дневное время (р0,01) и в ночное время (р0,01). После индукции суперовуляции повысились вариабельность систолического АД (р<0,01) и среднего АД (р<0,01) в дневное время суток, а также величина утреннего подъема систолического и диастолического АД (р<0,01). У 30,0% женщин после стимуляции суперовуляции наблюдалось изменение циркадной динамики по типу «Non-dipper». Относительный риск повышения систолического АД под влиянием индукции суперовуляции при экстракорпоральном оплодотворении составил 1,28 (95%-ный ДИ 0,73-2,56), а относительный риск повышения диастолического АД -2,0 (95%-ный ДИ 1,59-2,51). У большинства женщин без сердечно-сосудистой патологии в первые сутки после стимуляции суперовуляции происходят повышение среднедневных и/или средненочных показателей АД, увеличение дневной вариабельности систолического и среднего АД, ухудшение утренней динамики АД, а у 30% женщин изменяется циркадная динамика по типу «Non-dipper». Индукция суперовуляции ассоциирована с риском повышения АД. Ключевые слова: здоровье женщин, артериальная гипертензия, индукция суперовуляции, экстракорпоральное оплодотворение, артериальная гипертензия у женщин We examined 80 women aged 25 to 38 years (average age 32,3±3,6 years) who underwent in vitro fertilization at the reproductive technology center of the City Mariinsky Hospital. 24-hour monitoring of blood pressure was carried out twice: before induction of superovulation during in vitro fertilization and on the first day after this manipulation. The study showed that on the first day after stimulation of superovulation in 97,5% of women there was an increase in the average daily and/or average nightly blood pressure, of which in 52,5% of cases the increase in blood pressure was pathological (≥135/85 mm Hg during the day and ≥120/70 mmHg at night). When comparing the indicators of the 24-hour blood pressure before and after the induction of superovulation, data were obtained that, in response to manipulation, there is an increase in systolic blood pressure, diastolic blood pressure and average blood pressure in the daytime (p<0,01) and at night (p<0,01). After the induction of superovulation, the variability of systolic blood press...