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Ovary |
Animal Sciences Department, University of Kentucky, Lexington, Kentucky 40506-0033
| ABSTRACT |
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follicle, lactation, ovary, ovulation, progesterone
| INTRODUCTION |
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Traditionally, cysts have been defined as anovulatory, follicular structures (diameter, >25 mm) that persist for 10 or more days in the absence of a functional corpus luteum [1]. However, recent data using ultrasonography indicate that follicles typically ovulate at 17 mm in diameter, so follicles that persist at that diameter or greater may be considered to be "cystic." Eyestone and Ax [4] showed that considerable variability exists among follicular cysts with respect to their steroidogenic capacity. In general, cows with follicular cysts have greater estradiol concentrations in follicular fluid [5] and in the circulation [69] than do cows without follicular cysts or with normal follicles.
Cysts appear to form because of an "endocrine imbalance." The vast majority of data suggest that cysts form because of a failure of the preovulatory LH surge to occur at the appropriate time in follicular maturation [10]. Injections of GnRH are able to stimulate the release of an LH surge from the anterior pituitary gland in cows with follicular cysts, indicating that it is functioning normally [11, 12]. In cows with follicular cysts, high endogenous levels of estradiol [10] and estradiol injections [13] are unable to induce a surge of LH. Thus, the positive-feedback mechanism of estradiol on the LH surge may not be functioning properly in cows with follicular cysts. This malfunction appears to reside at the hypothalamic level. Hypothalamic responsiveness to estradiol injections in cows with follicular cysts was restored 6 wk after the removal of ovaries with follicular cysts [14]. This implies that the factor responsible for blocking the LH surge in cows with follicular cysts may be of ovarian origin. Progesterone, an ovarian steroid present in the fluid from follicular cysts [5], may contribute to the cystic condition by blocking the LH surge. Follicular dynamics can be disrupted by administration of progesterone during the follicular phase. If progesterone is administered at intermediate levels (0.52 ng/ml), it will block the LH surge, prevent ovulation, and result in formation of a follicle with a greater diameter and persistency than those of normal dominant follicles [15, 16].
The extent to which follicular cysts secrete progesterone is unknown. The fluid from ovarian follicular cysts contains progesterone [5, 1719]. Peripheral concentrations of progesterone in cows with follicular cysts frequently appear to fall in the intermediate (0.11.0 ng/ml) range [10, 2022]. To our knowledge, the extent to which intermediate concentrations of progesterone may contribute to the formation of ovarian follicular cysts has not been investigated.
The objectives of the present study were to determine how often cows diagnosed with ovarian follicular cysts have intermediate concentrations of progesterone and to relate the fate of follicles that form in the presence of a follicular cyst to circulating concentrations of progesterone during their development.
| MATERIALS AND METHODS |
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Ovarian follicular cysts were identified in lactating Holstein and Jersey cows during routine reproductive examinations of the University of Kentucky Dairy Research Herd. Ovaries of all cows in the breeding herd were palpated per rectum at 9- to 14-day intervals for detection of cysts beginning at least 40 days postpartum. Bred cows were also palpated per rectum 5060 days after breeding for pregnancy determination or cyst detection. When a cyst was diagnosed by palpation, the cystic structure was re-examined by transrectal ultrasonography. For a follicle to be classified as an ovarian follicular cyst, the follicle had to measure at least 17 mm in diameter and be free of tissue that had ecogenic characteristics similar to luteal tissue, and ovaries had to be free of corpora lutea. This size criterion (diameter, ≥17 mm) was chosen because Ginther et al. [23] reported that normal ovulatory follicles in dairy cattle reach an average diameter of 16 ± 0.4 mm or 13.9 ± 0.4 mm at ovulation (two vs. three waves of follicle growth, respectively). In our experience, persistent follicles often fail to reach 25 mm in diameter, which is the diameter traditionally chosen to define cysts. Gümen et al. [24] have reported a similar observation. The absence of luteal tissue on either ovary implied that the cyst was functional at diagnosis and that normal cycles were not occurring.
Once the presence of a follicular cyst was confirmed by transrectal ultrasonography (n = 32 cows), a blood sample was then collected via jugular or coccygeal venipuncture to determine the circulating concentration of progesterone. The concentration of progesterone at cyst confirmation was then classified as low (<0.1 ng/ml), intermediate (0.11.0 ng/ml), or high (1.02.0 ng/ml). After cyst confirmation, blood samples were collected daily, and ultrasonography of ovaries continued for the next 7 days to ensure that cysts were identified correctly as follicular (cysts maintained a diameter of ≥17 mm) and that ovulation did not occur. If ovulation occurred within 7 days after cyst confirmation, the cow was removed from the experiment.
Differences in the number of cows in each progesterone classification at the day of cyst confirmation were determined by chi-square analysis [25].
Experiment 2: Influence of Progesterone on Follicular Dynamics in Cows with Follicular Cysts
Cows confirmed as having ovarian follicular cysts in experiment 1 were moved to a tie-stall research barn for experiment 2. Cows were fed a lactating cow ration and had free access to water. Cows were milked twice each day and were released from the tie-stall barn into a dirt paddock to receive approximately 3 h of exercise each day.
Ovaries were examined via transrectal ultrasonography between 0800 and 1200 h three times each week (Monday, Wednesday, and Friday). The ultrasound technician would scan each ovary in several different planes to become oriented with the position and size of each follicle/cyst. The technician then measured all dominant follicles (diameter, ≥10 mm) and cysts at their greatest diameter and noted the relative position of each follicle/cyst. After each examination, a diagram of the position and size of each follicle/cyst on each ovary was made. Once data collection from a cow ended, the pattern of growth and regression of individual follicles/cysts was retrospectively identified from the ovarian diagrams made after each ultrasound examination. This method of follicle tracking allowed the growth and regression of an individual follicle/cyst to be mapped. Blood samples were collected daily via jugular or coccygeal venipuncture to quantify circulating concentrations of progesterone. Blood sampling and ultrasonographic procedures were approved by the University of Kentucky Institutional Animal Care and Use Committee.
The fate of follicles (diameter, ≥10 mm) that formed in the presence of an existing ovarian follicular cyst was examined. Follicles were classified into one of three categories: cyst formation, ovulation, or normal follicle growth and regression. Cyst formations were defined as follicles that obtained a diameter of 17 mm or greater and that persisted at that diameter or greater for three or more consecutive ultrasonographic scanning sessions (i.e., 56 days). Ovulation was defined as the emergence and then disappearance of a follicle 10 mm or greater in diameter and subsequent corpus luteum formation based on ultrasonographic scanning accompanied by an increase in circulating concentrations of progesterone. Normal follicle growth and regression was defined as a follicle that was detectable for three or more consecutive ultrasonographic imaging sessions (i.e., 56 days) and that did not persist or ovulate. Ultrasound scanning and blood sampling ceased once ovulation was confirmed, the cow received treatment to correct the cystic condition, or other management decisions dictated.
For follicles that ovulated in the presence of an ovarian follicular cyst, concentrations of progesterone were examined for the 7-day period before the day of ovulation. For follicles that formed cysts in the presence of an ovarian follicular cyst, concentrations of progesterone were examined for the 7-day period before the first day that the follicle attained a diameter of 17 mm or greater. For follicles that underwent normal growth and regression in the presence of an ovarian follicular cyst, concentrations of progesterone were examined for the 7-day period before the follicle attained maximum diameter. The progesterone environment associated with the development of each follicle in the presence of a follicular cyst was classified into one of three categories. Progesterone was classified as high if the endogenous progesterone level averaged greater than 1.0 ng/ml and never dropped to less than 0.1 ng/ml during the 7-day period. Progesterone was classified as intermediate if the endogenous progesterone level averaged between 0.1 and 1.0 ng/ml and never dropped to less than 0.1 ng/ml during the 7-day period. Progesterone was classified as low if the endogenous progesterone level dropped to less than 0.1 ng/ml for one or more days during the 7-day period. The physiological basis for these classifications was as follows: The presence of a follicular cyst is commonly associated with progesterone levels of less than 1.0 ng/ml [20]. Ovulation typically occurs when progesterone drops to less than 0.1 ng/ml [26]. To our knowledge, the follicular events that occur when progesterone concentrations are between 0.1 and 1.0 ng/ml have not been thoroughly investigated.
Statistics
A chi-square analysis was performed to detect differences in the frequency of the fates of follicles (cyst formation, ovulation, and normal growth and regression) that formed in the presence of an existing follicular cyst. The FREQ procedure of SAS [27] was used to determine if follicle fate and progesterone classification were independent. Chi-square analyses were then performed to detect differences in the frequency of follicle fate (cyst formation, ovulation, or normal growth and regression) within progesterone class (low, intermediate, or high) and in the frequency of follicles in each progesterone class (low, intermediate, or high) within each follicle fate (cyst formation, ovulation, or normal growth and regression).
Ultrasonography and Blood Sampling
Ultrasonographic examinations of ovaries were conducted with a real-time, B-mode instrument equipped with a 7.5-MHz, linear-array intrarectal transducer. Follicle diameter was measured to the nearest 0.1 mm using the internal caliper function of the ultrasound instrument.
Blood samples were collected daily via jugular or coccygeal venipuncture into tubes containing 100 µl of EDTA (6 mg/100 µl for 5 ml of blood). Immediately after collection, samples were centrifuged at 2500 rpm. Plasma was separated and stored in 7 ml scintillation vials at -20°C. Radioimmunoassay was performed using a solid-phase radioimmunoassay kit (Coat-A-Count Progesterone; Diagnostic Products Corporation, Los Angeles, CA) as previously described [28]. Inter- and intraassay coefficients of variation were 12% and 9%, respectively. The sensitivity of the assay was 2.0 pg/assay tube at 95% of maximum binding.
| RESULTS |
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Thirty-two cows were diagnosed as having follicular cysts. The distribution of cows with follicular cysts in the three progesterone categories was not random (P < 0.01) (Fig. 1). Twenty-one of these 32 cows (66%) had plasma concentrations of progesterone that were intermediate (range, 0.10.93 ng/ml; average, 0.5 ng/ml) at the time of cyst detection. Nine of the 32 cows (28%) had low plasma progesterone concentrations (range, 0.020.08 ng/ml; average, 0.05 ng/ml). Only two cows (6%) had high plasma progesterone concentrations (range, 1.441.71 ng/ml; average, 1.58 ng/ml). On average, follicular cysts in cows were first detected at 188 days in lactation (range, 47343 days). Of the 32 cows diagnosed as having follicular cysts, 17 had only one cyst, 12 had two cysts, and 3 had three cysts on the day of cyst detection.
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Experiment 2: Influence of Progesterone on Follicular Dynamics in Cows with Follicular Cysts
The fates of 59 follicles that formed in 26 of the cows with follicular cysts from experiment 1 were determined. Thirty-four of these follicles were the first large follicle that formed following initial detection of the cyst. The remaining 25 follicles were from subsequent cohorts that emerged in the presence of either the initial cyst or another cyst that formed later. Fates of the follicles did not occur at equal frequencies (P < 0.01). More follicles formed cysts (30 of 59 [51%]) than experienced normal growth and regression (10 of 59 [17%]; P < 0.01). Ovulation occurred at a frequency that was intermediate (32%) and not significantly different from that of either cyst formation or normal growth and regression.
The fate of follicles that formed in the presence of ovarian follicular cysts was influenced by the concentration of progesterone during the maturation of those follicles. Follicle fate and progesterone classification were not independent (P < 0.01). In the presence of intermediate progesterone (0.11.0 ng/ml), the large majority of follicles (15 of 20 [75%]) (Fig. 2, see representative animals in Figs. 3 and 4) formed cysts (P < 0.01). A much smaller number of follicles experienced either normal growth and regression (3 of 20 [15%]) or ovulation (2 of 20 [10%]). This is in contrast to follicles that formed in the presence of low progesterone (<0.1 ng/ml), in which the frequency of ovulation (17 of 32 [53%]) did not differ from that of cyst formation (13 of 32 [41%]). The vast majority of ovulations (17 of 19 is equal to 90%) occurred in this low category of progesterone (P < 0.01) (Fig. 5, see representative animal in Fig. 6). The only exception occurred in one cow classified as intermediate, in which circulating concentrations of progesterone dropped to only 0.12 ng/ml before the cow ovulated two follicles. Ovulation never occurred in the presence of high progesterone (>1.0 ng/ml).
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Ovulation occurred at an average of 19.3 days (range, 646 days) after initial cyst confirmation. Because the precise time of initial cyst formation could not be determined, the initial cyst effectively suppressed ovulation for at least 19.3 days. Ovulation of a single follicle occurred in a majority of the cows (8 of 13), whereas some cows (5 of 13) ovulated multiple follicles. Double ovulations occurred in four of these cows, and one cow ovulated three follicles.
The phenomenon of cyst turnover was evident in this experiment. Overall, 51% (30 of 59) of traceable follicles formed ovarian follicular cysts. These 30 cysts were observed in 19 cows. In 75% of the cases of cyst formation, a single cyst formed; in the remaining 25%, two cysts developed within 3 days of each other. In cases of multiple cyst formation, cysts apparently formed from the same cohort of follicles. Cysts formed in all three progesterone categories (Fig. 5). Half of these cysts (15 of 30, observed in eight cows) formed in the presence of intermediate concentrations of progesterone (see representative animals in Figs. 3 and 4). Another large proportion of the cysts (13 of 30 [43%], observed in nine cows) developed in the presence of low concentrations of progesterone (see representative animal in Fig. 7). Only two cysts (7%, observed in two cows) developed in the presence of high circulating levels of progesterone.
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Only 10 of the 59 traceable follicles were classified as undergoing normal follicle growth and regression (observed in seven cows). Normal follicle growth and regression occurred in all three progesterone categories (Fig. 5) at a similar frequency.
| DISCUSSION |
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The mechanism by which progesterone may contribute to cyst formation has not been determined. Subluteal levels of progesterone administered during the follicular phase can disrupt cyclic ovarian events. When circulating concentrations of progesterone are maintained at subluteal levels, the LH surge and subsequent ovulation can be prevented [15, 16]. These levels of progesterone were not associated with continuous follicular waves but, instead, prolonged the life span of the dominant follicle. This persistent follicle reached a greater maximum diameter (17 vs. 14 mm) and had a longer dominance period (11 vs. 5 days) than the ovulatory follicle of untreated controls. In nonlactating heifers, Duchens et al. [29, 30] reported that progesterone maintained at just 0.3 ng/ml during the follicular phase would delay ovulation and maintain the size of dominant follicles.
Formation of persistent follicles is associated with high LH pulse frequency. Subluteal levels of progesterone (12 ng/ml), maintained with progesterone-releasing intravaginal devices, do not inhibit LH pulsatility [19, 31], allowing the LH pulse frequency to reach a level comparable to that observed during the follicular phase [32]. Small doses of progesterone that result in subluteal concentrations of progesterone are capable of blocking the estradiol-induced preovulatory LH surge but do not slow the frequency of LH pulses [33]. This pattern of LH secretion may be an important contributor to the development of persistent follicles [34]. Persistent ovarian follicles have greater populations of LH receptors in granulosa and theca cells than the same cell types of dominant follicles [35]. Persistent follicles also contain more granulosa cells and have a larger thecal mass than dominant follicles contain [36]. This higher LH pulse frequency may promote follicular androgen production, leading to increased synthesis of estradiol [37].
Ovarian follicular cysts are similar in many ways to persistent anovulatory follicles induced by progesterone. First, both aberrant structures form because of a disruption in the follicular phase. Despite the fact that estradiol is secreted at a level that can induce an LH surge, estradiol does not induce an LH surge in cows with follicular cysts [10] or in cows with persistent follicles [15]. Second, both persistent follicles and ovarian follicular cysts are associated with high LH pulse frequency. Suppressing LH pulse frequency by administration of exogenous progesterone leads to regression of both persistent follicles maintained with progesterone and ovarian follicular cysts. Lastly, both follicular cysts and persistent follicles have been regressed by treatment with either a single injection of progesterone [38] or by several days of exposure to progesterone-releasing devices [15, 22].
The source of the intermediate level of progesterone found in cows with follicular cysts in these experiments is not known. Many investigators have examined intrafollicular fluid concentrations of progesterone in follicular cysts. Some cystic follicles contain high concentrations of progesterone in the follicular fluid [5, 18, 19]. Borromeo et al. [18] reported that follicular fluid of follicular cysts could be subdivided into an estradiol- or progesterone-dominant class. The reason why some follicular cysts have a relatively high concentration of intrafollicular progesterone and the extent to which progesterone is secreted are not known.
Ovaries with follicular cysts may be responsible for maintaining the cystic condition. Zaied et al. [13] reported that an estradiol injection was unable to induce a surge-like release of LH in cows with follicular cysts. DeSilva and Reeves [14] removed cystic ovaries and then injected estradiol 6 wk postovariectomy. This injection of estradiol induced a surge of LH. Whether the substance responsible for blocking the estradiol-induced LH surge is an ovarian factor, possibly progesterone, is presently unknown.
To our knowledge, this is the first comprehensive examination of follicular development in the presence of naturally occurring follicular cysts. Results from experiment 2 demonstrate the dynamic nature of the cystic condition. Only follicles that obtained a diameter of 10 mm of greater for 5 or 6 days were examined. Therefore, the follicles in the present study were most likely dominant follicles of a follicular wave. Only 17% (10 of 59) of these follicles experienced normal growth and regression. Our failure to detect more follicles in this group may result from the relatively infrequent ultrasound imaging schedule (three times per week) employed in this experiment. More than half of the follicles that were monitored in this experiment formed new cysts. This phenomenon is generally referred to as cyst turnover. Cook et al. [17] reported that 57% of all cystic follicles are replaced because of turnover. In experiment 2, 32% (19 of 59) of the traceable follicles ovulated. This frequency of ovulation is similar to that reported by Cook et al. but is somewhat less than that reported by Hamilton et al. [10]. Both Cook et al. [17] and Hamilton et al. [10] followed follicle dynamics in a mixed population of cows with both steroid-induced and spontaneously occurring cysts. The reason why cysts are frequently replaced by new cysts is unknown. One possibility is that the physiological condition that led to the formation of the original cyst is still present. Alternatively, the presence of a cyst may predispose new follicles to form cysts.
Not all cases of cyst formation can be attributed to the presence of intermediate progesterone concentrations. Forty-three percent of cysts formed in the presence of low progesterone. Thus, other mechanisms for cyst formation must exist. Recently, Gümen et al. [24, 39] have shown that premature induction of a preovulatory surge of LH, before development of an ovulatable follicle, resulted in persistent hypothalamic refractoriness to estradiol. Neither exogenous nor endogenous follicular estradiol were able to elicit an LH surge. Follicles that reached ovulatory size in this environment failed to ovulate and grew to an abnormally large size. This refractoriness to estradiol was overcome after cows were administered progesterone. Progesterone administration appeared to "reset" the hypothalamic surge center. Clearly, cyst-like structures can develop through multiple mechanisms.
| CONCLUSIONS |
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| ACKNOWLEDGMENTS |
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| FOOTNOTES |
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2 Correspondence: W.J. Silvia, Animal Sciences Department, 409 W.P. Garrigus Building, University of Kentucky, Lexington, KY 40506-0033. FAX: 859 257 7537; wsilvia{at}uky.edu ![]()
Received: 13 October 2002.
First decision: 5 November 2002.
Accepted: 26 February 2003.
| REFERENCES |
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