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Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 1
Ovarian cysts in the cow
Professor Ch. Hanzen
University of Liège
Faculty of Veterinary Medicine
Department of Pathology of Reproduction
B42 Sart Tilman, 4000 Liège
E-mail : [email protected]
Web site : www.fmv.ulg.ac.be/oga
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 2
Contents
● Definition
● Frequency
● Diagnosis
● Etio-pathogeny
● Treatment
● Conclusions
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 3
Definition
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 4
mm
2
8
10
12
14
16
1818
44
66
Recruitment phase :
prepuberty, postpartum
Growth phase :
puberty, pregnancy, postpartum
Preovulatory phase
Post-partum
Reproduction period
Puberty
Reproduction
periods and
anovulation
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 5
11 22 33 44 55 66 77 88 99 1010 1111 1212 1313 1414 1515 1616 1717 1818 1919 2020 2121 2222
mmmm
00
22
44
66
88
1010
1212
1414
1616
1818
Follicular reserve
1st group : recruted follicles
4rd group :
Preovulatory follicle
3rd group :
dominant follicle
Ovulation
Follicular
cyst
Luteinized
follicular
cyst
Cyst = abnormal follicular growth
2nd group : selected follicles
Three evolutions :
- Atresia
- Ovulation
- Cyst
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 6
So, the cyst is an abnormal ovarian structure …
� In 30 to 40 % of cases : cyst coexists with a CL
1. Absence of corpus luteum
� Duration of dominance : 5 to 6 days
2. More than 1 week
� In the cow, ovulation between 13 to 19 mm
3. Diameter more than 20 to 24 mm
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 7
Frequency
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 8
Frequency of ovarian cysts amongst different studies (1974 to 1994)
0 2 4 6 8 10 12 14 16 18
**
**
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 9
Frequency of ovarian cysts
● Fourichon et al., 2000 : meta-analysis (20.000 cows in 196
dairy herds) : 12 % (3 to 29 %)
● Lubbers 1998 (Holland) : 12.626 lactations during 10 years in
39 herds 7,2 % (1,9 to 11,3 % amongst herds)
● Erb et Martin, 1980 and Kinsel et Etherington, 1998
(Canada) 24.356 lactations : 9,3 %
More than 10 % : herd problem
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 10
Evolution with timeLopez-Gatius et al. Is fertility declining in dairy cattle ? A retrospective study in northeastern
Spain Theriogenology, 2003, 60, 89-99.
4 dairy farms
0
1
2
3
4
5
6
7
8
9
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Tot
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 11
Diagnosis
- Manual palpation
- Ultrasonography
- Hormones
- Ethology
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 12
Manual / US diagnosis
Follicular cyst
Luteinized cyst
Diameter : 31 ± 4 mm to 33 ± 7 mm
(if > 24 mm : Hanzen and Bascon 2007)
Easily depressed
Thin wall (< 3 mm)
Cavity anechogenous
Ovary
Cavity less large (24 to 49 mm)
and anechogenous
Diameter : 35 ± 7 mm to 39 ± 9 mm
(if > 24 mm : Hanzen and Bascon 2007
Thick wall (3 to 9 mm)
Less easily depressed
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 13
Caracteristics of cysts
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 14
Caracteristics of cysts (ultrasonography)
20 mm20 mm
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 15
Luteinized cyst an corpus luteum with cavity
20 mm
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 16
Diagnosis (hormones)
« high » : 1,08 et 10,4 ng/ml low : 0,13 et 2,1 ng/ml Progestérone
Oestradiol low or high low
Anoestrus or nymphomania
LC FC
> 0,5 or 1 ng/ml
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 17
Courtesy Prof Badinand ENV Lyon
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 18
Etio-pathogeny
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 19
Risks factors of ovarian cysts and their interrelationships in the cow
Negative energy balance Nutrition
Follicular
wallEnvironmentHypothalamo-
hypophysis
complex
Animal
Low
progesteronemia
Modification
of – FB of oestradiol
on cyclic LH
Lack of tonic LH
inhibitionModification of oestradiol
receptors
Abnormal production
of growth factors
Abnormal production of
proteines by cellular matrix
Number of lactation
Milk production
Stage of postpartum
Puerperal diseases
Genetic
Decrease of leptine IGF1 decreaseHypoglycemiaHypoinsulinemia
GnRH decrease
Increase of NEFA and
cetones
GnRH inhibition by
neuropeptide Y
Increase of LH inhibition
by alpha MSH and
endorphines
Decrease of LH/FSH
Cortisol
LH
inhibition
Season
Stress
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 20
Hormonal pathogeny
of ovarian cyst in the
cow
Tonic
LH
Hypothalamus
Progesterone
(0.1 à 1 ng) Growth
stimulationH
ypophysis
Wave 1
Oestradiol
Inhibine
1
2
3
4
Cyclic
LH
5
Impaired
ovulation
6
Cyst9
FSH
7
8New wave
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Frequency (%) of cysts according to stage of postpartum (days)
(Whitmore et al. 1974, Wiltbank et al. 1953, Whitmore et al. 1979, Erb et White 1981, Kirk et al. 1982)
0
5
10
15
20
25
30
0-15 16-30 31-45 46-60 61-75 76-90 91-105 106-120 121-135 136-150 >150
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Treatments
- To treat or not to treat ?
- Preventive treatments
- Non hormonal curative treatments
- Hormonal curative treatments
- individual approach
- hormonal associations
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 23
To treat or not to treat : that’ the question
● Stage of the postpartum period
� Lenght of the waiting period decided
� Diagnosis during the reproduction period
● Spontaneous regression of cysts
� 28 to 80 % before d60 of postpartum
● Accuracy level of the diagnosis : follicular vs luteinized
● Efficacy of the treatment : different parameters
� Interval treatment-pregnancy
� Fertility index after treatment
● Cost of the treatment
● Preventive or curative treatment
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Preventive treatments
● Association of GnRH and PGF2a (10d apart) at d15
postcalving
● Decrease the frequence of placental retention, endometritis,
lameness
● Regular control of the BCS to prevent a NEB
● Genetic selection ?
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Non hormonal curative treatments : manual ruptureLopez-Gatius personal communication
Effect of manual rupture of
a cyst on the oestrus return
rate in the 14 days after
treatment (388 dairy cows)
0
5
10
15
20
25
30
35
40
GnRH and
MP
PGF2a and
MP
MP
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Non hormonal curative treatments : manual rupture
Lopez-Gatius personnal communication
● Effect of manual rupture
of a cyst on the
pregnancy rate at first
AI after treatment
(10.634 lactations)
● Oestrus observed 6,8
days after treatment in
36 % of cows
20
22
24
26
28
30
32
34
PGF2a and MP MP
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Hormonal curative treatments : general objective
To obtain as soon as possible a new follicular
growth with expulsion of a mature oocyte
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 28
Hormonal curative treatments : three steps
to obtain
a P4 phase
to assume ovulation
of the dominant
follicle
to stop the P4 phase
and assume
the final follicular
growth
hCG
GnRH
PRID
CIDR
PGF2a Remote of
PRID
CIDR
hCG
GnRH
1 2 3
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Hormonal treatment steps of a follicular cyst
Endogenous synthesis of P4
hCG or GnRH
CL
3 ?
2
1
LH effect
Luteinization
if receptors
Ov
Ov PGF2a
7 to 14 d
Oestrus
GnRH
Increase of P4
7 to 20 days
70 to 90 % of cases
2 to 5 d
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 30
Hormonal treatment steps of a follicular cyst
Effect of an exogenous administration of P4
Progesterone treatment (7-12 days)
6 to 24 h
1
Oest R HPTH
- GnRH
+
LH
+
New wave
and DF ?
2
Increase of oestradiol
and LH receptors
3
4
Oestrus
(0 to 66 %)
Ovu
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 31
Hormonal treatment steps of a luteinized cyst
PGF2a
Oestrus
GnRH
2 to 5 d
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 32
Hormonal associations
Justifications :
- difficulty to make a differential diagnosis between cysts ?
- decrease time between treatment and pregnancy ?
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Some hormonal associations
1. hCG or GnRH (d0) – PGF2a (d7 or d14)
2. GnRH and PGF2a (d0) – PGF2a (d14)
3. hCG (d0) – PGF2a (d7 to d12) – GnRH (d9 to d14)
4. hCG or GnRH(d0) – Progesterone (d7 to d14 or d16) –
PGF2a (d14 or d16) – GnRH (d16 or d18)
5. Ovsynch : GnRH (d0) – PGF (d7) – GnRH (d9)
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2 to 5 dOB
Oestrus
Hormonal association : Progesterone with OBZulu et al. J. Vet. Med. Sci., 2003, 65, 57.
Douthwaite et Dobson Vet Rec. 2000, 147, 355
Progesterone treatment (12 d)
PR : 18 to 23 %
PR : 14 to 28 %
AI OD
LH
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GnRH
Oestrus
Hormonal association : GnRH-progesterone-PGF-GnRH
Bartolome et al. Theriogenology, 2005,63,1643-1658.
CIDR (7 days)
PGF2a d7 GnRH d9 PR : 38 %
PR : 27 %GnRH d9PGF2a d7
TAI 16 h
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 36
Hormonal association : GnRH-PGF-GnRH (Ovsynch)
16 – 24 h
AI
GnRH
0 7
PGF2a
9
GnRH
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Bibliography : Ovsynch and treatment of ovarian cysts
1. Bartolome et al. Theriogenology, 2000 , 53, 815- 825
2. Lopez-Gatius et Lopez-Bejar. Theriogenology, 2002, 58, 1337-1348
3. Bartolome et al. Theriogenology, 2003, 59, 1991-1997
4. Bartolome et al. Theriogenology, 2005,63,1628-1642
5. Bartolome et al. Theriogenology, 2005,63,1643-1658
6. Crane et al. Theriogenology, 2006, 65, 1563-1574
7. Crane et al. Theriogenology, 2006, 66, 1243-1248
8. De Rensis et al. Theriogenology, 2008, 69: 481-484.
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 38
Ovsynch and treatment of ovarian cysts (8 studies and 792
cases of cysts between year 2000 and 2008)
0
5
10
15
20
25
30
1 2 3 4 5 6 7 8 Total
% of pregnancy rate
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 39
Comparison of hormonal treatments of cysts (Hanzen et al. 2008)
3089GnRH(J0)-Ovsynch(J8)
17791OVSYNCH
22 to 3665GnRH-PGF (J0)-PGF(J14)
8 to 1662GnRH (J0)-PGF(J14)
14 to 2863PRID (12d) + OB
PR (%)NTreatment
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 40
Comparison of hormonal treatments of cysts (Hanzen et al. 2008)
2711CIDR(J0-J7)-PGF(J7)-GnRH(J9)
23 (CR)82CIDR 7J-PGFJ7
17791OVSYNCH
22 to 3665GnRH-PGF (J0)-PGF(J14)
8 to 1662GnRH (J0)-PGF(J14)
14 to 2863PRID (12d) + OB
PR/CR (%)NTreatment
Prof. Ch. Hanzen – Ovarian cysts in the cow -Salamanca 8th may 2008 41
Conclusions : to take home
1. Accuracy of ultrasonography diagnosis (> 24 mm)
→ Importance of correct diagnosis for quantification
2. Herd problem if > 10 %
→ Importance of HHM system
3. Impact of NEB in dairy cows and postpartum diseases
→ Importance of preventive approach
4. Poor results of hormonal therapy
→ Importance of quality and time of diagnosis