Obstetrics and Genital Diseases

Ther 707
4(2-2)

Lec 23: Cystic Follicular Degeneration

12.11.2013
Dr Mian Abdul Sattar
 Synonyms
• Cystic ovarian disease
• Cystic ovarian degeneration
• Cystic Graafian follicles
• Ovarian cysts
• Luteal ovarian cysts
• Cystic cows
• Cystic follicles
• Bulling
 Ovarian cyst
Based on ovarian structures present, ovarian
cysts are categorized into
• Physiological (Ovulatory)
– Cystic Corpus luteum
• Normal CL with a central cavity
• No influence on cycle length

• Pathological (Anovulatory)
– Follicular cyst
– Luteal cyst
 Cyctic CL
• With fluid filled central cavity
• Non-pathological
• Ovulatory
• Capable of normal progesterone
synthesis
• Estrous cycle length normal
 Cystic CL
• Present in normal cycling and pregnant
females without any abnormality
• Cystic CL = Soft, mushy core area (due to
presence of fluid in degenerating blood clot)
• Detected at 5-7 day post estrus when CL is
near the end of corpus hemorrhagicum
• Mostly ovulation crown or papilla is absent in
cystic CL
 Follicular dynamics
• In bovine usually there are 2-3 follicular
waves per cycle
• No. of follicles (3-5) are recruited and
develop to 8.5 mm in size
• Out of cohort one follicle continue to grow
and establishes dominance
• If luteal regression occur during growth of
dominant follicle then it ovulate otherwise
atresia occur
Ovarian Dynamics in bovine
 Ovarian cysts
• Anovulatory follicles persist on ovaries for more than 10
days in absence of CL
• The follicles usually attain dia 2.5 cm or more and
smooth convex surface
• 1.7 cm or more and may be upto 5-6 cm
• Steriodogenic (E2, P4, androgens)
• Changes in various hormones lead to changes in genital
tract, body conformation and general behavior
• Normal diameter of ovulatory follicles is 1.5 -1.6 cm
 Follicular/ luteal cyst
• Follicular – thin walled, single or multiple
on unilaterally or bilaterally, following
ovulatory failure

• Luteal – thick walled, single occurring

unilaterally, following ovulatory failure
 incidence
– Dairy cattle (10-20%)
– Beef very less
– Season
– High producers (or cystic have
more milk production)
– Nutrition
– Hereditary
 Incidence
– Age
– Stress around calving (Trauma, RFM,
hypocalcemia) lead to def of LH
– Exogenous E2 (ingested/ parenteral)
– Frequency of Rectal Palpation
– Length of PP interval (3-8 wk
Postpartum; first attempt to ovulate but
stress of high production coincide here,
rapidly BCS decreases)
 Pathogenesis
• Def of LH and FSH receptors in developing follicles
• Normal proestrus– regression of CL coincides with
development of selected follicle while growth of any
additional follicle is inhibited
• Disease – ovulation fails to occur and dominant follicle
continue to enlarge
• Hypothalamic defect that results in failure of follicular E2
to cause a release of GnRH
• Finally lack of ovulation
• Moreover, other follicles may also grow leading to multiple
cysts due to lack of ovulation (bilateral or unilateral)
 Etiology
• PP status, hypothesis
– At 1 wk PP hypothalamo-pit axis may not be
responsive to estradiol from follicles
– Lack of GnRH surge, hence LH surge
• This hypothesis does not work where cyst
is formed after a normal estrous cycle
• So multiple factors contribute to
pathogenesis
 Follicular Cyst- Symptoms
– Nymphomania (frequent, intermittent, exaggerated estrus)
– Anestrus
– Long term cases show adrenal virilism or buller cow (The
development of male characteristics in the female resulting from excessive
production of adrenal hormones with androgenic activity. A rare form of
pseudohermaphroditism)

– Masculinization of head/ neck, change in voice (male like)

– Sinking of sacro sciatic ligaments, tail head elevated
– Enlarged ovaries with blister like appearance
– Uterine wall thickened sponge like, atrophy
– Mucometra
 Treatment
• hCG 10,000 units or GnRH 100µg with PG 7
day after hCG or GnRH
• OvSynch protocol (0-7-9-TAI)
• CIDR protocol (Progesterone)
• Decreases tonic secretion of LH
• Restore hypothalamic responsiveness to E2
• Elevated E2 triggers surge centre of GnRH

• Manual rupture (easy but not advised recently)

why????
Prognosis depends upon the stage at which treatment initiated
Cow Ovary containing three follicular cysts
(blister-like structures).
 Luteal cyst
• Etiology same
• LH moderate somewhat higher than
follicular cyst
• Clinical finding
– Anestrus behavior
– Rectal Palpation (luteal phase like)
 Treatment

– PGF2
– hCG, GnRH

– Manual rupture not possible

 Cystic Ovarian Degeneration
(COD)
• Follicular cyst (Bilateral & multiple,
thin walled)
• Luteal cyst (Unilateral & single, thick
walled due to band of lutenization)
• Corpus Luteum (CL) Cyst (non-
pathological, mostly seen in CL
supurium and rarely in CL vernum)

Department of Theriogenology
 Etiology
• Follicular and luteal cysts both are due to the deficiency
of LH Hormone, necessary for ovulation. (Deficiency of LH in
case of follicular cyst is more as compared to Luteal cyst.)
• CL cyst is due to unknown etiology
Predisposing factors
• Genetic (Hereditary)
• Environmental (More incidence in following conditions)
– Age (4-5 years)
– Season (Winter)
– Physiological status (Early PP)
– Exogenous E2
– High milk producer

Department of Theriogenology
 Signs and symptoms
• Nymphomania (Exaggerated silent heat
with prolonged, irregular estrous cycle)-
mostly seen in earlier stages of follicular cyst
• Anestrus-mostly seen in chronic stages of
follicular cyst and earlier stages of luteal cycst
• Virilism (male like appearance and voice)-
mostly seen in chronic long standing cases of
luteal cyst

Department of Theriogenology
 Changes palpated rectally in
long standing cases of COD
• Relaxation of pelvic ligament
• Edema of genital tract
• Edematous vulva
• Cervix relaxed
• Uterus atonic, flaccid and
edematous
• Hydrometra (Thin uterine wall)
Department of Theriogenology
 Treatment of COD
• Manual rupture during rectal palpation (Primitive
method and dangerous)
• hCG inj/ LH hormone 3000 i.u. i/m
• GnRH inj 2 ml i/m
• Prgesterone (PRID/CIDR) )Suppress the
release of LH and favour the storage of LH)

Prognosis: Poor, It depends upon the chronicity

of condition

Department of Theriogenology
 Follicular vs Luteal
Follicular Luteal

• Multiple on ovaries Usually single

• Thin walled Thick wall
• Tense surface Soft Surface
• Pale yellow fluid Darker fluid
• More common 30% out of all cysts
 Ultrasound
Normal
Follicle

Follicular Cyst Luteal Cyst