Follicular development and ovulation in Macaca fascicularis,Saimiri sciureus and Galago senegalensis

A technique utilizing laparoscopy to determine the precise time of ovulation in three species is described. Determination is based on morphological changes that occur 24 to 36 hours before ovulation. This technique, coupled with mating sessions of short-duration, has been used to produce precisely defined pregnancies; the implications of this technique in reproduction research and teratology are discussed. A comparison of ovulation times in Macaca fascicularis indicates that ovulation normally occurs on day 13 of animals having a cycle length from 25 to 28 days. In animals with a cycle length from 31 to 34 days, ovulation occurred on day 14.8. Evidence presented does not substantiate previous claims for alternation between ovaries in consecutive cycles.     

Bayesian Modeling of the Level and Duration of Fertility in the Menstrual Cycle

Time to pregnancy studies that identify ovulation days and collect daily intercourse data can be used to estimate the day-specific probabilities of conception given intercourse on a single day relative to ovulation. In this article, a Bayesian semiparametric model is described for flexibly characterizing covariate effects and heterogeneity among couples in daily fecundability. The proposed model is characterized by the timing of the most fertile day of the cycle relative to ovulation, by the probability of conception due to intercourse on the most fertile day, and by the ratios of the daily conception probabilities for other days of the cycle relative to this peak probability. The ratios are assumed to be increasing in time to the peak and decreasing thereafter. Generalized linear mixed models are used to incorporate covariate and couple-specific effects on the peak probability and on the day-specific ratios. A Markov chain Monte Carlo algorithm is described for posterior estimation, and the methods are illustrated through application to caffeine data from a North Carolina pregnancy study.     

The ovarian cycle and control of ovulation

The ovarian cycle of primates is a sequence of events reflecting follicular growth and development, the ovulation of a mature oocyte and the formation of a functional corpus luteum. A typical cycle generally consists of three phases: (1) the follicular or proliferative phase, (2) ovulation and (3) the luteal or secretory phase. Within this general pattern exists considerable species variation in terms of cycle length, timing of ovulation, presence or absence of menstruation and influence of season.
Details of the basic physiological mechanisms controlling cyclic ovarian function in primates are known for only a few species. Concentrating on information derived from studies in women and in rhesus and marmoset monkeys, this paper examines some of the hormonal mechanisms underlying the primate ovarian cycle with particular reference to the factors controlling preovulatory follicular development during the follicular phase.     

Ovarian follicle growth and consequences for fertility in sheep

Understanding the pattern of ovarian follicle development is seen as an important step leading to the development of techniques that maximise fertility in sheep. Repeated observations of the growth of individual follicles have led to the understanding that follicles develop in a wave-like pattern during the oestrous cycle, with two to four waves per cycle being the most common. The ease with which follicle waves are described seems to depend on the their frequency and the number of follicles per wave. There is evidence for the largest follicle(s) of a follicle wave inhibiting the development of other follicles; however, in some cases this is not apparent as other follicle waves emerge when a previous large, healthy follicle is still present. Follicle development can be manipulated using exogenous gonadotrophins or progestagens and these have been shown to alter the number or age profile of developing follicles. The ovulation of aged follicles in cattle clearly has a detrimental effect on fertility, but this relationship is less clear and seems to be less critical in sheep. Recent findings at the molecular level show that the bone morphogenetic proteins (BMP) and their receptors are critically involved in the control of ovulation rate, but fully understanding their mechanism remains to be described. This highlights the potential for the integration of molecular and physiological findings to better develop methods to manipulate follicle development and reproduction in sheep.     

The morphology of follicular development and ovulation in non-human primates.

A colony of Macaca fascicularis have been under continuous observation for the past 4 years to ascertain the follicular morphological changes that occur prior to ovulation and during the development of the corpus luteum. Of 609 experimental cycles, laparoscopy was performed at least once in 44-5% of the cycles. Of the 104 cycles where the ovulatory status was definitely known, 89-4% were deemed ovulatory and 10-6% anovulatory. The presence or absence of ovulation in the previous cycle did not have an effect on the cycle length either for the total cycles or when analysing only cycles over 28 days. Similarly, the occurrence of two consecutive ovulations (in consecutive cycles) on the same vs. opposite ovaries did not have a significant effect on the cycle length. Neither laparoscopic stress or anaesthesia effected the normal cyclicity of the animals. The characteristic changes in follicular morphology are most clearly defined in M. fascicularis. In this species the 24 of 36 hr prior to ovulation are accompanied by discrete changes which occur in a fixed sequence, allowing one to predict the time of ovulation with reasonable accuracy. In S. sciureus ovulation is preceded by extensive bulging at the follicular apex and haemorrhaging at the base of the follicle. Due to this haemorrhaging post-ovulatory follicles in S. sciureus are generally more easily discernible than in fascicularis. The formation of clear areas (stigma) is not as evident in either S. sciureus or G. senegalensis as in the macaque. Actual ovulation has been observed four times in M. fascicularis and twice in S. sciureus.     

Lynx reproduction – Long-lasting life cycle of corpora lutea in a feline species

A review of lynxes’ reproductive biology and comparison between the reproductive cycles of the domestic cat and lynxes is presented. Three of the four lynx species (the bobcat excluded) express quite similar reproductive pattern (age at sexual maturity, estrus and pregnancy length, litter size). Similarly to the domestic cat, the bobcat is polyestric and can have more than one litter per year. Domestic cats and many other felid species are known to express anovulatory, pregnant and pseudo-pregnant reproductive cycles in dependence on ovulation induction and fertilization. The formation of corpora lutea (CLs) occurs after ovulation. In pregnant animals, luteal function ends with parturition, whereas during pseudo-pregnancy a shorter life span and lower hormone secretion are observed. The life cycle of corpora lutea in Eurasian lynxes is different from the pattern described in domestic cats. Lynx CLs produce progestagens in distinctive amounts permanently for at least two years, regardless of their origin (pregnancy or pseudo-pregnancy). It is suggested that long-lasting CLs induce a negative feedback to inactivate folliculogenesis, turning a normally polyestric cycle observed in most felids into a monoestric cycle in lynxes.     

Day of cycle affects changes in equine intrauterine pressure in response to teasing

Oxytocin is released in response to teasing during both estrus and diestrus in mares, and at least during estrus, teasing results in an increase in electromyographic activity in the uterus. Exogenous oxytocin causes an increase in intrauterine pressure and prior studies have shown that this response is correlated to the day of the estrous cycle. To determine if teasing causes an increase in intrauterine pressure and if this response varies by day of the cycle, intrauterine pressure was measured while mares were teased with a stallion 2 days before ovulation, on the day ovulation was detected and 2 days after ovulation. A significant increase in intrauterine pressure was observed in response to teasing both 2 days before ovulation and on the day of ovulation, when plasma concentrations of progesterone were low. No significant increase in intrauterine pressure was observed in response to teasing 2 days after ovulation when progesterone concentrations were elevated. Management practices that include teasing or stallion exposure may be beneficial in stimulating uterine clearance mechanisms in mares during the preovulatory period.     

The critical period in which splenectomy causes functional disorder of the ovary in adult rats

On account of recent reports suggesting that ovulation and luteinization involve immunological reactions, we examined the effect of splenectomy in rats on the recurrence of an estrous cycle. The spleen was removed from adult female rats at various times during an estrous cycle. A delay in ovulation was specifically induced in the rats splenectomized on the metestrous morning between 0700 and 0900 h. This delay in ovulation was reversed by an injection of splenocytes obtained either from estrous or metestrous donors, but not from diestrous or proestrous donors. The isolated splenic macrophage preparation mimicked the effect of splenocytes. Measurement of progestin levels throughout the estrous cycle suggested that the delay in ovulation was caused primarily by a delay in luteolysis; progesterone levels in ovulation delayed rats were higher and 20 alpha-dihydroprogesterone levels were lower than those of intact rats on the diestrous day. These results suggest that the macrophages in the spleen under the influence of endocrine milieu probably play a role in the recurrence of an estrous cycle by controlling luteolysis. The specific time of splenectomy to cause delay in ovulation will afford a new approach in analyzing the function of immunocytes in the ovary.     

Ultrasound and endocrine evaluation of the ovarian response to PGF2alpha given at different stages of the luteal phase in ewes

The purpose of this study was to evaluate the ovarian response of ewes to two treatments with PGF2alpha using transrectal ovarian ultrasonography and hormone measurements. Fifteen milligrams of PGF2alpha was given to six cyclic Western White Face (WWF) ewes early in the estrous cycle (Days 4 to 7) and to six late in the cycle (Days 10 to 12 after ovulation), and a second treatment was given 9 days after the first. Ultrasound scanning and blood sampling started 7 days prior to the first PGF2alpha treatment and ended 10 days (scanning) or 19 days (blood sampling) after the second PGF2alpha treatment, for both groups of ewes. Mean ovulation rate (2.6 +/- 0.7) did not differ significantly between the ewes first treated early or late in the cycle, or after the first or second treatments with PGF2alpha. The time from treatment to ovulation was longer in ewes first treated early (4.0 +/- 0.3 days) compared to late (2.8 +/- 0.4 days) in the cycle (P < 0.05). Both the number of ovulations (range: 0-7) and time from treatment to ovulation (range: 1-9 days) were highly variable. This variability appeared to be due to the extension of the life span of ovulating follicles that emerged prior to PGF2alpha administration and also ovulation of some follicles that emerged after treatment. When results for first and second treatments were pooled, the total number of follicles > 5 mm in diameter on the day of treatment that failed to ovulate in response to PGF2alpha was higher in ewes first treated early (0.8 +/- 0.2/ewe) compared to late (0.3 +/- 0.2/ewe) in the cycle (P < 0.05). The proportion of detected luteal structures relative to the number of ovulations was lower in ewes first treated early compared to late in the cycle (60 and 86%, respectively; P < 0.05). Disruption of ovulatory follicle dynamics and normal luteogenesis, and variability in the timing of ovulation after PGF2alpha treatments could all contribute to poor or variable fertility when prostaglandins are used for estrus synchronization.     

Time of ovarian follicular recruitment in cyclic pony mares

An experiment was carried out on pony mares to establish the time of the oestrous cycle at which ovarian follicles are recruited for ovulation. In one group (n=7), the cycle was interrupted at the preovulatory stage by removing the preovulatory follicle; in another group (n=13) the cycle was interrupted at day 6 of the luteal phase by inducing luteolysis with a prostaglandin injection (PG). In a subgroup (n=7) of those given PG, the ovary not bearing the corpus luteum was removed at the time of injection. A further group (n=6) served as surgical controls. The interval to the next ovulation and blood concentrations of FSH were observed. Anaesthesia alone induced in preovulatory mares was followed by normal ovulation 2.5+/-1 days later. Removal of the preovulatory follicle delayed the next ovulation (14.6+/-2.1 days; P < 0.01). Following PG injection, the interval to ovulation was similar regardless of whether an ovary was removed (12.8+/-4.3 days) or not (10+/-4.1 days). This similarity occurred despite a large and prolonged rise in plasma FSH levels that occurred only in the hemiovariectomized group. In addition, the intervals found after PG injection did not differ from those found after ablation of the preovulatory follicle. These observations indicate that 1) in the presence of the early active corpus luteum or dominant follicle, follicles grow to a similar stage of development; 2) recruitment of the follicle due to ovulation occurs 12 to 14 days before ovulation; 3) limiting new follicular growth to one ovary does not affect the time course to ovulation; and 4) prolonged high FSH levels do not alter the time course or ovulation rate.     

Supression by copulation of the inhibitory effect of p-chlorophenylalanine on rat ovulation (author's transl)]

The effect of copulating on reflex ovulation was studied in rat. The effect of PCPA (300 mg/kg, i.p.) on ovulation and reproduction was compared by evaluating number of oocytes in tubes, histologic features of ovaries, vaginal cycle, insemination, fertilization and number of embryos per rat. PCPA, administered on 9th and 16th h of the estrus phase, totally inhibits ovulation, stimulates reproductive behaviour and prolongs the estrogenic phase. When the animals are kept in copulatory conditions for 16 or 46 hours, the inhibition induced in ovulation disappears to the extent that 60% of the rats become pregnant though the number of embryos is under that of the control group. The farther the treatment with PCPA within the same cycle in the ovulatory period, the greater the inhibitory effect on ovulation is and the lesser the neutralizing effect produced by reflexes related to copulation. Administration of PCPA at the 16 hour of the diestrus causes a greater increase in the average number of embryos-as compared to administration at the 9 hour. In periods longer than 48 hours before ovulation, the inhibition brought about by PCPA is not suppressed by copulatory conditions kept for 16 or 24 hours and is only neutralized if they are kept during a complete cycle. Those treated with PCPA in the diestrus phase and maintained in copulatory conditions for 46 hours, present a higher average of embryos than those maintained in similar conditions for 16 hours.     

Increased ovulation rate in gilts after oral administration of epostane

In Phase I of this study to enhance ovulation rate and hence litter size, gilts received 0 (sham control), 0.625, 1.25, 2.5 or 5.0 mg epostane/kg body weight on Days 10, 11 and 12 of the oestrous cycle (5 gilts/group). After epostane treatment, plasma progesterone concentrations were reduced (P less than 0.01) in a dose-related manner, % progesterone decline = 21.30 x square root of (dose) + 10.45, R2 = 0.70, but recovered to pretreatment levels by 24 h. In Phase II the effects of epostane on ovulation rate and litter size were tested at two study centres. At each centre 108 gilts were treated with the same doses of epostane as used in Phase I and the doses were given for 7 days (Days 15-21) or 12 days (Days 10-21) during the first oestrous cycle. Gilts were inseminated twice during the oestrus after treatment and were slaughtered 30 days later. Mean (+/- s.d.) ovulation rate was 16 +/- 2.7 (N = 8) and 21 +/- 4.0 (N = 61) for control and epostane-treated gilts in Centre A and 12 +/- 2.4 (N = 5) and 17 +/- 3.8 (N = 55) respectively in Centre B (P less than 0.01 for both) and was dose related (ovulation rate = 3.38 x square root of (dose) + 16.17, R2 = 0.31). The effects of 7- or 12-day epostane treatment on ovulation rate were not different (P greater than 0.05), indicating that effects of treatment after Day 14 of the oestrous cycle are most important to subsequent ovulation frequency.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estrus induction in white rhinoceros (Ceratotherium simum)

The estrous cycle length in the white rhinoceros (Ceratotherium simum) is either 4 or 10 wk. The cause(s) for this variation as well as the poor fertility rate in captivity remains under debate in this species. Most captive adult white rhinoceros undergo long anovulatory periods without luteal activity which are considered a major reason for their low reproductive rate. In this study, the synthetic progestin chlormadinone acetate (CMA) was tested in combination with hCG or the GnRH analogue deslorelin for its efficiency to induce ovulation in fourteen females without luteal activity and in three, regular cycling females. HCG (N = 12), injectable GnRH analogue (N = 8) and GnRH analogue implants (N = 15) were given to induce ovulation after CMA treatment. Treatment success was determined using both transrectal ultrasonography and progesterone metabolite EIA analysis. A preovulatory sized follicle (3.5 ± 0.1 cm) or a corpus luteum (5.1 ± 0.7) was present on the ovary one day after induction in 93.1% of the treatments. Despite this high rate of ovarian response, ovulation rate differed between the study groups. The ovulation rate for hCG, injectable GnRH analogue and GnRH analogue implants was 66.7%, 62.5% and 93.3%, respectively. Ovulation rate in cyclic females treated with GnRH implants was 100% (6/6) compared with 89% (8/9) in females without luteal activity receiving the same treatment. The length of the estrous cycle when induced with hCG was 4 wk (85.7%). The estrous cycle when induced with GnRH analogue was predominantly 10 wk long. Two females without luteal activity treated with GnRH became pregnant. In conclusion, CMA in combination with GnRH analogue implants was highly effective to induce ovulation in white rhinoceroses and thus can contribute to efforts aimed at increasing natural mating and reproductive rates in the captive white rhinoceros population.     

Modelling multiple ovulation,fertilization, and embryo loss in human fertility studies

Models of human fertility that incorporate information on timing of intercourse have assumed that a single ovum is released each menstrual cycle. These models are misspecified if two or more viable ova are sometimes released in a single cycle, which is known to occur in dizygotic twin pregnancies. In this paper, we propose a model for multiple ovulation in humans. We assume that the unobservable number of viable ova in each cycle follows a multinomial distribution. Successful fertilization of each ovum depends on the ability of the cycle to support a pregnancy and on the aggregate of a set of unobservable Bernoulli trials representing the fertilizing effects of intercourse on various days. Our model accommodates general covariate effects, allows for heterogeneity among couples, and accounts for a sterile subpopulation of couples. Information on early detection of pregnancy can be incorporated to estimate the probability of embryo loss. We outline a Markov chain Monte Carlo algorithm for estimation of the posterior distributions of the parameters. The methods are applied to data from a North Carolina pregnancy study, and applications to studies of assisted reproduction are described.     

Female ovarian cycle phase affects the timing of male sexual activity in free-ranging Barbary macaques (Macaca sylvanus) of Gibraltar

Although all macaques have a multimale multifemale mating system, the degree of promiscuity shown by the Barbary macaque is considered to be extreme in terms of both mating frequency and number of mating partners. How mating activity is distributed throughout the female menstrual cycle and whether or not copulations are concentrated around the fertile phase as in other members of the genus is, however, not known. To examine this, we collected data on rates of copulation throughout 29 ovarian cycles from 13 free-ranging females of the Gibraltar Barbary macaque population and related them to the time of ovulation and the female fertile phase as determined from fecal hormone analysis. In addition, patterns of male inspection of females and time spent in consortship, both indicators of female attractivity, were also analyzed. The results indicate that both mating behavior and female attractivity vary predictably with ovarian cycle stage. Rates of copulation were found to increase toward the time of ovulation, with a distinct peak of ejaculatory (but not non-ejaculatory) copulations occurring in the fertile phase. Additionally, we show that frequency of inspection of females by males and time spent in consortship were also highest during the fertile phase and that ejaculatory copulations and male pericopulatory behaviors were significantly correlated with levels of female sex hormones. Our findings indicate that the Barbary macaque shows a mating pattern during the cycle similar to that described for other members of the genus. More importantly, however, our study provides clear evidence that despite an extreme degree of promiscuity Barbary macaque males concentrate their reproductive effort to the fertile phase, implying that they are able to discern this period and that thus timing of ovulation is not concealed from them. Estrogen-related cues appear to be involved in the process of recognition of female reproductive status by males, but the exact nature of these cues and how male Barbary macaques use them remains to be clarified.     

Seasonal variation in ovarian histology of the viviparous lizard Sceloporus torquatus torquatus

Changes in ovarian histology during the reproductive cycle of the viviparous lizard Sceloporus torquatus torquatus are described. In general, the variation in follicular histology observed during the seasonal cycle is similar to that of other lizards. Sceloporus t. torquatus exhibits a cycle in which small, previtellogenic follicles exist in the ovary from December to August. Vitellogenesis occurs between September and November, followed by ovulation from late November to early December. Parturition occurs the following spring. After ovulation, the remaining follicular cells form the corpus luteum and luteolysis did not occur until April-May. Follicular atresia is commonly observed in previtellogenic follicles with polymorphic granulosa, but occurs less frequently in follicles during late vitellogenesis. There are two germinal beds in each ovary. The yolk nucleus is evident in young oocytes as is a vacuolated ooplasma prior to vitellogenesis. Extensive polymorphism is observed in yolk platelets. Mast cells and secretory cells are observed in the thecal layer of the follicular wall as are melanocytes in the ovarian stroma. © 1995 Wiley-Liss, Inc.     

Modeling human fertility in the presence of measurement error

The probability of conception in a given menstrual cycle is closely related to the timing of intercourse relative to ovulation. Although commonly used markers of time of ovulation are known to be error prone, most fertility models assume the day of ovulation is measured without error. We develop a mixture model that allows the day to be misspecified. We assume that the measurement errors are i.i.d. across menstrual cycles. Heterogeneity among couples in the per cycle likelihood of conception is accounted for using a beta mixture model. Bayesian estimation is straightforward using Markov chain Monte Carlo techniques. The methods are applied to a prospective study of couples at risk of pregnancy. In the absence of validation data or multiple independent markers of ovulation, the identifiability of the measurement error distribution depends on the assumed model. Thus, the results of studies relating the timing of intercourse to the probability of conception should be interpreted cautiously.     

The effects of superior ovarian nerve sectioning on ovulation in the guinea pig

The effects on spontaneous ovulation associated with the unilateral or bilateral sectioning of the superior ovarian nerves (SON) were analyzed in guinea pigs at different time intervals of the estrous cycle. Day 1 of the estrous cycle was defined as the day when the animal presents complete loss of the vaginal membrane (open vagina). Subsequent phases of the cycle were determined by counting the days after Day 1. All animals were autopsied on the fifth day of the estrous cycle after surgery. Sectioning the right, left, or both SONs on day 5 (early luteal phase) resulted in a significant increase in the number of fresh corpora lutea. Ovulation increased significantly when the left SON (L-SON) was sectioned during late follicular phase (day 1) and medium luteal phase (day 8). When surgery was performed on days 1 or 8, neither sectioning the right SON (R-SON) nor sectioning the SON bilaterally had an apparent effect on ovulation rates. Similarly, ovulation rates were not affected when unilateral (right or left) or bilateral sectioning of the SON was performed during late luteal phase two (day 12). Unilateral or bilateral sectioning of the SON performed during the early luteal phase (day 5) was associated with a significant decrease in uterine weight. A comparable effect was observed when the L-SON was sectioned during late follicular phase (day 1), or medium luteal phase (day 8). No effects on uterine weight were observed when unilateral or bilateral sectioning of the SON was performed during late luteal phase. Our results suggest that in the guinea pig the SON modulates ovulation, and that the degree of modulation varies along the estrous cycle. The strongest influence of the SONs on ovulation occurs during early luteal phase, and decrease thereafter, being absent by late luteal phase. In addition, sectioning the left or the right SON caused different responses by the ovaries of adult guinea pigs. This paper discusses the mechanisms by which ovulation increased when the SON was surgically cut.     

Evaluation of two treatments in superovulation of mares

The efficiency of superovulating mares with an enriched fraction of equine follicle-stimulating hormone (feFSH) and an equine pituitary extract (EPE) with similar FSH content but differing in the LH amount was compared. Mares were randomly assigned to an feFSH (n = 5) or EPE (n = 5) treatment. The experimental period was of 2 successive estrous cycles, with the first cycle as the control. At Days 6 and 7 of the estrous cycle, the mares received 250 micrograms i.m. cloprostenol. The treatments consisted of daily injections of 25 mg feFSH or EPE beginning on Day 6 post ovulation. Mares were inseminated every other day until the last ovulation was detected. When the mares in the control and treatment cycles developed at least 1 or 2 > or = 35-mm follicle, respectively, the treatment was interrupted, and a single injection of EPE (25 mg, i.v.) was administered to induce ovulation(s). Nonsurgical embryo recovery was performed 6 or 7 d after ovulation in both control and treatment cycles. The number of ovulations per mare was not significantly different (P > 0.05) between feFSH and EPE groups, but both were higher (P < 0.05) than that of the control cycle. The number of recovered embryos per ovulation was similar (P > 0.05) for control, feFSH and EPE groups. The high amount of LH presented in EPE did not affect the superovulatory response of the mares. Superovulatory treatments increased the ovulation rate of mares but did not affect the embryo recovery rate per ovulation.     

The ability of subordinate follicles of the second follicular wave to become dominant is lost by day 15 of the estrous cycle in cattle

Generally, unilateral ovariectomy before a critical period in the latter part of the estrous cycle induces a transitory increase in plasma FSH, which causes subordinate follicles to develop and maintain ovulation rates characteristic of the species. A limiting period for subordinate follicles to assume dominance and from which ovulation occurs has not been shown for cattle. Growth and/or regression of subordinate follicles were characterized following removal of the dominant follicle at different days of the luteal phase of the estrous cycle in cattle in this study. In the mid-luteal phase (Day 13 or 15), the ovary with the dominant follicle of the second wave was ablated via unilateral ovariectomy; the corpus luteum also was removed. In the late luteal phase (Day 17 or 19), the dominant follicle was ablated with an ultrasonically guided 20 gauge needle. When the dominant follicle was removed on Day 13, the largest subordinate follicle of the second wave of follicular development became dominant and ovulation occurred from this follicle in 4 of 4 animals. However, when the dominant follicle was removed on Day 15, 17 or 19, a new wave of follicular development was induced in 14 of 15 animals. Moreover, the recovered subordinate follicle of the second wave of follicular development had similar growth characteristics to naturally occurring dominant follicles. In conclusion, the subordinate follicle in the second follicular wave in cattle retained the ability to become dominant, but this ability was lost by Day 15 of the estrous cycle. However, cattle then were able to maintain ovulation by developing a new wave of follicular growth.