Microvascular endothelial cells of the corpus luteum

The cyclic nature of the capillary bed in the corpus luteum offers a unique experimental model to examine the life cycle of endothelial cells, involving discrete physiologically regulated steps of angiogenesis, blood vessel maturation and blood vessel regression. The granulosa cells and theca cells of the developing antral follicle and the steroidogenic cells of the corpus luteum produce and respond to angiogenic factors and vasoactive peptides. Following ovulation the neovascularization during the early stages of corpus luteum development has been compared to the rapid angiogenesis observed during tumor formation. On the other end of the spectrum, the microvascular endothelial cells are the first cells to undergo apoptosis at the onset of corpus luteum regression. Important insights on the morphology and function of luteal endothelial cells have been gained from a combination of in vitro and in vivo studies on endothelial cells. Endothelial cells communicate with cells comprising the functional unit of the corpus luteum, i.e., other vascular cells, steroidogenic cells, and immune cells. This review is designed to provide an overview of the types of endothelial cells present in the corpus luteum and their involvement in corpus luteum development and regression. Available evidence indicates that microvascular endothelial cells of the corpus luteum are not alike, and may differ during the process of angiogenesis and angioregression. The contributions of vasoactive peptides generated by the luteal endothelin-1 and the renin-angiotensin systems are discussed in context with the function of endothelial cells during corpus luteum formation and regression. The ability of two cytokines, tumor necrosis factor alpha and interferon gamma, are evaluated as paracrine mediators of endothelial cell function during angioregression. Finally, chemokines are discussed as a vital endothelial cell secretory products that contribute to the recruitment of eosinophils and macrophages. The review highlights areas for future investigation of ovarian microvascular endothelial cells. The potential clinical applications of research directed on corpus luteum endothelial cells are intriguing considering reproductive processes in which vascular dysfunctions may play a role such as ovarian failure, polycystic ovary syndrome (PCOS), and ovarian hyperstimulation syndrome (OHSS).     

HIF-1在卵巢黄体发育过程中对血管新生的调控作用

在哺乳动物中,卵巢黄体（corpus luteum,CL）是由破裂排卵后的卵泡所形成的,也是血管增生比较激烈的地方。尤其是在卵巢黄体早期发育阶段,这种快速形成的致密毛细血管网可以确保产生激素的细胞获得氧气、营养和合成激素等所必要的前体,同时释放大量的激素用于早期妊娠的建立和维持。目前的研究已经表明,血管内皮生长因子（vascular endothel ial growth factor,VEGF）作为重要的促血管生成因子,在卵巢黄体发育过程中对血管增生具有至关重要的调节作用,而VEGF作为转录因子HIF－1的下游靶基因,受缺氧诱导因子HIF－1信号通路的调控。该文一方面对卵巢黄体发育过程中VEGF依赖性血管增生的调控机制进行概述,另一方面就转录因子H1F－1对VEGF的转录激活调控机制进行系统阐述,从而揭示HIF－1对卵巢黄体发育过程dgVEGF依赖性血管新生的调控作用,为进一步研究哺乳动物卵巢黄体发育过程中血管增生的分子调控机制提供坚实的理论基础。     

Possible role of cyclooxygenase II in the acquisition of ovarian luteal function in rodents

The development of the corpus luteum (CL), which involves angiogenesis, is essential for the establishment of early pregnancy. We investigated the roles of the prostaglandin synthases cyclooxygenase (COX) I and COX-II in angiogenesis and progesterone production in the newly formed CL, using inhibitors of the COX enzymes and the gonadotropin-induced pseudopregnant rat as a model. Injection of indomethacin, a nonselective COX inhibitor, on the day of ovulation and the following day decreased serum levels of progesterone, as did injection of the selective COX-II inhibitor NS-398. In contrast, a selective COX-I inhibitor, SC-560, had no effect on serum progesterone concentrations. None of the inhibitors had any effect on the weight of the superovulated ovaries or on the synthesis of progesterone by cultured luteal cells. To determine whether changes in angiogenesis are responsible for the decrease in progesterone synthesis, we measured hemoglobin and CD34 levels in luteinized ovaries following injection of COX inhibitors and measured the relative frequency of cells positive for platelet-endothelial cell adhesion molecule as a specific marker for endothelial cells. All of these parameters were reduced by the COX-II inhibitors, suggesting that changes in the vasculature are responsible for the decrease in serum progesterone. Histological examination of ovarian corrosion casts indicated that NS-398 inhibited the establishment of luteal capillary vessels following the injection of hCG. The results are consistent with the hypothesis that the activity of COX-II is associated with the formation of functional CL via its stimulation of angiogenesis.     

An IP-10 (CXCL10)-derived peptide inhibits angiogenesis

Angiogenesis plays a critical role in processes such as organ development, wound healing, and tumor growth. It requires well-orchestrated integration of soluble and matrix factors and timely recognition of such signals to regulate this process. Previous work has shown that newly forming vessels express the chemokine receptor CXC receptor 3 (CXCR3) and, activation by its ligand IP-10 (CXCL10), both inhibits development of new vasculature and causes regression of newly formed vessels. To identify and develop new therapeutic agents to limit or reverse pathological angiogenesis, we identified a 21 amino acid fragment of IP-10, spanning the α-helical domain residues 77-98, that mimic the actions of the whole IP-10 molecule on endothelial cells. Treatment of the endothelial cells with the 22 amino acid fragment referred to as IP-10p significantly inhibited VEGF-induced endothelial motility and tube formation in vitro, properties critical for angiogenesis. Using a Matrigel plug assay in vivo, we demonstrate that IP-10p both prevented vessel formation and induced involution of nascent vessels. CXCR3 neutralizing antibody was able to block the inhibitory effects of the IP-10p, demonstrating specificity of the peptide. Inhibition of endothelial function by IP-10p was similar to that described for IP-10, secondary to CXCR3-mediated increase in cAMP production, activation of PKA inhibiting cell migration, and inhibition of VEGF-mediated m-calpain activation. IP-10p provides a novel therapeutic agent that inhibits endothelial cell function thus, allowing for the modulation of angiogenesis.     

Expression of tissue kallikrein and kinin receptors in angiogenic microvascular endothelial cells

Angiogenesis is the sprouting of new capillary blood vessels from pre-existing ones. The kinin family of vasoactive peptides, formed by the serine protease tissue kallikrein from its endogenous multifunctional protein substrate kininogen, is believed to regulate the angiogenic process. The aim of this study was to determine the expression of tissue kallikrein and kinin receptors in an in vitro model of angiogenesis. Microvascular endothelial cells from the bovine mature and regressing corpus luteum were used only if they reacted with known endothelial cell markers. At first the cultured endothelial cells began sprouting, and within four weeks formed three-dimensional, capillary-like structures. Immunolabelling for tissue prokallikrein and the mature enzyme was intense in the angiogenic endothelial cells derived from mature corpora lutea. Immunoreactivity was lower in non-angiogenic endothelial cells and least in angiogenic endothelial cultures of the regressing corpus luteum. Additionally, using specific antisense DIG-labelled probes, tissue kallikrein mRNA was demonstrated in cells of the angiogenic phenotype. Immunolabelled kinin B2 receptors, but not kinin B1 receptors, were visualised on angiogenic endothelial cells. Our results suggest an important regulatory role for kinins in the multiple steps of the angiogenic cascade that may occur in wound healing and cancer cell growth.     

Prostaglandin F2-alpha receptor (FPr) expression on porcine corpus luteum microvascular endothelial cells (pCL-MVECs)

Background  

The corpus luteum (CL) is a transient endocrine gland and prostaglandin F2-alpha is considered to be the principal luteolysin in pigs. In this species, the in vivo administration of prostaglandin F2-alpha induces apoptosis in large vessels as early as 6 hours after administration. The presence of the prostaglandin F2-alpha receptor (FPr) on the microvascular endothelial cells (pCL-MVECs) of the porcine corpus luteum has not yet been defined. The aim of the study was to assess FPr expression in pCL-MVECs in the early and mid-luteal phases (EL-p, ML-p), and during pregnancy (P-p). Moreover, the effectiveness of prostaglandin F2-alpha treatment in inducing pCL-MVEC apoptosis was tested.     

The enigmatic role of angiopoietin-1 in tumor angiogenesis

A tumor vasculature is highly unstable and immature, characterized by a high proliferation rate of endothelial cells, hyper-permeability, and chaotic blood flow. The dysfunctional vasculature gives rise to continual plasma leakage and hypoxia in the tumor, resulting in constant on-sets of inflammation and angiogenesis. Tumors are thus likened to wounds that will not heal. The lack of functional mural cells, including pericytes and vascular smooth muscle cells, in tumor vascular structure contributes significantly to the abnormality of tumor vessels. Angiopoietin-1 (Ang 1) is aphysiological angiogenesis promoter during embryonic development. The function of Angl is essential to endothelial cell survival, vascular branching, and pericyte recruitment. However, an increasing amount of experimental data suggest that Angl-stimulated association of mural cells with endothelial cells lead to stabilization of newly formed blood vessels. This in turn may limit the otherwise continuous angiogenesis in the tumor, and consequently give riseto inhibition of tumor growth. We discuss the enigmatic role of Angl in tumor angiogenesis in this review.     

Progesterone is a cell death suppressor that downregulates Fas expression in rat corpus luteum

In female rats, apoptotic cell death in the corpus luteum is induced by the prolactin (PRL) surge occurring in the proestrous afternoon during the estrous cycle. We have previously shown that this luteolytic action of PRL is mediated by the Fas/Fas ligand (FasL) system. During pregnancy or pseudopregnancy, apoptosis does not occur in the corpus luteum. Progesterone (P4), a steroid hormone secreted from luteal steroidogenic cells, attenuated PRL-induced apoptosis in cultured luteal cells in a dose-dependent manner. P4 significantly decreased the expression of mRNA of Fas, but not FasL, in cultured luteal cells prepared from both proestrous and mid-pseudopregnant rats. These data indicate that P4 suppresses PRL-induced luteal cell apoptosis via reduction of the expression level of Fas mRNA in the corpus luteum, suggesting that P4 acts as an important factor that can change the sensitivity of corpus luteum to PRL.     

Differences of microvascular endothelium in the bovine corpus luterum of pregnancy and the corpus luteum of the estrous cycle

Summary— The purpose of the present study was to investigate potential modulations of endothelial cells of the bovine corpus luteum (CL) during pregnancy. Luteal endothelia of pregnant and non-pregnant cows were isolated and purity of cultures was verified by flow cytometric quantification of three independent endothelial markers (von Willebrand factor, angiotensin converting enzyme, Bandeiraea simplicifolia agglutinin I ligands). Different cellular parameters including light and electron microscopical investigation of morphology and growth characteristics as well as quantification of cellular lectin binding sites were compared. Extensive heterogeneity between luteal endothelial cells in pregnant and non-pregnant animals could be demonstrated, reflected in functional attributes like angiogenic activity, ultrastructural characteristics and the quantitative expression of cellular carbohydrates. Two different morphological types of cells (‘cobblestone growth pattern’ and ‘arcuate growth pattern’) were isolated from the CL of pregnancy as well as from the cyclic CL. Spontaneous angiogenic activities, including cellular migration in band-like structures and formation of ring-like structures, were observed in endothelial cells isolated from the CL of pregnant cows exclusively. This strongly suggests that microvascular luteal endothelium of pregnant animals, in contrast to the one of non-pregnant animals, is able to produce quantitatively and/or qualitatively specific angiogenesis factor(s). Heterogeneity between luteal endothelial cells in the pregnant and non-pregnant animal could also be demonstrated by quantification of lectin (Bandeiraea simplicifolia agglutinin I, concanavalin A, Dolichos biflorus agglutinin, Ulex europaeus agglutinin I, wheat germ agglutinin) binding sites: quantitative expression of specific endothelial cell surface carbohydrates could be correlated to be status of pregnancy, thus emphasizing the actual need of quantification of lectin binding.     

Angiogenesis in the corpus luteum

The corpus luteum (CL) is a site of intense angiogenesis. Within a short period, this is followed either by controlled regression of the microvascular tree in the non-fertile cycle, or maintenance and stabilisation of the new vasculature a conceptual cycle. The molecular regulation of these diverse aspects is examined. The CL provides a unique model system in which to study the cellular and molecular regulation of angiogenesis. Vascular endothelial growth factor (VEGF) has been found to have a major role in the CL. By targeting its action at specific stages of the luteal phase in vivo by antagonists, profound inhibitory effects on luteal angiogenesis and function are observed.     

A novel <Emphasis Type="Italic">Flk1</Emphasis>-TVA transgenic mouse model for gene delivery to angiogenic vasculature

The genes that regulate the formation of blood vessels in adult tissues represent promising therapeutic targets because angiogenesis plays a role in many diseases, including cancer. We wished to develop a mouse model allowing characterization of gene function in adult angiogenic vasculature while minimizing effects on embryonic vasculature or adult quiescent vasculature. Here we describe a transgenic mouse model that allows expression of proteins in the endothelial cells of newly forming blood vessels in the adult using a selective retroviral gene delivery system. We generated transgenic mouse lines that express the TVA receptor for the RCAS avian-specific retrovirus from Flk1 gene regulatory elements that drive expression in proliferating endothelial cells. Several of these Flk1-TVA lines expressed TVA mRNA in the embryonic vasculature and TVA protein in new blood vessels growing into subcutaneous extracellular matrix implants in adult mice. In a Flk1-TVA line that was crossed with the MMTV-PyMT transgenic mammary tumor model, tumor endothelial cells also expressed the TVA protein. Furthermore, endothelial cells in extracellular matrix implants and the tumors of Flk1-TVA mice were susceptible to RCAS infection, as determined by expression of green fluorescent protein encoded by the virus. The Flk1-TVA mouse model in conjunction with the RCAS gene delivery system will be useful to study molecular mechanisms underlying adult forms of angiogenesis.     

Transformation of fibroblasts into endothelial cells during angiogenesis

Light-and electron-microscopic autoradiography have been used to study fibroblast transformation into endothelial cells in the formation of new blood vessels during wound healing in rabbit ear chambers. When cultured fibroblasts labeled with tritium thymidine were transplanted autologously into the chambers, newly formed blood vessels contained endothelial cells labeled with tritium thymidine. This result suggests that fibroblasts play a pivotal role in angiogenesis, as progenitors of endothelial cells in newly formed blood vessels.     

Impact of angiogenic and innate immune systems on the corpus luteum function during its formation and maintenance in ruminants

The corpus luteum (CL) is formed from an ovulated follicle, and grows rapidly to secrete progesterone (P4) thereby supporting implantation and maintenance of pregnancy. It is now evident that angiogenesis is necessary to form the structure of the developing CL as well as to acquire the steroidogenic capacity to secrete large amounts of P4. It is of interest that the increases in CL size, plasma P4 concentration and luteal blood flow are occurring in parallel during the first seven days after ovulation. Angiogenic factors, such as vascular endothelial growth factor-A (VEFGA) and basic fibroblast growth factor (FGF2), play a central role in promoting cell proliferation and angiogenesis in the developing CL. Angiopoietins regulate the stability of blood vessels, which directly affects angiogenesis or angiolysis via angiogenic factors. Vasohibin-1 is a novel negative feedback regulator, which inhibits VEGF-based vasculogenesis. It became evident that the immune cells, i.e., macrophages, eosinophils and neutrophils are recruited into the CL – using the innate immune system – just after ovulation which is accompanied by bleeding. The immune cells support active angiogenesis and thus the growth of the CL. In cows, the lymphatic system, but not blood vascular system, is reconstituted during early pregnancy, and embryonic trophoblast-derived interferon tau could play a crucial role in inducing lymphangiogenesis. This novel phenomenon may support a maternal recognition of pregnancy in shifting the local systems in such a way that they ensure a long-term supply of P4 over the period of pregnancy. Overall, the current findings support the concept that several major components involved in the regulation of the CL development and maintenance overlap in stimulating steroidogenesis, angiogenesis, vascular function and the innate immune system.     

Angiopoietin-1 inhibits endothelial cell apoptosis via the Akt/survivin pathway

A productive angiogenic response must couple to the survival machinery of endothelial cells to preserve the integrity of newly formed vessels. Angiopoietin-1 (Ang-1) is an endothelium-specific ligand essential for embryonic vascular stabilization, branching morphogenesis, and post-natal angiogenesis, but its contribution to endothelial cell survival has not been completely elucidated. Here we show that Ang-1 acting via the Tie 2 receptor induces phosphorylation of the survival serine-threonine kinase, Akt (or protein kinase B). This is associated with up-regulation of the apoptosis inhibitor, survivin, in endothelial cells and protection of endothelium from death-inducing stimuli. Moreover, dominant negative survivin negates the ability of Ang-1 to protect cells from undergoing apoptosis. The activation of anti-apoptotic pathways mediated by Akt and survivin in endothelial cells may contribute to Ang-1 stabilization of vascular structures during angiogenesis, in vivo.     

Development and regression of non-capillary vessels in the bovine corpus luteum

The corpus luteum life cycle is accompanied by capillary growth, maturation and degeneration. Arterial blood vessels are thought to undergo hyperplasia and hypertrophy during the stage of regression, as is the case with non-capillary vessels. In this study, we used morphological studies to show that the development of non-capillary vessels occurs at other corpus luteum stages. Non-capillary vessels were present at the developmental stage of the corpus luteum, and increased markedly in number in the subsequent stages. After double-staining for ASM-1 actin and Ki-67 nuclear antigen, the proliferation of smooth muscle cells (SMCs) was only detected during stages of development and secretion. When the capillaries had disappeared at the regression stage, the arterial blood-vessel walls thickened noticeably. This was attributed to the development of fibroelastosis as shown by staining for collagenous and elastic fibres. In conclusion, the bovine corpus luteum represents a physiological model for studying arteriolization at all stages of development and secretion. At the regression stage, arterioregression sets in.     

Acetylcholinesterase in blood vessels of the guinea-pig ovary during different phases of the reproductive cycle

Synopsis The distribution of acetylcholinesterase-containing blood vessels in the ovary has been investigated histochemically during the reproductive cycle of the guinea-pig. Whole mounts as well as frozen sections have been studied. Stained vessels were found in the stroma throughout the oestrous cycle and pregnancy. In the corpus luteum the vascular reaction varied at different stages of the oestrous cycle; while never very pronounced it was more marked in lactating than in non-lactating animals. A few vessels in the corpus luteum of early pregnancy showed some reaction but as pregnancy advanced an increasing number of vessels were strongly stained. At the end of pregnancy, stained vessels were less prominent.acetylcholinesterase appeared to be localized principally in the vessels themselves (possibly in muscle cells) rather than is associated nerves. Experiments in which ovaries were injected, via their arterial or venous supply, with starch or coloured gelatine suggested that most stained vessels were arterioles but a reaction also occurred in some vessels which were probably arteries and others which could have been the postulated arterio-venous shunts. Capillaries were unstained; whether the veins were also totally unreactive could not be established.The significance of the changes in acetylcholinesterase staining in varying functional states remains obscure; they may or may not reflect the emergence of certain types of vessel at different stages.     

Physiological and immunocytochemical evidence for a new concept of blood flow regulation in the corpus luteum

To explain the high rate of blood flow in the corpus luteum, we hypothesize that luteal blood vessels offer minimal resistance to flow and are incapable of vasomotion. This hypothesis was tested in rabbits at mid-pseudopregnancy by measuring blood flow in the corpus luteum and ovarian stroma with tracer-labeled microspheres at three levels of arterial blood pressure, which was manipulated by constricting the aorta above the ovarian artery. In addition, the distribution of vascular smooth muscle in the ovary was evaluated with morphological and immunocytochemical techniques. Decreases in arterial pressure were paralleled by reductions in blood flow in the corpus luteum, whereas ovarian stromal blood flow was unchanged. Consistent with our hypothesis, there was no change in the low level of vascular resistance offered by blood vessels in the corpus luteum, supporting the view that they are maximally dilated and incapable of autoregulation. Morphologically, the vessels within the corpus luteum appeared as large sinusoidal capillaries without smooth muscle, providing an anatomical explanation for the lack of vasomotor control demonstrated physiologically. The absence of vascular smooth muscle was confirmed with immunocytochemistry using an antibody against the muscle-specific intermediate filament, desmin. The fluorescein-labeled antibody decorated arteries and arterioles within the ovarian stroma and near the capsule of the corpus luteum, but did not decorate vessels in the corpus luteum of pseudopregnancy, providing additional evidence that the vessels of the corpus luteum lack the smooth muscle investment necessary to change vascular caliber. From these findings, we have proposed a novel scheme to explain intraovarian blood flow regulation. Vascular resistance in the ovarian stroma, as in most tissues, is acutely regulated by dilation or constriction of intratissue arterioles. In contrast, vascular resistance within the corpus luteum is modeled as a relatively invariable parameter, fixed at a low level by the morphological characteristics of the luteal vasculature. Therefore, the corpus luteum operates on a linear (maximally "vasodilated") pressure-flow curve, does not actively regulate intratissue blood flow, and is subject to acute regulation of perfusion only through changes in extra-luteal vessels.     

Unique patterns of Notch1, Notch4 and Jagged1 expression in ovarian vessels during folliculogenesis and corpus luteum formation

Notch signaling functions to regulate cell-fate decisions by modulating differentiation, proliferation, and survival of cells. Notch receptors and ligands are expressed in embryonic vasculature and are required for the remodeling of the primary embryonic vasculature of mice. Here, we characterize the expression patterns of Notch1, Notch4, and Jagged1 proteins during the process of folliculogenesis and corpus luteum formation in the mouse ovary, an organ with dynamic physiological angiogenic growth. These Notch proteins and ligand are expressed in a subset of ovarian vessels, including both mature ovarian vasculature as well as angiogenic neovessels. Their expression in the ovary was found in both endothelial and vascular associated mural cells. Our data suggest a complex regulatory role for the Notch signaling pathway during mouse oogenesis and ovarian neovascularization.     

Morphogenesis and histophysiology of the corpus luteum

A great amount of different problems on morphogenesis and histophysiology of the corpus luteum is presented, with an emphasis on light optic and ultrastructural data that characterize the developmental dynamics of the corpus luteum. The vascular reaction is described in details, beginning from the preovulatory period. The total high vascularization rate is demonstrated and certain information on ultrastructure of newly formed capillaries and macrophages is concerned with. For the first time the authors' data on intravascular macrophages are given. The role of macrophages in the function and structural dynamics of the corpus luteum is discussed. Owing to the results obtained histochemically, ultrastructurally and biochemically, the subject on dynamics of the corpus luteum hormonoproduction, on processes participating in the hormone secretion, as well as on the role of the interstitial tissue in the corpus luteum formation is considered. The data from the literature and those of the authors are presented concerning the means and ways of progesteron transport in the form of vesicles, granules, or by means of molecular diffusion. Participation of the corpus luteum macrophages (tissue and vascular ones) in processes of synthesis and transport of progesteron is analysed. The role of prostaglandins in the chain of regulation of development, function and involution of the corpus luteum is studied. The changes in balance of prostaglandins, when prostaglandin F2 is administered result in decreasing amount of progesterone in blood. In the experiment, synthesis of prostaglandins is blocked by indometacin administration and it causes certain disturbances in luteal transformation.     

Angiogenesis in the corpus luteum of early pregnancy in the marmoset and the effects of vascular endothelial growth factor immunoneutralization on establishment of pregnancy

This study investigated vascular and molecular changes in the corpus luteum (CL) of early pregnancy in the marmoset. Ovaries were studied on Days 21 (n = 6) and 28 (n = 6) of pregnancy and compared with corpora lutea from Day 21 (late luteal) of the nonconception cycle (n = 8). Endothelial cell proliferation was measured by immunocytochemical detection of incorporated bromodeoxyuridine. Endothelial cell and pericyte area were assessed by quantitative immunocytochemistry for CD31 and alpha-smooth muscle actin, respectively. Vascular endothelial growth factor (VEGF) and its receptors, kinase insert domain-containing region (KDR) and fms-like tyrosine kinase (Flt) mRNA, were localized and quantified in in situ hybridization. In addition, the effects of immunoneutralization of VEGF on establishment and maintenance of pregnancy were investigated by administering a VEGF neutralizing antibody on Days 0-10 of the luteal phase during potentially fertile cycles (n = 10) and compared with fertile controls (n = 6). No differences in the cellular or morphological parameters were found between pregnant and structurally intact nonpregnant corpora lutea. No major differences were found in expression of VEGF, Flt, or KDR in these CL. VEGF immunoneutralization markedly suppressed plasma progesterone secretion during treatment, but pregnancy rate was not significantly reduced. Thus, a role for VEGF in early pregnancy in the marmoset remains to be established. These results show that, by the late luteal phase in the marmoset, the corpus luteum has established a mature vascular system and the molecular capacity to synthesize VEGF and its receptors. A pregnancy-induced spurt of angiogenesis or gene expression does not appear to take place; rather, maintenance of the existing vasculature is all that is required for the establishment of pregnancy.