Age-related changes in plasma oestrogen concentration, behavioural responsiveness to oestrogen, and reproductive success in female gray-tailed voles, Microtus canicaudus

Age-related increases in the incidence of vaginal cornification were associated with increases in the reproductive success of female gray-tailed voles previously isolated from males. The pregnancy rate of females first paired with males at 30-50 days of age was significantly lower than that of females first paired at 90-120 or 150-200 days of age. The improvement was due to increases in propensities to display receptive behaviours and decreases in the incidence of sterile matings. Although plasma oestrogen concentrations increased with age and were higher in receptive than unreceptive females, plasma oestrogen values alone did not account completely for differences in receptive behaviours amongst females of different ages. Females ovariectomized at 30-50 days of age rarely displayed receptive behaviours when treated with large doses of oestradiol benzoate, whereas nearly all females similarly treated were receptive if ovariectomies were performed between 150 and 200 days of age. The receptivity rate of females ovariectomized between 90 and 150 days was intermediate between the rates of the other two groups.     

Crystallization patterns in anterior vaginal fluid from bitches in oestrus

Bitches exhibited a characteristic arborization pattern of the fluid from the anterior vagina during pro-oestrus and oestrus. These changes were monitored together with conventional vaginal cytology and plasma oestrogen and progestagen concentrations. A classical ferning pattern, similar to that seen in bovine cervical mucus at oestrus, occurred after the peak in plasma oestrogen concentrations. Ferning was most intense after the second peak of cornification of vaginal epithelial cells. It is suggested that a 'Ferning Index', when combined with conventional vaginal cytology, can be of use in determining the optimum mating time in the bitch.     

Progesterone and testosterone concentrations during oestrous cycle and pregnancy in the common vole (Microtus arvalis Pallas)

Serum progesterone and testosterone concentrations were measured during different stages of oestrous and pregnancy in paired and unpaired female common voles (Microtus arvalis). Hormone concentrations were measured by ELISA, and cycle stages were determined by vaginal smears. Paired females usually had serum progesterone concentrations of more than 10 ng/ml in the oestrous cycle. A significant maximum was detected in prooestrous (51.70 +/- 7.84 ng/ml, mean +/- S.D.). Serum progesterone concentrations increased from about 40 ng/ml at the beginning of pregnancy to about 70 ng/ml on days 15 and 16. The last 2 days before parturition (days 19 and 20) were characterised by a decrease of progesterone concentrations to ca. 30 ng/ml. The maximum concentration of testosterone was found in prooestrous (1.58 +/- 0.31 ng/ml). Concentrations during pregnancy varied between 1.5 and 2.1 ng/ml. In two of three cases unpaired females exhibited progesterone values below 10 ng/ml, but with varying vaginal smear patterns. The combination of progesterone concentrations and vaginal smear patterns was found to be regular in only 23.8% of the cases. The most frequent cycle stage found was the oestrous (44.2%). Mean concentrations of progesterone (10.43 +/- 13.81 ng/ml) and testosterone (0.85 +/- 1.11 ng/ml) in unpaired females were significantly lower than in paired females, thereby denoting reproductive inactivity in the former. The study presents basic data for several parameters of the reproductive biology in the common vole and confirms the importance of combining hormone assays and vaginal smear monitoring in reproductive research.     

Non-invasive repeated measurement of urinary progesterone, 17beta-estradiol, and testosterone in developing, cycling, pregnant, and postpartum female mice

Excretory samples from adult female mice were collected non-invasively during development, estrous cycling, pregnancy, and postpartum. In initial studies, urinary measures were statistically more dynamic over days than were fecal measures; thus subsequent studies focused on urine. Higher 17beta-estradiol levels were present in isolated females than in those exposed to males. In cycling females, urinary 17beta-estradiol was more variable than were measures of testosterone or progesterone, showing peaks with an approximate 5-day periodicity. When urinary estradiol and progesterone were monitored in conjunction with vaginal smear cell counts, patterns were idiosyncratic; most females showed distinct peaks in urinary steroids, not in clear synchrony with vaginal cell cornification. Levels of progesterone rose markedly during the first 10 days of pregnancy, then declined before birth. Estradiol showed a substantial peak on days 7-8 of gestation in all females measured. Urinary testosterone was not dynamic during pregnancy, but rose in immediate prenatal and postpartum measures. During post-weaning, pre-pubertal development, urinary levels of progesterone remained constant but levels of estradiol rose substantially over time.     

First postpartum estrus and pregnancy in the female collared peccary (Tayassu tajacu) from the amazon

The onset of sexual cycle postpartum was described in the collared peccary (Tayassu tajacu). Serum progesterone and 17beta-estradiol profiles, vaginal smears and external genitalia were analyzed in 20 animals housed with their piglets during the first postpartum month. The appearance of external genitalia showed no variation in any of the females: a shallow, reddish vulva, and vaginal mucus were constant features throughout the study. Based on hormonal profiles and vaginal smear cell patterns, 16 (80%) of the 20 peccaries showed signs of estrus and were considered cycling. The remaining four females (20%) did no show signs of estrus confirmed by low levels of progesterone (0.9+/-0.4 ng/mL) during the first postpartum month. In the cycling peccaries, a serum 17beta-estradiol peak (53.4+/-8.1 pg/mL) was observed on Day 7+/-1 postpartum, along with a linear increase in progesterone concentration from 3 (4.3+/-2.6 ng/mL) to 11 (30.8+/-4.9 ng/mL) days after this estradiol peak. Proportions of the different cells of the vaginal epithelium also changed in these females: superficial plus intermediate cells amounted to 76% of the cell total between Days 6 and 9 postpartum, corresponding to the estradiol peak. Nine (56%) of the 16 cycling females mated, indicated by the presence of sperm cells in their vaginal smears, and 6 (67%) became pregnant, reaching term. Non-pregnant cycling females (n=10) showed a steady decrease in serum progesterone concentration from 11 to 23 days after the estradiol peak, when basal levels were attained and a new estradiol peak registered, indicating the resumption of cyclicity in these females. The time interval between the two estradiol peaks was 23.5+/-2.1 days in these females. In pregnant females, progesterone concentrations continued to rise to levels of 60 ng/mL (n=6) 23 days after mating. These findings indicate that the lactating collared peccary female can become cycling and fertile during the early postpartum period, and that a predominance of superficial plus intermediate vaginal cells can be taken as the first sign of estrus.     

The estrous cycle of captive woodchucks (Marmota monax)

Changes in vaginal cytology were assessed and correlated with temporal changes in circulating concentrations of progesterone (P) and estradiol-17 beta (E2) during the breeding season (February to March) in a seasonally breeding rodent, the woodchuck (Marmota monax). Ten individually caged adult females, maintained under laboratory conditions for 3-11 mo, were studied. Vaginal smears were taken each morning for 2 consecutive months beginning 1 February 1990. Seven of 10 females exhibited readily identifiable estrus, characterized by a clear predominance (83%) of cornified cells. The earliest estrous smear was recorded on 3 February and the latest on 12 March. These animals were monoestrous and remained in a prolonged estrous period during their brief breeding season. The average duration of estrus was 18.1 +/- 2.1 days, ranging from 12-27 days. Levels of P and E2 were determined in serum samples taken before, during, and after estrus from 7 females who exhibited estrus. No changes in the circulating levels of P were apparent during the estrous cycle. However, there was a consistent pattern of estradiol secretion characterized by elevated levels of E2 before and during estrus, followed by a significant (p less than 0.05) decline in E2 levels one week after the end of estrus. Elevated levels of E2 preceded and coincided with maximal degree of vaginal cornification. Thus, the termination, but not the onset, of estrus in woodchucks reflected closely the temporal pattern of changes in serum E2 levels during the breeding season.     

Transient shortening of estrous cycles in aging C57BL/6J mice: effects of spontaneous pseudopregnancy, progesterone, L-dihydroxyphenylalanine, and hydergine

Regular estrous cycles can be reinitiated in old acyclic female rats by pharmacologic, hormonal, and environmental manipulations. The most responsive acyclic states are persistent vaginal cornification (PVC) and spontaneous pseudopregnancy (SP). However, it is not known if the irregular cyclicity that precedes acyclicity during aging can also be alleviated. We found that transient shortening of estrous cycles follows smear sequences indicative of pseudopregnancy in C57BL/6J mice, aged 9-15 mo, suggesting a role for progesterone. This phenomenon was investigated through a limited model of pseudopregnancy in which intact aging mice with lengthened cycles were given progesterone implants (yielding 70 ng progesterone/ml plasma) that suppressed estrous cycles; upon removal of the implants, cycles were transiently shortened in aging mice. Therefore, we hypothesize that withdrawal from the progesterone elevations associated with SP is the mechanism in shortening subsequent estrous cycles. Effects of central-acting drugs, similar to those used to reinitiate cyclicity in acyclic old rats, were also examined. Hydergine, an ergot mixture with partial dopaminergic and serotonergic agonist activities, suppressed SP when fed to 10- to 12-mo-old, middle-aged mice. Hydergine did not otherwise affect estrous cycle length, prevent PVC, or reinitiate cycling in acyclic PVC mice. Feeding L-dihydroxyphenylalanine to middle-aged mice did not suppress SP, affect estrous cycle lengths, or reinitiate cycles from PVC.     

Shifts in gonadotropin and steroid levels that precede anestrus in female golden hamsters exposed to a short photoperiod

Female golden hamsters exposed to short photoperiods become anestrous and exhibit daily surges of gonadotropins and progesterone. Since little is known about the transition between the cycling and anovulatory states, the following experiments were done to determine whether there are hormonal changes that precede cessation of estrous cyclicity. Females killed on the morning of estrus, up to the tenth estrous cycle in short days, showed no hormonal or ovarian morphologic evidence of changes in reproductive function. When assessed on the afternoon of estrus, however, serum levels of luteinizing hormone and progesterone increased significantly before vaginal and ovarian cyclicity ceased. Females sampled in both the morning and afternoon at increasing durations since their last vaginal estrus revealed that maximal daily surges of both gonadotropins and progesterone were not consistently manifested until the vaginal cycle had been absent for 2 weeks. By then, estrogen levels and uterine weights were low and ovaries showed hypertrophied interstitia and arrested follicular growth. We have demonstrated that there are hormonal changes in females before the loss of the vaginal cycle and onset of major daily hormonal surges. Our results suggest that alterations in feedback relationships between steroid hormones and gonadotropins may precede photoperiod-induced anestrus.     

Reappearance of cyclicity of vaginal smears in androgen-sterilized rats following thyroidectomy

During studies on the mechanism of hypersensitivity to gonadotropins of thyroidectomized rat ovary, results were obtained which suggest an increase in the endogenous luteinizing hormone (LH) release after thyroidectomy in androgen-sterilized rats. Female rats were injected subcutaneously with 1 mg of testosterone propionate dissolved in .05 ml of olive oil on Day 5 after birth. At the age of 10-12 weeks, those animals which showed persistent vaginal cornification were thyroidectomized. Within 1-2 days after thyroidectomy, the thyroidectomized rats exhibited leukocytic and epithelial vaginal smears for 2-6 days. Irregular cyclicity with the pattern of 2-6 days diestrus and 3-10 days estrus persisted for 1 month. Histological examination revealed that the corpora lutea were intermingled with a number of cystic follicles in the ovaries of the androgen-sterilized and throidectomized rats while the ovaries of androgen-sterilized controls had vesicular follicles but were devoid of corpora lutea. The results indicate a rapid enhancement in the LH release in androgen-sterilized rats following thyroidectomy.     

Antagonistic effects of estradiol dipropionate and progesterone on the histology of the vagina and uterus of the mouse

Administration of estradiol dipropionate (20 micrograms/day; 7 days) to ovariectomized mice caused heavy epithelial proliferation and intense cornification in the vagina and cellular as well as glandular proliferation in uterine tissues. Endometrial hypertrophy with cystlike appearance of uterine glands was seen in response to a long-term (14 days) administration of estradiol dipropionate. Daily injection of progesterone (2 mg; 7 days) to ovariectomized mice resulted in desquamating mucosa, without any trace of vaginal cornification, and the presence of dense uterine connective tissue in the stromal region with typical uterine glands. However, treatment of estradiol depropionate in combination with progesterone at 1:100 dose ratio for 7 days produced vaginal histology similar to that in proestrus and uterine histology equivalent to the ovariectomized condition. The results revealed that progesterone antagonized the estrogenic effects and also that estradiol dipropionate antagonized the effects of progesterone. The effects of the two female sex steroids (estradiol dipropionate and progesterone) in vivo appeared to be more potent in the uterus than in the vagina.     

Proestrous hormonal changes preceding the onset of ovulatory failure in lightly androgenized female rats

Proestrous hormonal profiles were characterized in lightly androgenized female rats prior to the onset of the delayed anovulatory syndrome (DAS). In these females, ovulatory failure and persistent vaginal estrus (PVE) occur at a very early age. Female Sprague-Dawley rats were injected with 10 micrograms testosterone propionate (TP) on postnatal Day 5. Control rats were untreated. All animals were weaned at 21 days of age, and following the onset of puberty, estrous cyclicity was monitored by vaginal smear. Rats showing regular 4-day cycles were used. Between 50-70 days of age, intra-atrial cannulae were implanted on a morning of proestrus (0700-0900 h) and blood was sampled at 2-h intervals from 1000 to 2000 h. Additional samples were taken at 0.5-h intervals from 1600 to 1800 h. Plasma was assayed for luteinizing hormone (LH), follicle-stimulating hormone (FSH) and progesterone (P) by radioimmunoassay (RIA). All animals were monitored for the onset of PVE or other alterations in estrous cyclicity. Females treated neonatally with TP that subsequently showed PVE by 150 days of age (PRE DAS) displayed a reduced peak amplitude (P less than 0.01) and delay in onset (1600 vs. 1400 h) of LH but not FSH secretion, when compared to controls. Females treated neonatally with TP that did not enter PVE by 150 days of age (No DAS) also showed a delayed rise in LH when compared to controls. However, the amplitude of LH secretion was not different from controls or PRE DAS females.(ABSTRACT TRUNCATED AT 250 WORDS)     

Occurrence of permanent changes in vaginal and uterine epithelia in mice treated neonatally with progestin, estrogen and aromatizable or non-aromatizable androgens.

Female mice of the C57 Black/Tw strain were injected daily with 100 microng testosterone, 50 microng testosterone propionate (TP), 100 microng 5 alpha-dihydrotestosterone (DHT) or 50 microng 5 alpha-dihydrotestosterone propionate (DHTP), for 10 days from the day of birth. Two other groups of female mice were given neonatal injections with 20 microng estradiol-17 beta and 100 microng progesterone for 10 days, respectively. All mice were ovariectomized at 60 days of age and killed at 90 days. In 100% of neonatally estrogenized or androgenized, ovariectomized mice, the cranial part of the vagina was lined with stratified epithelium with either cornification or parakeratosis or mucification. Stratification only or stratification with superficial squamous metaplasia or cornification took place in the uterine epithelia of 18% of the TP-treated, 75% of the DHT-treated and 50% of the DHTP-treated, ovariectomized mice. In contrast, neonatally estrogenized, ovariectomized mice did not show the estrogen-independent, persistent uterine changes. Neonatal progesterone treatment failed to induce the permanent changes in the vaginal and uterine epithelia.     

Oestrous cycle of captive southern hairy-nosed wombats (Lasiorhinus latifrons) in South Australia, Australia

There is limited information available on the oestrous cycle of female southern hairy-nosed wombats (Lasiorhinus latifrons). This is mainly due to an extremely poor breeding success in captivity and the difficulty in routine recapturing of these cryptic, semi-fossorial animals in the wild. The aim of this study was to characterise the oestrous cycle of this species by monitoring peripheral plasma concentrations of progesterone and oestradiol, assessing changes in vaginal cytology, pouch condition and the urogenital sinus. Eight adult female wombats were monitored during the breeding season (July-December) over 2 years (2002-2003). Samples were collected up to three times a week. Vaginal smears contained several cell types, categorised by morphology, as either superficial epithelial cells or parabasal-intermediate cells. Leucocytes were also counted. Plasma progesterone profiles showed a mean oestrous cycle length of 36.33+/-0.67 days with a peak progesterone concentration of 139.53+/-10.62nmol/L. Levels of oestradiol peaked at a mean level of 467.33+/-44.32pmol/L on average 5 days before a rise in plasma progesterone values. The proportion of epithelial cells in vaginal smears varied throughout the cycle, with a high percentage of superficial epithelial cells observed during the follicular phase. During periods when progesterone concentrations were high, a greater percentage of parabasal-intermediate cells was observed. In conclusion, this study has characterised the oestrous cycle of the southern hairy-nosed wombat and confirmed that changes in vaginal smears together with pouch and urogenital sinus details could be used to determine signs of oestrus in this species.     

Autonomic innervation and plasma estradiol-17β and progesterone levels in rats with subcutaneous ovarian autografts

Summary Ovaries were removed from female rats and immediately autografted into a subcutaneous pouch in the flank in order to quantitate the relationship of graft re-innervation, steroid secretion and vaginal smear pattern. Animals were killed at three time periods: three days after grafting, on the first day a cornified vaginal smear appeared and at the first metestrus. In addition, control animals were killed at metestrus. Plasma samples were obtained from all rats and analyzed for estradiol-17 and progesterone concentration by radioimmunoassay.At the first day of vaginal cornification after grafting, plasma estradiol-17 (45.8±4.0 pg/ml) was elevated in comparison to controls at metestrus (24.0±2.6 pg/ml), but plasma progesterone (21.5±4.0 ng/ml) was not different (30.6±1.7 ng/ml). Subsequently, at the first metestrus following grafting, plasma estradiol-17 (23.0±3.5 pg/ml) was comparable to control values. In contrast, progesterone was decreased (17.5±1.9 ng/ml). A definite correlation was detected between the vaginal smear and plasma levels of steroid hormones in the castrated female rat with subcutaneous ovarian autografts.Histochemical techniques were used to study the adrenergic and cholinergic innervations of grafts three days after grafting, at the first day of vaginal cornification, and at the first metestrus. No correlation was shown between density of adrenergic or cholinergic innervation and plasma levels of estradiol-17 and progesterone or onset of a cycling vaginal smear.Supported in part by USPHS Grant T01-DE00241-04The authors wish to thank J. Canale, S. Hemelt, E. Schwartz and J. Skaggs for their technical and secretarial assistance. Anti-estradiol-17 antibody was obtained from Dr. I.H. Thorneycroft, University of Southern California School of Medicine, and anti-progesterone antibody from Dr. D. Tulchinsky, Harvard Medical Center     

Reproductive functional anatomy and oestrous cycle pattern of the female brush-tailed porcupine (Atherurus africanus,Gray 1842) from Gabon

In the present study, we examined certain features of the functional anatomy of the female genital tract of the wild brush-tailed porcupine (Atherurus africanus) to obtain data on the reproductive biology of this African forest rodent. Two consecutive experiments were performed. The aim of the first was to establish macroscopic and microscopic features of the genital organs, and to explore correlations between predominant ovarian structures and vaginal contents in 20 wild, mature females. In the second experiment, we inspected the external genitalia and vaginal smears of a further 10 females in captivity on a daily basis for 90 days. The uterus of the brush-tailed porcupine is bicornuate and composed of two separated uterine horns, a uterine body and cervix. The genital tract does not present a vaginal vestibule. Thus, there is no portion common to genital and urinary tracts. Females in the follicular phase of the oestrous cycle showed increased cornification of the vaginal epithelium and a high density of eosinophilic cells in vaginal smears. The vulva and vaginal opening were open, reddish and tumefacted. In luteal phase or in pregnancy, epithelial cornification and eosinophilic features were notably reduced and the vagina presented a pale, non-tumefacted vulva and a vaginal closure membrane. Females in captivity showed spontaneous cycles, a polyoestrous reproduction pattern and, based on features of the external genitalia and vaginal smears, their oestrous cycle length was 27.1+/-6.4 days (n=12).     

Induction of persistent diestrus followed by persistent estrus is indicative of delayed maturation of tonic gonadotropin-releasing systems in rats

The relationship between the amount and duration of administration of estradiol benzoate (EB) to newborn female rats and the induction of sterility was examined in 407 animals. Vaginal smear patterns were classified into 3 types according to the incidence of vaginal proestrus and estrus over a 10-day period: persistent estrous (PE), persistent diestrus (PD), and intermediate (INT), so that the changes in vaginal smear patterns could be analyzed quantitatively. Incidence of the PE pattern was most frequent in the rats that received a single injection of 10 micrograms EB on the day of birth (Day 1). Almost all of the animals receiving 10 daily injections of 10 micrograms EB from Day 1 showed persistent diestrus until at least 100 days of age. In the rats that were given 5 daily injections of 10 micrograms EB Day 1 through Day 5, or a single injection of 100 micrograms EB on Day 3, the incidence of the PD pattern was high at 41-60 days of age, but later the PD-type was replaced by the PE pattern of vaginal smears. In the rats that were treated with 5 daily injections of 10 micrograms EB from Day 1 through Day 5 and were ovariectomized on Day 22, a slight but significant increase in the level of luteinizing hormone in plasma was noted after administration of EB and progesterone on Day 100 but not on Day 50. These results indicated that neonatal injections of EB induce sterility, but the effect is dependent on the amount of EB injected and length of time over which the injections are given.(ABSTRACT TRUNCATED AT 250 WORDS)     

Conditions for establishment of reflex ovulation in light estrous rats.

Continual anovulatory state associating with persistent vaginal cornification (light estrus) was induced by placing 4-day cycling rats under continuous lighting (LL). Uterine cervical stimulation was applied at arbitrary solar hours to light estrous rats showing continual vaginal estrus for more than 2 weeks. The ovulation was induced between 14 and 16 hr after the stimulation dissociating entirely with solar hours. Injection of anti-LHRH serum 5 min after the stimulation but not later than 20 min blocked this ovulation. Ovulation thus induced was always followed by pseudopregnancy with continual leucocytic vaginal smear lasting 10.70 days. The change in concentrations of peripheral serum progesterone during this period was almost similar to that of normal pseudopregnancy except extremely low levels observed at the start and end. Effectiveness of the cervical stimulation for induction of ovulation in light estrous rats was related to not only the duration of light estrus but also the time after transfer to LL, suggesting that the neural mechanism of ovulation in light estrous rats shifted from that of the spontaneous to reflex ovulators due to the extinction of environmental photic cue.     

Repeatability of events during spontaneous and gonadotrophin-induced oestrus in bitches.

Oestrus induction using equine chorionic gonadotrophin and human chorionic gonadotrophin was successful in five out of six bitches, although the first day of increased plasma progestagen concentration differed considerably between bitches. Induced oestrous periods differed from spontaneous cycles in the timing of vaginal epithelial cell cornification; plasma oestrogen concentrations were generally greater and progestogen concentrations were less in induced cycles. These results suggest that this schedule of oestrus induction would not be suitable for allowing mating on a predetermined day.     

Peripheral plasma progesterone: a marker for determining cyclicity in yaks (Poephagus grunniens L.)

An attempt was made to determine cyclicity in yaks using plasma progesterone during the breeding and non-breeding seasons. Fifteen non-lactating yaks were used in this experiment. During the breeding season (July to November), blood samples were collected from 8 yaks at least twice weekly until estrus was observed and then at 2 days interval for 30 days. During the non-breeding season (February to March), blood samples were collected from the same number of yaks at 2-day interval for 30 days. Progesterone was determined in plasma samples by radioimmunoassay. During the breeding season, plasma progesterone at estrus was basal (< or = 0.2 ng/ml). Concentrations increased thereafter with a sharp increase during the late luteal phase, typically reaching peak levels around day 15. Concentrations then declined rapidly over the following 4 days, reaching basal levels at estrus. A high proportion (66.7%) of potential estrous periods (based on progesterone concentrations) went undetected, indicating that silent or weak estrus was a prominent problem in yak cows. During the non-breeding season, three animals were found to be cycling as determined by the patterns of plasma progesterone. Yet, behavioral symptoms of estrus were not observed in any of these yak cows. We conclude that peripheral plasma progesterone concentrations can be used to monitor cyclicity in yak cows effectively.     

Relationships between ovarian morphology, vaginal cytology, serum progesterone, and urinary immunoreactive pregnanediol during the menstrual cycle of the cynomolgus monkey

Three different indices of ovulation and luteal activity were studied in eight regularly cycling cynomolgus monkeys. A significant relation between changes in serum progesterone and immunoreactive pregnanediol (I-PD) in urine was obtained. The occurrence of ovulation could be determined reliably from a change in the ratio of cornified to basal epithelial cells in vaginal smears, and luteal activity could be assessed reliably from daily measurements of urinary pregnanediol. The time of ovulation could be defined more precisely by daily I-PD radioimmunoassays than by the vaginal smear pattern. Measurements of I-PD also have the advantage of ease and noninvasiveness over serum progesterone determinations. More detailed information about changes in hormonal activities could not be obtained reproducibly from thorough examination of cell types in vaginal smears.