Equine health encompasses the study and management of diseases, disorders, and overall well-being of horses. It involves understanding various physiological systems, preventive care, and treatment strategies to maintain optimal health in equine populations. Common areas of focus include nutrition, infectious diseases, orthopedic conditions, and reproductive health. Research in equine health aims to advance knowledge on diagnostic methods, therapeutic interventions, and management practices that improve horse welfare and performance. This page collects peer-reviewed research studies and scholarly articles that explore the diverse aspects of equine health, offering insights into current findings and advancements in the field.
Habel RE, Budras KD.Analyses of the fibers in the prepubic tendon of the horse and ruminants have shown that it is composed of the crossed and uncrossed tendons of origin of the pectineus muscles, the pelvic tendons of the rectus and obliquus abdominis muscles, and the tendons of origin of the cranial parts of the gracilis muscles. Pelvic attachments of the linea alba and the yellow abdominal tunic are incorporated in it. It is not a transverse ligament, and it is not homologous to the human superior (cranial) pubic ligament. The dog differs in 4 respects: (1) the pectineus tendons do not cross, but each originat...
van Weeren PR, Jansen MO, van den Bogert AJ, Barneveld A.Hind limb kinematics were recorded in five horses at walk and trot using an opto-electronic CODA-3 system. Simultaneously, in vivo strain in the completely tendinous peroneus tertius muscle was registered by implanted mercury-in-silastic strain gauges. The origin-insertion length patterns of the peroneus tertius were calculated from raw kinematic data and from data corrected for the error caused by skin displacement, and compared with the directly measured strain. The strain patterns calculated from externally measured kinematic data appeared to be in accordance with the directly measured stra...
Coyne CP, Smith JE, Keeton K.A selected group of pharmaceutical compounds were evaluated for the ability to inhibit the biochemical activity of fibrinoligase (coagulation factor XIIIa*) in pooled equine plasma. Criteria for the pharmaceuticals selected were based on the mechanism of the transglutamination biochemical reaction mediated by coagulation factor XIIa*. These criteria were complemented by recognition of the molecular configuration and chemical composition of amino acid residue side chains involved in the process of covalent fibrin monomer polymerization (cross-linking, transglutamination) mediated by this enzyme...
McConnico RS, Roberts MC, Tompkins M.A 5-year-old female American Quarter Horse was determined to have immune-mediated hemolytic anemia after detection of a positive response to a direct Coombs' test. Penicillin-induced immune-mediated hemolytic anemia was confirmed via a direct antiglobulin test, using penicillin-coated RBC. The horse was clinically improved and the anemia resolved in response to supportive care and discontinuation of penicillin treatment. Penicillin should be considered a possible cause of immune-mediated hemolytic anemia in horses.
Muesing RA, Miller VT, LaRosa JC, Stoy DB, Phillips EA.Administration of conjugated equine estrogen to 31 postmenopausal women for 3 months produced 14.6% and 9.4% decreases in low density lipoprotein cholesterol (LDL-C) and apolipoprotein-B (apoB), and 11.5%, 12.7%, and 9.6% increases in high density lipoprotein cholesterol (HDL-C), apoA-I and apoA-II, respectively. Phospholipids of HDL2 and HDL3 were increased 57.9% and 19.3%, respectively, while relatively small increases in cholesterol of the two subfractions were not significant. Compositions of LDL and HDL and its subfractions were altered substantially with estrogen treatment. The proportio...
Blikslager AT, Bowman KF, Haven ML, Tate LP, Bristol DG.The medical records of 17 horses that were evaluated and treated because of colic caused by pedunculated lipomas between 1983 and 1990 were reviewed. The mean age of the horses was 16.6 +/- 3.9 years (range, 10 to 26 years), which was significantly greater than that of the population of horses evaluated because of colic (control population) during the same period. There were significantly more geldings (76.5%), compared with the control population. Nasogastric reflux ranged from 1 to 16 L in 8 horses and was not obtained in 9 horses. Abdominal palpation per rectum revealed small intestinal dis...
Chambers TM.A novel strain of equine influenza virus, influenza A/equine/Jilin (China)/1/89, has emerged which is genetically distinct from all earlier strains of equine influenza. It is therefore possible that the vaccines against equine influenza may be unable to protect horses against disease caused by this virus strain. In vitro serological assays established that there were low levels of immunological cross-reactivity between the new virus, the current vaccine strains and the strains of equine-2 influenza virus now in circulation.
Reimer JM, Reef VB, Sweeney RW.Ventricular premature depolarizations (VPD) were identified in 21 horses in which unexplained tachycardia or an arrhythmia was detected on auscultation. Horses were categorized into 3 groups on the basis of ECG findings. Seven horses had uniform isolated VPD (group 1); 7 horses had repetitive uniform VPD at a rate or = 100 VPD/min (group 3). Concurrent systemic disease was identified in 12 horses, 7 of which had gastrointestinal tract disorders. Serum cardiac isoenzyme activities were high in 6 (2 from each group) of 13 horses in which they were measured. Serum electrolyte concentrations were...
Squire KR, Adams SB.A 450-kg yearling Clydesdale filly was determined to have bilateral ectopic ureters. The resulting incontinence caused severe malodorous perineal dermatitis. Bladder capacity was measured at 800 ml. The urethral sphincter lacked tone, and the horse was seen to urinate in a normal manner only 2 or 3 times a week. A midline celiotomy was performed, and the ureters were identified by cannulation from the ectopic openings. The ureters were ligated, and the cut ends were anastomosed to the dorsal bladder surface by an extravesicular end-to-side technique. A partial thickness seromuscular layer of t...
Dart AJ, Snyder JR, Spier SJ, Sullivan KE.Packed cell volume, total plasma protein, serum sodium, potassium, and ionized Ca2+ concentrations, and blood pH were determined at the time of admission and following surgery in 147 horses with acute abdominal crisis. Horses were allotted to 3 categories on the basis of the surgical lesion: (1) nonstrangulating obstruction of the ascending or descending colon (category A, n = 76), (2) strangulating and nonstrangulating infarction of the cecum or ascending colon (category B, n = 37), and (3) strangulating and nonstrangulating infarction of the small intestine (category C, n = 25). Horses with ...
Squire KR, Adams SB, Widmer WR, Coatney RW, Habig C.A 5-year-old Arabian stallion with moderate effusion in the right carpal canal and intermittent lameness in this limb was diagnosed to have an osteochondroma projecting from the distal portion of the radius into the carpal canal. oral phenylbutazone treatment over the next 3 years allowed the stallion to continue its show career. Right forelimb lameness returned at that time, and ultrasonography revealed the osteochondroma impinging on the dorsal surface of the deep digital flexor tendon. The owner elected to have the osteochondroma surgically removed. The horse was anesthetized, and the carpa...
Lester GD, MacKay RJ, Smith-Meyer B.Primary meningeal lymphoma was diagnosed in an 18-year-old Morgan gelding. The horse was examined because of a 3-day history of progressive ataxia and weakness. The gait abnormalities were worse on the left side, and the pelvic limbs were more affected than the thoracic limbs. Additional findings included signs of depression, miosis of the left pupil, ptosis of the left upper eyelid, and areas of muscle atrophy on the left side of the neck and over the dorsal aspect of the left scapula. Inflammatory changes were evident in the CSF. At necropsy, there was diffuse and irregular thickening of the...
Henninger DD, Snyder JR, Pascoe JR, Dilling GW.The normal microvascular permeability of the ascending colon in horses and the microvascular permeability of that segment after ischemia and reperfusion were investigated. Microvascular permeability was estimated by the ratio of lymphatic protein to plasma protein concentration (Cl/Cp) at high lymph flow rates in 8 adult horses in 2 equal groups: normal and ischemic (2-hour period). Lymphatic flow rates and lymph and plasma protein concentrations were determined. Intestinal biopsy specimens were obtained at the end of each experiment. Flow independent values were selected and compared by one-w...
Robertson SA, Green SL, Carter SW, Bolon BN, Brown MP, Shields RP.Anesthesia and surgery in a Quarter Horse affected with hyperkalemic periodic paralysis resulted in euthanasia after 7 days of postoperative recumbency. Initial recovery was uneventful after extensive sinus surgery, but within 2 hours, the horse had severe muscle weakness. Plasma electrolyte concentrations were within the normal range during the period of recumbency. There was no clinical or laboratory evidence of severe muscle damage. Despite treatment with acetazolamide, isoproterenol, and intensive nursing, the horse was unable to stand for more than a few seconds and developed severe decub...
Boatwright RB, Williams DO, Rugh KS, Sarazan RD, Ross CR, Garner HE, Griggs DM.Coronary collateral growth was stimulated in chronically instrumented conscious ponies by a previously validated intermittent coronary occlusion method. Changes in regional myocardial function (sonomicrometry) and reactive hyperemia (Doppler method) were used to monitor collateral growth and to program measurements of regional myocardial blood flow (microsphere method). A serial analysis of the transmural and lateral distributions of collateral blood flow was performed at the native and three superimposed levels of collateral growth. Results in nine animals undergoing an average of 553 +/- 188...
Granstrom DE, Alvarez O, Dubey JP, Comer PF, Williams NM.Schizonts of Sarcocystis neurona were identified microscopically in hematoxylin-eosin-stained spinal cord sections from 2 native Panamanian horses that exhibited clinical signs of equine protozoal myelitis (EPM). Spinal cord homogenate from a third Panamanian horse with EPM was inoculated onto monolayers of cultured bovine monocytes (M617). Intracytoplasmic schizonts containing merozoites arranged in rosette forms surrounding a central residual body first were observed 13 wk postinoculation. Parasites divided by endopolygeny and lacked rhoptries. Schizonts from each horse reacted with Sarcocys...
Pfeiffer CJ, Dabareiner RM.Investigation of the duodenal submucosal glands of Brunner in the horse for the first time at the ultrastructural level has clarified some of the unique features of these equine glands. The horse is one of the very few mammals in which Brunner's glands are comprised of both mucous and serous tubuloacinar glands. Although the ultrastructural differences between the serous and mucous cell types are marked, particularly with respect to secretory granules and rough endoplasmic reticula, these cell types closely correspond to serous and mucous cells in the upper digestive system of other mammals. A...
Bermúdez VM, Miller RB, Rosendal S, Fernando MA, Johnson WH, O'Brien PJ.The cytopathic effects induced by five strains of Mycoplasma equigenitalium for cells of equine uterine tube explants were tested by measuring changes in cellular and extracellular concentrations of calmodulin (CaM). Calmodulin concentrations in samples of total homogenate (TH) and total homogenate supernates (THS) of the infected equine uterine tube explants were significantly lower than respective measurements on noninfected controls. In tissue culture medium fractions (TCM) of some infected explants, CaM concentrations were significantly higher than noninfected controls (p > 0.95). The r...
Sweeney CR, Weiher J, Baez JL, Lindborg SR.The endobronchial anatomy of 12 lung specimens from horses and 12 healthy, standing, sedated horses was evaluated, using a 200-cm-long, 9.5-mm-diameter videoendoscope. On the basis of these findings, the nomenclature system of Amis and McKiernan was modified for identification of airways of horses during bronchoscopy. Lobar bronchi are identified on the basis of the side of the bronchial tree on which they were found and the order in which they originated from the primary bronchus. Thus, RB1, RB2, and RB3 referred to right cranial lobar bronchus, respectively. On the left side, the designation...
Traub-Dargatz JL, McKinnon AO, Thrall MA, Jones RL, Bruyninckx W, Blancquaert AM, Dargatz DA.We evaluated the efficacy of 3 treatments for chronic obstructive pulmonary disease in horses: prednisone (400 mg/horse, PO, daily; n = 7), methyl sulfonmethane (10 g/horse, PO, q 12 h; n = 6), and clenbuterol hydrochloride (0.4 mg/horse, PO, q 12 h; n = 7). A fourth group acted as controls (n = 6) and was not treated. The treatment period lasted 10 days. Each horse was a member of 2 different groups for 10 days, separated by an 18-day interval of no treatment. All horses were housed together in an outdoor pen without bedding. Horses were fed alfalfa/grass hay mix ad libitum from a large feede...
Murray MJ, Schaudies RP, Cavey DM.Epidermal growth factor (EGF)-like activity was measured in mares' colostrum and milk by radioreceptor assay. Milk samples were collected from 22 mares 1 or more times during early lactation. Samples of colostrum were taken after parturition and before the foal first suckled (presuckle), within 6 hours after the foal first suckled (postsuckle), and on days 1, 2, 4, and 8 of lactation. In the 5 mares from which milk samples were obtained at each sampling time, presuckle colostral mean EGF-like activity (17.8 ng/ml) was greatest (P less than 0.05). The mean values for EGF-like activity at all ot...
Broadstone RV, Gray PR, Robinson NE, Derksen FJ.The effect of IV administration of the alpha 2-adrenoceptor agonist xylazine hydrochloride (0.5 mg/kg of body weight) was examined in ponies with recurrent obstructive pulmonary disease, commonly called heaves. Six ponies with the disease (principals) were studied during clinical remission and during an acute attack of airway obstruction precipitated by stabling and feeding of dusty hay. Six control ponies were also studied. In principal ponies with airway obstruction, xylazine administration significantly (P < 0.05) decreased pulmonary resistance and increased dynamic compliance, but did n...
Levionnois OL, Mevissen M, Thormann W, Spadavecchia C.The objective of this study was to assess a pharmacokinetic algorithm to predict ketamine plasma concentration and drive a target-controlled infusion (TCI) in ponies. Firstly, the algorithm was used to simulate the course of ketamine enantiomers plasma concentrations after the administration of an intravenous bolus in six ponies based on individual pharmacokinetic parameters obtained from a previous experiment. Using the same pharmacokinetic parameters, a TCI of S-ketamine was then performed over 120 min to maintain a concentration of 1 microg/mL in plasma. The actual plasma concentrations of ...
Steiger R, Feige K.A 13 year old Thoroughbred gelding was presented with a history of a single episode of collapse during mild exercise. Clinical examination revealed a high packed cell volume (PCV) of 72%, a haemoglobin concentration of 24.9 g/l and 15.2 millions erythrocytes/microliters. Despite continuous intravenous infusion therapy with large volumes, the PCV never decreased to a physiological level. The animal showed a normal appetite and no signs of discomfort or syncope. Arterial blood gas values were in the normal range as well as the concentration of erythropoietin (measured by radioimmunoassay, RIA). ...
Turek B, Potyński A, Wajler C, Szara T, Czopowicz M, Drewnowska O.Diaphyseal fractures of the III metacarpal bone represent 22% of all fractures of the long bones in horses. Treatment of such cases is difficult. The most popular solution used in these types of fractures is two plates applied directly to the bone surface, but they are not applicable on contaminated and infected fractures. External fixators are quite commonly used in human medicine, although in veterinary practice there is no typical stabilizer designed for the treatment of diaphyseal fractures of the III metacarpal bone so far. In this study, an external semicircular fixator of our own design...
Sullivan HM, Barrett MF, Zhou T, Kawcak CE.Ultrasound remains a mainstay in proximal suspensory ligament (PSL) evaluation. Despite recent improvements facilitating earlier diagnosis/treatment, needs exist for (1) characterization of normal ultrasonographic PSL cross-sectional area (CSA) in specific breeds/disciplines, (2) improved detection of early/subtle changes in the PSL, and (3) an understanding of suspensory ligament (SL) morphology change from work-related stress. The objectives of this study were to establish normal PSL CSA in Quarter Horses (QH) used for cutting via angle contrast ultrasonography, ultrasonographically monitor ...
Miller SM, Stover SM, Taylor KT, Zarucco LA.A technique was developed for arthrocentesis of the palmaroproximal pouch of the pastern joint. The landmark for percutaneous puncture is a 'V' shaped depression formed by the palmar aspect of the proximal phalanx (P1) dorsally, an eminence associated with the attachment of the collateral ligaments to P1 and the middle phalanx distally and the insertion of the lateral branch of the superficial digital flexor tendon palmarodistally. Comparison of arthrocentesis between the palmaroproximal approach and the traditional dorsal approach in 8 cadavers and 8 horses demonstrated that the palmaroproxim...
Faramarzi B.Hoof health is a major concern of horse owners as well as the equine industry. However, many questions remain concerning regional variations of laminar junction and its potential to remodel. Objective: To examine regional variations in the morphology of the laminar junction and thickness of the hoof wall in Thoroughbred horses. Methods: The forefeet of 25 Thoroughbred cadavers were examined. Each hoof was divided into 20 blocks through 4 proximodistal slices (below the coronary band, each 1 cm apart) and 5 circumferential positions (toe, medial and lateral quarters and heels). In each block, 2...
Doyle AJ, Freeman DE, Sauberli DS, Hammock PD, Lock TF, Rötting AK.Two mares were evaluated because of chronic uterine torsions of 2 and 4 weeks' duration; both were pyrectic, anemic, tachycardic, and anorectic, had signs of depression, and had an abnormal uterus and contents on transrectal examination. Both mares underwent cesarean section for lysis of adhesions from the uterus to the peritoneum, correction of the torsion, and ovariohysterectomy Both mares recovered with only minor complications and returned to be used as riding horses. Chronic uterine torsion should be considered in mares in late stages of gestation that have vague clinical signs and transr...
Kerr CL, Bouré LP, Pearce SG, McDonell WN.To evaluate cardiopulmonary effects of anesthetic induction with diazepam and ketamine or xylazine and ketamine, with subsequent maintenance of anesthesia with isoflurane, in foals undergoing abdominal surgery. Methods: 17 pony foals. Methods: Foals underwent laparotomy at 7 to 15 days of age and laparoscopy 7 to 10 days later. Foals were randomly assigned to receive diazepam, ketamine, and isoflurane (D/K/Iso; n = 8) or xylazine, ketamine, and isoflurane (X/K/Iso; 9) for both procedures. Results: During anesthesia for laparotomy, cardiac index, and mean arterial blood pressure ranged from 110...
Svalastoga E, Reimann I, Nielsen K.Histological and histochemical investigations of the fibrocartilage of facies flexoria from navicular bones of horses with navicular disease have shown alterations similar to those described in the hyaline articular cartilage in osteoarthritic joints.
Bastos HB, Kretzmann NA, Santos GO, Esmeraldino AT, Rechsteiner SF, Mattos RC, Neves AP.The period from the emergence of a dominant follicle until its formation requires tissue remodeling. Enzymes promoting collagen lysis, such as matrix metalloproteinases (MMPs), are fundamental for the process of extracellular matrix remodeling, which allows changes in ovarian tissue architecture during follicular growth. It has been suggested that the production of these enzymes may be affected by the rise in circulating concentrations of LH, which acts on the ovarian surface epithelium (OSE). The aim of this study was to determine the expression of MMP-1, MMP-2, and LH receptor (LHR) in the o...
Amat JP, Vergne T, Tapprest J, Ferry B, Hans A, Hendrikx P, Dufour B, Leblond A.Equine viral arteritis (EVA) may have serious economic impact on the equine industry. For this reason, it is monitored in many countries, especially in breeding stock, to avoid its spread during breeding activities. In France, surveillance is mainly based on serological tests, since mares are not vaccinated, but difficulties in interpreting certain series of results may impair the estimation of the number of outbreaks. In this study, we propose specific rules for identifying seroconversion in order to estimate the number of outbreaks that were detected by the breeding stock surveillance compon...
Jones LE, Dyson SJ.To describe in detail the radiographic appearance of ossified ungular cartilages in horses and to evaluate the usefulness of a flexed dorsolateral-palmaromedial oblique (flexed oblique) radiographic view in evaluating the ungular cartilages. Methods: Retrospective case series. Sample-Radiographs of 1,255 front feet of horses. Methods: Ossification of the ungular cartilages was graded during evaluation of radiographs on a scale from 0 to 5; feet with cartilages with an ossification grade ≥ 2 were included (386 feet [271 horses]). The shape (straight, curved outward or inward, and dorsopalmar ...
Gross DK, Morley PS, Hinchcliff KW, Reichle JK, Slemons RD.The purpose of this investigation was to determine if naturally occurring acute infectious upper respiratory disease (IRD) caused by equine influenza virus is associated with ultrasonographically detectable pleural and pulmonary abnormalities in horses. Standardbred racehorses were evaluated for signs of IRD, defined as acute coughing or mucopurulent nasal discharge. For every horse with IRD (n = 16), 1 or 2 horses with no signs of IRD and the same owner or trainer (n = 30) were included. Thoracic ultrasonography was performed within 5-10 days of the onset of clinical disease in horses with IR...
Jones DL, Barber SM, Jack SW, Doige CE.Gross and microscopic effects of arthroscopic partial synovectomy on synovium and articular cartilage of middle carpal joints were studied in 15 horses. A 7-mm diameter motorized synovial resector was inserted into each middle carpal joint and arthroscopic partial synovectomy and lavage or arthroscopic lavage alone was performed. Study periods were 0 (three horses), 16 (three horses), and 30 days (six horses). No gross evidence of degenerative joint disease was observed at day 16 or 30. At 30 days, resected areas lacked villi and there was deposition of fibrin on the synovial surface with vary...
Marble GP, Sullins KE.To evaluate the use of arthroscopy as the primary method for removal of large patellar fracture fragments. Methods: Retrospective study. Methods: 5 performance horses of various breeds with patellar fractures. Methods: Clinical signs of lameness, external evidence of injury, and radiography were used to diagnose and determine fracture orientation. Arthroscopy of the stifle joint was performed on the affected limb with the horse positioned in dorsal recumbency and under general anesthesia. Progress after surgery was determined by evaluating medical records and via telephone conversations with o...
Klohnen A, Wilson DG, Hendrickson DA, Cooley AJ, MacWilliams PS.To evaluate the bactericidal properties of chlorhexidine diacetate (CHD) after potentiation with EDTA and Tris buffer (EDTA-Tris), and to find a potentiated CHD concentration that would achieve 90 to 100% killing for all bacteria tested. Methods: 6 adult ponies. Methods: Serial dilutions of CHD, CHD in EDTA-Tris and EDTA-Tris alone were evaluated for bactericidal activity against Staphylococcus aureus, Escherichia coli, and Streptococcus zooepidemicus. The tarsocrural joints of 6 ponies were lavaged with either 1 L phosphate-buffered saline solution (control) or 1 L of 0.0005% CHD in EDTA-Tris...
Manohar M, Goetz TE, Rothenbaum P, Humphrey S.The present study was carried out to examine whether pentoxifylline administration to horses premedicated with frusemide would attenuate the exercise-induced pulmonary arterial, capillary and venous hypertension to a greater extent than frusemide alone, thereby affecting the occurrence of exercise-induced pulmonary haemorrhage (EIPH). Using established techniques, we determined right heart and pulmonary vascular pressures in 6 healthy, sound Thoroughbred horses at rest and during exercise performed at maximal heart rate at a workload of 14 m/s on 3.5% uphill grade in the control (no medication...
Brankston G, Rossi TM, O'Sullivan TL, Greer AL.This retrospective study describes testing patterns and the incidence of subsp. in Ontario to assess the utility of laboratory data for surveillance purposes. Laboratory records for equine infectious disease test submissions were extracted from the Animal Health Laboratory (AHL) at the University of Guelph for the years 2008 to 2018. Yearly and seasonal trends in testing and the proportion of tests that returned positive results were assessed. The number of samples submitted for testing decreased over the 11-year period (odds ratio = 0.96, 95% confidence interval: 0.92 to 0.999; = 0.04). ...
Senderska-Płonowska M, Zielińska P, Żak A, Stefaniak T.Heel contraction is an undesired but common condition in domestic horses. Some authors indicate shoeing as a risk factor. There is a correlation between shoeing and a restriction of heel expansion, but the clinical significance is unknown. This study aimed to evaluate the influence of shoeing and other risk factors, such as age, access to paddock, and breed, on heel contraction. This study included 114 horses, 55 of which were barefoot their whole life and 59 had been shod consistently for at least the previous year. The width and length of the frog were measured. Linear mixed-effects models w...
McD￮ LA.Stem cell therapy and cell-based therapies using other progenitor cells are becoming the treatment of choice for many equine orthopedic lesions. Important criteria for obtaining autogenous equine progenitor cells in vitro for use in clinical cell-based therapy include the ability to isolate and expand cells repeatedly to high numbers (millions) required for therapy, in a clinically relevant time frame. Cells must also maintain their ability to differentiate into the tissue type of choice. The objective of this study was to compare isolation and expansion techniques for preparation of periostea...
Lawler DF, Brazil TJ, Dagleish MP, Watson ED.This study investigated the chemotactic activity of equine CL at different stages of the oestrous cycle. The purpose of this was to ascertain whether luteal tissue itself contributes to the massive influx of leucocytes around the time of natural and induced luteal regression. Corpora lutea were collected at different stages of dioestrus and after treatment with PGF2alpha. Culture medium harvested after incubation of luteal tissue for 20 h was chemotactic for both polymorphonuclear and mononuclear cells in late dioestrus (before functional regression) as well as after natural and induced luteal...
