BACKGROUND The aims of this study were to establish the incidence of cystic ovarian disease (COD) and its geographical and seasonal variation in Norway, investigate the effect of COD on culling rates, and describe the effects of COD on subsequent reproductive performance and its association to twins. METHODS Diagnosis of COD was made by veterinary surgeons in the field. Four statistical models were made all including herd as random effect: The four different dependent variables investigated were: 1) Diagnosis of COD between 40 and 165 days in milk or not; (n = 511,657); 2) Twins or singleton; data restricted to lactations with new calving (n = 156,661): 3) Culling/removal or not (n = 573,184): 4) Culling due to reproductive problems; data included only lactations which ended in culling (n = 234,232). Model 1, 3 and 4 applied Cox regression models, and model 2 logistic regression. Independent variables were parity, twins/singletons, calving season, herd size, region, COD occurrence in present lactation (if not dependent), and COD diagnosis in previous lactation. RESULTS The incidence was 0.82% per lactation. COD increased with increasing parity, was smallest at herd size between 35 and 85 cows. Cows in 1st parity and calved in spring had lowest hazard of COD and hazard for COD diagnosis was highest in autumn with HR = 2.6 (1.9-3.4) compared to spring. There was an interaction between parity and season. COD incidence was lower south of 60°N. Cows which experienced COD had an increased odds of giving birth to twins OR = 2.2 (1.7-2.7). Of those that were culled, those with COD were culled more frequently because of reproductive problems; HR = 2.1 (1.9-2.3) for higher parity than 2. Having COD diagnosed in the preceding lactation was a hazard for diagnosis in the lactation studied. CONCLUSIONS COD diagnosis is strongly associated with season (autumn calving) and parity. Herds north of 60°N have more COD. Occurrence of COD is associated with twin births as well as culling due to reproduction.