Abnormalities and Infertility in Female Small Animals Flashcards
- Daisy is a 9 month old springer spaniel that has had vulval swelling and a sero-sangineous discharge for 30 days
- Is this normal?
- How would you investigate this case?
- When was she last in heat
- What is her behaviour like
- Is she attracted to male dogs
- Is she entire?
She has swelling and discharge
Swelling of vulva and red coloured discharge – makes you think that she is in heat now. Likely in some sort of oestrous now
To confirm this – vagina cytology, but behaviour, swelling and behaviour of discharge is likely enough to indicate oestrus
30 days of this discharge – is this normal? Quite a long time but it can be up to 30 days, its right at the end of the extreme of normal.
Its ‘abnormal’ or extremes of normal, but at the first oestrous this is very common
Prolonged pro-oestrous or oestrous at pubertal cycle is common, especially for first season
May ovulate or may carry on with this for some time to come
When does it become a concern? Usually becomes a concern when owner is concerned! Often worry when owner does!
Other DD possible:
–Something like an ovarian cyst? Very uncommon but possible – also less common in younger animal
–Could be ovarian tumour producing oestrogen, but also uncommon in this young a dog
–Pyometra – is this possible? If its been in oestrous previously and now had a discharge, had all signs for oestrous, but not very likely!!! If it had ovulated a month ago and then comes back, then might be more concerned
Most likely to say do nothing as she will ovulate, or it will go away or will come into oestrous again a few weeks later
What are common endocrine reproductive problems in bitch and queen?
What are common infectious reproductive problems in the bitch and queen?
Discuss mating difficulties for queen and bitch?
Discuss common reproductive problems with pregnancy?
What is normal reproduction in the bitch?
–Normal proestrus and oestrus phases (20d)
–Normal luteal phase (65d)
–Normal anoestrus (150d)
What is normal puberty in the bitch?
- Normal puberty between 6 and 23 months
- Small breeds earlier than larger breeds
- Other effects e.g. working dogs, administration of androgens to prevent oestrus
- Might be concurrent disease that prevents the onset of puberty
What are common problems at puberty?
- Passage through first cycle isn’t always straight forward!
- Delayed puberty
- Prolonged proestrus/oestrus
–Might be extended and ovulation doesn’t occur when you would expect
- Split oestrus
- Silent oestrus
Discuss delayed puberty in the bitch?
Delayed Puberty
•A common problem is the owner not observing the clinical signs of oestrus
–Documented by progesterone measurement (elevated values means oestrus was within last 60 days)
•True delayed puberty
–Caused by systemic disease (including hypothyroidism)
–Caused by slow to reach adult bodyweight
–Caused by chromosomal abnormality
•Should oestrus induction be attempted?
–Probably not before 2.5 years of age
–Consider assessment of karyotype first
–Might not be sure if the animal is the best example of its breed befor we breed with it! Might have other diseases that manifest later in its life such as atopy
Discuss Delayed Puberty in the Queen?
•First oestrus at 6 to 10 months of age
–But influenced by season of birth
–And body weight / condition score
- Puberty frequently occurs during the spring
- If no oestrus behaviour after this then investigate as for prolonged anoestrus
- If born in autumn, 6months of age before they each puberty. If born in summer, often 9 months of age
Discuss Prolonged proestrus / oestrus?
- Follicles present but they do not ovulate, don’t know why they don’t but in other species it has shown that associated with not enough LH or LH receptors, so follicles hang around for a longer period of some. Sometimes they ovulate, sometimes they don’t and they regress and then the dog comes back into oestrous with a short interval
- Can be, and often is, normal (ovulation may be as late as day 32 after onset of vulval bleeding [proestrus])
–Treatment therefore rarely required
•In some cases mating may be at the wrong time
–Induction of ovulation with hCG can be helpful
•Other causes of prolonged oestrus can
include:
–follicular cysts (rare)
–ovarian tumour (rare)
–adrenal tumour (rare)
–non-oestrus attraction (rare)
•A bitch may have vaginitis, so may have a smelly discharge, so the male dogs find this smell attractive and chase her, but she isn’t interested – and its just due to the smelly discharge
Discuss split oestrus?
- Common at puberty
- Bitch has apparent normal oestrus but then oestrus returns a short while later
- Essentially an absence of ovulation
–Oestrus returns 3 weeks to 3 months later
–At this oestrus often ovulation occurs so normal cyclicity from here onwards
•Treatment not required in most cases
–In some cases may
need to induce ovulation
Follicles may regress, no progesterone as they didn’t ovulate, so come back into oestrous with a short interval and most ovulate at the 2nd oestrous – called this as they show signs of oestrus and then they show signs again in a short period of time
Discuss silent oestrus?
Silent Oestrus
- Normal cyclicity without external signs
- Bitch ovulates and has normal luteal phase
–Confirm ovulation by measuring progesterone
•Problems are that oestrus not detected therefore bitch not mated
–Consider weekly vaginal cytology
•Dogs might not show external, overt signs. Might lick vulvar clean, wont see discharge, not that much swelling etc.
Discuss Failure to Cycle?
- Absence of puberty
- Failure to return to oestrus (often described as prolonged anoestrus)
- Animal that has first pubertal oestrous or doesn’t return to normal interval or has an extended interval at some point in its life – 7 months of average for the dog
Discuss prolonged anoestrus in the bitch?
•Commonly associated with failure of observation
–Detected as for delayed puberty
•Occasionally related to:
–Systemic disease
–Drug-induced (corticosteroids, progestogens)
•Consider oestrus-induction (e.g. with Cabergoline [Galastop])
–Licensed use for treating pseudopregnancy but also works well as a method of oestrous induction
Discuss prolong anoestrus in the queen?
Prolonged Anoestrus Queen
- Cyclicity is dependant upon photoperiod
- 14 hours of light per day will abolish anoestrus
- True prolonged anoestrus may be caused by
–Systemic disease
–Exogenous hormones
Discuss failure of ovulation?
- Common in queen associated with inappropriate breeding management (not mated sufficient times on the correct day)
- Seen in some bitches where presentation is ‘split oestrus’
- Queens are induced ovulation so failure of ovulation occurs if she is not bred or if she is not bred enough times when she is in oestrus
Discuss ovulation failure in the queen?
Queen
•Each copulation causes a release of LH BUT;
–< 50% of queens ovulate following a single mating
–>90% of queens ovulate if mated 3 times at 4 hour intervals
- Thus ensure that multiple matings occur on day 2 or 3 of oestrus
- Or consider induction of ovulation with a single injection of 500 IU/cat hCG on day 1 of oestrus
- How would we know if queen not ovulated? Could measure progesterone and see if its gone up and if still low, not ovulated. First question to ask cat breeder – if she doesn’t ovulate, she will come back into season in 2-3 weeks, if she ovulates, she wont come back into heat in 2-3 weeks, if she ovulates and doesn’t get pregnant, she has a pseudopregnancy that lasts 45d – so say to the breeder – when did she come back into season after she’s been mated? If its every 3 weeks, she didn’t ovulate, if its every 45-50d or so, she did ovulate but didn’t get pregnant.
- Queen that ovulate goes out of oestrous quicker than one that doesn’t ovulate
Discuss the LH surge release in queens?
LH surge release
- Some queens will have an LH surge that isn’t large enough to induce ovulation.
- In natural situation, queens will have multiple matings over a short period of time, the next LH surge will start from a higher point which will take it over a threshold – summation of LH surge.
- Vast majority of queens will ovulate if mated regularly over a short period of time.
- Reason it doesn’t happen as owner presents queen to tom early and they only allow a single mating as females get aggressive after mating and tries to attack male.
- So they are often only mated once and it is not enough of a stimuli to get the LH surge above the threshold for ovulation
Optimal mating time in the bitch?
•Physical changes
–Onset of vulval softening occurs one day after the LH surge
- Vaginal cytology
- Vaginal endoscopy – seeing change in appearance of mucosa, becomes swollen and then shrunken and then angulated etc. when oestrogen falls and progesterone rises, get softening of the vulvar
- Measurement of plasma hormone
What are the clinical signs of Vestibulo-vaginal Remnants?
Clinical signs
- Pain at attempted coitus
- Chronic vaginitis in some cases
Treatment
–Transection (via episiotomy)
•Vast majority of vaginitis have an underlying cause. Likely to be something as above in the younger dogs, older dogs likely to be neoplasia, can be foreign bodies – unlikely to be primary bacteria
Discuss vaginal hyperplasia?
•Exaggerated response of the vaginal wall to normal oestrogen concentrations during oestrus
–Ventral vaginal wall thickens
–May prolapse
–Occasionally is circumferential
•Clinical signs
–A mass at the vulval with the bitch in oestrus
–Pain at attempted coitus
•Treatment (see previous lecture)
–Conservative (disappears end of oestrus)
–Surgical resection
–Ovariohysterectomy for prevention
•Before its gets as bad as prolapse of the hyperplasia tissue, like in the middle pic of the top right, penis can bang against this abnormal thickening and this can also cause pain.
Big mass of tissue – big thickened reason, usually on ventral floor of vagina, exaggerated response of vaginal wall. Only present under influence of oestrogen, if you want to breed this dog, could inseminate her.
Discuss Cystic endometrial hyperplasia (CEH) further?
Cystic Endometrial Hyperplasia
- Ultrasound documentation of CEH is common in bitches that fail to get pregnant
- Can see cysts in top picture – bitch may have difficulty getting or staying pregnant as cannot maintain a placenta.
- Condition may lead accumulation of sterile (?) fluid within the uterus
- May progress ultimately after a number of cycles to clinical pyometra
Discuss pyometra?
Pyometra
- Bacterial contamination may occur during oestrus (cervix is relaxed) -> Pyometra
- Most common in middle aged and elderly bitches
- Pyometra may also be induced by:
–therapeutic administration of oestrogens for treatment of unwanted pregnancy
–therapeutic administration of progestogens for prevention of oestrus
- Echogenic material in it
- Wall of uterus is thick in middle pic, can see look with some cystic structures within in. in bottom picture, there is lots of cystic structures apparent – think about the CEH underpinning biology
Discuss bursal cysts?
- It is very common to find cyst-like structures at spay
- These are usually para-bursal in origin and are not significant for cyclicity or fertility
- Cystic structure associated with the ovary but not originating from the ovary – cystic structures associated with broad ligament often don’t come from ovary, so aren’t often endocrinologically active, can just be developmental cysts just close to the ovary – don’t produce hormones or clinical signs. But if you scan this dog, can confuse self and infer some significance from them – difficult to see where they come from. On US, just see fluid filled structures. If they are endocrinologically active and associated with ovary, will produce hormones
Discuss ‘True’ (Functional) Ovarian Cysts?
•True cysts can be follicular and luteal cysts are rare. If they are associated with the ovary, they will produce hormones:
–Follicular cysts produce oestrogen
•Thus signs of persistent oestrus
–Luteal cysts produce progesterone
- Thus signs of acyclicity and occasionally pyometra
- Consider first other differential diagnoses as cysts are uncommon:
–Bitch with persistent oestrus
- prolonged oestrus (young)
- ovarian neoplasia (old)
–Bitch with persistent anoestrus
- Delayed puberty (young)
- Prolonged anoestrus
Ovarian neoplasia (old)
Discuss Functional Ovarian Cysts?
Follicle cysts
–May respond to hCG administration (ovulate and dog goes into luteal phase)
–Or may need suppression with progestogens
–Endoscopic exam, multiple fluid filled structures. Rare condition. Bursa cysts (or within broad ligaments) ARE more common
Luteal cysts
–Usually only diagnosed when OVH because of pyometra. No treatment reported.
Discuss Intersexuality?
- Abnormalities of chromosomal, gonadal or phenotypic sex
- Phenotypic female – owner buys as a female animals
–Clitoris enlarges at puberty, protrudes through the vulvar – often a surprise
–Odd shaped vulva
–Male behaviour
•Phenotypic male – thought to be a male, but when it reaches puberty, gets discharge through penis
–Small penis
–Slit-like prepuce
–May have penile bleeding (oestrus)
–May develop pyometra
- May have ovo-testes
- May have uterus
•Recognition of chromosomal abnormalities requires karyotyping
Discuss canine herpes virus?
Discuss FeLV?
Discuss other causes of resorption/abortion in the bitch?
Discuss other causes of resorption/abortion in the queen?
- Brandy was in oestrus approximately 4 weeks ago and presents today with polydipsia and lethargy
- Naturally you are concerned that is is a pyometra
- What aspects of your clinical examination might be helpful in reaching a diagnosis
- What diagnostic tests might you use and in which order?
- TPR – looking for temperature and basal heart and resp rate
- PUPD
- Might be other disease – in terms of clinical questions, is it PUDP? Is it eating? Any v+/d+? Is it lethargic? What’s temperature? Clearly thinking about general clinical exam, specific repro exam, further diagnostic tests.
- May be that the dog had pyo and might go to surgery
- Repro exam – appearance of discharge from vulvar, could do cytology, diagnostic test for this dog due to history will be US of uterus, or a radiograph but wont be as specific. Further diagnostic tests might be haematology and biochemistry
- Open vs closed – open if cervix is open and lots of discharge. Closed cervix – no obvious discharge. If open, no discharge
- For pyo, surgery predominant choice but high recurrence rate – might try medical in animal if they want to breed from in animal
