Clinical Conditions of the Female Causing Infertility Flashcards
What are the 6 diseases of the ovary
1) ovarian tumours
2) ovaritis/ ovarian abscess
3) paraovarian cysts
4) cystic ovarian disease (COD)/ ovarian cysts
5) ovarian hematoma
6) spring transitional ovaries
what species can get ovarian cysts
cows, mares, bitch
what determines the clinical signs produced by an ovarian tumor
the type of hormones produced -> can also be an incidental finding on a rectal exam
what is the most common type of ovarian tumor
granulosa-theca cell tumor aka G(T)CT or GCT
what are the clinical signs of G(T)CT based on:
- if producing testosterone
- if producing estrogen
- inhibin production
- if producing testosterone: stallion-like behaviour (aggressive, hard to handle, mounting other mares)
- if producing estrogen: persistent estrus, nymphomania in cows
- inhibin production: inhibits FSH so the contralateral ovary is very small
what do you find on physical exam of a mare with a G(T)CT
1) one ovary is very small and one ovary is very large
2) loss of ovulation fossa on large ovary
3) variable appearance (cystic or solid) on ultrasound, but usually cystic
we suspect a granulosa theca cell tumor based on rectal exam and history of a mare; how can we confirm this?
histopathology and laboratory testing
what does the GCT panel test for (3)
- testosterone
- inhibin
- AMH
T/F elevated inhibin and testosterone level can provide earlier detection of GCT than elevated AMH
F; other way around
how do bovine GCT’s present and how do we treat
Presentation:
- infertility
- unretractable uterus
- very large, lumpy ovary
- aggressive, bull-like behaviour
Treatment:
- unilateral ovariectomy
why do we perform unilateral ovariectomy for a cow with a GCT
to stop the unwanted behaviour (note, they rarely metastasize)
how long does it take a cow to resume cycling after removing a granulosa-theca cell tumor and why
several months, due to inhibin
what is the appearance of an ovarian teratoma
- from embryonic origin so you will see teeth, hair, bone, cartilage, etc
serous cystadenoma:
- where do they arise from
- what is their impact on cycling and behaviour
- what hormones produced
- relative occurrence
- lining epithelium of ovulation fossa
- no impact
- none
- rare
what are paraovarian cysts formed from
remnants of the mesonephric ducts
how are paraovarian cysts diagnosed
incidental on ultrasound
what is the effect of paraovarian cysts on fertility and what is the treatment
no effect, no treatment
how do we differentiate transition follicles from tumors? what can be similar
Differentiate:
- both ovaries enlarged
- palpable ovulation fossa
- normal hormone levels
Similar:
- appearance on U/S can resemble a GCT
how are ovarian hematomas diagnosed
- usually incidental
- history of pain
- rarely, abdominal bleeding
what is the treatment for an ovarian hematoma
- give 4-6 weeks to let it regress
T/F ovarian hematomas often rupture into the abdomen, causing death
F; this happens rarely
what is the most common cause of a large tumor in cows
cystic ovarian disease
what is the DEFINITION of a cystic ovary
- persist for longer than 10 days
- absence of a CL
- greater than 2.5cm diameter
up to 70% of cows with endometritis/pyometra also have: (3)(5)
- salpingitis/ hydrosalpinx
- bursal cysts/ bursitis
- ovaritis
what are 2 common consequences of oviductal disease
oviductal blockage or bursal adhesions
what are bursal adhesions and what is a consequence
- adhesions between ovary and fimbria
- can result in infertility due to impaired oocyte pickup
what happens when a bursal adhesion becomes severe
fluid accumulation -> bursal cyst
how do we diagnose and how do we treat oviductal blockage in mares
1) diagnosed by exclusion, aka we rule out all other causes of infertility
2) treat with PGE2 gel application onto oviduct or oviductal opening -> contractions -> clears blockage
what are the 6 conditions of the cervix
1) cervicitis
2) fibrotic cervix
3) cervical tears
4) tumors, polyps
5) segmental aplasia and double cervix
6) varicose veins
what causes cervicitis and how is it diagnosed and treated
- due to an underlying cause resulting in chronic irritation (trauma, air, feces, urine, endometritis)
- diagnosed by vaginoscopy
- treated by fixing the underlying cause
what is often the underlying cause of cervicitis
endometritis
what causes cervical tears in
- mares
- cows
mares: often when there is a “normal” appearing foaling or a dystocia
cows: often when a cow is pulled before the cervix is fully dilated
how do we diagnose cervical tears
- palpate on vaginal exam
- visualize with vaginoscope
how do we treat cervical tears
surgically
note: severe trauma often leads to adhesions and stenosis
when is surgical repair indicated to treat a cervical tear
greater than 50% of the length of the cervix is affected
what is the long term treatment for cervical tears:
often has to be retreated after subsequent foaling, so the best long-term prevention is embryo transfer
how is double cervix diagnosed and what is its common presentation
- vaginoscopy or infertility
- can be complete (each opens into their own horn) or partial (open into a common uterine body)
what causes double cervix
incomplete fusion of paramesonephric ducts
where can varicose veins be found
- cervix
- hymen of vagina
what is the most common cause of frank bloody discharge during pregnancy
varicose veins
how do we treat varicose veins
- minor: apply preparation H
- major: surgical laser or ligature cautery
what are the 7 conditions of the vagina, vestibule, vulva
1) itis (vaginitis, vestibulitis, vulvitis)
2) pneumovagina
3) urovagina
4) vaginal cysts (cystic Gartner’s ducts)
5) persistent hymen
6) tumors
7) perineal lacerations
how do we treat vaginitis
fixing the underlying cause (IBR or ureaplasma common in cows)
what causes a persistent hymen
failure to canalize the paramesonephric duct system at the level of the urogenital sinus during development
how does a complete persistent hymen appear
protruding pink membrane from vulva of a maiden filly
what is a consequence of a complete persistent hymen
fluid accumulates anterior to it (in vagina and uterine body)
what causes vaginal cysts? how are they diagnosed? how are they treated?
remnants of the mesonephric ducts; incidental finding usually; large cysts are drained
you see a cow with a large protruding mass in the lateral wall of the vulva… what is on your list of differentials
1) cystic Bartholin’s glands
2) tumor (need to rule out)
what causes cystic Bartholin ducts to form
obstruction of the duct of the vestibular glands in the lateral wall of the vulva
what are 3 common vaginal tumors
1) fibrosarcoma
2) leiomyoma
3) squamous cell carcinoma
how do vaginal tumors present and what is an important differential in bitches and in pregnant, late gestation cows
Presentation
- vaginal discharge
- self-mutilation
Differential
- bitches: vaginal hyperplasia
- cows: vaginal prolapse
what are the types of perineal lacerations (severity)? when do they usually occur
- first degree
- second degree
- third degree
Usually occur at parturition
what defines a first degree perineal laceration? how is it treated?
- minor tear of the dorsal commisure of the vulva
- limited to skin and mucous membrane
- clean, debride and suture
what defines a second degree perineal laceration and how do we treat
- tear of skin, mucous membrane and extension into muscle layer
- debride and suture if fresh OR allow to granulate if too old
what defines a third degree perineal tear, what are the consequences and what is the treatment
complete tearing of the shelf between rectum and vulva; fecal contamination with resultant inflammation; must wash and debride daily for 6-8 weeks until healthier tissue forms, then surgically repair
what is the prognosis for a third degree perineal tear
good for future breeding and fertility
what is a rectovaginal fistula and how is it diagnosed and then treated
hole between vagina and rectum typically formed by the foal during parturition
diagnosed on post-partum exam, or by feces in vagina
treatment by conversion to a third degree perineal tear, then repair
what are the 5 uterine conditions that can cause infertility
1) segmental aplasia and intersex conditions
2) uterine infections (metritis, endometritis, pyometra)
3) uterine cysts in mares
4) degenerative endometrial fibrosis in mares
5) uterine tumors
what causes segmental aplasia
lack of development of a portion of the paramesonephric duct system
why might an animal with segmental aplasia be falsely diagnosed as pregnant
fluid accumulation in the cranial parts of the tract often occurs
animals with segmental aplasia most often present for what
infertility
segmental aplasia causes _____________ disease in __________ (breed of ________)
white heifer disease; white shorthorns; cattle
a heifer presents for pregnancy check; you notice a small vulva and a big tuft of fur at the bottom of it….
what is this condition?
freemartin (chimerism)
what changes occur in a freemartin heifer?
- hypoplastic vulva and vagina
- underdeveloped ovaries and uterus
- enlarged clitoris
- seminal vesicles present
what causes freemartins
placental vascular anastamoses results in the male fetus influencing the female reproductive tract
how is chimerism diagnosed
physical exam findings; PCR for Y-specific sequence
what is the range in appearance of equine DSD or intersex
- normal appearing female with male behaviour to an clitoromegaly and a long ano-genital distance
how does equine DSD commonly present
inappropriate stallion-like behaviour in an (apparent) filly
T/F persistent mullerian duct syndrome and polled intersex syndrome are examples of intersex conditions in dogs and goats, respectively
T
match the following:
1) endometritis
2) metritis
3) pyometra
4) mucometra
5) septic metritis
a) pus accumulation in uterus, with CL retained
b) mucous accumulation in uterus
c) inflammation of endometrium, animal is not systemtically ill
d) inflammation of all 3 uterine layers, animal is systemically ill
e) early postpartum, toxic infection, acute, severe illness
1) c
2) d
3) a
4) b
5) e
why is the CL retained in the case of pyometra
1) damage to endometrium, so it is not able to produce PGE2 and cause luteolysis
2) production of luteotropic PGEs from WBCs present in the pus
what are the clinical signs of pyometra in cows
1) greater than 25 days postpartum (after first ovulation has occurred)
2) large, fluid-filled uterus
3) anestrus
4) may see vaginal discharge
5) cows are not sick
the prognosis for pyometra is ____________ depending on ___________
guarded to poor; chronicity
how do you treat pyometra?
how do you prevent it?
- 2 PGF2a injections, 2 weeks apart
- prevent by examining all cows by 30 days postpartum
how does pyometra present in the mare? how is it caused? how is it treated?
- presents as periodic vaginal discharge
- usually due to cervical trauma
- previously treated by hysterectomy; now treated with cervical wedge resection, lavage and antibiotics
T/F there is a way to treat pyometra in the mare without causing infertility
F
how does pyometra present in the bitch
- open: vaginal discharge 4-6 weeks after a heat
- closed: sick, no discharge
how is pyometra treated in the bitch
- spay
- medical treatment for breeding bitches
what is associated with pyometra in the bitch
cystic endometrial hyperplasia, due to prolonged exposure to progesterone
mucometra in cows is secondary to ______________ or associated with ______________
cystic ovarian disease; segmental aplasia
how do you treat mucometra in cows
1) ovsynch/PGF2a/treat underlying COD
2) cull if segmental aplasia
what is one of the most common medical conditions reported in equine practice and is generally a condition of the postpartum period in cows?
endometritis
endometritis results in
infertility
what are the 3 types of endometritis in the mare
1) persistent breeding induced
2) acute
3) chronic
chronic endometritis is characterized by (2)
presence of lymphocytes and plasma cells
describe breeding induced endometritis
- inflammation is a normal physiologic reaction to semen
- involves innate immune system and mechanical clearance
- normal mares resolve inflammation within 24 hours
- susceptible mares cannot clear the inflammation and develop PBIE
what percentage of mares have failure of their natural immune defense mechanisms against semen
10-15%
what are some reasons a mare may fail to physically clear semen, resulting in endometritis
1) decreased uterine contractility
2) failure of cervical relaxation
3) pendulous uterus
how is PBIE diagnosed in mares
1) history of infertility
2) previously retained fluid after breeding
3) perform ultrasound within 24 of breeding -> if fluid is present this is diagnostic
how do you manage mares with PBIE
1) breed only once per cycle
2) US within 24 of breeding to check for fluid
3) uterine lavage with sterile saline, 1L at a time until fluid is clear
4) ecbolic (PGF2a, oxytocin)
what are the clinical signs of acute endometritis
- vaginal discharge after breeding or at next estrus (note: may not see!)
- short-cycling (due to inflammation and endometrial PGF2a release)
acute endometritis in mares is usually ____________but can also be _____________or _______________ due to irritants infused into the uterus
bacterial; venereal; iatrogenic
how is acute endometritis diagnosed
1) ultrasound
2) endometrial swab -> culture and cytology
what is the best way to prevent endometritis in mares
aseptic technique when breeding or treating mares
what are the goals of treating endometritis (4)
1) correct defects in uterine defense mechanisms
2) promote clearanve
3) control inflammation
4) neutralize bacterial/fungal contaminants
endometritis treatment usually involves
1) uterine lavage
2) antibiotics
3) ecbolic therapy
4) correcting perineal conformation defects
what are the qualities of a good antibiotic
1) effective against organism
2) effective in environment
3) reaches a good uterine concentration
4) non-irritating to the uterus
what do you NOT want to use as a uterine lavage/antibiotic influsion combo to treat acute endometritis in mares
Baytril (enrofloxacin) -> causes uterine adhesions
what do you want to correct to treat chronic endometritis
poor perineal conformation
why might a culture swab be negative in a horse with chronic endometritis
bacteria has been cleared out but inflammation remains
endometrial cysts:
- what type of structure?
- usually located where?
- usually are what origin?
- sometimes what origin?
- often seen in what age?
- fluid-filled structure
- lumen
- lymphatic in origin
- glandular
- older mares
T/F endometrial cysts can interfere with fertility if they are large or grouped
T -> they prevent the embryo from migrating -> no maternal recognition of pregnancy
note: can also interfere with placental attachment
uterine cysts indicate what pathology
fibrosis usually
how do you treat endometrial cysts in mares
1) nothing if small and few in number
2) laser ablation if large or clustered
3) uterine biopsy to determine prognosis
degenerative endometrial fibrosis (DEF) is a ____________ degenerative process with ________ changes over time:
1)
2)
3)
4)
chronic; progressive
1) fibrosis
2) gland dilation
3) nesting of glands
4) vascular degeneration
T/F DEF is non-reversible and results in infertility
T
how is DEF diagnosed
biopsy
uterine tumors:
- common/uncommon
- most common:
- what kind is the nastiest (metastasizes)
- treatment
- uncommon
- leiomyoma
- adenocarcinoma
- partial hysterectomy
