Infertility in the female

Question 1

What are the main causes of infertility?

Answer 1

1. Aberrant development of the genitalia
2. Irregular or abnormal oestrous cycles
3. Vulvar or vaginal discharge
4. Failure to become pregnant
5. Embryonic death
6. Miscellaneous

Question 2

List some examples of congenital and developmental anomalies of infertility in the female.

Answer 2

Largely structural

• Ovarian hypoplasia
• Reproductive tract dysplasia
• Freemartinism
• Inter-sex

Question 3

What is ovarian hypoplasia?

Answer 3

When one or both ovaries are absent.

Virtually no follicles, no cycle, no oestrus.

Often bilateral, flaccid uterus.

Question 4

What is the treatment for ovarian hypoplasia?

Answer 4

None

Question 5

What does ovarian hypoplasia commonly occur in?

Answer 5

Swedish Highland cows

Mares with XO chromosomes

Question 6

What is reproductive tract dysplasia?

Answer 6

Segmental dysplasia of paramesonephric ducts.
Developmental obstruction.
Ovaries function normally

Question 7

What does a persistence of hymen (mare) result in?

Answer 7

bulge from vulva and strain at service

Question 8

What is free-martinism/ how does it occur?

Answer 8

Vascular anastomosis of adjacent chorioallantoic sacs of heterozygous fetuses. Female becomes masculinised.

Question 9

What are some of the features of the reproductive tract in free-martinism?

Answer 9

• Prominent clitorisis hairy vulva
• Paramesonephric ducts absent or grossly hypoplastic
• ovaries vestigial and/or masculinarised

Question 10

How do you diagnose free-martinisim

Answer 10

Failure to detect cervix

Sex chromosome chimerism

Question 11

What species does free-martinism occur in?

Answer 11

95% of female with male twins in cow

Also occurs in goats

Question 12

What is inter-sex?

Answer 12

Intersex encompasses developmental abnormalities resulting in discordance between genetic, gonadal or phenotypic sex.

Question 13

What are some of the chromosomal abnormalities in inter-sex?

Answer 13

• Default to develop female - SRY gene on the Y chromosome
• XX: male pseudohermaphrodite
• XO: Turners syndrome

Question 14

How do you diagnose inter-sex

Answer 14

Karotyping

Question 15

What is the incidence of inter-sex?

Answer 15

Relatively common in pigs (0.1-0.6%), goats and some dog breeds (American Cocker Spaniel)

Question 16

What is Anovulatory anoestrus

Answer 16

Lack/cessation of cyclicity - delayed post partum or season. Associated with NEB

Question 17

What is the incidence of anovulatory anoestrus?

Answer 17

• Common in dairy cows (especially high yielding)
• Prolonged anoestrus in bitches (>5-7mo)
• Sows (associated with MMA)
• Pregnancy failure in mare

NB mare in transition period has irregular oestrus and this is NORMAL

Question 18

What is the clinical presentation of anovulatory anoestrus?

Answer 18

Failure to detect oestrus
(e.g. NSB, ONO)

Small, inactive ovaries
i.e. no dominant follicle or CL

Irregular progesterone profile

Question 19

What are the pre-disposing factors for anovulatory anoestrus?

Answer 19

Nutrition / body condition score
Stress
Lameness
Animals that are still growing
Suckling/maternal bond
Hormonal treatments
Endometritis

Question 20

What are the two underlying endocrinologies of anovulatory anoestrus

Answer 20

Aberrant LH (and FSH) pulsatile secretion

Low insulin/ insulin-like growth factor 1 levels

Question 21

What is the treatment for anovulatory anoestrus?

Answer 21

A combination of GnRH and progesterone.

GnRH stimulates FSH and LH which stimulates follicles to grow.

Progesterone will mimic the luteal phase, therefore withdrawl of P4 will stimulate the follicular phase to begin.

Question 22

What is cystic ovarian disease?

Answer 22

Follicular structures that have failed to ovulate. Persistent, large follicles.

Question 23

What are the different types of cystic ovarian disease?

Answer 23

Follicular- thin walled, under influence of oestrogen –> nymphomania

Luteal- partial luteinised; thickened wall, not ovulated, persistent structure –> anoestrus

Question 24

What is the incidence of cystic ovarian disease?

Answer 24

Common in cows (6-20%) and sows (5-10%) but very rare in mare, ewe, bitch and cat

Question 25

What is the pathogenesis of cystic ovarian disease?

Answer 25

Hormonal insuffieiciency- not producing enough LH, this may be because: - surge centre not producing enough GnRH or LH - Follicle does not grow efficiently, do not get enought estradiol production

Question 26

How do you diagnose cystic ovarian disease?

Answer 26

- ultrasound: differential based on thickness of wall, always check both ovaries, normal CL can have thin walls - plasma/milk progesterone e.g. >2ng/ml: luteal Accurate diagnosis is difficult

Question 27

What are the predisposing factors of cystic ovarian disease?

Answer 27

- Treatment of underlying cause - Immediate post-partum period - Stress - Concurrent disease- Ketosis, uterine infections, mastitis - Breed (e.g. common in Holstein; rare in beef breeds)

Question 28

What is the treatment of cystic ovarian disease?

Answer 28

- most spontaneously recover - Hormonal (single or combination) - Likely to re-occur - Avoid manual rupture

Question 29

What are the hormonal treatments for cystic ovarian disease?

Answer 29

-GnRH/ hCG (follicular) - causes follcile to lutenise, then remove luteal structure with PG -Progesterone (follicular) - Prostaglandin (luteal )

Question 30

What is a prolonged CL?

Answer 30

Failure to return to oestrus . CL persists in absence of pregnancy. Can occur in unmated animals. Early Post-Partum period Secondary endometrial problems

Question 31

What are the causes of prolonged CL?

Answer 31

``` Failure to produce endogenous PG Dioestrus ovulation (mare) ```

Question 32

What is the treatment for prolonged CL

Answer 32

PGF2a

Question 33

What is the incidence of prolonged CL

Answer 33

Common in the mare (20% of cycles) | Less common in the cow (2%)

Question 34

What does a granulosa cell tumour produce?

Answer 34

Oestrogens/ androgens

Question 35

What is the behaviour of granulosa cell tumours

Answer 35

Generally benign with infrequent metastasis

Question 36

What is the contra-lateral ovary like with granulosa cell tumours

Answer 36

Often small

Question 37

What hormones are elevated in granulosa cell tumours

Answer 37

Plasma testosterone/ inhibin

Question 38

What do granulosa cell tumours look like ultrasonographically?

Answer 38

Enlarged ovary with multiocular appearance

Question 39

What is the prognosis of granulosa cell tumour?

Answer 39

Good with removal

Question 40

What are some examples of veneral pathogens?

Answer 40

Bovine venereal campylobacterosis Infectious pustular vulvovaginitis (IPV/IBR) Contagious equine metritis

Question 41

When does metritis, endometritis and pyometra occur?

Answer 41

Post partum period (associated with retain fetal membranes) Post mating (mare) - anatomic barrier integrity or following dioestrus

Question 42

What are the treatment options for metritis, endometritis and pyometra?

Answer 42

Abs can be effective Lavage Prostaglandin, oxytocin encourage contractions to expel the infection

Question 43

What is the incidence of metritis, endometritis and pyometra?

Answer 43

Cows (10-15%), Also occurs in mares and dogs

Question 44

What can be given (at the next mating) if there is a failure to establish pregnancy?

Answer 44

No product licenssed. Stimulate progesterone production (GnRG/hCG) Supplement with P4 - little evidence for benefit in mares

Question 45

What are some examples of acquired adhesions (reproductive tract lesions)?

Answer 45

Ovario-bursal | Hydrosalphinx

Question 46

What occurs with repro tract adhesions

Answer 46

Lumen is occluded and can cause sterility Increase incidence with age

Question 47

What species does endometrial fibrosis occur in?

Answer 47

Mare

Question 48

What is endometrial fibrosis in the mare associated with?

Answer 48

Trauma | Parturient injuries

Question 49

What is the consequence of endometrial fibrosis?

Answer 49

Can result in the mare becoming infertile

Question 50

What species does cystic endometrial hyperplasia occur in?

Answer 50

Bitch

Question 51

What occurs in cystic endometrial hyperplasia?

Answer 51

Repeated hyperplasia in luteal phase

Question 52

What are the causes of cystic endometrial hyperplasia

Answer 52

Bitch not spayed – series of luteal phases, full of cysts

Question 53

What is cystic endometrial hyperplasia assocaited with?

Answer 53

Pyometra

Question 54

What management options influence infertility?

Answer 54

Oestrus detection - rate and accuracy Timing of mating/AI in relationship to ovulation Number of matings (Queen)

Question 55

What are some of the nutritional influences on infertility?

Answer 55

Energy / metabolic status e.g. anovulatory anoestrus, second litter syndrome Pass energy balance nadir Reduced gonadotrophin / IGF1 levels (see additional slide) Vitamin / mineral deficiencies / toxicities: Copper / molybdenum / Selenium Management of dry / pregnant animal Oestrogenic substances in plants Dietary proteins: Increased urea  poor fertility

Question 56

What are pigs/ewes genetic influences on infertility?

Answer 56

- Increased number of ovulation doubled - Reduced embryonic survival - Uterine capacity

Question 57

What are cows genetic influences on infertility?

Answer 57

- Selection for yield rather than fertility - Holsteins: poorer fertility? - Heritability for fertility