Infertility in the female Flashcards
What are the main causes of infertility?
- Aberrant development of the genitalia
- Irregular or abnormal oestrous cycles
- Vulvar or vaginal discharge
- Failure to become pregnant
- Embryonic death
- Miscellaneous
List some examples of congenital and developmental anomalies of infertility in the female.
Largely structural
- Ovarian hypoplasia
- Reproductive tract dysplasia
- Freemartinism
- Inter-sex
What is ovarian hypoplasia?
When one or both ovaries are absent.
Virtually no follicles, no cycle, no oestrus.
Often bilateral, flaccid uterus.
What is the treatment for ovarian hypoplasia?
None
What does ovarian hypoplasia commonly occur in?
Swedish Highland cows
Mares with XO chromosomes
What is reproductive tract dysplasia?
Segmental dysplasia of paramesonephric ducts.
Developmental obstruction.
Ovaries function normally
What does a persistence of hymen (mare) result in?
bulge from vulva and strain at service
What is free-martinism/ how does it occur?
Vascular anastomosis of adjacent chorioallantoic sacs of heterozygous fetuses. Female becomes masculinised.
What are some of the features of the reproductive tract in free-martinism?
- Prominent clitorisis hairy vulva
- Paramesonephric ducts absent or grossly hypoplastic
- ovaries vestigial and/or masculinarised
How do you diagnose free-martinisim
Failure to detect cervix
Sex chromosome chimerism
What species does free-martinism occur in?
95% of female with male twins in cow
Also occurs in goats
What is inter-sex?
Intersex encompasses developmental abnormalities resulting in discordance between genetic, gonadal or phenotypic sex.
What are some of the chromosomal abnormalities in inter-sex?
- Default to develop female - SRY gene on the Y chromosome
- XX: male pseudohermaphrodite
- XO: Turners syndrome
How do you diagnose inter-sex
Karotyping
What is the incidence of inter-sex?
Relatively common in pigs (0.1-0.6%), goats and some dog breeds (American Cocker Spaniel)
What is Anovulatory anoestrus
Lack/cessation of cyclicity - delayed post partum or season. Associated with NEB
What is the incidence of anovulatory anoestrus?
- 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
What is the clinical presentation of anovulatory anoestrus?
Failure to detect oestrus
(e.g. NSB, ONO)
Small, inactive ovaries
i.e. no dominant follicle or CL
Irregular progesterone profile
What are the pre-disposing factors for anovulatory anoestrus?
Nutrition / body condition score Stress Lameness Animals that are still growing Suckling/maternal bond Hormonal treatments Endometritis
What are the two underlying endocrinologies of anovulatory anoestrus
Aberrant LH (and FSH) pulsatile secretion
Low insulin/ insulin-like growth factor 1 levels
What is the treatment for anovulatory anoestrus?
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.
What is cystic ovarian disease?
Follicular structures that have failed to ovulate. Persistent, large follicles.
What are the different types of cystic ovarian disease?
Follicular- thin walled, under influence of oestrogen –> nymphomania
Luteal- partial luteinised; thickened wall, not ovulated, persistent structure –> anoestrus
What is the incidence of cystic ovarian disease?
Common in cows (6-20%) and sows (5-10%) but very rare in mare, ewe, bitch and cat
What is the pathogenesis of cystic ovarian disease?
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
How do you diagnose cystic ovarian disease?
- 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
What are the predisposing factors of cystic ovarian disease?
- 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)
What is the treatment of cystic ovarian disease?
- most spontaneously recover
- Hormonal (single or combination)
- Likely to re-occur
- Avoid manual rupture
What are the hormonal treatments for cystic ovarian disease?
-GnRH/ hCG (follicular) - causes follcile to lutenise, then remove luteal structure with PG
-Progesterone (follicular)
- Prostaglandin (luteal
)
What is a prolonged CL?
Failure to return to oestrus . CL persists in absence of pregnancy.
Can occur in unmated animals.
Early Post-Partum period
Secondary endometrial problems
What are the causes of prolonged CL?
Failure to produce endogenous PG Dioestrus ovulation (mare)
What is the treatment for prolonged CL
PGF2a
What is the incidence of prolonged CL
Common in the mare (20% of cycles)
Less common in the cow (2%)
What does a granulosa cell tumour produce?
Oestrogens/ androgens
What is the behaviour of granulosa cell tumours
Generally benign with infrequent metastasis
What is the contra-lateral ovary like with granulosa cell tumours
Often small
What hormones are elevated in granulosa cell tumours
Plasma testosterone/ inhibin
What do granulosa cell tumours look like ultrasonographically?
Enlarged ovary with multiocular appearance
What is the prognosis of granulosa cell tumour?
Good with removal
What are some examples of veneral pathogens?
Bovine venereal campylobacterosis
Infectious pustular vulvovaginitis (IPV/IBR)
Contagious equine metritis
When does metritis, endometritis and pyometra occur?
Post partum period (associated with retain fetal membranes)
Post mating (mare) - anatomic barrier integrity or following dioestrus
What are the treatment options for metritis, endometritis and pyometra?
Abs can be effective
Lavage
Prostaglandin, oxytocin encourage contractions to expel the infection
What is the incidence of metritis, endometritis and pyometra?
Cows (10-15%), Also occurs in mares and dogs
What can be given (at the next mating) if there is a failure to establish pregnancy?
No product licenssed.
Stimulate progesterone production (GnRG/hCG)
Supplement with P4 - little evidence for benefit in mares
What are some examples of acquired adhesions (reproductive tract lesions)?
Ovario-bursal
Hydrosalphinx
What occurs with repro tract adhesions
Lumen is occluded and can cause sterility
Increase incidence with age
What species does endometrial fibrosis occur in?
Mare
What is endometrial fibrosis in the mare associated with?
Trauma
Parturient injuries
What is the consequence of endometrial fibrosis?
Can result in the mare becoming infertile
What species does cystic endometrial hyperplasia occur in?
Bitch
What occurs in cystic endometrial hyperplasia?
Repeated hyperplasia in luteal phase
What are the causes of cystic endometrial hyperplasia
Bitch not spayed – series of luteal phases, full of cysts
What is cystic endometrial hyperplasia assocaited with?
Pyometra
What management options influence infertility?
Oestrus detection - rate and accuracy
Timing of mating/AI in relationship to ovulation
Number of matings (Queen)
What are some of the nutritional influences on infertility?
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
What are pigs/ewes genetic influences on infertility?
- Increased number of ovulation doubled
- Reduced embryonic survival
- Uterine capacity
What are cows genetic influences on infertility?
- Selection for yield rather than fertility
- Holsteins: poorer fertility?
- Heritability for fertility
