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A - Equine Repro > Infertility problems in the mare > Flashcards

Infertility problems in the mare Flashcards

1
Q

What are 3 types of oviductal developmental defects in the mare?

A

Segmental aplasiaHydrosalpinx Cysts - remnants of paramesonephric ducts

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2
Q

What are 3 types of developmental defects of the uterus?

A

HypoplasiaSegmental aplasiaDuplication of uterine body -failure of fusion of bilateral paramesonephric ducts

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3
Q

What are 3 types of developmental defects of the cervix?

A

HypoplasiaDouble cervixCongenital absence -rare

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4
Q

What is a developmental defect of the vagina?

A

Persistent hymen

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5
Q

What are 6 abnormalities of the vagina?

A

Persistent hymenLacerationsAdhesionsUrine pooling3rd degree perineal lacerations and recto-vaginal fistulas Vaginal bleeding

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6
Q

What are 4 causes of vaginal bleeding in the mare? (pregnant and non-pregnant)

A

TraumaticVaricose vesselsRemnants of the hymenPlacental separation

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7
Q

What developmentally occurs for a persistent hymen to form?

A

Caudal end of the paramesonephric duct fails to join the invagination of the vestible

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8
Q

What is endometriosis?

A

Glandular problems associated with age-Periglandular fibrosis, cystic dilation of glands, glandular necrosis or hyperplasia

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9
Q

What is the most common neoplasia of the uterus?

A

Leiomyoma

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10
Q

What abnormality of the uterus is associated with aged mares?

A

Ventral sacculations -Accumulates fluid

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11
Q

What abnormality of the uterus is associated with poor conformation?

A

Pneumouterus from a pneumovagina

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12
Q

Describe a grade I endometrial biopsy?

A

Normal endometrium, or mild focal inflammation/fibrosis-Foaling rate 80-90%

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13
Q

Describe a grade IIA endometrial biopsy?

A

Mild to moderate inflammation/multifocal fibrosis 1-3 layers of fibroblasts or 2 fibrotic nests per field-Foaling rate 50-80%

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14
Q

Describe a grade IIB endometrial biopsy?

A

Moderate inflammation/multifocal diffuse fibrosis4+ layers of fibroblasts or 2-4 fibrotic nests per field-Foaling rate 10-50%

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15
Q

Describe a grade III endometrial biopsy?

A

Severe inflammation/diffuse fibrosis 5+ fibrotic nests per field -Foaling rate under 10%

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16
Q

What are the 2 types of endometrial cysts?

A

Glandular -associated with periglandular fibrosisLymphatic lacunae -dilated lymphatic vessels

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17
Q

What 3 things can help to determine an endometrial cyst from a pregnancy?

A

Cysts not sphericalHave irregular outlineConsistent in position and size

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18
Q

How do you treat endometrial cysts?

A

Ablate them if large using forceps, needle aspiration or laser -Otherwise may not significantly affect fertility

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19
Q

What can you do to help with visualisation of endometrial cysts?

A

Infusing 1-2 litres of saline

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20
Q

What are some clinical signs of 63XO gonadal dysgenesis? (Turner’s syndrome)

A 
External genitalia are female
Vulva may be smaller
Mare may be smaller
Persistent anoestrous or irregular periods of oestrus
Small ovaries under 1cm diameter
Small uterus
Flaccid pale, dilated cervix
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21
Q

How do you diagnose 63 XO gonadal dysgenesis?

A

Karyotyping

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22
Q

What are the 3 types of abnormalities of sexual differentiation?

A

Genetic sex
Gonadal sex common
Phenotypic sex

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23
Q

What is the most ovarian neoplasm in mares?

A

Granulosa and thecal cell tumours

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24
Q

Are ovarian neoplasms usually benign or malignant?

A

Usually benign since most are granulosa and thecal cell tumours

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25
Q

Depending on the type and quantity of hormone produced by granulosa and thecal cell tumours, what are the 3 main presentations?

A

Anoestrous
Prolonged or erratic oestrous behaviour
Stallion-like behaviour

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26
Q

In a mare with a granulosa thecal cell tumour, what are the 5 hormonal changes you will see?

A 
Elevated 
-Inhibin 
-Testosterone
-Anti-mullerian hormone
Low Progesterone
High oestrogen
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27
Q

Why in a mare with a granulosa thecal cell tumour will the normal ovary be smaller than normal?

A

The GTCT secretes inhibin
This suppresses FSH
Therefore the other ovary becomes smaller and inactive

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28
Q

What will a GTCT look like on ultrasound?

A

Variable

Often polycystic and/or solid

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29
Q

What does a GTCT need to be differentiated from?

A

An ovarian haematoma

  • Appear abruptly and slowly regress
  • Contralateral ovary will be normal
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30
Q

How do you treat a GTCT?

A

Ovariectomy

Will return to oestrus within 6-8 months

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31
Q

What are 2 causes of irregular oestrous cycles?

A

Vernal transition

Aging - over 20 y.o.

32
Q

When does fertility decline in the mare?

A

After 13 with serious decline after 20

33
Q

In aged mares what is the major cause of infertility?

A

Decreased oocyte quality

-Fertilisation rates are adequate but early embryonic loss is increased

34
Q

What are the 3 broad categories of causes of anoestrous in mares?

A

Ovarian quiescence
Behavioural anoestrous
Anoestrous caused by prolonged luteal function

35
Q

List some causes of prolonged dioestrus?

A 
Pregnancy
Foetal loss after day 36 
Foetal mummification
Uterine inflammatory disease
Dioestrous ovulation
36
Q

What causes a shortened luteal phase?

A

Uterine inflammatory disease

-Dioestrus under 14 days

37
Q

What is an anovulatory follicle?

A

Follicle that reaches ovulatory size during oestrous but fail to ovulate
-Often 70-100mm

38
Q

How long can an anovulatory follicle last for?

A

3-7 weeks

39
Q

On ultrasound what will an anovulatory follicle look like?

A

Initially small echogenic spots within a large anechoic follicle
Later fibrin bands may be seen

40
Q

How can you treat an anovulatory follicle?

A

PGF2alpha after day 5 of formation

41
Q

In what stage of formation may you confuse an anovulatory follicle with a GTCT?

A

After intrafollicular haemorrhage

  • Will then have a echogenic, multilocular appearance (like a GTCT)
  • With time organises into a CL
42
Q

What are the 3 mechanisms that endometritis causes infertility?

A

Death of the conceptus
Induces release of PGF2alpha which results in premature CL regression
In later pregnancy get placentitis with death of foetus/abortion

43
Q

What are the 5 main types of endometritis?

A 
Infectious/transient
Persistent mating-induced
Chronic infectious
Endometriosis 
Pyometra
44
Q

What are 5 conformational factors that can contribute to development of endometritis in the mare?

A

Incompetent vulvar seal
Cranial sloping of the vulva
Tears in the vulvar lips
Recto-vaginal fistula, perineal laceration
Incompetent vestibulo-vaginal constriction

45
Q

What are the 3 physical barriers to the uterus?

A

Vulval barrier
Vestibular seal
Cervix

46
Q

What 4 things make up a normal vulval conformation?

A

Under 10% slope from vertical
75% of vulva length is ventral to the floor of the pelvis
Vulval lips should be closed
Seal should be resistant to parting and 2.5cm deep

47
Q

What is persistent mating-induced endometritis?

A

Retention of over 2cm of fluid in the uterus over 18 hours after breeding

48
Q

How long after breeding should normal transient endometritis clear?

A

24-72 hours

49
Q

How is normal uterine clearance achieved post-breeding?

A

Immune response and mechanically

50
Q

List some predisposing factors for persistent mating-induced endometritis?

A

Older mares
Reduced/defective myometrial mechanical activity
Failure of cervix to relax during oestrous
Insufficient reabsorption by lymphatic vessels
Excessive production of endometrial glandular secretions
Cranial displacement of uterus over pelvic brim

51
Q

How do you diagnose a mare with persistent mating-induced endometritis?

A

Detection of intraluminal fluid with ultrasound

  • 2+cm of fluid during oestrus is at risk
  • 2+cm of fluid in uterus 18+hours after breeding
52
Q

What is the aim of treating a mare with persistent mating-induced endometritis?

A

Remove fluid from the uterus and the associated inflammatory by products

53
Q

What 2 things do you need to remember before treating a mare with persistent mating-induced endometritis?

A

You can remove fluid 4hours post-mating
-Spermatozoa are located within oviduct
But not after day 3
-Embryo descends at 5.5 days, want to make sure uterus is back to normal before this

54
Q

What are some specific treatments for a mare with persistent mating-induced endometritis?

A

Sexual rest if severe
Minimum contamination breeding technique
Breed only once per oestrus
Uterine lavage
Ecbolics to stimulate uterine contraction
Intrauterine antibiotics
Exercise and tease post-lavage

55
Q

What are 2 ecbolics you can use, and what one should you not administer post ovulation?

A

Oxytocin -Use anytime
Prostaglandins - Cloprostenol
-Don’t use post-ovulation as there is a risk of causing a decline in progesterone

56
Q

Describe a treatment strategy for a mare with persistent mating-induced endometritis, both pre and post breeding?

A
  • Before breeding
  • Over 0.5cm fluid admin oxytocin IV
  • Over 2cm fluid lavage uterus
  • Re-check and repeat if fluid persists
  • Single mating, exercise and tease
  • After breeding
  • Oxytocin IM 4-6 hours after
  • Ultrasound next day
  • If over 2cm fluid, lavage and admin oxytocin
  • +/- antibiotic infusion, with oxytocin IM every 4-6 hours before ovulation
  • Re-examine next day and repeat oxytocin if needed
  • +/- exercise, teasing
57
Q

What are some signs of chronic endometritis?

A

History of infertility
Matting of tail hairs
Exudate at ventral commissure of vulva
Urine pooling
Faecal debris in vagin
Ultrasound see fluid accumulation within uterine lumen
Vaginal speculum see reddening, increased vascularity and exudate in vagina

58
Q

What are the 2 most common bacterial causes of chronic endometritis?

A

Streptococcus equi subsp. zooepidemicus

E.coli

59
Q

What are the 3 yeast/fungal causes of chronic endometritis?

A

Candida
Aspergillus
Mucor

60
Q

How do you diagnose chronic endometritis?

A 
Cytology swab or flush
-Over 2 neutrophils/field
Culture
-Uterine swab, flush, biopsy
Biopsy
-Definitive 
*use range of tests to increase sensitivity and specificity
61
Q

What are the pro’s and con’s of testing for endometritis during oestrus or at dioestrus?

A

Oestrus
-More resistant to iatrogenic infection
-Increased chance of contamination
Dioestrus
-Uterus should be sterile so results more significant
-Must administer PGF2alpha afterwards to prevent developing endometritis

62
Q

Is the presence of neutrophils on endometrial cytology always significant?

A

No
-Low numbers can still have a high pregnancy rate
If over 2 per field, then may be more significant, however needs to be in the presence of a clinically significant bacterial infection

63
Q

How do you treat a mare with chronic endometritis?

A

Correct underlying conformational or management causes
Check cervix for adhesions, manually dilate to facilitate drainage if needed
Uterine lavage
Administer ecbolics
Antimicrobial therapy
If a refractory case, consider a treatment to disrupt any biofilm prior to antimicrobial therapy
-Once resolved recommend minimum contamination breeding techniques to reduce reinfection

64
Q

When performing antimicrobial therapy to a mare with chronic endometritis, how should it be administered?

A

Intrauterine therapy is preferable
-Get higher endometrial concentrations
Give daily for 3-7 days

65
Q

What are 6 things that can contribute to a minimum contamination breeding technique?

A
  • Wash mares perineum and stallion’s penis before breeding
  • Use AI with semen incubated with extender that has antibiotics
  • Prebreeding treatment of mares uterus with antibiotic +/- extender (must be non-spermicidal)
  • Scan follicle +/- induce ovulation to keep number of breedings to a minimum
  • Post breeding uterine lavage and ecbolic treatment
  • Systemic antibiotics in conjunction with intrauterine therapy
66
Q

What exotic pathogen causes contagious equine metritis?

A

Taylorella equigenitalis

67
Q

How is Taylorella equigenitalis transmitted?

A 
Natural mating
AI equipment
Infected semen
Infected fomites 
Incubation period 2-14 days
68
Q

What are clinical signs of Taylorella equigenitalis?

A

Stallion - asymptomatic
Mare -
*Acute infection signs of endometritis with discharge 1-14 days post mating, lasting few days to 2 weeks
*Chronic infection may be asymptomatic

69
Q

How do you diagnose a case of Taylorella equigenitalis?

A

Swab and culture
*Mare - clitoral fossa and sinuses, vestibula, uterus
*Stallion - urethreal fossa, urethra, pre-ejac fluid, prepucial folds, skin of penis
PCR
Serology as screening test or 21-45 days after acute infection in the mare

70
Q

How do you treat Taylorella equigenitalis?

A

Intrauterine infusion and topical treatment of clitorial fossa, sinuses and clitoris
Local clitoral treatment daily for 5 days - Water, detergent, pack area with sensitive antibiotic cream
Intrauterine treatment - penicillin
Clitoral sinusectomy if residual infection
Male - Daily for 5 days - Water, soap, chlorhex, antibiotic creams, the fossa glandis, urethral fossa and prepuce acked with penicillin, chlorhex or nitrofurazone

71
Q

How do you treat pyometra?

A

Establish drainage
Lavage
Initiate luteolysis
Intrauterine antibiotics
Check cervix for fibrosis and adhesions for why it developed
Biopsy after initial treatment for response
Refractory cases consider ovariectomy, wedge resection of cervix for drainage, hysterectomy

72
Q

Why do you initiate luteolysis in a mare with pyometra?

A

Want to decrease progesterone levels as it inhibits immune cells
Also increased estrogen loosens the cervix and helps facilitate drainage

73
Q

Why do you administer prostaglandins in a mare with pyometra?

A

To initiate luteolysis

74
Q

What is endometriosis?

A

Chronic degenerative changes within the endometrium

-Age and parity related

75
Q

What 2 changes cause the signs seen in endometriosis?

A

Progressive fibrosis and degeneration of endometrium
*Reduced lymphatic drainage, dilation of lymphatics which cause uterine cysts
Glandular degeneration
*Reduced nourishment of embryos

76
Q

How do you diagnose and treat endometriosis?

A

Diagnose by endometrial biopsy

Treatment - correct conformational inadequacies, saline lavage, but poor prognosis

A - Equine Repro (4 decks)

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