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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
Depending on the type and quantity of hormone produced by granulosa and thecal cell tumours, what are the 3 main presentations?
Anoestrous Prolonged or erratic oestrous behaviour Stallion-like behaviour
26
In a mare with a granulosa thecal cell tumour, what are the 5 hormonal changes you will see?
``` Elevated -Inhibin -Testosterone -Anti-mullerian hormone Low Progesterone High oestrogen ```
27
Why in a mare with a granulosa thecal cell tumour will the normal ovary be smaller than normal?
The GTCT secretes inhibin This suppresses FSH Therefore the other ovary becomes smaller and inactive
28
What will a GTCT look like on ultrasound?
Variable | Often polycystic and/or solid
29
What does a GTCT need to be differentiated from?
An ovarian haematoma - Appear abruptly and slowly regress - Contralateral ovary will be normal
30
How do you treat a GTCT?
Ovariectomy | Will return to oestrus within 6-8 months
31
What are 2 causes of irregular oestrous cycles?
Vernal transition | Aging - over 20 y.o.
32
When does fertility decline in the mare?
After 13 with serious decline after 20
33
In aged mares what is the major cause of infertility?
Decreased oocyte quality | -Fertilisation rates are adequate but early embryonic loss is increased
34
What are the 3 broad categories of causes of anoestrous in mares?
Ovarian quiescence Behavioural anoestrous Anoestrous caused by prolonged luteal function
35
List some causes of prolonged dioestrus?
``` Pregnancy Foetal loss after day 36 Foetal mummification Uterine inflammatory disease Dioestrous ovulation ```
36
What causes a shortened luteal phase?
Uterine inflammatory disease | -Dioestrus under 14 days
37
What is an anovulatory follicle?
Follicle that reaches ovulatory size during oestrous but fail to ovulate -Often 70-100mm
38
How long can an anovulatory follicle last for?
3-7 weeks
39
On ultrasound what will an anovulatory follicle look like?
Initially small echogenic spots within a large anechoic follicle Later fibrin bands may be seen
40
How can you treat an anovulatory follicle?
PGF2alpha after day 5 of formation
41
In what stage of formation may you confuse an anovulatory follicle with a GTCT?
After intrafollicular haemorrhage - Will then have a echogenic, multilocular appearance (like a GTCT) - With time organises into a CL
42
What are the 3 mechanisms that endometritis causes infertility?
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
What are the 5 main types of endometritis?
``` Infectious/transient Persistent mating-induced Chronic infectious Endometriosis Pyometra ```
44
What are 5 conformational factors that can contribute to development of endometritis in the mare?
Incompetent vulvar seal Cranial sloping of the vulva Tears in the vulvar lips Recto-vaginal fistula, perineal laceration Incompetent vestibulo-vaginal constriction
45
What are the 3 physical barriers to the uterus?
Vulval barrier Vestibular seal Cervix
46
What 4 things make up a normal vulval conformation?
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
What is persistent mating-induced endometritis?
Retention of over 2cm of fluid in the uterus over 18 hours after breeding
48
How long after breeding should normal transient endometritis clear?
24-72 hours
49
How is normal uterine clearance achieved post-breeding?
Immune response and mechanically
50
List some predisposing factors for persistent mating-induced endometritis?
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
How do you diagnose a mare with persistent mating-induced endometritis?
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
What is the aim of treating a mare with persistent mating-induced endometritis?
Remove fluid from the uterus and the associated inflammatory by products
53
What 2 things do you need to remember before treating a mare with persistent mating-induced endometritis?
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
What are some specific treatments for a mare with persistent mating-induced endometritis?
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
What are 2 ecbolics you can use, and what one should you not administer post ovulation?
Oxytocin -Use anytime Prostaglandins - Cloprostenol -Don't use post-ovulation as there is a risk of causing a decline in progesterone
56
Describe a treatment strategy for a mare with persistent mating-induced endometritis, both pre and post breeding?
- 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
What are some signs of chronic endometritis?
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
What are the 2 most common bacterial causes of chronic endometritis?
Streptococcus equi subsp. zooepidemicus | E.coli
59
What are the 3 yeast/fungal causes of chronic endometritis?
Candida Aspergillus Mucor
60
How do you diagnose chronic endometritis?
``` 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
What are the pro's and con's of testing for endometritis during oestrus or at dioestrus?
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
Is the presence of neutrophils on endometrial cytology always significant?
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
How do you treat a mare with chronic endometritis?
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
When performing antimicrobial therapy to a mare with chronic endometritis, how should it be administered?
Intrauterine therapy is preferable -Get higher endometrial concentrations Give daily for 3-7 days
65
What are 6 things that can contribute to a minimum contamination breeding technique?
- 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
What exotic pathogen causes contagious equine metritis?
Taylorella equigenitalis
67
How is Taylorella equigenitalis transmitted?
``` Natural mating AI equipment Infected semen Infected fomites Incubation period 2-14 days ```
68
What are clinical signs of Taylorella equigenitalis?
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
How do you diagnose a case of Taylorella equigenitalis?
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
How do you treat Taylorella equigenitalis?
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
How do you treat pyometra?
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
Why do you initiate luteolysis in a mare with pyometra?
Want to decrease progesterone levels as it inhibits immune cells Also increased estrogen loosens the cervix and helps facilitate drainage
73
Why do you administer prostaglandins in a mare with pyometra?
To initiate luteolysis
74
What is endometriosis?
Chronic degenerative changes within the endometrium | -Age and parity related
75
What 2 changes cause the signs seen in endometriosis?
Progressive fibrosis and degeneration of endometrium *Reduced lymphatic drainage, dilation of lymphatics which cause uterine cysts Glandular degeneration *Reduced nourishment of embryos
76
How do you diagnose and treat endometriosis?
Diagnose by endometrial biopsy | Treatment - correct conformational inadequacies, saline lavage, but poor prognosis

A - Equine Repro (4 decks)

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