12. Non infectious Infertility

What is the apparent inability to get pregnant?

Infertility

What is one of the most important things you can do narrow down infertility causes?

take a good history and BSE

(•When was the last foal born, Number of times tried to breed, Breeding method, Cycles Stallion info)

If your client thinks that the horse is NEVER in heat, what are broad issues that could cause this?

- could be pregnant

- may not show signs

- chromosomal isssue

What are some times that the mare may not show signs of heat?

•Transition

•Silent heat

•No stallion on premises

•Foal present

•Dominant mare in the pasture

If you have a client that thinks that the mare is ALWAYS in heat, what are some things that you can suggest?

•Submissive mare

•Ovarian pathology

•Perception

•Endometritis

If the mare is thought to always be in heat, what ovarian pathology would you expect to see?

GCT (inhibin)

What disease process needs to be ruled out if there is uterine fluid present?

endometritis

What age/type of mare would you expect to see uterine fluid present in?

maiden mare cervix

Tract patency can cause there to be uterine fluid present. What are THREE examples of tract patency?

•Persistent hyman

•Segmental aplasia

•Stricture/adhesion

In a normal cycle, if there is no fluid present, what may the issue be?

•Stallion issue

•Improper breeding timing

•Blocked oviducts

•Uterine pathology (Cysts, Fibrosis)

What is the MOST common chromosomal abnormality that causes non infectious infertility in mares?

XO mare (turner syndrome)

What do you have to do to diagnose a XO mare?

karyotype

T/F In a XO mare, the female anatomy is normal but they just cycle bad and the ovary stay in a consistent anestrus

True

What is a VERY common issue that causes inflammation after breeding?

Post Mating Induced Endometritis (PMIE)

How long should it take the fluid to clear from PMIE?

24 hours

What can you use to treat PMIE that helps to promote uterine clearance?

oxytocin

What can you do in cases of PMIE to help clean out debris and dead space?

lavage

A 23-year old Dutch Warmblood mare presents to your clinic for multiple unsuccessful breeding attempts were made during the breeding season. On physical, BCS: 3/9 remainder of the exam was within normal limits. Her repro exam showed intraluminal fluid and diffuse large endometrial cysts. You decide to short cycle her. How would you go about doing this?

- begin Regumate (P4) and give q24 for 10 days

- on day 10 give PGF2a (concerns about sweating and colic)

- enter estrus within 3 to 4 days and ovulate within 7-10 days of administration of PGF2 α

What size follicle typically ovulates?

40-50mm

What are some contributing factors to the Dutch Warmbloods infertility?

•Age

•Poor body condition

•Delayed uterine clearance

•Semen quality

•Endometrial cysts

If you elect to remove the endometrial cysts via ablation, when in the season should you do this?

early in breeding season (improve pregnancy prognosis)

What is a a non-pathologic incidental finding of dilations of lymphatics or glandular tissue which leads to an accumulation of glandular secreations?

Endometrial Cysts

What are some predisposing factors that can lead to endometrial cysts?

age, multiple pregnancies, and delayed uterine clearance

How do you diagnose endometrial cysts?

transrectal ultrasound examination or hysteroscopy

What is a cyst map?

a map of the uterus that shows the location, number, and size of the cysts

What makes a cyst map useful?

tracking changes in the size and number of the cysts.

What are THREE complications of cysts?

1.Interfere with pregnancy ID

2.Interfere with embryonic movement and fixation

3. Interfere with delivery of placental nutrition

What are the parameters that leads to an increase risk of embryo loss so if this happens it is important to treat? (i have this starred, do with that what you want)

Five or more cysts greater than 1-2 cm

T/F Cysts can hinder the early ID of twins because they look similar on U/S

True

When is treatment of the mare necessary?

when the mare fails to conceive or suffers early embryonic loss for undiagnosed reasons

What are THREE ways to treat endometrial cysts?

•Cautery

•Rupture via biopsy instrument

•Ablation via laser

What is the postop treatment for the cyst ablation?

•Uterus was lavaged once daily for three days

•Oxytocin continued

•Recommend breeding on the mare's next cycle

Back to the Dutch warmblood, the client wants you to breed her so in may you AI w/ 60 ml cooled transported semen. Ovulation is detected following day with 3 cm intraluminal fluid. What should you do?

•Lavage with LRS

•Oxytocin 20 IU q6 hrs

What is it called when there is thickened tissue at vestibulovaginal junction?

Persistent or Imperforate Hyman

What type of mare will you see this in?

Maiden mares (they usually find it at natural breeding bc the stallion cannot break through the hymen)

T/F A persistent hyman may prolapse

True

What does surgical correction depend upon?

amount of tissue

What must you do to diagnose blocked oviducts?

•Diagnosis of exclusion (rule everything else out first...)

How do you treat blocked oviducts?

- apply PGE2 for relaxation

•Laparoscopy

•Retrograde cannulation

•Application to oviductal papillae

What is classified as early embryotic loss?

Loss of a pregnancy before approximately 45 days

Before how many days is it typically difficult to tell if there has been embryonic loss?

14 days

If the embryo dies before 14 days, what is most often the cause?

chromosomal/embryo defect

After 14 days, when are you typically gonna lose an embryo so you should be checking the mare?

•Before 30 days

•90 days

•6-7 month

T/F It is imporant to check both ovaries because a mare can double ovulate and it can lead to twins which is very bad in the horse

True

What is it called when there is a double ovulation within 24 hours of each other?

Synchronous

What is it called when there is an ovulation that is more than 24 hours apart? How will you be able to tell?

- Asynchronous

- Different sizes

Why is a 14 day ultrasound super important?

to see if there are twins or not

How can you confirm if something you see on ultrasound is an embryo or a cysts?

•Pregnancies move

•Measure both

•Re-measure next day (15)

•Vesicles grow, cysts do not!

Which type of endometrial cyst envolvemnet in the uterus should you treat?

Bicornuate (bilateral)

T/F 80% of Unicornuate (unilateral) cysts reduce naturally by day 40

True

Walk me through how you are going to terminate one of the twins.

•Pre-treat with flunixin meglumine

•Regumate

•Manipulate twin to tip of horn

•Crush with hand or u/s probe

Why would you want to give regumate?

in case the CL is damaged

If you find out past 14 days that there is twins, what are THREE things you can do?

•Transvaginal Ultrasound Guided Aspiration (TUGA)

•Cranio-cervical disarticulation

•Transabdominal injection (over 120 days)

Before how many days is a better prognosis if you are going to eliminate via •Transvaginal Ultrasound Guided Aspiration (TUGA)?

before 30 days

What is the procedure used to preform a Cranio-cervical disarticulation? How many days along can you preform this procedure?

flank incision

55-70 days

What are the TWO substances that you can use to kill the fetus if they are over 120 days?

•KCl

•Procaine Pen