6/7. Infertility Flashcards
Non-infectious causes of infertility
◦ Poor bitch breeding management
◦ Irregularities of the estrous cycle
◦ Structural anomalies of reproductive tract
◦ Disorders of sexual development (DSDs)
◦ Ovarian disease
◦ Uterine disease
◦ Hypothyroidism
◦ Systemic disease
◦ Nutrition
◦ Stress
most common cause of infertility/subfertility
Poor bitch breeding management (poor/no ovulation timing)
Irregularities of the estrous cycle that contribute to infertility
◦ Anestrus
◦ Anovulation
◦ “Slow rise” in pre-ovulatory progesterone levels
◦ Split heat
◦ Persistent estrus
◦ Insufficient luteal phase
if split heat is suspected as a cause of infertility, what do we need to distinguish between?
Need to distinguish between true split heat & shortened diestral/anestrus phase (4 months inter-estrus interval)
important to distinguish persistent estrus from what?
vaginitis
how does persistent estrus relate to vaginal cytology and progesterone? what does a bitch with this condition likely have?
◦ If have cornified vaginal cytology for >30 days without rise in progesterone
◦ Likely have repro tract pathology > secreting hormones
common congenital vaginal structural abnormalities
Vaginal structural abnormalities are common
◦ Vaginal septum
◦ Vaginal circumferential stricture
◦ Hymenal remnants
vaginal structural abnormalities can cause:
◦ Vaginitis
◦ Infertility/subfertility
> Male cannot penetrate (painful or completely unable)
=> Bitch reactive to natural breeding
> Can block sperm transport
◦ UTIs, urinary incontinence
how to diagnose vaginal structural abnormalities
*digital palpation
-also, history, vaginoscopy
how to treat vaginal septum?
◦ If small and can place finger around – can use spay hook with sedation + lidocaine gel
◦ Sometimes too large – has to be done under GA
◦ Want to incise the tissue as cranially as possible
◦ If left inside > issues at whelping > dystocia
vaginal hyperplasia occurs in response to what hormone? when, generally?
Occurs in response to estrogen (during proestrus & estrus)
breeds predisposed to vaginal hyperplasia
Brachycephalic bitches = predisposed
vaginal hyperplasia always originates from where?
ALWAYS originates from vaginal floor just cranial to urethral papilla
possible sequelae from lots of vaginal hyperplasia
circumferential vaginal prolapse
Sequelae
◦ 2nd infections
◦ Self mutilation
◦ Interference with urination
◦ Inability to be bred naturally
possible sequelae from lots of vaginal hyperplasia
circumferential vaginal prolapse
Sequelae
◦ 2nd infections
◦ Self mutilation
◦ Interference with urination
◦ Inability to be bred naturally
will vaginal hyperplasia resolve on its own? when?when might it recur and what is a result?
Subsides on its own post-ovulation as estrogen levels decrease
Can reoccur just prior to whelping as estrogen levels rise again > obstructive dystocia?
Reoccur at each subsequent heat, usually gets worse at each cycle
Vaginal hyperplasia treatment
◦ Keep mucosa moist – lubricant with panties
◦ Can AI around it (genetics; parturition?)
◦ Surgical removal > reoccurrence
◦ Can induce ovulation if really bad to remove estrogen earlier – can’t breed if this is done
vaginal growth other than hyperplasia
Vaginal polyps
Vaginal tumors
◦ Occasionally hormone dependent
◦ Leiomyomas, leiomyosarcomas
are disorders of sexual development common in dogs?
yes
types of disorders of sexual development in dogs
-Can have both ovaries + testes,
-both uterine tubes + vas deferens,
-ovaries + external male genitalia,
-testis + external female genitalia + ambiguous external genitalia + any other combinations of the above
Examples include: os clitoris, Persistent Mullerian Duct Syndrome (PMDS), segmental aplasia of uterus, hypoplastic ovaries, etc.
how do disorders of sexual development usually arise?
Often hereditary
◦ Miniature Schnauzers ◦ Cocker Spaniels
bitches affected by disorders of sexual development are usually
infertile
ovarian diseases contributing to infertility
ovarian cysts
follicular cysts
neoplasia
symptoms of follicular cysts
◦ Can secrete estrogen
◦ Persistent estrus
◦ Vulvar swelling, discharge
◦ Other signs of hyperestrogenism
◦ Cornification on estrus smear
how do we diagnose ovarian disease
ultrasound
how can we treat ovarian or follicular cysts
OHE, or induce ovulation in valuable breeding bitch – may reoccur
are ovarian neoplasias common in dogs?
no
most common type of ovarian neoplasia in dogs and what it does/signs
Granulosa cell tumor
◦ Often secretes estrogen
◦ Signs of persistent estrus, as in follicular cysts
◦ Can also secrete progesterone
◦ Can metastasize
how do we diagnose ovarian neoplasia
History & clinical signs
◦ Cornified vaginal epithelium
◦ Ultrasound
how can we treat ovarian neoplasia
◦ OHE
◦ Chemotherapy if metastatic
◦ Histopathology
what is ovarian remnant syndome and what are clinical signs? how does it arise and what do we need to distinguish it from?
Signs of functional ovarian tissue being present in a dog that had OHE previously
◦ Ovarian tissue “left behind” re-vascularizes
◦ Anomalous reproductive anatomy
◦ Surgeon error
◦ Abnormal accessory ovarian tissue
Clinical signs
◦ Estrous signs
◦ Pseudopregnancy signs
Important to distinguish from exogenous hormone exposure
how to diagnose ovarian remnant syndome
◦ Estrogen detection > vaginal cytology
◦ Progesterone
◦ LH test
◦ AMH
◦ Abdominal ultrasound
how to treat ovarian remnant syndrome
surgery
uterine diseases that can lead to infertility
◦ Endometritis
◦ Cystic Endometrial Hyperplasia
◦ Pyometra
endometritis clinical signs
Does not cause overt clinical disease
Can cause infertility/subfertility
diagnosis of endometritis
◦ Vaginal cytology
◦ Endometrial culture, biopsy & cytology
◦ Ultrasound?
