; | 0 S89 F f ; Normal Cervix Diestrus Cervix ‘Anestrus Cervix Vaginoscopic view of the lumen of| Vaginoscopic view of a diestrus | Vaginoscopic view of the cervix of the cervix of a mare cervix. The cervix is dry. an anestrus mare. The cervix and vagina resemble those of a pregnant mare. Occasionally, a small pool of clear, serous mucus may be seen just caudal to the external os of the cervix. At this time, with stimulation, the cervix may dilate completely and readily allow the passage of the entire hand into the uterus Another normal cervical condition that may be encountered in pregnancy is that of a “capped cervix" where the cervical appearance is similar to a CX 1 but in this case the external os is not Visible because of a cervical plug and the appearance that one of the cervical folds has covered and sealed off the end of the cervix After ovulation and during diestrus the uterus becomes less edematous, less congested and more tonic. t is easily identifiable as a firm tubular structure. The early pregnant uterus is also tonic and can be differentiated from the diestrus uterus by an amniotic vesicle bulge after about 20 to 25 days of pregnancy. Involution of the uterus after normal foaling is extremely rapid. Regression in size is almost completed at the 1” day of “foal heat”. The relatively low conception rate observed from services on the “foal heat” appear to indicate that the involution of the endometrium is not completed at this time in all mares. ABNORMALITIES INVOLVING UTERUS Uterine abnormalities can be subdivided into © Abnormalities associated with a uniformaly enlarged uterus © Abnormalities associated with discrete abnormalities within the uterus © Parauterine abnormalitiesUniformaly Enlarged Uterus Pyometra Pyometra in a mare with an occluded cervix due to adhesions. Both horns are distended with pus Must be differentiated from pregnancy and a postpartum uterus. Involution of the mares uterus occurs very rapidly after foaling in comparison to the cows. By the beginning of foal heat, it should be no more than two to three times its normal size. Other causes of a uniformly enlarged uterus are pyometra and pneumo uterus. Discrete Uterine Enlargements * Must be differentiated from early pregnancy by identifying the embryo as a discrete bulge in the uterine horn. Dilated Lymphatic on the Perimetrium of the Left Horn INo clinical significance in terms of fertility, It may be confusing to the palpater or on ultrasound examination+ Other enlargements include © endometrial cysts (result from blocked and dilated endometrial glands), © lymphatic lacunae (which result from blocked lymph channels), abscesses in the uterine wall and corneal dilatation (following atrophy of the uterine mucosa in older mares) Parauterine abnormalities include hematomas in the broad ligament of the uterus that are usually associated with parturition. A fresh hematoma should not be disturbed, and the mare should be treated with systemic antibiotics to prevent abscessation. A chronic hematoma rarely causes a fertility problem and usually regresses over time. Hematoma in the broad ligament caused by rupture of the uterine artery ABNORMALITIES INVOLVING OVARIES ‘+ Ovarian abnormalities identified on physical examination can be divided into small ovaries and large ovaries Small Ovaries These may be either normal or abnormal. Prepubertal or juvenile ovaries are small; therefore, ‘the age and previous cyclic history of the mare is important In anestrus the ovaries are inactive and one half the size they will attain during the breeding season. In some small, docile, chronically anestrus mares a chromosomal anomaly called XO Gonadal dysgenesis may be the cause of small ovaries. An endometrial biopsy from these mares often demonstrates glandular insufficiency “True” nymphomaniac mares also contain smal ovaries. These mares act as if they are in persistent estrus, yet often they will not allow mounting; some of these mares will demonstrate 32male like behavior. Other than small, firm ovaries, no other abnormalities of the genital tract, are noted in the nymphomaniac mare Wvulatory Follicle of a Mare in Estrus Enlarged Ovaries ‘+ May be a seasonal phenomenone. During the transitional periods, follicles may grow to abnormally large sizes and persist for various lengths of time before ovulating or regressing They usually do not suppress activity in the other ovary and resolve themselves and cause no permanent problem In the early transition period they can be treated with 1000 to 5000 IU of Human Chorionic Gonadotropin but results are variable. These persistent follicles are often diagnosed as cystic ovaries by practitioners unaccustomed to palpating the mare’s ovaries Cystic ovaries, such as those that occur in cows, do not occur in mares. The biggest problem in dealing with persistent follicles in mares is differentiating them from certain types of ovarian tumors Ovarian tumors Cystadenoma Serous Cystadenoma Rare ovarian tumor that isnot | This is a rare polycystic accompanied by aberrant —_|tumor. These tumors appear| reproductive behavior to be endocrinologically inactiveIn the mare ovarian tumors are usually classified according to the main type of cell making up ‘the tumor. Most of these tumors are unilateral and rarely malignant The cystadenoma must be differentiated from persistent follicles. These usually enlarge over a period of time unlike the persistent follicle that remains the same or regresses. They probably arise from the surface epithelium of the ovary or the rete ovarii and have one or several large fluid-filled cavities within them. Diagnosis is by ultrasound treatment is only ovariectomy Granulose-theca cell tumors Most common ovarian tumor in the mare Grow to very large sizes and are usually unilateral and benign Produce a variety of hormones and usually suppress activity of the opposite ovary In addition to secreting inhibin, these tumors frequently secrete testosterone causing the mare to exhibit stallion-like behavior. Hormonal analysis and endometrial biopsy may also be helpful in diagnosing this tumor. Clinical signs vary from anestrus to nymphomania and even to virility depending on the predominant hormone produced by these tumors. Treatment is removal of the affected ovary, and the prognosis for fertility is fair to good, depending on the length of time that the tumor has existed and the degree of suppression of ‘the opposite ovary. Resumption of cycle occurs 1 to 4 month after the tumor is removed. Much less common ovarian tumors are teratoma and the dysgerminoma. Teratoma The teratoma is a multiple tissue type tumor that usually has epithelial structures including cartilage, bone, hair and glandular epithelium. ‘Are usually benign and produce no hormones, so the contralateral ovary usually remains functional, and the mare may continue to cycle. As in the other ovarian tumors, ovariectomy is indicated. Dysgerminoma GCT Surgically Removed This granulosa cell tumor was _| Cross section of a granulosa cell tumor surgically removed via a flank _| following surgical removal, showing the| laparotomy. The ovary was large and | multilocular, cystic structures typical of firm on palpation this type of tumor 34+ Unlike the previously discussed ovarian tumors, the dysgerminoma can be malignant. ‘+ Itarises from the germinal epithelium of the ovary and can become very large. The tumors may be solid or contain fluid-filled multiple cysts. Ovariectomy is the treatment of choice. ‘Non-Neoplastic Ovarian Enlargements Other causes of ovarian enlargement such as non-neoplastic ovarian abscesses and hematoma are common and are difficult to differentiate. The mare’s temperature and white blood cell count may help identify the ovarian abscess, yet these abscesses are often encapsulated within the ovary and do not produce a systemic reaction after they become chronic. Ovarian hematomas often feel similar to ovarian abscesses. In both cases the opposite ovary usually remains functional and the mare continues to cycle. Ovarian hematomas usually regress over a period of time and cause no fertility problems. Hormone stimulation tests may differentiate these from ovarian tumors. An ultrasound examination may be of some help in differentiating them. The last cause of ovarian enlargement that should not be overlooked is the unusually large, normal cyclic follicle. Most cyclic follicles range in size from 2.5 to 6 cm in diameter prior to ovulation. Occasionally, one or several large follicles grow to 10 cm or more before ovulation. In this and all cases of ovarian enlargement, several examinations over a 15 to 30 day period are a valuable means of differentiating these ovarian abnormalities. ABNORMALITIES INVOLVING OVIDUCT The incidence and abnormalities of salphingitis and hydrosalpinx seems to be very low when compared with cattle. Fimbrial cysts are not a rare finding in the mare. These are usually small and inconsequential. Occasionally, they may grow large enough to interfere with the collection of the ovum by the fimbria. Fimbrial Cysts There is no ovarian activity. There are several several small fimbrial cysts along the edge of the ovarian bursa. There is also a fibrin tag at the ovulation fossa, 35ABNORMALITIES INVOLVING CERVIX, VAGINA AND VULVA Cervical Abnormalities When evaluating the cervix, the normal pinkness of estrus must be differentiated from the redness of inflammation. Cervicitis may be caused by contagious equine metritis, endometritis or vaginitis or may be secondary to pneumo vagina or recto vaginal fistula The most common non-infectious abnormalities noted are cervical adhesions and scars secondary to foaling or breeding problems. These abnormalities may prevent the cervix from opening and/or closing properly dilate thereby © preventing the stallion from ejaculating into the uterus © making delivery of a foal difficult © predisposing the mare to endometritis which may prevent her from carrying a foal to term. Other abnormalities of the cervix include leiomyoma of the cervix and squamous cell carcinomas. 3 Leiomyoma ‘Squamous Cell Carcinoma of the Cervix Vaginal Abnormalities Scars, adhesions and lacerations are some of the more common vaginal abnormalities that may lead to difficulies in foaling and breeding. Lacerations subsequent to breeding often occur in the fornix of the vagina; are usually retroperitoneal and heal well Recto vaginal fistula, which is a foaling accident, occurs as a result of the foal sticking a foot ‘through the dorsal wall of the vagina and through the ventral floor of the rectum. If the foot is not withdrawn into the vagina, the entire perineal body between the rectum and vagina may be torn, producing a third degree perineal laceration. Other vaginal problems encountered arePneumovagina secondary to cervicitis and endometritis. Caslick’s operation is performed routinely on many farms and may be one of the best management aids to ‘overcome the problem of the barren mare. Vaginal abscesses occasionally occur subsequent to a vaginal laceration. They should be drained into the vagina, with care taken to avoid the large perivaginal blood vessels. ‘Systemic and local antibiotics should be used to speed healing. Persistent hymen can be identified by vaginoscopy. Correction involves manually or surgically dilating the hymen. Prepartum vaginal prolapse is rare in the mare. Occasionally, a persistent hymen, perivaginal abscess or hematoma may be mistaken for a vaginal prolapse. Vulvovaginal Sphincter Pneumovagina The vulvovaginal sphincter is intact and) Poor muscle tone of the labia lead to normal parting of the lips and aspiration of air into the vagina Urine Pooling Persistent Hymen Urine can be seen pooling inboth | Developmental defect whereby the uterine horns following pneumovagina|caudal end of the paramesonephric duct) (Mullerian duct) fails to join the invagination of the vestibuleDorsocranial slope associated with pneumovagina is the most common vulvar abnormality encountered. At least 70 per cent of the vulvar cleft should be below the brim of the pelvis. Abnormal labial apposition can result in the same problems as abnormal slope and should be corrected by Caslick’s operation. Occasionally, a mare will be encountered that has suffered a severe vulvar laceration because an episiotomy was not performed on a mare that has had Caslick’s operation. Third degree perineal lacerations involve the vulva. Reconstructive surgery should be attempted. Clitoral hypertrophy is occasionally seen in fillies. This is usually a manifestation of pseudohermaphroditism Neoplasia of the vulva include fibromas or fibropapillomas, malignant melanomas and squamous cell carcinomas Coital Vesicular Exanthema Vulvar Insufficiency Coital vesicular exanthema, The | The perineum of this mare shows | Pneumovagina due to horizontal stallion also showed lesions | a gaping deficit. This abnormal | slant of the dorsal portion of the conformation leads to vulva and poor tone of the labial pneumovagina muscles. This causes the mare to aspirate air into the vagina. A Caslick operation is indicated ALTERNATIVE METHODS OF EXAMINATION Can be used to identify the amniotic vesicle as early as day 15 of gestation and is valuable in predicting the presence of twins early enough in gestation to correct the problem without danger to the mare. ‘Also helpful in producing an image of various vaginal, uterine and ovarian masses to determine if they are solid or fluid filled.Normal Day 40 Embryo \ultrasonographic image of a normal, healthy, day 40 developing embryo. Hormonal and Chromosomal Analysis Analysis for progesterone, estrogen and/or testosterone may be of value in differentiating the several causes of enlarged ovaries. Detection of pregnancy with pregnant mare serum gonadotrophin requires a blood test. Chromosomal analysis may be of value in ruling out specific cases of persistent anestrus in mares. CLINICAL EVALUATION OF SOWS AND GILT PHYSICAL EXAMINATION Careful physical examination is required for © selecting potentially fertile breeding animals © culling gilts with structural or genital abnormalities prior to breeding © along with a herd history helpful in the diagnosis of reproductive failure in individual animals or in breeding groups within a herd When indicated, internal reproductive organs should be recovered from slaughtered animals for a thorough examination as useful information can be obtained when other procedures fail Structural Soundness Soundness in replacement gilts is especially significant, since most structural faults and weaknesses are aggravated with age and confinement rearing. Special attention should be given to selecting gilts free from foot, leg and joint problems, which ‘may impair their future reproductively. © Amoderate slope to the pasterns provides the animal with a cushion to the foot and leg, joints, enabling her to cope with solid surfaces in confinement. Gilts and sows with hoof cracks, sole bruises or other foot problems should be culled because attempted 39treatments are often unsuccessful. Such problems may arise from abrasive or damp, slick flooring Too much slope in the rump area tends to make the animal more prone to unsoundness as she matures. A steep rump also displaces the vulva to a low position and angle so that boars often experience difficulties in entering the sow during mating. Extreme muscling leads to delayed puberty, low conception rate, farrowing difficulty and poor mothering ability. Examination of External Genitalia + Observing the vulva of replacement gilts at 5 % to 6 months of age can help detect potentially sterile or slow-breeding females. + The most commonly observed abnormality is the infantile vulva which is usually accompanied by small, prepubertal ovaries and uterine horns. dorsally “tipped vulva”. Boars may experience difficulty in servicing gilts having this trait. Injures of the vulva may occur from fighting or at parturition. Unless they are severe, they generally do not contribute to future reproductive problems. Atresia ani, or imperforate anus, is a congenital defect observed in all breeds. + In gilts the rectum and vagina may be joined, forming a recto vaginal fistula just anterior to the vulva. Males die because they are unable to defecate. Gilts defecate via the vulva ‘opening. Occasionally, an unusually large percentage of females within a group is observed to have red, swollen vulvas, typical of females in estrus. This observation, when coupled with mammary development in non pregnant females and barrows, indicates the presence of exogenous estrogenic substances in the feed \ ‘Small Vulva Delayed Puberty Small vulva in a gilt Anestrus 10-month old gilt with multiple small follicles and no corpora lutea on her ovaries. Delayed puberty‘A sound underline with atleast six functional, well developed and evenly spaced teats on each side, with three in front of the navel is prefered Gilts with a blind teat that does not fully develop, a pin nipple or an inverted nipple should not be considered as replacement animals INTERNAL EXAMINATION OF THE REPRODUCTIVE TRACT In herds with a high incidence of reproductive failure that are not diagnosed by other methods, examination at slaughter is recommended. Females should be tattooed prior to slaughter for identification so that the individual animal's reproductive history can be related to the observed reproductive tract disorder. Observe for © the presence and size of follicles, corpora lutea and cysts in each ovary © any adhesions surrounding the ovaries or within the ovarian bursa © size of the uterine horns Externally, each oviduct and uterine horn to the vagina should be traced, for occlusions, missing parts or adhesions. ‘After gross examination the tract is opened and is examined and noted for the presence and characteristics of fluid or embryonic tissue. Normal Corpora Lutea Normal Corpora Hemorrh ‘Many small follicles during early | Normal corpora lutea and several] Normal corpora hemorrhagica, 3 proestrus small normal anevulatory follicles|___ to 4 days after ovulationProestrus Uterus Estrus Uterus Firm Estrus Uterus Normal uterus from an animal in| Regressing corpora lutea, large | Uterus of a sow in heat. Some of lproestrus. Old, pale corpora lutea| follicles. Sow had been in estrus | the large follicles are hyperemic. ‘and hyperemic follicles are | for 24 hours. Notice the normal |There are some corpora albicantia| present on the ovaries tortuous cervix which has been |of the previous cycle. The fimbriae| ‘opened up in this specimen. The have been laid out empty bladder is off to the right r Diestrus Uterus Midcycle Uterus Nulliparous Uterus Uterus and ovaries 6 to 7 days | Uterus and ovaries of a sow in Estrus uterus in a gilt. after ovulation. Mature corpora | diestrus. Mature corpora lutea lutea. Vascularization of the are present uterine horns is nicely illustrated by the prominent blood vessels in| the broad ligament ABNORMALITIES OF THE REPRODUCTIVE TRACT Anatomical Abnormalities Hydrosalpinx and Pyosalpinx Hydrosalpinx and pyosalpinx refer to distention of oviduct with clear fluid and pus like material, respectively. Occur more frequently in gilts than in sows Result from abnormal embryonic development and may be hereditary. ‘Affected females have regular estrous cycles but are prone to repeat breeding and reduced litter size. If lesions are bilateral, affected females are sterile. Segmental Aplasia ‘+ Segmental aplasia may occur at any position along the uterine horn but most commonly occurs near the uterine body. Occasionally, an entire uterine horn may be absent. Afflicted females will cycle normally. It is possible to have pregnancy in the patent side, but litter size is usually reduced.Bilateral Hydrosalphinx Both uterine tubes (oviducts) are grossly Pyosalpingitis in a pregnant sow bred with distended with fluid. The ovarian bursae are | Staphylococcus aureus contaminated semen also sealed off (adhered) and distended with blood tinged fluid. The gilts cycle but do not conceive ‘Segmental Hypoplasia Congenital defect. The base of the left horn is missing causing the distal portion to distend with uterine secretions. Conception on the contralateral side is possible. Normal corpora lutea are present on both ovaries Blind, Double + These abnormalities occur infrequently. Females with either condition cycle normally. + If part or the entire cervix is missing, the female is sterile. Pregnancy can be achieved in females with a double cervix. 43is a common abnormality and is generally but not always associated with confinement- reared gilts wherein the presence of a very small vulva and the absence of estrus are suggestive of this condition, ‘The infantile tract is approximately 30 per cent of the size of a tract from normally cycling gilt. The ovaries are hypoplastic and nonfunctional with numerous small follicles and no corpora lutea. This condition is common in gilts with delayed puberty or gilts less than 6 months of age. ‘Adhesions have been observed in all areas of the reproductive tract but more frequently in the oviduct and ovarian bursa. Cyclic activity is normal. Reduced litter size and infertility are frequently noted. More predominant in the Yorkshire breed in which a portion of the female reproductive tract, has differentiated into its male homolog. Mostly inherited, inheritance is thought to be autosomal recessive accompanied by modifier genes. Characterised by presence of an ovotestis, which may be internal or external, whereas others may have a prominent clitoris and “sky hood” vulva. ‘Some intersexes show male characteristics such as tusk development and mounting behavior. Large Cystic Follicles Cystic Follicles Large cystic follicles in a sow (note striae | Cystic follicles caused by low dose on the uterine surface) progestins 3 to 4 days after estrus occurred. The fimbria partially envelope the ovariesCystic ovaries originate in a complete or partial failure of ovulation. Therefore, cystic follicles ‘may appear on the same ovary as normal appearing corpora lutea. Cysts may vary in size from 12 to 50 mm. Affected females may be anestrus or exhibit near normal estrus cycle patterns. Most attempts at treatment are ineffective. CLINICAL EVALUATION OF SHEEP AND GOAT - HISTORY History is an essential component of the clinical examination, particularly in sheep and goats due to inaccessibility of the majority of the reproductive tract to palpation or observation. Degree of seasonality varies with breeds of sheep and goats and whether a male is present or not A prolonged breeding season indicates increased or earlier months of transition Meat goats as a breed are known for their ability to breed more than once per year Introduction of a buck or ram during periods of transition hips in advancing the onset of the breeding season by 4 to 6 weeks Nutrition and size + Young females should be two thirds of their expected adult body weight before they are bred ‘+ Thin animals with dull hair coats may take months to recover from poor nutritional conditions. Social Order To the extent possible, the “comfort” of the animal should be determined in terms of whether it is a dominant or submissive animal in the group. Amount of feeding space, access to shelter for all animals and the opportunity for dominant does to keep timid ones from seeking the buck should be investigated. PHYSICAL EXAMINATION Physical examination should be done to © evaluate the current body condition and femininity of the animal and determine the age by examining the dentition in order to avoid mistaking under grown infertile adults for young ones. Determine whether the animal is polled or horned when the potential for the intersex condition is considered. Intersex animals can present with a wide array of clinical features. Examination of External Genitalia + Includes evaluation of the anogenital distance and whether the clitoris is visible without parting the lips of the vulva 45Vulva should be examined for possible abnormalities such as pox or herpesvirus lesions, ‘tumors, pustular dermatitis, and ectopic mammary tissues Includes the palpation of abnormal lumps or swellings in the inguinal region Vaginal speculum examination or, alternatively, an endoscopic examination to rule out any membranes or adhesions present Presence of any discharges from the cervix or vagina should be noted It should be remembered that the normal caprine vaginal discharge turns from clear mucus early in standing estrus to thick "cheesy” exudate late in standing estrus. This type of discharge at this time of the estrous cycle is normal and does not require treatment Enlarged Clitoris Posterior view of an enlarged | The clitoris is grossly and clitoris in an intersex sheep. | abnormally enlarged which could Apparent testes could be | be due to the presence of male palpated subcutaneously in the |gonad{s) in an intersex individual, inguinal area. The gonads were | or due to the rare occurrence of not identified histologically Sreemartinism ABNORMALITIES OF THE REPRODUCTIVE TRACT Pathological lesions of reproductive system in sheep and goats are similar in most respects to those in calttle. ‘Abnormalities Involving Uterus Hydrometra in Ewe \ccumulation of serous fluid in a Jnongravid uterus as a result of lockage. In this case an imperforate cervix. The wall of the uterus is thin.Vulvitis, vaginitis, cervicitis, metritis, pyometra, perimetritis, and salphingitis may occcur in sheep and goats as a sequelae to dystocia, embryotomy, difficult parturition, retained placenta, and delayed involution of the uterus. ‘Tumours of the ovaries and genital tract of the ewe are rare. Abnormalities Involving Oviduct Fimbrial Cyst in Ewe Mesonephric Duct Cyst in Ewe | _ Paraovarian Cyst in Ewe [A large fimbrial cyst on the right) Remnant of the male duct | A bi-lobed parovarian cyst is These cysts may block the | system (Wolffian duct). These | present in the left mesovarian. oviduct and prevent the sperm | cysts are capable of occluding | These cysts are mesonephric in \from reaching the ovum / ova. If| the oviduct. Not so in this case | origin. The left oviduct is the blockage is unilateral, the | as the oviduct is not distended | distended with fluid due to an |ewe is still capable of conceiving] with fluid. This cyst may create obstruction. on the contralateral side. _| confusion in an ultrasonogram. Abnormalities involving Cervix, Vagina and Vulva i — Prolapsed Cervix in Ewe Vaginal Prolapse in Ewe Vaginal Prolapse with \Prepartum prolapse of the cervix, Prepartum vaginal and rectal Evisceration in Ewe is |prolapse. Possible causes include| Fatal evisceration through the not common. Exposure of the | short tail dock and overfull_ | vaginal wall. Previous vaginal cervix and the vaginal mucosa | abdomen (multiple fetuses, | prolapse with weakening / will ead to drying out, abdominal fat, low quality | rupture of the dorsal vaginal contamination, infection and roughage). wall is a possible cause. injury.SS eet Prominant Clitoris in Ewe | Cervical Leiomyoma in Doe | — Prolapsed Vagina in Doe The clitoris is grossly and | The cervix and the base of the | Prolapsed vagina during late abnormally enlarged which | left horn have been opened. A | gestation when estrogen could be due to the presence of \large, firm tumor (leiomyoma) is|_ concentrations are rising and male gonad(s) in an intersex |present in the area of the cervix.| tissues are beginning to relax. individual, or due to the rare | The caruncles are prominent | Straining has also produced a ‘occurrence of freemartinism indicating that the doe has been| _smail rectal prolapse pregnant, although she was infertile for the last 3 years. ULTRASONOGRAPHY + Transabdominal ultrasonography can be used to examine the animal for pregnancy, pseudopregnancy (hypoechoic uterine fluid but no cardinal signs of pregnancy), pyometra, fetal death, fetal maceration or resorption of the pregnancy. ‘Transabdominal Ultrasound Examination With the ewe standing, the ultrasound transducer (probe) is placed in the woolless / hairless inguinal area and aimed towards the uterus. Clipping the hair in the inguinal region prior to the examination permits the best quality images to be obtained. Transrectal imaging with 5 to 7.5 MHz linear probes often allows visualization of ‘the nonpregnant caprine uterus and ovaries, or early cases of the previously mentioned conditions.‘The quality of transrectal scanning depends to some extent on the size of the animal and whether the reproductive tract has descended ventrally along the body wall, Holding animals off feed for 24 hours may improve the image quality in some case. LAPAROSCOPY, LAPAROTOMY AND NECROPSY A definitive diagnosis of infertility sometimes cannot be made without examination and palpation of the reproductive tract. Laparoscopy is less invasive and preferred over laparotomy when the equipment is available. The gonads may be aberrantly positioned in intersex animals, or various degrees of maldevelopment of the three tubular portions of the reproductive tract may be present. In animals that have had peritonitis, abdominal surgery, or embryo collections performed, the presence of abdominal abscesses or adhesions involving the reproductive tract may be identified. Ovarian cysts or reproductive tract tumors may also be diagnosed by these methods. Laparoscopic Examination Laparoscopic View of Uterus The sterile laparoscope has been Laparoscopic view of the uterine inserted to view the uterus and the | _ bifurcation in a nonpregnant ewe. ovaries, CLINICAL EVALUATION OF THE BITCH - HISTORY + The differential diagnosis for most infertility disorders is established by obtaining a thorough history from the owner + The initial history should include information regarding, © how well the owners know the bitch and does she live indoors with them or away. © is she hosed alone, with another bitch that recently completed ovarian cycles, with ovariohysterectomized bitch or with males? Is she normal in height and weight for her breed and for her line? Is she receiving any medication and is she well or ill? 49Onset of the pubertal estrus occurs at ages ranging from 6.3 to 23 months Toy poodles may benefit from evaluation earlier in life than Bull Mastiffs PHYSICAL EXAMINATION The problem area should always be examined last to mk sure that each bitch receives a complete physical examination prior to an evaluation of the reproductive tract. Vulva should be examined to check for size and conformation and for presence of any discharge. ‘Small immature vulva or one that is recessed under a fold of tissue owing to body type or obesity interfere with normal breeding while an obese bitch is prone to perivulvar dermatitis. ‘A swollen, turgid vulva is suggestive of proestrus while a swollen and flaccid one can be consistent with estrus or approaching parturition, Vaginal Discharges ‘+The bitch in anestrus or diestrus usually has no vaginal discharge. Pei Peed [Bloody discharge Proestrus, estrus, separation of the placental sites, or severe vaginitis [Greenish black or dark bloody vaginal discharge [Placental separation as well as postpartum Reddish brown yellowish, or grayish, thick, reamy, malodorous vaginal discharge traw-colored vaginal discharges lear mucus jormal and precede parturition ‘+ Vaginal cytology specimens should be an integral part of any reproductive evaluation and should be performed in any bitch with a vaginal discharge. Digital Examination of the Vestibule and Vagina + A digital examination of the vaginal vault should be performed routinely and should follow culture and cytology. Masses, foreign bodies, strictures, painful vaginitis, or abnormal tissue bands all prevent easy and painless examination If the digital examination is abnormal but inconclusive, vaginoscopy provides a more thorough evaluation Mammary Glands + The mammary gland should be palpated for the presence of mammary tumors, for evidence of lactation, mastitis, inverted teats, or benign nodulesThe ventral midline can also be checked for evidence of a previous surgical incision, which might be a clue suggesting that the bitch has undergone ovariohysterectomy. Rectal Examination A rectal examination ensures that the pelvic canal has been assessed for previous fractures or ‘other unsuspected abnormalities as compression of the pelvic canal is a potential cause of dystocia. Abdominal Palpation The abdomen should be palpated in an effort to identify and characterize the uterus. However, except in pregnancy and pyometra, the uterus almost never can be evaluated with confidence ‘on abdominal palpation. ABNORMALITIES INVOLVING UTERUS Abnormal development of the uterus or uterine tubes may occur in intersex animals © Male pseudohermaphrodites are animals with testes and female external genitalia © Female pseudohermaphrodites are animals with normal uterus and ovaries and male external genitalia XX sex reversed cocker spaniels are genetic females with male gonads and abnormal male external genitalia Hydrometra and mucometra are accumulations of sterile serous or mucoid fluid in the uterus © Incidental findings either at the time of elective OHE or in aged intact female dogs undergoing diagnostic work-ups for unrelated disorders, such as congestive heart failure ‘or mammary neoplasia Cystic endometrial hyperplasia frequently is associated with hydrometra and mucometra. Pathogenesis is likely to include that of CEH Presumptive diagnosis of hydrometra and mucometra is based on presence of uterine enlargement, documented by abdominal palpation, radiography or ultrasound and lack of a systemic inflammatory response ‘The primary differential diagnoses are pyometra and pregnancy Definitive diagnosis requires cytology and culture of the intrauterine fluid ‘The fluid varies in character from serous to mucoid and in color from straw colored to serosanguineous The treatment of choice is OHE, especially in bitches not intended for breeding. Hematometra is sterile accumulation of blood within the uterus Cystic endometrial hyperplasia - pyometra complex is an acute or chronic post-estrual disease of adult intact bitches leading to inflammatory exudates in the uterus that is associated with variable clinical and pathologic signs. It also is called pyometritis, pyometra complex, catarthal endometritis, purulent endometritis, chronic cystic endometritis, and chronic purulentABNORMALITIES INVOLVING OVARIES Congenital Abnormalities + Complete absence of one or both ovaries known as ovarian agenesis may be associated with other abnormalities of the reproductive tract, such as uterus unicornis. ‘+ Ovarian hypoplasia has been reported in female dogs with abnormal chromosome number. Female dogs with anomalous numbers of sex chromosomes and abnormal ovaries are usually infertile and include + True hermaphrodites + Pseudohermaphrodites © Male Pseudohermaphrodities © Female Pseudohermaphrodites Ovarian Cysts + Ovarian cysts are fluid-filled structures with a distinct wall that develop within the ovary. + Parovarian cysts are similar in morphology to ovarian cysts but lie next to the ovary. ‘+ Follicular cysts are thin ~ walled structures containing clear, serous fluid, may be single or multiple and if multiple cysts are present on one ovary, the cysts do not communicate. More about follicular cyst in dogs Follicular Cyst cystic Endometrial Hyperplasia Follicular cyst in a Dalmation bitch.| Cystic endometrial hyperplasia in Prolonged estrus was the the Dalmation bitch with cystic characteristic sign exhibited. ovary. Other Ovarian Cysts Other ovarian cysts include luteal cysts, germinal cysts, cystic corpora lutea, cystic rete ovarii or rete cysts (are small masses of irregular, anastamosing tubules with cystic changes in the hilus region of the ovary) and parovarian cysts (cystic structures in remnants of the mesonephric and paramesonephric tubules surrounding the ovary 52Ovarian Remnant Syndrome ‘+ Ovarian remnant syndrome occurs when a retained piece of ovarian tissue revascularizes and becomes functional. The condition may occur following surgeon’s error in incomplete removal of the ovary. The most common presentation of ovarian remnant syndrome is recurrent estrus after OHE. More about ovarian remnant syndrome Ovarian Remnant Syndrome Retained ovary removed from an ovariohysterectomised non- descript dog during exploratory laparotomy performed during the diestrus period. Note the presence of corpora lutea Oophoritis ‘+ ophoritis is diffuse infiltration of the ovary with mononuclear inflammatory cells, with subsequent degeneration of germ cells and fibrosis of surrounding tissues wherein an autoimmune pathogenesis is hypothesized. Ovarian Neoplasia ‘The three general categories of primary ovarian neoplasms are those arising from epithelial cells, those tumors of sex cord / stromal origin, and those arising from germ May be palpable per abdomen, and often are visible on radiographs or sonograms. Secondary tumors of the canine ovary include lymphosarcoma. CLINICAL EXAMINATION OF THE QUEEN - NORMAL TRACT Ovaries +The ovaries of the adult queen are oval structures approximately 1.0 x 0.3 x0.5 em in size 220 mg in weight located in the dorsal abdomen caudal to the kidneys attached to the diaphragm by the suspensory ligament, to the dorsal body wall by the mesovarium, and to the end of the uterine horn by the short, thick proper ligament of the ovary enclosed by the ovarian bursa that has a small slit-like opening on the medial side 53+The queen is an induced ovulator. © Copulation, vaginal stimulation, or gonadotropin administration induces ovulation within approximately 24 to 32 hours. Corpora lutea, which form after ovulation, appear orange-yellow grossly and may reach 4.5 mm in diameter, peaking in size about 16 days after ovulation. Oviduct + The uterine tube (oviduct) of the adult queen is 5 to 6 cm in length ‘+The wall of the uterine tube is thin, and the lining is thrown up into longitudinal folds or ridges. Uterus ‘+ The uterus of the adult queen is a Y-shaped organ consisting of a 2-cm-long body lying between the descending colon dorsally and the urinary bladder ventrally and two 10-cm uterine tubes (oviducts). The cervix is the thick-walled neck of the uterus, connecting it to the vagina. Vagina + The vagina and the vestibule are each about 2 cm long, so that the cervix is located about 40 to 45 mm cranial to the vulva; in pregnancy the vagina is stretched cranially by the weight of the uterus. Vestibule ‘The vestibule extends from just cranial to the external urethral cranially, to the vulva caudally, a distance of about 2 cm. ‘The external urethral orifice in the cat opens into a mucosal groove located on the floor of the vestibule just caudal to a transverse fold of mucosa that represents the hymen. ‘The vulva of the adult queen consists of two small, round labia located just below the anus, which unite at dorsal and ventral commissures The labia are similar in spayed than in intact cats. During estrus the labia are slightly edematous and reddened, vulvar discharge is negligible Mammary Glands + The queen has four pairs of mammary glands, arranged in two bilaterally symmetrical rows from the ventral thoracic to ventral abdominal region. + They have been designated as © the right and left axillary © thoracic © abdominal and inguinal mammary glands‘+ Also designated as right and left mammary glands 1,2,3 and 4 when counting from cranial to caudal ABNORMALITIES INVOLVING OVARY Ovarian Dysgenesis, ‘+ Ovarian dysgenesis refers to underdevelopment of the ovary; ovarian hypoplasia or to hermaphroditic and streak gonads usually associated with an abnormal sex chromosome ‘complement, such as XO monosomy or mosacicim. True Hermaphroditism + Rare in cats, and has not been reported in phenotypic females where both gonad histology and chromosome complement are known. Reported in cats that are phenotypically male, where both gonad histology and chromosome compliment are known, suggesting that presence of testicular tissue in the embryo induces development of (male phenotype) secondary sexual characteristics, regardless of presence of ovarian tissue or karyotype. Diagnosis of ovarian anomalies is based on history of primary anestrus (ovarian agenesis or dysgenesis) on careful gross evaluation of internal and external genital organs, on histologic examination of the ovary, and on karyotype of affected queens Ectopic Adrenocortical Paraovarian Nodules + Ectopic adrenal gland nodules occur in the broad ligament of the ovary, within 1 to 4 cm of the ovary, as single, unilateral nodules, as bilateral nodules, or as two nodules on a single side and range in size from 2 to 5 mm in diameter. Ovarian Cysts + Follicular cysts that arise from mature or atretic follicles are common and affected queens may be asymptomatic or may exhibit prolonged estrus if cells lining the cyst secrete estrogen. Prolonged estrus may be hard to distinguish from normal estrus, because the normal queen may cycle in and out of the follicular phase as frequently as every 4 to 7 days. ‘The Ovarian Remnant Syndrome + The ovarian remnent syndrome describes presence of ovarian tissue and signs of estrus in a female cat after OHE. The causes are © may be failure to remove all or a normal ovary at OHE © presence of a partial or complete separation of a portion of normal ovary during development (the fragment may be located near the ovary or in the broad ligament) that is not detected at OHE supernumerary ovary although rare may also be considered as the cause of estrus signs after bilateral OHEAffected queens demonstrate normal signs of estrus, and may allow copulation, but do not become pregnant if bred. Diagnosis is based on confirmation of estrus, on detection of serum progesterone concentrations exceeding 2 ng/ml 2 to 3 weeks after induction of ovulation at estrus in a neutered cat. Treatment is exploratory laparotomy within 3 to 6 weeks of induction of ovulation at which time presence of corpora lutea in a “grape cluster” appearance on the surface of the ovarian remnant may make small remnants easier to identify. Ovarian Neoplasia ‘+ The granulose cell tumor of sex cord-stromal origin is the most common primary ovarian tumor in the cat. Presence of palpable mass in the cranial or mid abdomen. Abdominal and thoracic radiographs and abdominal ultrasonography are indicated in all cases to assess tumor size and location, and evidence, if any, of the presence of metastases. A vaginal cytology specimen should be examined for cornification as evidence of estrogen secretion in suspect queens. Measurements of serum estrogen, testosterone, and progesterone are of interest if functional tumors are suspected based on clinical signs of prolonged estrus, virilization, or pyometra. Evaluation of ‘the hemogram and serum chemistry profile is indicated prior to exploratory surgery. ‘+ Adenoma/Cystadenoma, Adenocarcinoma, Dysgerminoma have also been reported in cats. ABNORMALITIES INVOLVING FELINE UTERUS AND OVIDUCT Hyperplasia of the Uterus and Uterine Tubes + Multiple, broad-based or pedunculated hyperplastic endometrial polyps have been reported in cats ranging in age from 4 to 15 years and protrude into the uterine lumen, Hydrometra/ Mucometra Hydrometra and mucometra, the accumulation of non-inflammatory, clear to slightly cloudy, watery to viscid, sterile fluid in the uterine lumen, occurs occasionally in the cat and are caused by lack of patency of vulva, vagina, cervix, or uterus resulting from congenital anomaly, neoplasia Inflammation, © scarring, © accidental ligation. Fluid volume in the uterine lumen may reach 500 mi, and distention of the uterine body and/or horns may be diffuse or segmental. Treatment is OHE.Cystic Endometrial Hyperplasia/Pyometra Complex + Pyometra in cats is @ uterine inflammatory disorder characterized by cystic endometri hyperplasia (CEH). Clinical signs include purulent vulvar discharge, anorexia, dehydration, lethargy, pyrexia, vomiting, polyuria/polydipsia, and weight loss. The uterus becomes palpably enlarged. Diagnosis in the intact queen is based on © signalment, © history of previous estrus and clinical signs, © physical examination, hemogram, presence of a purulent vulvar discharge and /or enlarged uterus in the nonpregnant animal. Abdominal radiography or ultrasonography is indicated to define uterine size and shape for initial diagnosis, to rule out pregnancy (ultrasonography, after 21 days following estrus). Recommended treatment for CEH/pyometra in the queen is OHE with concurrent fluid and antibiotic therapy. In females with reproductive value and an open-cervix pyometra (diagnosed by the presence of a purulent vulvar discharge), uterine evacuation can be attempted with © PGF alpha at a dose rate ranging from 0.05 to 0.5 mg/kg subcutaneously (SC) once or twice daily for 2 to 5 days until uterine size decreases to normal. Prostaglandin analogues should not be used in the cat, because safe and effective does have not been established. Within 1 to 60 minutes of drug injection, panting, restlessness, grooming, tenesmus, salivation, vomition, defecation, or diarrhoea. Salpingitis ‘+ Inflammation of the feline uterine tube, salpingitis, usually is purulent, and occurs secondary to uterine inflammation Neoplasia of the Uterus/Uterine Tubes + Uterine tumors constitute 1 to 2 per cent of tumors of the female reproductive organs of the cat including mammary glands), or 0.2 to 0.4 per cent of all feline tumors and include uterine leiomyomas and leiomyosarcomas. Clincal signs of uterine adenocarcinomas depend on tumor size and pattern of metastatsis and include ascitis, anorexia, weight loss, purulent or hemorrhagic vulvar discharge, vomiting, constipation, dysuria, and presence of a palpable abdominal mass. Diagnosis is based on uterine palpation, abdominal and thoracic radiographs, surgical exploration, and histopathologic examination of tumor tissue.Ultrasonography has been used to detect uterine neoplasia in the diffusely enlarged uterus with pyometra, ‘The recommended treatment for primary uterine neoplasia without metastasis is OHE. ‘Tumors of the uterine tubes have not been reported in the queen. DISORDERS OF THE FELINE VAGINA, VESTIBULE AND VULVA. ‘Anomalies of the vagina and vulva that have been described in the cat include © Segmental aplasia of the cranial vaginal (mullerian duct systern), © presence of a common wulvovestibular-anal opening, © rectovaginal fistula. Neoplasia The most common primary vaginal tumor type in the cat is the leiomyoma, which may measure up to 7 x7 x 8m, Clinical signs of vaginal tumors include © bulging of the perineal region, © prolapse of tumour tissue from the vulva, © dysuria, © pollakiuria, © constipation. Initial diagnosis is based on palpation and on retrograde vaginography and/or cystourethrography to characterize size and extent of the mass. Abdominal and thoracic radiography to look for tumor metastasis should be performed prior to surgical excision. Exfoliative cytology may be diagnostic and should be performed on accessible masses of the vagina and vestibule. Final diagnosis is based on histopathologic examination after core or excision biopsy.VGO 411: VETERINARY GYNAECOLOGY (2+1) MODULE-2 DELAYED PUBERTY AND SEXUAL MATURITY Puberty represents the initiation of estrous cycle and is defined as the age or time at which the female gonads are able to produce gametes and reproduction may occur, It is not a single event, but a process. In the female, puberty is characterized by the exhibition of estrum and ovulation Onset of puberty normally occurs at a certain age relative| to the animal's body weight. Heifers must attain approximately two thirds their adult sizes before they reach puberty. ‘The word puberty originated from latin word "pubscere" that means "to be covered with hair". The original definition that relates to the presence of hair in certain anatomical regions, obviously does not hold good to other animals. LEARNING OBJECTIVES After going through this module one will be able to + understand what puberty is and when it occurs ‘+ understand how puberty occurs, and what are the factors that influence it HYPOTHALAMUS DEFEMINIZATION MECHANISM ‘+ It is important to know the fundamental differences in the hypothalamus of the male and female in order to have a clear understanding of the puberty in both the sexes. To address this issue, one should first neccessarily understand Why GnRH surge centre develops only in female and not in males? + Inthe male © During prenatal development, defeminization of the brain occurs due to testosterone from the fetal testis + Inthe femal. 0 Since there is no testis to produce testosterone, GnRH surge centre develops in the hypothalamus. 59In order to defeminize the hypothalamus, it is most important that, first testosterone has to be converted into estradiol. In order to cause defeminization, the estradiol produced by the fetal ovaries has to cross the blood-brain barrier and gain access to the hypothalamus. A protein called, alpha-fetoprotein binds to the estradiol thus preventing it from crossing the blood-brain barrier. Alpha-fetoprotein, is a glycoprotein synthesized by the embryonic yolk sac and later the fetal liver and serves as a fetal blood osmotic regulator and a carrier of fatty acids. In Female In Male [Alpha fetoprotein prevents estradiol from entering| Testosterone freely enters the brain because alpha the brain. The hypothalamus is thus “feminized" | fetoprotein does not bind to it. Testosterone is and the surge centre develops. aromatized in to estradiol and the male brain is "defeminized”. Therefore, a GnRH surge centre does not develop. CRITERIA USED TO DEFINE PUBERTY Female becomes sexually receptive and displays her first heat Exhibit behavioural signs of sexual receptivity In heifers and ewes, silent ovulation is common and generally not accompanied by behavioural estrus Age at first estrus may not reflect true acquisition of puberty First Ovulation ‘Age at which first ovulation occurs. In bovine, it can be assessed by rectal palpation, ultrasound and laparoscopy. Requires frequent observations for precise determination. 60