Abnormal conditions of the bitch (Proceedings)

Diagnosis

The history is too important and too frequently ignored!

Historical assessment of the bitch's general health, cyclicity, previous conceptions, pregnancy termination, delivery of nonviable offspring, and failure of neonates to survive usually identify infertility. The fertility of the male will be presumed satisfactory for the remainder of the discussion on female infertility with the understanding that male fertility status must be known. Diagnostic evaluation is used in conjunction with the history to identify the cause and outline prognostic and therapeutic guidelines. It is important to evaluate breeding management practices historically and prospectively as a significant number of infertility cases are resolved "simply" by initiating good reproductive management practices. The recommendations made regarding the approach to the infertile bitch are confined to the brucella negative animal. Due to the poor success rates obtained with medical therapy and the risk of zoonosis, the author currently recommends that breeding animals confirmed positive for brucellosis be euthanized.

Infertility in bitches with abnormal cycles

Attempt to determine a possible hormonal reason for this failure. Could be ovarian, pituitary, thyroid, etc. but the problem is not going to be infectious or structural!

Failure to cycle

Obtain the history as to previous cycles, if any and when they occurred!

• Has bitch been on androgenic steroids?

• True failure to cycle bitches (by two years of age) are uncommon but seen.

     o Physical examination – Pay particular attention to the external genitalia. Is it normal?

• Evaluations could include:

     o Vaginal cytology

     o Brucella canis screening test because it is part of all reproductive examinations. It will not prevent the bitch from cycling.

     o Thyroid panel. Hypothyroidism will first be observed affecting the reproductive system.

     o Endocrine testing – Maybe?

          - Progesterone concentration – maybe bitch is cycling and owner is missing heat!

          - Luteinizing hormone concentration – Maybe bitch has been spayed!!!!!!!!

          - Estradiol concentration – maybe bitch is cycling and owner is missing the heats!

     o Karyotyping – Maybe the bitch isn't!!! XXY?

     o Complete blood count, profile and urinalysis may be performed if indicated. Rarely of any value unless the bitch is noticeably sick, underweight, etc.

     o Ultrasonographic evaluation of the reproductive tract – rarely of value! Functional ovarian tumor producing progestogens or androgens thus preventing estrus.

     o Radiographs – unnecessary.

     o Laparoscopic examination or exploratory laparotomy may be considered – rarely of value in a bitch that is not cycling!

• Diagnostic Recommendations:

     o Vaginal cytology – Normal anestrous cytology.

     o Brucella screening test – Because it is a breeding animal.

     o Progesterone - If the owner may have missed the heat(s).

     o Estradiol - If the owner may have missed the heat(s).

     o Thyroid panel - To determine if hypothyroid.

     o Karyotyping - If external genitalia looks the least bit suspicious.

• Treatment Plan:

     o Abnormal karyotype – neuter (now a pet animal).

     o Hypothyroid – inherited (??).

     o All appears normal – place with cycling bitch at least 30 to 45 days before she is due to come into estrus.

     o Administer cabergoline to induce estrus (average cost $350 to 400 per bitch). Success of pregnancy over 80% in otherwise normal bitches.

Prolonged anestrus

Obtain the history as to previous cycles and when they occurred!

Has bitch been on androgenic steroids?

Were heats normal before this prolonged anestrus?

• Physical examination – Pay particular attention to the external genitalia. Is it normal?

Evaluations could include:

• Vaginal cytology – Gives some idea as to estral cycle status.

• Brucella canis screening test - Because it is part of all reproductive

• examinations. It will not prevent the bitch from cycling.

• Thyroid panel - Hypothyroidism will first be observed affecting the reproductive system.

• Endocrine testing – Maybe?

• Progesterone concentration – Maybe bitch is cycling and owner is missing heat!

• Luteinizing hormone concentration – Maybe bitch has been spayed!!!!!!!!

• Estradiol concentration – Maybe bitch is cycling and owner is missing the heats!

• Karyotyping – Abnormal karyotype not likely if bitch normal estrous cycle previously.

• Complete blood count, profile and urinalysis - May be performed if indicated. Rarely of any value unless the bitch is noticeably sick, underweight, etc.

• Ultrasonographic evaluation of the reproductive tract – Rarely of value! Functional ovarian tumor producing progestogens or androgens thus preventing estrus?

• Radiographs – Unnecessary.

• Laparoscopic examination or exploratory laparotomy may be considered – Rarely of value in a bitch that is not cycling!

Diagnostic Recommendations:

• Vaginal cytology – Normal anestrous cytology.

• Brucella screening test – Because it is a breeding animal.

• Progesterone - If the owner may have missed the heat(s).

• Estradiol - If the owner may have missed the heat(s).

• Thyroid panel - To determine if hypothyroid.

Treatment Plan:

• Abnormal karyotype – Neuter (now a pet animal).

• Hypothyroid – Inherited (??).

• All appears normal – Place with cycling bitch at least 30 to 45 days before she is due to come into estrus.

• Administer cabergoline to induce estrus (average cost $350 to 400 per bitch). Success of pregnancy over 80% in otherwise normal bitches.

Prolonged proestrus/estrus

Obtain the history as to previous cycles and when they occurred!

Were heats normal before this estrus?

• Physical examination

Evaluations could include:

• Vaginal cytology – Indicator of where she is in the cycle.

• Brucella canis screening test - Because it is part of all reproductive examinations. It will not cause the bitch to remain in proestrus or estrus.

• Thyroid panel - Hypothyroidism will first be observed affecting

• The reproductive system. Usually does NOT cause prolonged proestrus/estrus.

• Endocrine testing – Maybe?

• Progesterone concentration, however, if elevated would prevent proestrus/estrus?

• Luteinizing hormone concentration – No value.

• Estradiol – No more value than a vaginal cytology.

• Karyotyping – Not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated - Not of any value.

• Ultrasonographic evaluation of the reproductive tract – Rarely of value! May locate follicular-like (cysts?) structures or granulosa cell tumor (rare) on the ovaries.

• Radiographs – Unnecessary.

• Laparoscopic examination or exploratory laparotomy may be considered – Rarely of value in a bitch with these signs!

Diagnostic Recommendations:

• Vaginal cytology – normal proestrous/estrous cytology

• Brucella screening test – Because it is a breeding animal.

• Thyroid panel - To determine if hypothyroid (?)

Treatment Plan:

• Hypothyroid – Inherited (??)

• Administer hCG - Diagnostic test and treatment for cystic ovaries (persistent follicles). Single treatment 95% successful. If that isn't successful, do an ultrasonographic examination and/or endocrine profile.

Shortened interestrous interval

Obtain the history as to the previous cycles and when they occurred!

Were heats normal before this estrus?

• Physical examination

Evaluations could include:

• Vaginal cytology – Little value.

• Brucella canis screening test - Because it is part of all reproductive examinations. It will not cause the bitch to have a shortened interestrous interval.

• Thyroid panel. Hypothyroidism will first be observed affecting the reproductive system. Usually does NOT cause shortened interestrous interval.

• Endocrine testing – Maybe?

• Progesterone concentration - however, determination would be performed following the previous ovulation to determine if a CL was formed and maintained.

• Usually not possible by the time the shortened interval has occurred.

• Luteinizing hormone concentration – No value.

• Estradiol – No more value than a vaginal cytology.

• Karyotyping – Not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated - Not of any value.

• Ultrasonographic evaluation of the reproductive tract – Rarely if ever of value.

• Radiographs – Unnecessary.

• Laparoscopic examination or exploratory laparotomy may be considered – Rarely of value in a bitch with these signs!

Diagnostic Recommendations:

• Vaginal cytology – normal cytology

• Brucella screening test - OK

Treatment Plan:

• This condition is hormonal in nature and the cause is unknown.

• If the bitch repeats this activity or is to be bred on the next heat, place her on mibolerone for 60 to 90 days to delay the onset of the next estrus and permit the uterus to heal. The uterus requires 120 days to "heal" following a heat and bitches bred less than this following an estrus have lower conception rates.

Infertility in bitches with normal cycles

Refusal to breed

Why? Obtain a very complete history.

• Obtain the history as to the previous cycles and if breedings were attempted at that time.

     o Was she ever receptive to a male? Does the male live in the same household?

     o Which is the alpha animal?

     o Physical examination – Pay close attention to rear legs and back for pain.

Evaluations could include:

• Vaginal cytology – Important if she is in proestrus or estrus.

• Physical examination - Include digital of vestible and vagina.

• Brucella canis screening test - Because it is part of all reproductive examinations.

• Endocrine testing

     o Progesterone concentration - will determine if bitch "really" should be receptive! Many owners think they should be receptive when they should not!

     o Luteinizing hormone concentration – Could use – more expensive and no more value than progesterone.

     o Estradiol – No value.

• Karyotyping – Not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated - Not of any value.

• Ultrasonographic evaluation of the reproductive tract – No value.

• Radiographs – Unnecessary.

• Laparoscopic examination or exploratory laparotomy – No value.

• Digital examination to look for stricture of vulva, vestibular sphincter or vagina – Excellent.

• Examine back and legs - For indications of pain.

Diagnostic Recommendations:

• Vaginal cytology – normal cytology.

• Brucella screening test – Will not cause the bitch to refuse to breed.

• Progesterone assay – Progesterone above 5 ng/ml.

• Digital examination – Check for stricture.

Treatment Plan:

• Since most of these situations appear due to the male not "liking"the female or vice versa, artificial insemination is usually the best recommendation.

Occlusive lesions

Results in obstruction to passage of semen and/or ova may occur due congenital or secondarily to acquired defects involving the reproductive tract of the female. Obtain the history as to the previous cycles and when they occurred!

Were heats normal before this estrus? Remember if the bitch bled during estrus,the cervix and remainder of the reproductive tract must be patent to somedegree!!!

Physical examination including digital of vestibule and vagina.

Evaluations could include:

• Vaginal cytology

• Brucella canis screening test because it is part of all reproductive examinations. It will not cause an obstruction unless severe and then it will be the oviducts following severe metritis.

• Thyroid panel - Hypothyroid bitches may demonstrate reduced libido.

• Endocrine testing – Maybe?

     o Progesterone concentration – primarily to determine breeding or insemination is occurring at the proper time.

     o Luteinizing hormone concentration – No value.

     o Estradiol – no more value than a vaginal cytology.

• Karyotyping – not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated - Not of any value.

• Ultrasonographic evaluation of the reproductive tract – May be of value depending on lesion.

• Radiographs – If large enough may show up on film or do contrast

• Radiography (excellent) – To determine structures which would be radio-opaque.

• Laparoscopic examination or exploratory laparotomy may be considered – Rarely of value in a bitch with these signs unless lesion is palpalated!

Diagnostic Recommendations:

• Vaginal cytology – normal cytology.

• Brucella screening test – OK.

• Digital examination – Vestibule and vagina.

• Ultrasonographic examination – of pelvic area.

• Contrast radiography – Excellent.

Treatment Plan:

• Rarely can blockage of the tubular genitalia be repaired. If it is unilateral (uterine horn), consideration should be given to removal of the affected side.

Tumors of the uterus or cervix

Results in obstruction to passage of semen, ova, or embryo may occur due to tumors involving the reproductive tract of the female. Obtain the history as to the previous cycles and when they occurred!

Were heats normal before this estrus? ? Remember if the bitch bled during estrus, the cervix and remainder of the reproductive tract must be patent tosome degree!!!

Evaluations could include:

• Vaginal cytology – Observe for increased white blood cells on cytology.

• Brucella canis screening test - Because it is part of all reproductive examinations. It will not cause the obstruction of the reproductive tract.

• Thyroid panel. No value.

• Endocrine testing – No value – cyclicity is normal.

• Progesterone concentration – normal for stage of cycle in which sample was drawn.

• Luteinizing hormone concentration – No value.

• Estradiol – No value.

• Karyotyping – Not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated. Not of any value.

• Ultrasonographic evaluation of the reproductive tract – May show the lesion better than scout films.

• Radiographs – If large enough may show up on film or do contrast radiography.

• Laparoscopic examination or exploratory laparotomy may be considered – especially if lesion is palpalated!

Diagnostic Recommendations:

• Vaginal cytology – Increased white blood cells.

• Brucella screening test – OK.

• Digital examination – Probably will not be able to palpate,

• Contrast radiography – Usually excellent.

• Ultrasonographic examination – May be of great value.

Treatment Plan:

• If possible remove the tumor from the reproductive tract while leaving as much of the normal tissue as possible for future reproductive capability.

Infections of the reproductive tract

May interfere with fertilization and pregnancy maintenance via effect sperm, ovum or embryo or indirectly due to stimulation of the mediators and by-products of the inflammatory response.

History of previous discharges, normal cycles, attempts to breed, etc. are All-important.

Physical examination including visual; examination of external genitalia for signs and nature of discharge.

Evaluations could include:

• Vaginal cytology – Observe for the presence of white blood cells.

• Vaginal culture – Excellent.

• Brucella canis screening test - Because it is part of all reproductive examinations. It can cause severe uterine infections.

• Thyroid panel. Hypothyroidism will not be related to uterine infection.

• Endocrine testing – No value except if history is lacking regarding last estrus (pyometra).

• Karyotyping – Not indicated.

• Complete blood count, profile and urinalysis may be performed if indicated. – May be of value to determine if systemic.

• Ultrasonographic evaluation of the reproductive tract – Could determine degree of uterine involvement.

• Radiographs – If uterus distended enough may show up on film.

• Laparoscopic examination or exploratory laparotomy may be considered – But if this is necessary for diagnosis, consider spaying while in there!

Diagnostic Recommendations:

• Vaginal cytology – Increased white blood cells.

• Brucella screening test – Hopefully will be negative!

• Vaginal culture – Treat specifically.

• Complete blood count, profile and urinalysis may be performed if indicated. – May be of value to determine if systemic.

• Ultrasonographic evaluation of the reproductive tract – Could determine degree of uterine involvement.

Treatment Plan:

• Prostaglandin F2alpha – Depending on uterine enlargement and fluid presence.

• Antibiotics – Treat specifically – Based on sensitivity –systemically and locally.

Advanced age

Historical information - Bitches older than 6 years of age may have an age associated decline in fertility. Usually smaller litters, decreased milk production increased dystocias occur before depletion of oocytes.

Hypoluteoidism

Not been substantiated in the canine - an unlikely cause of infertility.

Cycle lengths may run 4 months instead of 6 months.

Evaluations: Progesterone concentrations – less than 5 ng/ml 10-30 days after ovulation is considered to be suggestive of inadequate luteal function. Concentrations less than 2ng/ml are indicative of failure of ovulation and/or luteinization with inadequate lutealfunction.

Breeding management

Although not a direct cause of female infertility, certainly can be and many times is an indirect cause of infertility. It must always be considered and emphasizes the importance of an accurate and complete history.