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Grade II Biopsy - cytology and culture clear! HELP

Discuss all kinds of problems encountered in breeding mares from not standing for live cover, through to not getting pregnant for unknown reasons!

Moderator: Jos

Grade II Biopsy - cytology and culture clear! HELP

Postby ryq799 » Wed May 21, 2014 10:03 am

Any advise would be much appreciated. There is only one equine vet in my area and travelling 3 hours away is not an option. I do not have 100% trust in this vet for several reasons but I am stuck between the proverbial rock and hard place. It is for this reason I took the breeders assistant course earlier this year and bought and ultra sound machine. Maybe it's overkill for breeding just one foal but it was my dream and I threw myself 100% into this.

I tried breeding mare AI two times last year and failed. Actually bred three times but 2nd time ovulation was delayed. Prior to breeding the vet did cytology and culture but determined biopsy was not needed at that time. After obtaining the results and speaking to the lab this January I came to find out that the cytology and culture was sent to the lab two weeks after being taken and that the samples were deemed unsuitable for testing. I am upset that I put my trust into the vet and was led to believe we had a thumbs up for breeding. Knowing what I know now I would have thought very long and hard before embarking on this journey. I feel as though I threw thousands down the drain and I can't afford to make the same mistakes again.

My mare is in great health and does not look her 20 years. I purchased her last year ( being told she is 16 years old - a story for another day! trust me I am not usually stupid and gullible) She is a 17.3hh Dutch warmblood by Rolls Royce and had a foal when she was 14.

Last week her biopsy results came back Grade II B. Any suggested course of treatment? or should I let her be and let the contract fall through. Below are the results of her biopsy.

1. Category IIb - moderate endometrial fibrosis
This endometrium is so categorized based on the cumulative presence of mild fibrosis and mild inflammation. Kenney and Doig (1986) reported a 10-50% foaling rate for animals with similar lesions. Effective treatment of the inflammation could result in downgrading to category IIA (50-80% foaling rate), but the fibrosis in such cases is suggested to be a permanent feature. Endometrial morphology is typical of proestrus-estrus transition.

Histopathology

ENDOMETRIUM – The endometrial propria is diffusely edematous; surface epithelium is columnar and ciliated with cytoplasmic vacuolation/clarification, and endometrial glands are convoluted, lined by columnar epithelium, and occasional contain coagulated mucus.
Glands are occasionally bound together by fibrous connective tissue as nests, separated by edematous endometrial stroma. There is a scant and patchy increase in the numbers of lymphocytes, plasma cells, and rare neutrophils in the superficial endometrium.
ryq799
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Re: Grade II Biopsy - cytology and culture clear! HELP

Postby Jos » Wed May 21, 2014 10:36 pm

Was there a culture done in association with the biopsy? The chances are that the inflammation is related to pathogenic presence, so a culture would have been valuable to determine exactly what. You'll probably need to find that out in order to treat it.

There has been success with the use of a DMSO uterine lavage to reduce fibrotic changes, so you might want to consider that as well.
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
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Jos
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Re: Grade II Biopsy - cytology and culture clear! HELP

Postby ryq799 » Thu May 22, 2014 10:14 am

Thank you for your response. She did have a culture (swab) and cytology (slide)done at the same time and both came back clear - is there any other reason for inflamation besides infection? During her ultrasound she did have s little fluid retention by the left horn.
ryq799
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Re: Grade II Biopsy - cytology and culture clear! HELP

Postby Jos » Thu May 22, 2014 10:08 pm

The inflammation is caused by something irritating the uterus, so now your job is to determine what. the next step I would take would be to perform a culture of a low-volume lavage as described by LeBlanc et. al. (LeBlanc MM, Magsig J, Stromberg AJ. (2007) Use of a low-volume uterine flush for diagnosing endometritis in chronically infertile mares. Theriogenology 68(3):403-12). As you will see by following that link, this technique is more effective than a uterine swab.

There are other reasons for inflammation beyond infection - for example if the mare is bred sperm cause inflammation, or if the mare has been in competition and has had a marble placed in her uterus to suppress estrus, that can cause irritation, so essentially what you are facing is a matter of more in-depth diagnostics.

Good luck! :)
We're always happy to try and help, but don't forget to check the articles section
of the website too, which has a search engine to help you look for answers!
:)
User avatar
Jos
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Posts: 3948
Joined: Sun Jun 10, 2012 12:11 am


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