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Is an endometrial biopsy indicated?

Equine-Reproduction.com Bulletin Board » Breeding Problem Mares - Volume 2 » Is an endometrial biopsy indicated? « Previous Next »


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Julie Gabel
Neonate
Username: Julie_g

Post Number: 1
Registered: 07-2009
Posted on Wednesday, July 15, 2009 - 09:10 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Would love some opinions on where to go from here...I aquired a lovely 16 yo Oldenburg mare last fall - she has an excellent production record - 10 foals in 12 years. Several years ago (before I owned her) she had a late-term abortion - not sure if the cause was documented and last year she was open. She has always been an easy breeder and has never had any uterine clearance problems. I had a breeding soundness exam done on her by a Theriogenologist in mid-late April this year. A uterine cytology was done and was normal - no culture was performed. Everything looked great. Good uterine tone, no cysts. Good vulvar conformation. An endometrial biopsy was not performed. She was bred by AI on the subsequent cycle and ovulation was documented 24 hours after insemination with fresh cooled semen. She was ultrasounded at Day 17 and was not in foal and was coming back into estrus. She was then bred again - good timing again with insemination w/ fresh cooled in the 24 hour period before ovulation. Checked again at Day 16 - not in foal. This time we used Regumate daily 3 days post-ovulation until the preg check. I really want to get this mare in foal and am planning to try again as she will be coming into heat in a few days. Plan to get another cytology AND a culture on the first day of estrus. Any suggestions on where to go from here? Is an endometrial biopsy indicated (16 yo and open last year)? If so, can that be done after the culture and cytology when the mare is in estrus. Can the mare be bred during that cycle if the biopsy is ok? I read about Jos' oxytocin protocol and that it can be helpful for older mares even if they do not have uterine clearance problems. Jos, or anyone, in this situation would you still recommend the intra-uterine antibiotic infusion or just the oxytocin presuming she is clean. Any suggestions would be appreciated! Thanks!
 

Jos
Board Administrator
Username: Admin

Post Number: 2548
Registered: 10-1999
Posted on Thursday, July 16, 2009 - 10:08 am:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Think of the endometrium (the uterine lining) as the tires on your car. If you're a little old lady who only drives to the corner store and back twice a week, then in 10 years time, there will still be lots of tread left on the tires; while if you're a travelling salesman who's doing 100,000 miles a year, the tires are going to be worn out within the first year.

The same thing applies to your mare's endometrium. The more foals she has, the more miles there are on the tires. 10 foals in 12 years is a lot of miles...!

The only way to know the mileage of the tires involved is to check the odometer with an endometrial biopsy. It could be a very cheap investment - if you get a biopsy score of III returned, you will know that there is a less than 10% chance of a live foal production, and you may decide to call it quits at that point, and save yourself a lot of money in the long run. Your best diagnostic is going to be a biopsy and culture, and that can be performed on the same cycle that you are breeding on as long as there is enough time to get the results back before she needs to be bred.

I would be astounded if this mare does not have some degree of delayed uterine clearance issues, so use of the oxytocin protocol is almost certainly warranted. We would use it as routine on mares of this age and parental status that we are breeding. Pycock has found beneficial results from the addition of the antibiotic uterine infusion post-breeding, and we have certainly used it in some situations. If you want to do an "all stops out" breeding, then it is probably a worthwhile addition.
 

Julie Gabel
Neonate
Username: Julie_g

Post Number: 2
Registered: 07-2009
Posted on Thursday, July 16, 2009 - 03:54 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thanks Jos! I will talk to my veterinarian about adding the endometrial biopsy. (I am a veterinarian as well but I work in public health and don't know much about equine repro. - although I am learning fast!) I think the oxytocin protocol is a "no-brainer". I'll definitely plan on using the protocol. What antibiotic do you typically use?
 

Jos
Board Administrator
Username: Admin

Post Number: 2550
Registered: 10-1999
Posted on Thursday, July 16, 2009 - 05:30 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

We like to use "Timentin®" as a broad-spectrum post-breeding infusion (Ticarcillin +Clavulanate potassium) unless there is something else specifically indicated by a pathogen (sensitivity) present.
 

Julie G
Neonate
Username: Julie_g

Post Number: 3
Registered: 07-2009
Posted on Tuesday, July 21, 2009 - 03:49 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

Thank Jos. Another question....the mare above in is Day 3 of estrus today and has a mod. amount of intrauterine fluid present per ultrasound. (She had a small amount of sterile intrauterine fluid on the first cycle we bred her on this season and was treated with oxytocin and resolved before breeding. Intrauterine fluid was not seen on ultrasound pre-breeding on the second cycle.) She had a culture and cytology yesterday (not enough time to get the results for the endometrial bx back so we opted to go ahead and breed and use the oxytocin protocol this time and if she doesn't settle, she'll have an endometrial bx before anything else is done). I don't have the results of the cytology and so far the culture has no growth after 24 hours. We will lavage the mare today and treat with oxytocin and recheck tomorrow and possibly lavage again tomorrow and follow with oxytocin again. We plan to breed via AI Thursday - hopefully only one dose of semen will be required and we will use the oxytocin protocol post-breeding and monitor closely for a couple days after breeding. My question is, if the fluid is sterile or until we have culture results back, should we avoid the use of intra-uterine antibiotics (Timentin) pre-breeding? Will it behoove us to wait on the culture to decide whether or not to use antibiotics pre-breeding? Can Timentin use pre-breeding have detrimental effects on the semen? Thanks so much for your advice!
 

Jos
Board Administrator
Username: Admin

Post Number: 2553
Registered: 10-1999
Posted on Tuesday, July 21, 2009 - 05:03 pm:   Edit Post Delete Post    Move Post (Moderator/Admin Only)

I would not treat with antibiotics prior to getting the results of the cytology smear back. If the smear is clear of inflammatory cells and fungus/yeast, then if you want to use an antibiotic, it's most likely safe to do so. In the absence of inflammatory cells, the culture results - even if positive (with the exception of Pseudomonas spp.) - are really quite academic. OTOH, if you have inflammatory cells (or yeast/fungus), you would be well advised not to breed, but wait for the culture results back (and if necessary reculture for the yeast/fungus, as they often do not show in a bacterial culture environment), and then treat with an appropriate (one to which the pathogen is sensitive) treatment.

Timentin is used in semen extenders, so although there is always a possibility of irritation/incompatability, it probably would not present a problem.



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