Trastornos uterinos en la yegua: Diagnóstico, tratamiento y prevención

Abstract

The majority of infertility or subfertility cases in mares is caused by uterine pathology. This paper presents the state of the art in diagnostic techniques used to investigate uterine health. Clinical evaluation including physical examination transrectal palpation and ultrasonography as well as endometrial cytology, culture and biopsy remain the cornerstone for working up any case of infertility. Endometritis remains the major infertility causing uterine disorder. New therapeutic strategies have been developed in recent years to deal with infections caused by organisms that produce biofilm. Also, increased understanding of the innate uterine defense mechanisms has generated interest in new therapies. Aging affects uterine health in several ways, but most importantly the development of chronic degenerative disease. New therapeutic approaches are being developed in the hope of slowing down or reversing these degenerative changes. Referral to a specialty hospital may be warranted in some cases for advanced reproductive evaluation.

The association between the endometrial biopsy grade and selected epidemiological and reproductive variables in a population of subfertile mares

“…This association may at least partially reflect the effects of age on the endometrial response to haemodynamic stressors and vascular injury (Grüninger et al, 1998). In turn, the association between chronic endometrial degeneration (endometrosis) is widely accepted as an important contributor to reduced reproductive performance in the mare (Tibary & Ruiz, 2018; Todd et al, 2020). In the current study, a probable limitation resulted from the few mares <7 years old, arguably due to the bias associated with the selection of sub‐fertile mares.…”

“…Seven variables were selected based on their reported association with subfertility: Breed; specifically Thoroughbred or non‐Thoroughbred (Mahon & Cunningham, 1982; Todd et al, 2020) age (Grüninger et al, 1998; Morris & Allen, 2002); barren status ≥2 years (Leishman et al, 1982; Morris & Allen, 2002); uterine fluid retention (Woodward et al, 2012); acute endometritis (LeBlanc & Causey, 2009; Riddle et al, 2007; Tibary & Ruiz, 2018); positive bacterial culture (LeBlanc & Causey, 2009; Riddle et al, 2007; Tibary & Ruiz, 2018); and previous dystocia (Morley & Townsend, 1997). …”

“…Chronic endometrial inflammation with resultant fibrosis, including the degree of severity and extent of distribution was an important finding. This permanent change, if widespread, negatively affects future reproductive performance in the mare (Kenney & Doig, 1986; Tibary & Ruiz, 2018).…”

“…In the Thoroughbred, the overall rate of pregnancy failure contributes to a major loss to this industry (Morris & Allen, 2002; Todd et al, 2020), and the incidence of pregnancy loss remains largely unchanged over the past few years despite increased application of reproductive therapeutics (Rose et al, 2018). Endometrosis or degenerative endometrial fibrosis with glandular changes is an important cause of subfertility in the mare (Brinsko et al, 2011; Tibary & Pearson, 2015; Tibary & Ruiz, 2018). Endometrial biopsy is considered the gold standard for diagnosis of endometrial pathology and is indicated in any nonpregnant mare where uterine disease is suspected (Ricketts, 1975; Schlafer, 2007; Snider et al, 2011).…”

“…Subfertility is defined as any form of reduced fertility with a prolonged period of unwanted nonconception (Gnoth et al, 2005). Subfertility is associated with mare‐level factors including breed (Mahon & Cunningham, 1982; Todd et al, 2020), age (Grüninger et al, 1998; Morris & Allen, 2002; Todd et al, 2020), barren status (Leishman et al, 1982; Morris & Allen, 2002), uterine fluid retention (Woodward et al, 2012), acute bacterial endometritis (LeBlanc & Causey, 2009; Riddle et al, 2007; Tibary & Ruiz, 2018), endometrial fibrosis (Brinsko et al, 2011; Grüninger et al, 1998; Tibary & Ruiz, 2018), previous dystocia (Morley & Townsend, 1997) and biopsy grade (Brinsko et al, 2011). Endometritis and endometrosis have been reported to be the most common uterine pathologies causing mare subfertility or infertility (Tibary & Ruiz, 2018).…”