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How to proceed with a low biopsy score?

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  • How to proceed with a low biopsy score?

    I was wondering if any experienced breeders could share their advice/experiences in dealing with mares with low uterine biopsy scores.
    Do you just stop breeding these mares?
    Is there a different protocal that will help? Are there any supplements or herbs that can improve the condition of a mare's uterine cells? Could doing on farm AI rather than shipped semen help?
    Any insight would be greatly appreciated.

  • #2
    To better help you, just how low a biopsy score are we talking about here?
    Tranquility Farm - Proud breeder of Born in the USA Sport Horses, and Cob-sized Warmbloods
    Now apparently completely invisible!

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    • #3
      What is the score?
      It also depends upon if you are dealing with a concurrent infection, as well. If you have a lot of inflammation giving you a poor score, you may be able to address the inflammation and "improve" the score. If you are dealing with a large amount of fibrosis then that is more difficult.
      If it is a IIB we almost always advise owners to stop trying to breed, unless they are willing to do an embryo transfer. There are some treatments that we can try, again depending upon the individual biopsy report. I have seen some IIB mares carry to term, but not many.
      If it is a III then I woudn't bother trying anything. That is as bad as it gets.
      Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
      https://www.facebook.com/pages/Hills...h/112931293227

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      • #4
        We have a mare with a IIA who gets in foal almost every time but loses it around implantation (16-17 days). We've tried Settle, done tons of Oxytocin, you name it, tried just about everything. It's frustrating to see the black dot at 14 days and not at 18. She would be ideal for embryo transfer but we are not sure we want to spend the $$ to try. She is an SPS Hanoverian mare who is 17 and has had 6 foals, 2 of them VhW stallion candidates. They told us 50%-80% chance of maintaining pregnancy based on the score... guess it's not meant to be! But, I've heard of mares with worst scores carrying fine too! Go figure!

        Our vet said remember that you're taking a small sample relative to the whole uterus, so unless you do several over different areas you may not be getting a good representation of the entire picture.
        Signature Sporthorses
        www.signaturesporthorses.com

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        • #5
          I would suggest using Settle. Info is here http://www.expectbetterresults.com/index.html
          It's not true that I had nothing on. I had the radio on.”
          ? Marilyn Monroe

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          • #6
            Settle is a good product; however we don't know if it is appropriate for this mare or not. It is primarily efficacious for use in mares with endometritis due to Strep. zooepidimicus. We don't know if that applies to this mare or not.
            Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
            https://www.facebook.com/pages/Hills...h/112931293227

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            • #7
              FYI about Settle- some mares have had major issues with this product.
              "Sometimes you just have to shut up and color."

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              • #8
                I have had good results from using Settle. It is only available from a Vet so if it is not an appropriate treatment in this case the Vet will not use it. I am unaware of any problems using Settle and the case studies in South America and the US are very positive. I guess everyone has their own opinion.
                It's not true that I had nothing on. I had the radio on.”
                ? Marilyn Monroe

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                • #9
                  I have a few friends who's mares were hospitalized b/c of reactions to it. Extremely high fevers, lethargic, etc, etc. These mares were good candidates for it as well per the vets. One friend called the company and they are aware of such reactions.
                  "Sometimes you just have to shut up and color."

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                  • #10
                    I have seen Settle used in many mares, and a very few of them will run a fever. However, if you read the product info. that is expected to a certain extent. You have to realize that Settle is designed to stimulate the immune system and part of that "stimulation" can lead to a fever (a normal immune system reaction). See below, directly from the Settle product information:

                    Product Description:

                    SETTLE is an emulsion of purified mycobacterium cell walls that have been extracted by a process that reduces their toxic and allergic effects. SETTLE enhances the innate humoral immune responses by activating macrophages and stimulating the cloning of polymorphonuclear leukocytes (PMN). These activated phagocytic cells stimulate a cytokine cascade that results in the destruction of bacteria, such as Streptococcus zooepidemicus.

                    Side Effects:

                    Mild fever, drowsiness, and decreased appetite may occur for 1 to 2 days following intravenous injection. These are normal responses to the release of IL-1. An elevated body temperature enhances the immune function by stimulating leukocyte activity and thus is not an adverse side effect.
                    Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
                    https://www.facebook.com/pages/Hills...h/112931293227

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                    • #11
                      Understood, but a few mares went the extreme here and did in fact run very high fevers and went off food and water. I've not used the product myself but have a couple of friends who have and had bad reactions to it. Sort of like that 1% of folks who can't take what 99% of everyone else can.
                      "Sometimes you just have to shut up and color."

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                      • #12
                        BREEDING DIFFICULT MARES

                        I posted this earlier this year on another bb. Thought I should repeat here:
                        After waiting 7 years, our hoped for filly finally arrived on Good Friday. For those of you who sometimes think of giving up on a difficult mare, I encourage you to persevere. This filly is worth every bit of effort it took to get her, and every minute of the wait!

                        The filly is by Werther, out of DJanna, our Derwisch/Gutenberg/Novize mare who up until 2003 had been the ideal broodmare (always conceived on the first insemination cycle, produced outstanding foals, and has been an excellent mother).

                        But beginning in 2003, things changed. First, in 2003 and early 2004 she was bred multiple times to Londonderry, all resulting in development of uterine infections.

                        By mid-2004 we gave up on Londonderry, and instead bred to Fabuleux. Again, she conceived on the first attempt. Unfortunately, the fetus died at approximately 7 months, but instead of aborting, it decayed inside her. She had a massive uterine infection, and a skeleton still remained in her uterus. Numerous times a day for the next week or so, a vet had to insert her hand/arm into DJanna’s uterus and removed the skeleton, a few bones at a time.

                        And then, the question was: how much damage had this caused to DJanna’s uterus; and, would she ever be able to carry another foal to term? The results from her uterine biopsy in the spring of 2005 were IB, the same as all previous biopsies. DJanna had her first normal cycle in early April 2005; we decided to breed her, hoping she would conceive, and then we would flush an embryo to transfer to a recip mare. After we were unable to recover an embryo on 3 successive breedings, we began to wonder whether DJanna was still able to conceive. So in August 2005 we bred her, did not flush for an embryo, and on day 22 DJanna was pronounced in foal. A subsequent check, however, found no fetus. Good news, she was able to conceive; bad news, she did not maintain the pregnancy. Was the uterus too damaged, even thought biopsy results indicated no change from previous years?

                        In 2006 she was bred once, we used Settle, but she developed a yeast infection that took the rest of the breeding season to get cleared up (not implying the Settle had anything to do with the infection).

                        By now, a great deal of time, effort and $ had been spent trying to get another foal from this mare. Should we admit defeat, or continue trying? We decided 2007 would be our final attempt. Another failed attempt and sadly we would retire DJanna without having produced her replacement.

                        But, as the saying goes “BLESSED ARE THE BROODMARES”. DJanna conceived on the first insemination in 2007, carried her foal to term, delivered without complications, AND produced the dreamed of replacement, a healthy, bouncy, beautiful bay filly who we have named Ferradae!
                        AND, DJanna is currently pregnant again (we are at Day 100) for a 2009 foal. If you want a detailed description of the breeding protocol that has resulted in these latest pregnancies let me know and I can provide it for you.
                        Last edited by wildswan; Aug. 12, 2008, 06:47 PM. Reason: correct biopsy score
                        SherryM
                        WildSwan Hanoverians

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                        • #13
                          Does anybody know if you can breed a mare on the same cycle that the biopsy was performed?

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                          • #14
                            Originally posted by password View Post
                            Does anybody know if you can breed a mare on the same cycle that the biopsy was performed?
                            Yes, you can.
                            Already excited about our 2016 foals! Expecting babies by Indoctro, Diamant de Semilly, Zirocco Blue and Calido!
                            https://www.facebook.com/pages/Hills...h/112931293227

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                            • Original Poster

                              #15
                              Thank you very much for all of the replies.

                              The mare is an older maiden who has had no previous breeding attempts. She was bred once with shipped semen and had a large fluid reaction. She was treated with Oxy on this breeding but was not in foal at the 15 day ultrasound. We bred her a second time, the fluid reaction was less but she still was treated with Oxy then was put on regumate until the 15 day ultrasound where she was not in foal again.

                              We then did the biopsy and the score was IIB. The vet said that this was not the result of infection, just weak or poorly developed endometrial cells. Does that sound right? I can't remember the exact type of cells. He said it was likely due to old age.

                              The vet suggested that she may be a good embryo transfer cadidate since she is ovulating well. She is a special mare to me so I would consider embryo transfer but if she were able to carry her own foal I would prefer that.

                              Thank you Wildswan for sharing your experience, somewhat different circumstances but encouraging all the same! I think that next year will be the last try for this mare for me.

                              Comment


                              • #16
                                Breeding Protocol for Problem Mare

                                Since several people have PMd me requesting the details on the breeding protocol we used to get DJanna to conceive and carry to term after all her problems. I've decided to post it here. Nothing too unusual about it for those breeding with frozen. The only thing that might be considered different is highlighted in bold below.

                                I should add that DJanna is 16 this year.

                                AFTER CYCLING BEGINS IN SPRING:

                                Reevaluate reproductive soundness:

                                • Evaluate cervical area with vaginal speculum to determine whether there is any urine pooling in front of cervix.

                                • Ultrasound to determine whether she has delayed uterine clearance.

                                • Culture & perform endometrial cytology smear when in heat to determine whether she is infected and/or has endometritis (inflammation of the endometrium).

                                If any of the above are outside normal limits, we treat before breeding. Let me know if you need further details on how we treat.

                                • Check for endometrial cysts. If there are cysts, we map them so we know where they are when we ultrasound for pregnancy check.

                                • Perform endometrial biopsy

                                These are done to establish baseline.


                                WHEN READY TO BREED:

                                • Do not have on Regumate prior to this. It is not helpful and screws up prostin/HCG timing.

                                • Ultrasound until establish date of next ovulation.

                                • Injection of prostaglandin 7 days post ovulation.

                                • Injection of HCG when there is a follicle >35mm (approximately 7-8 days after giving shot of prostaglandin but you have to do repeated ultrasounds to determine when this occurs).

                                • Ultrasound and 1st insemination 24 hours after giving HCG

                                • Ultrasound and 2nd insemination 40 hours after giving HCG
                                o We are usually breeding with frozen so if ultrasound showed that mare had already ovulated at 24 hours we would scratch this cycle and start over. So far, this has never happened. If mare has not already ovulated at 24 hours, we breed at 24 and 40 hours post HCG injection regardless of follicle size.

                                o If mare hasn’t ovulated at 40 hours post HCG, we may try inseminating once more in another 12 hours, or we may decide to skip this cycle and start over.
                                POST BREEDING:

                                • Ultrasound 4-8 hours after final insemination to assess how mare is clearing uterus of fluids. If fluid found in uterus at this time, treat with oxytocin. There are different theories regarding how to treat with oxytocin. I think it depends on the mare. For this mare, we treat w/2cc oxytocin at both 6 hours and again at 8 hours after the final insemination, if we see ANY fluid at 1st post breeding ultrasound. Do not continue to treat with oxytocin after day 3 post ovulation.

                                • Ultrasound again at 24 after final insemination regardless of what we saw at 4-8 hours. If we see fluid at this time we culture and flush with saline. If the saline flush returns fluid that is cloudy, or suspect in any way we treat with infusion of a broad spectrum antibiotic. Then give oxytocin again at 6 and 8 hours after infusion.

                                • We may repeat above at 48 hours post insemination if we didn’t like what we saw at 24 hours.

                                • Ultrasound at day 15 and day 28 to confirm pregnancy and ensure don’t have 2 pregnancies due to asynchronous ovulation.

                                • Administer 12cc Regumate daily, as soon as pregnancy is confirmed, continuing through entire pregnancy. Again, many people do not continue Regumate after day “x” but I have found with this mare “better safe than sorry” is a good rule to follow. We discontinue Regumate about 2 weeks before expected foal date.

                                • Keep mare toxin free during first 45 - 90 days (no deworming, no vaccinating, no fly spray, etc.)

                                In addition this mare is given 1 scoop Thyro-L and 10 aspirin daily.

                                • The Thyro-L is because there is reason to believe that low thyroid can be a contributing factor in “problem” mares not conceiving or carrying to term. My vet is not convinced that current thyroid testing methods are very reliable for mares. He believes there are too many variables, so we didn’t have her tested. But when this mare started having frequent hoof abscesses (sometimes another symptom of thyroid problems), and began having fertility issues as well, we decided that we would try putting her on the thyroid meds. Little or no risk to the mare, just additional cost for us.

                                • The aspirin is because there is a condition called elastosis which results in not enough blood supply/nutrients to the uterus. Specifically, elastosis is a buildup of elastic tissue in the arteries and miometrium (the muscle of the uterus as opposed to the endometrium which is the lining of the uterus). The condition is known to occur in pregnant women and is treated with aspirin therapy. Apparently there is some speculation in veterinary circles that this same condition occurs in some of our problem mares. No equine scientific data to support this yet, but based on the human studies and my vet's advice, I was willing to try it.


                                No one knows whether the Thyro-L or the aspirin had any affect, but she was not getting these meds when we were having fertility problems, and she is getting these meds now and we are not having fertility problems. So this mare will probably be on these meds until I decide to retire her.
                                SherryM
                                WildSwan Hanoverians

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                                • Original Poster

                                  #17
                                  Thank you so much for posting such a detailed description of your breeding practice for your mare.

                                  Comment


                                  • #18
                                    Thank you Sherry! I'm going to try your protocol with my problem mare next year if I still have her.
                                    http://ShowjumpersUSA.com
                                    CAMPESINO (1990 - 2008)
                                    Capitol I - Sacramento Song xx
                                    http://www.caringbridge.org/visit/annalisasmith

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                                    • #19
                                      Thanks Hillside. And Wildswan, that was a very inspiring story!

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                                      • Original Poster

                                        #20
                                        Just to bump this thread, I am still unclear if there is any way to improve the score? My mare was a IIb and it is my understanding that the vet does not feel there is any infection, that it is just due to her age. In that case the settle would not apply, correct? She is 16.

                                        The mare was not in great condtion when I got her. Could improved feed, fitness and an overall improvement in condition improve her uterine health?

                                        Thanks again for any information, I am still trying to understand what is realistic.

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