Episode 190: Tackling Canine Infertility in Females

Dr. Andrea Hesser, DVM, DACT, joins us from Purina to teach us about the most common ailments in canine breeding programs that affect conception and carriage of pregnancy, including diagnosis and treatment options.

Watch the video version of this presentation here.

Transcript:

Nicole Engelman  00:04

Welcome to the Good Dog Pod. Join us every other Wednesday when we discuss all things dogs, from health and veterinary care to training and behavior science, as well as the ins and outs of Good Dog and how our platform can help you successfully run your breeding program. Follow us and join Good Dog’s mission to build a better world for our dogs and the people who love them.

Dr. Nate Ritter  00:28

Hi everyone. My name is Dr. Nate Ritter. I'm Good Dog’s Medical Director. Thank you so much for joining us today for our presentation on tackling infertility in breeding females with our guest, Dr. Andrea Hesser. I wanted to share a quick overview of what we'll be focusing on today. We'll learn from Dr. Hesser about the most common ailments in canine breeding programs that affect conception and carriage of pregnancy, including diagnosis and treatment options. We're so excited to partner with Purina again to bring you this Good Breeder webinar. This was a topic requested by our community, so thank you for letting us know what you'd like to see more of in terms of canine health content, and please continue sending suggestions our way. We hope this will be helpful for all of you and your breeding programs. And we've already hosted a ton of webinars this year, so I wanted to remind everyone that you can always find all recordings in the Good Breeder Center at the link we’ll drop in the chat. During the Q&A segment of this presentation, we'll be prioritizing the previously submitted questions from our community first, but if you would like to ask any questions, please feel free to drop them in the Q&A box at the bottom of our screen, and we'll do our best to answer them. Before we kick things off, I wanted to share a little more information about Good Dog for anyone new who's joining. Good Dog is on a mission to build a better world for our dogs and the people who love them by advocating for dog breeders, educating the public, and promoting canine health and responsible dog ownership. We're a secure online community created just for responsible dog breeders to connect with serious quality Good Dog applicants and find forever homes for your pups. We use the power of technology to help our Good Breeders level up their breeding programs by providing them with tools like our secure payment system to protect them from scams and our best in class software to post available litters and start connecting with Good Dog applicants, as well as a number of free educational resources and health related discounts to help your breeding programs thrive. If you aren't a member of our community, we invite you to learn more about our mission and apply to join at www.GoodDog.com/join. And before we get this presentation started, I wanted to share a little bit more about Dr. Hesser and her amazing background in canine health. Andrea Hester, DVM, DACT, is a board certified reproductive veterinarian who practices in small animal medicine in the Dallas-Fort Worth area. Her clinical time is spent doing general practice veterinary medicine and reproductive consultations in surgery. Dr. Hesser also provides semen collection and health testing services at local dog shows. She's a long time canine breeder and enthusiast with an interest in Whippets and Bullmastiffs. Her mission is to serve breeders by helping them achieve their goals with their breeding programs. With that, I will pass it off to you, Dr. Hesser, to get this presentation started.

Dr. Andrea Hesser, DVM, DACT  02:42

Thank you guys for being here. We'll be talking today about infertility and female dogs. So this is a large amount of consultations that I see. Certainly, it's always one of those scenarios. You know, there's two pieces of the puzzle, right? There's the dam and the sire, if they produce litter, but if they don't, it's kind of a “who is at fault”? And I think a lot of the times the fingers get pointed at the stud dog because, you know, it's just common, but there's two components to that, and I think a lot of the issues happen on her end, some of the times, and sometimes it's a combination of things. So I think it's good to kind of review what things we know are out there in dogs, and just give you guys some tools as far as what could be pursued if you wanted to pursue, working up a dog that was really important to your program, that might take a little bit more effort to get pregnant or to carry pregnancy. 

So we're going to talk about infertility—what it means. So you can certainly have infertility at different points, or poor carriage of pregnancy at different points. Some of the time, it's things at conception. Sometimes it's uterine problems. Sometimes they're resorbing or having loss in other ways. They can have a number of different diseases that can contribute to that, one of which you guys are experts on now. So neospora is on that list. Strategies for infertility: so if you are kind of in that boat, and you feel like you have a dog that kind of qualifies to work up. And then I'm going to talk a little bit—just if we have time—on some optimization for the breeding program approach in general. So just like basic husbandry things that are just going to promote you getting the best results you can on the female side. And if we have some time, maybe talk about some cases. I'll probably just work the cases in as we go. 

So, true infertility (when I'm thinking about it) is when she doesn't conceive, so whenever she is unable to actually—if for egg to fuse to sperm, for that to become an embryo, for that embryo to adhere to the uterine lining. Conception in dogs is basically from the period where, like, immediately post-breeding—it's not going to necessarily be the day of breeding, right? So sperm take some time to make their way through the tract. The eggs aren't always ready at that time, but once egg and sperm are both mature and in the right environment on the right date, from that date to about 19 days. So 19 days post-LH is what we're talking about. We think of it as basically a medical dead zone for dogs. So we can't tell you if she got pregnant, right? So, like a person, we have EPTs. You can pee on a stick, and you can know in relevance of timeline. We're talking in dogs where it's only a 65 day gestation length, right? So basically, the entire first trimester for the dog, we can't even tell that they're pregnant—even with a really, really nice ultrasound. Nineteen days post-LH, we can see what we think are, like, almost like cysts. So we call them vesicles, but they're very, very tiny—like millimeters wide—small, circular dots, if you will, in the uterine lumen. But it's not something I would recommend for my personal clients. We're talking like human grade ultrasounds can find it. I usually say 21 is pushing it. There are some dogs we've been able to check as early as 21 days post-LH in kind of some of these weird scenarios, but it's tough, because in the first trimester, in a human, that's when we experienced the most loss. So there's probably a lot of dogs that we just can't document exactly why they weren't pregnant, but they did try. Maybe they got to 10 days and then they resorbed, or the embryos didn't stick very well, or something to that effect. 

So why don't we have an EPT for dogs? It would be great, right? If we had something where you could run a test at five days post-breeding and you could know did she conceive? Because we basically have that in people. So wolves, they are pack animals. We say that dogs and wolves obviously have a lot of common genetics, dogs having descended from them or from similar canids. So wolves existed in a structure where they would have an alpha female that would carry litters, and the rest of the pack would not necessarily be bred, but they would cycle, and they would cycle, go through their process in the exact same way as a non-pregnant dog, as the pregnant dog; so the pregnant wolf and a non-pregnant wolf would both cycle. And the idea was, if their cyclicity was kind of at the same time frame, they all kind of came in at the same time, or had the kennel effect, is what we call it in dogs, and then they go through a similar cascade of LH, peak progesterone, having ovulation, etc., and then going into a low progesterone state after having that, it creates the effect of those other wolves being able to lactate for this alpha female. There are some endocrinologists that I know, so people that were like the people that really study progesterone in dogs at a high level, that really think that dogs don't have any recognition of pregnancy, because their body, no matter what happened to them during their cycle, goes through the same thing. So it doesn't have to tell its own body, “Keep this pregnancy.” It already will do that by design, if they're bred and if they get pregnant. So if the progesterone is climbing and it's going up and going up and going up, and maybe there was something here in another species where we started to go up, but she doesn't get pregnant, or she loses her pregnancy—well, a lot of other species, their hormones go down. So they'd start to climb, and then they go back down if they didn't get pregnant, either progesterone or another endogenous hormone. Other species have early recognition factors that happen at different periods. So if we have that kind of scenario, in some species, they just go right back into cycle. So things like cats, if she doesn't get pregnant, and her progesterone doesn't go up, she just goes back out of heat for about a week, and then she'll come back in heat. So it's just a very different dynamic for the way that they function. 

In that first 19 days, postal-LH, there's a few different things that we kind of break down. Again, this is all theoretical, because we can't prove what happened when. But just to give you some perspective on what should be happening in their body, that we know does happen, but we can't define from an ultrasound perspective. So clinically, we can't tell what's going on. Microscopically, they've been able to look at some of this with electron microscopy, for example, but it's really tiny stuff, way tinier than what we can see. So from LH to fertilization, or, you know, that kind of window where we're doing our breeding work, we could have failed fertility based on simply breeding and timing. So did this stud dog have the right sperm in the right place at the right time? Are those sperm and eggs happy to go through the process to make a zygote and produce an embryo? Did they not for some reason, and then, like, once that period happens, once fertilization happens, we have something to work with. We are going forward with an embryo. From there to implantation, which is about 12 days gestation, when they implant, we're thinking of uterine health. So when those babies that are starting to form in the oviduct (so they're way up high, they're not in the uterus yet), the oviductal embryos will float down into the uterus, and they'll kind of float around between six and 12 days. They'll float from horn to horn. They kind of find their own space. So sometimes when they're migrating around, maybe they get stuck around in a spot that's not super healthy, or maybe they didn't lay down a really good placenta for themselves, or the kind of foundations of the placenta, they started to kind of have some hiccups with where they were. That's kind of that time frame. Again, we can't see it with ultrasound or traditional means, but that implantation is just like the moment where this puppy decided to be here so they can no longer kind of bounce around and float around to find a good spot. From implantation at 12-ish days to ultrasound visibility, they can also just not grow where they landed right? So say they landed on a cyst in the uterus and they stuck to the wall, but it was kind of right next to a cyst, and they're trying to get blood supply. Well, a cyst isn't going to have very good blood supply if it's kind of blocking out where they can get some of that nutrition from their mom. So that could happen. Also just things like chromosomal type defects. There might be some stages where some things that just happened in nature did not want to go forward in a healthy way, and sometimes they'll lose puppies that way. They also can lose puppies at this stage. This is a stage where a lot of infectious things can happen, right? There's lots of blood flow to your uterus. They're really young and fragile at this point, and it's hard for us to confirm. Did this really happen or not at this stage?

Dr. Andrea Hesser, DVM, DACT  11:34

So I know you guys probably already know the answer to this, but the number one reason for infertility is . . . (drumroll) poor breeding management. So I would say 95% of consultations that I see, I will go through the history with them, and we'll talk about things that can be improved. But almost always, I will encourage people to say, you know, if we bred without ovulation timing, if we bred to a stud dog with maybe iffy semen, if she had funny things with her cycle, if she wasn't followed out because you were traveling to your stud dog, and we don't know exactly when she ovulated, but we went ahead and bred her. There's lots of those types of things that I think we like to give them the benefit of the doubt and presume that we did things right, because we're trying to do things as best we can. But sometimes we can't work all those details out. Sometimes the labs are closed. I mean, my example with my own dog, had I not had the access to multiple clinics to run progesterones? My progesterones all got lost in the mail when I was breeding my own bitch this spring, right? So I ended up running them twice. Fortunately, I had a friend down the street who said, “Come, bring all your samples.” I saved a bunch of samples in my freezer, so I like Hail Mary’d that scenario. But those kinds of things can certainly happen. If my bitch had not gotten pregnant—well, I mean, that's you can't fault that necessarily as a true strike against her having a fertility issue. 

All right. So I know we kind of talked through some of these things, but they can have problems of different kinds at different stages. So we'll just talk a little bit about each of those, just as an overview so you guys have a list in your mind: Conception, like we discussed, could be semen timing. Could be something to do with her cycle, how it went through, maybe the technique used. I've got a good friend of mine who is a good example. She has a five or six year old Boerboel bitch who's wonderful, and she's a really good contributor for this breed if we can get her pregnant. She's never gotten her pregnant because she's just had something happen. Each time they've bred, they've had something happen. So one of the times she bred, they tried to do a natural breeding, and they ended up doing a vaginal AI. Well, vaginal AI and a giant breed dog is just a much harder feat. Sometimes it just doesn't have good outcomes. I think it is just the breed specific thing. I don't fault the Boerboel bitch for not getting pregnant from a vaginal insemination. They wonder if they were a little late. They had to run progesterones at two different places. She went to their National. You know, it was just one of those things where everything didn't work the way it needed to go on that particular cycle. And sometimes those things happen. They also can have just incompatibility. So there are some stud dogs and some females. When you combine Dog A with Dog B, Dog A and Dog B do not get pregnant with each other. You breed DOg A to dog C, and she'll get pregnant, and you breed that stud dog, you breed that said dog to a different female, and they'll get pregnant. But for some reason, you keep trying that same stud dog, and you might not get a good outcome. So sometimes we might say—I know this is what you'd prefer if you're going forward to try to get your infertility kind of concern female pregnant, we might say, “Would you rather have a puppy from this female or would you rather have a puppy and sacrifice that potentially she won't get pregnant if we keep trying the same stud dog?” That's the ideal dog. That's the only dog that you have in your head. I think a lot of people—it's a tough pill to swallow when we get to that kind of discussion, but sometimes repeating the same dog over and over and over is its own kind of hole to dig. 

All right. So I know you guys already kind of saw the same graph. So just as a reminder, there's different stages of when things happen with the canine cycle. We can breed them outside of this fertile window. So the fertile period here, the days of the bottom are post-LH: seven is probably pushing it, but I would include it as part of like frozen semen, or if you were doing intrauterine breeding with either a TCI or surgical breeding, sometimes even natural breeding at that far post-ovulation, so it would be day five post-ovulation—it's pushing it, but the oocytes of the eggs are fertile, usually, and young, healthy, you know, reasonably young, healthy bitches. We can't get the semen to them sometimes that late, but technically, they can conceive. And we do see a lot of dogs that have good conception rates with them. But we're waiting until, you know, a few days post-ovulation before we really see that fertility window spike. Now, can a really fertile dog with fresh semen breed her way back at -5 and have a pregnancy? Absolutely, we see it all the time. My personal record is 73 days post-TCI, with fresh semen with a singleton, and I used to say 72 was the extreme on the furthest out it could be. But from natural breeding, there's a lot of variety. From fresh semen breeding, there's a lot of variety. Even if you're doing your own fresh AIs at home, say, and you didn't have the timing, or you didn't trust the timing, something was weird with the timing. I think you know, things to be considering. 

So there is this thing that's called an anovulatory cycle that can happen. So normally, progesterone goes up and it continues to climb. It might not climb really aggressively. And some dogs don't have a really pretty trend like the graph, but there are some dogs that go up and they sit and then they come back down. This is going to look identical to a split heat. So some dogs will do this and spend a lot of your money doing progesterones, and then they'll go out of season, and then four weeks later, they'll be back in season, go through a cycle and ovulate. Other dogs will do this serially every time they cycle. And I will tell you, this is one of the most frustrating conditions to fix. For those of you guys that are attending this, that this was like your hot button, “I've seen this in my lines. I think it has a genetic component.” I think some breeds like to do this, and I think it does have to do with some lines. But truly, there are ways we can try to fix it hormonally. We can. The cycle, when it's happening in front of you, by the time we figure out she's doing this and see the trend not going and not going and not going, we let that trend go for a little while, but by the time they do stall for enough time that we say they're definitely stalling, their egg health—so the actual health of those oocytes, or eggs that haven't ovulated yet, at these numbers—those start to get real, I would just say just poor quality. Once they ovulate, we think that the eggs themselves are just not happy on this cycle. So I usually recommend, if this happens, if it's a recurrent problem for sure, then don't breed her, necessarily, or throw a lot of money into her at this cycle. I would recommend next cycle to purposely force her to ovulate with drugs. So there are some drugs that we can use. There's a few different hormonal injectable drugs that people will use, lots of different studies that have different protocols. So I won't go into a specific protocol here, but there are some kind of combined GnRH and HCG type injectable protocols that have been successful. I will tell you, in my personal experience, these are very challenging to fix, and German Shepherds, especially, very challenging to fix. If they have this once, I would just presume she's having a split heat. They can have a split heat anytime. That just means that they're doing that. They're going to have this little rise, and then they go back out, and then they go forward in a month or so in another subsequent cycle. But it's not good for them to kind of keep doing this and keep doing this and keep doing this. I think that's part of the issue of why we can't get these pregnant sometimes. Sometimes we can't make their cycles go forward. Sometimes we can make their cycles go forward. But this like sitting with low progesterones and having frequent cycles that aren't doing anything, it primes your uterus to be super unhappy. So it makes that estrogen that's kind of coming and going with these cycles, if they're kind of not cycling in long intervals like a normal cyclic heat would, it can just be a recipe for problems. 

So just as a reminder, if we're talking about confirming when she ovulated . . . In reference to these numbers, so you can see she goes up, 0.4, then couple days later, 2.5, couple days later, 5.3, then she goes down to 3.5. Usually, if they start doing this, I'll look at a cytology for sure as part of the “what is she doing?” She can putz around at 5.3, 3.5. I mean, there's some variability that can happen. They don't have to go up in a steady line. Sometimes they kind of do some funny things. But for, you know, classical purposes, we want to see a three nanogram per milliliter. So three point rise if you're in the United States, that's the measurements we use. If you're in Canada or overseas from the US, you might be using nanomoles per mil, and that'll be a little bit different trend. I don't know what the conversion factor would be for that, but I can look it up. If anybody is interested in that, we probably can get that information for you, posted. So we want to see three nanograms per mil in 24 hours. Well, for most people, I would say how most veterinarians are timing and recommending, and because most owners are reluctant to be running daily progesterone for a lot of their readings, we might not see specifically when she did this three nanogram per mil rise, but say, if you checked her today and she was a six and she was a 12 on Friday, well, she's definitely ovulated, right? Like, we know that trend. We can't prove it, but, like, there's a pretty big jump there, and we can presume that she did something in there. Did she do it on the day she was a six? Or did she sit at six for another day and then she ovulated off of a six? That's also possible. The old rule of five, four or five is—I'd say—it's like 90% of dogs will ovulate off of those types of numbers, but they don't all do it, right? So like this dog? Well, there's plenty of people who would have done 0.4, 2.5, 5.3 and then they would have just planned a breeder. There's lots of very good veteranians—I hate to say that—but lots of good veterinarians that are my colleagues that I wouldn't do the timing in the same way, but that don't follow them after they hit roughly ovulatory ranges. Some vets will maybe run progesterone the day they bred. But I'm more interested in—after this 5.3, I want to know what she did after that, before I plan for when I'm breeding her, because it'll give me more specificity. If they're greater than 10, though, we know that they've ovulated at that point. They're high enough they have to have. Some dogs will sit there and go—I'm sorry if you're that owner—but they'll go 4,5, 6, 7, 8, 9, 10, 12. That dog. Or the 4, 5, 6 , 7, 7, 7, 7, 7, 7, 7, 8, 7, 7, 7 dog that carries their pregnancy and somehow went through the motions. They really can do a lot of different things. Sometimes it can be hard to interpret. 

All right, so I know we talked about oocyte quality, or egg quality, in relevance to holding onto your eggs too long. So if you don't ovulate, and they sit there and sit there and sit there and finally they ovulate. Well, sometimes they're not super healthy. They also just can be unhealthy. So this is a common issue with older dogs. So there's kind of two fold reasons why older dogs don't like to get pregnant. Dogs cycle forever. They do not have menopause like women. It's a totally different type of cyclicity than what we're dealing with with dogs. Dogs will cycle until they die. For the most part. The reason they might not cycle is pathology or having an issue such as, you know, ovarian tumor, something functionally going on. Their ovaries and uterus never actually shut down completely. But they don't make very healthy eggs when they're older, and sometimes their uterine health is the other reason. But I would say the association: the younger they are, the healthier their oocytes and embryos tend to be.

Dr. Andrea Hesser, DVM, DACT  23:16

So sometimes we don't get to know all the information. So semen quality, we love to know. So we talk about this sometimes when we're planning for infertility scenarios with maybe they have a young stud dog that they have naturally bred, and it's been six months since he had a litter of puppies, and he's really hard to collect in the clinic. But you can get a natural breeding on him. It's one of those kind of question mark scenarios. So do we try to collect him to do something artificial so that we can physically see what's going on in there as part of the cycle, or do we just leave it well alone and say natural breeding is fine? Well, if she doesn't get pregnant, and all we did was natural? Did he have good sperm at that time? And I think we have to presume a little bit. I think if he's being bred on either side of that, you can pretty well rest on that he's probably okay. And maybe it's a combined male and female issue. Maybe it's just on her end as to why it didn't work. Or, you know, things we just visited about: the actual timing and things. The only way, even with semen evaluation, though, like if I did evaluate the semen and do a TCI, and it's a novice male, never been bred before, maybe he's got something, some DNA damage, or something that's not showing up on his motility. His motility looks good, his numbers look good, his morphology looks fine. We use those things as an indirect way to say he looks fine. But the only way to prove that he is fine is that he produced a litter, because there's a lot of little microscopic things that have to happen. Sometimes those show up as red flags in the semen evaluation. Sometimes they don't. And there's some dogs that always looked fine that had a flagellar problem. There's some kind of unusual tests that we can run that are not super well studied, but there's some kind of odds and ends stuff that we can look at that has to do with mostly DNA damage and oxidative stress and sperm. But basically, the sperm isn't healthy, even though it looks like it's okay; it's not as healthy as it looks. So again, this is kind of a given. What was the count like? Were we happy with the motility? Were we happy with the morphology? Did we run a semen eval? And that's okay, and sometimes it's, well, I do my own AIs, you know, at home, and I always have good success, and that's okay. I don't hold that against her, necessarily, if we didn't have really complete data. And I will say a ton of times, people look at concentration, so they'll see this sample in the center, and they'll say, “Oh yeah, it was super concentrated.” This is fractionated, by the way, so there's clear on either side. If that was all combined, that's typically what the owner would see in their bag, right? So more volume than what you see. He's super concentrated in this picture. But they might say, “Oh yeah, it was a ton. Gave us a ton of sperm, and not worried about that.” And yeah, I looked at it under the microscope and it, you know, super modal. “Did you do a morphology?” Well, no. I had a breeder, a Labrador breeder. A lot of you guys that have Labs: it's very common for the Labrador community to ship semen to each other without a veterinarian, which is fine, as long as things are going well and both parties are cool with that. As far as not having complete morphologies and more specific data, I mean, you only have what you can work with at your own home. So some people don't have as much equipment, but it's expensive, right, to be doing all this and miss a bitch on a cycle. I had a breeder that said, “You know, I have this dog. He's like, seven, and he's awesome, and he collects a ton of sperm and it’s super modal.” And sure enough, she just said, “I've been shipping semen on him, and nothing's getting pregnant. I'm shipping all this chilled on him, and I don't know what's going on. I haven't bred him in like, a year, but you know”—something like that for history? Well, we brought him into the clinic, and he's got like, 95% proximal droplets. He's 95% mobile, and he's producing a billion and a half sperm, and he's super easy to collect, and I'm sure it chilled super well. But if you have some defects that you don't see at a distance, like at a low magnification or just the motility sample, you might miss a very clear reason. That's a really clear cause and effect. That stud dog. Those female dogs did not miss because they had an issue. Those owners don't need to be worried on their end. It was all him, and we can confirm that kind of after the fact and presume that that's what was going on. So just as I mentioned, sometimes if we think that we're really struggling to get something pregnant, there are some stud dogs—and you guys might own some of these dogs; you are very lucky if you do—there are some stud dogs that just flat out have an It factor, and I cannot explain it, but they are just good at getting things pregnant. And if you are really struggling to get something pregnant, that is important. Again, sometimes you have to sacrifice which dog you wanted to use. But sometimes there are just some dogs that just don't miss very often. They're stud dogs that are good, natural breeders and vigorous breeders and, like, know their job and always get things pregnant. And I think it might not be something you know a lot of information on when you're looking at dog options, but that's something to consider. Like, if you had something at home that you're like, “Well, you know, he's not really right for her, but he always gets things pregnant, and he has a litter on the ground that I have right now, and I love them.” I use that dog. I mean, that's a really good approach to improving your outcomes. 

Okay, so I know we alluded to some of these things, but just to review: So there's a lot of different things you can use to improve the timing, to make sure that everything's proper and that you did everything you possibly could. So cytology is one approach. So if they have kind of that weird, crummy looking cytology, if I see a ton of debris and stuff that really shouldn't be there at the stage that they're at, it might give me some clues as to: Is she progressing like she should? Are we happy with how she went through her cytology? Progesterone we've already talked about, we track. As well as LH. In some cases, I think LH just gives you another backup point to say, like, we know what she did and what day she did what she did, and we know what day we put semen in her. Vaginoscopy can help. I think sometimes, from a diagnostic perspective, sometimes we see, like, discharge visually like when we're doing this with a TCI scope. So both of these images are TCI scopes. They show different stages. So the top one shows kind of a Pinker, smoother appearance that we'd see earlier in a cycle. The bottom is more what we'd expect to see when she's ready to be bred. If that doesn't look right when it should, I will tell that owner when we're doing their TCI she's not crenulated, or she's not progressing in the way that she should look on her TCI scope. And that is a red flag for me that she's having issues with the cycle. There's something weird going on with the cycle. So I know this is all like weighing money to some extent, right? So if you're in the office, and I've got a weird feeling about what she's doing, and she never really crenulated—and you've got some irreplaceable semen from 1975 that you imported from Scotland that you cannot get back—I might, if it was me, and there was unlimited funds, and you know, there was a backup option for stud dog, I would breed her to a different stud dog that cycle, if you had it available, leave that frozen semen alone and take the position of if things don't match and things don't progress visually the way that they should, it's a red flag that hormonally, even if on paper, she looked like she did what she should, something is not connecting the dots properly, and she might not go through and get pregnant. Not always true. We breed plenty of dogs that are kind of slick and not appearing like they should with fresh or frozen or, you know, chilled semen, but it's just more things to consider in the long run.

And then behavior! Certainly, I think behavior, for me, is just helpful for, like, reinforcing that we felt like the timing was good. I don't think it's like the crux of what you need to focus on, but it's just good information to know what she was doing. It could make absolutely no relevance to the situation that she's at hormonally; it could be just temperament, the interaction of the two dogs. Sometimes, some dogs just cannot be put together and expected to perform with one another, depending on their temperaments, the breed. Some breeds, it really makes no difference, because we're doing lots of side by side type approaches, and they might not have the appropriate libido, like other breeds, where we rely a lot on Natural Cover. 

So just to review, this is actually where she conceives. It's way up in the oviduct. We're doing vaginal inseminations way down here. So it's asking a lot of things to swim, right? So some of that is her body is moving the sperm too. So it's not just relying on the tail of the swimmer, but I think it makes sense that, you know, especially giant breed dogs that we're not going to see as much, they've got to travel a long way to get where they're going, and it might not go as smoothly as, say, toy breed dogs, where we have a lot more success with vaginal insemination. TCIs and natural breedings, we're going to end up with semen basically in the body of the uterus and filling the uterine lumen. Surgical insemination, it's not really in a different spot. It's just where I put my needles and my catheters—that’s going to be at the base of each uterine horn. The idea is we end up filling the uterus again. We fill the space, but I like to place those there, and that way I can kind of control things a little bit better in surgery. 

So this is old data from Josie Ranch, just so, you know. Josie Ranch is a practice in my area that I used to work at, and so this is their kind of in-house data, which is excellent result-wise. So in general, we don't see a tremendous amount of difference. Oh, gosh. And this is Ridgeback specific, but it gives you some perspective. So we'll use Ridgebacks as an example. They do have kind of an overall view of that, and you guys might see they usually provide those numbers. They've got them on little stickies, in case you guys use them. So for this breed, you know, it's not a giant breed dog. Vaginal insemination is pretty successful. TCI is a little bit better for fresh and for chilled. We don't do vaginal with frozen, obviously. The approach with frozen, they do get pregnant a little bit more frequently. So in the TCAI, which is the TCI column, the first number is one, the second number is two. So if we did two breedings, depending on the cycle, fresh and chilled, we might be doing them a couple days apart. Frozen, we're going to be doing two, kind of at three and four post-ovulation, or four and five post-ovulation. So slightly better, maybe 5% better outcomes. Few percent better outcomes when you have a little bit more insemination, like you have two inseminations versus one? Well, it might be that we overcame some of those semen concerns, right? Like, if we didn't have enough numbers, maybe the timing wasn't quite right. So that second breeding sometimes gives you that advantage. 

Surgery, we are not able to do a second one. There's not a way for us to have teased out. There's some dogs that also get a TCI and a surgical. Those dogs, I don't think they were teased out for data for this purpose. But just to give you some perspective, in a very successful practice, a very good practice that is doing very good quality reproductive care, this is the type of outcome that you'd love to see. There are some studies out there that have more specific data, especially for frozen now, for TCI versus surgical and things. They're going to have different data points and numbers. It's different numbers of dogs. So this is really healthy, like for this. This is 3500; this is over like 20 years, I think. But 3500 Ridgebacks individually, just Ridgebacks that are included in this data. So it's pretty strong. And I think you can optimize when you're approaching infertility. We want to optimize with the best technique, the best approach. Sometimes your vet might have those types of suggestions. So if they say, well, we feel like we get more things pregnant with surgical than we do with TCI, follow what their feeling is, clinically. I might have a different clinical opinion and have a different approach than another veterinarian, and that's okay. So I think, like in this clinic, and I'll speak for them, because I used to work there, like I said, but at this clinic, we're very pro-TCI, because our TCI results are better than our surgical results. We just go based on what the trends are medically and what is out there medically, and try to improve ourselves and make ourselves the best clinic that we can. I think that's what any of us are kind of trying to do in medicine. 

So other mentions! I know we already kind of beat this to death, but we have different success rates with different procedures, so we don't expect a Boerboel that has a vaginal insemination. Well, that might be the reason why she didn't get pregnant. Just as simple as that. Sometimes, like I just mentioned, how comfortable was the vet? If they're just learning how to do TCI, maybe they don't do a TCI for your infertile, kind of end-of-the-road, this-is-my-last-heat-cycle-that-we-can-try-because-she's-six-years-old situation. Or maybe you travel. And I think just being honest with us, we don't mind if you go somewhere else. We absolutely don't mind. We understand if there's, like, something that makes more sense. We want your dog to be pregnant. 

So just a short mention. You guys might have already seen this data, so I'll just briefly touch on it. I know this was something that came out a little while ago. This was probably five years ago, but they did this study in Dandie Dinmonts and they said: If we disregard physical choice of the dog, and we say we need more genetic diversity, there is proof (at least within Dandie Dinmonts), they basically documented that if they ran a genetic panel, and they said, “These are the most genetically different from each other dogs,” those two dogs would end up producing an extra puppy in the grand scheme—like when they ran the stats on it—an extra puppy would be born, which in this breed, one or two puppies can be a very successful outcome. They're very difficult to get pregnant. They're very rare as a breed. And I think the concern is, you know, are we going to lose the breed overall? Because there's just not enough of them left, and we want to make sure that we have them going forward. So I think the breed club showed some interest, and they did this study. Maybe it's been probably five or seven years or so, but there is something to do with inbreeding coefficients, or how tightly they are bred to one another, that they can impact your litter size. We appreciate that, right? Like, you're not supposed to marry your cousin. But, like, we breed cousins in dogs all the time, right? We're not as worried about how close they are. They're all relatives, because we've selected them for very specific features and the way that we got Dandie Dinmonts . . . In some regard, you know every breed—well, for most breeds, I would say maybe not, the breeds that are like really developed in a wild state, things like African-bred dogs and things of that nature—but a lot of these breeds, we said, “Well, we love this dog, and we're going to strongly line breed on this pedigree, on this particular stud dog, and have him in the background of the pedigree, and try to, like, kind of keep him on to that whole kind of mission going forward, and try to keep his line tight.” We produce a very consistent dog. That's what purebred dogs are. They are similar bred to similar that went forward generationally and then became a little bit more narrow genetically. And that's why they're different, why Dandies don't look like Labradors. Because we selected for their traits. But by doing that, we also narrow their genetics. When you have this really small pool of genetics, you kind of get yourself back into a corner where everybody's related, and certainly like bottlenecking and popular stud dog syndrome, it could be a big problem for some of these guys. 

So I say all that in the effort to say there's not technology to prove this. So what they showed in the Dandie study, they had some of the breeders that were involved. They said, “Give us some stud dogs you like, and we will run the genetic panel, and then we can show you which ones are most genetically different.” What they thought they would find based on the inbreeding code: the traditional pedigree based inbreeding coefficients did not necessarily match how diverse that dog was from the other so, you know, if you breed your two dogs today, some of those offspring might have had a lot more genetics picked up from the sire, and some of them might have picked up a lot more genetics from the dam. But we go forward with them mathematically and say that it's 50/50, and it's not. What they found was, I think, the two dogs that this particular Dandie was looking between. There was a dog in Pennsylvania, there was a dog in California, which they presumed would be more genetically similar, because they were both United States, bred recently, like from the pedigrees. They were both kind of from the US, Dandies with more closely related pedigrees. And then there was a dog in Russia. The dog in Russia, they thought for sure that would be more genetically diverse, and it wasn't. The dog in California was actually the better match for that dog in Pennsylvania. So I think there's a lot that hopefully we will have more genetic testing at like, low cost, and some species we have really cool like, they can take a sample and run all sorts of predictive factors for things like the livestock industry. We use this all the time for dairy cattle, for example, for predicting what you want to select in your offspring and how to go about going forward with the breeding.

All right, so we're going to shift and talk about some uterine problems now. So once we're kind of past the early stages of things, we then have to focus on: Okay, what is happening when the embryo attaches to the uterus? Is everything going forward properly? And is everything happy? I think there's a number, but the most common ones we see: Cystic change (so the cysts on the inside of the uterus, not on the outside of the uterus). Inflammation, so some dogs just have an overactive inflammatory process that happens in the tissue. It's not something you can see from the outside, she'll act totally fine, but we think that that's quite frequent. For some of these girls that we work up, that is super common as an outcome, if we don't find any findings, low level inflammation is usually my biggest suspect. They can have an infection. So they don't have to have a pyometra to have an infection. So this is really well studied and well understood more in mares, in horses, than in dogs. I think we're kind of scratching the surface on dogs. I think that traditionally, a lot of people just kind of blanket treated with antibiotics, which we know is not ideal, to be doing that. But also, vaginal cultures are not really the way that we go anymore. I think we can sample things in the uterus, which we'll talk a little bit about later. 

They can have fibrosis, which just means, like, they lay down extra scar tissue in between all of the little components of the uterus, the cells in the uterus that are supposed to provide nutrition to these embryos whenever they attach. There are kind of really strong correlations of this in the equine species. So in horses, fibrosis is a big thing. There's lots of grading schemes, like we do biopsies just to assess fibrosis in mares as they get older. This isn't really a dog problem. Sometimes we get it reported on some of our biopsies, but it's not really a problem in dogs. I think scar tissue can be. So like scar tissue from, say, previous C-sections could impact things. Lack of rest between cycles. So if your dog cycles every four months, three months, that is going to be inhibitory for her uterus to have enough rest between those periods of time. They should have six months between their cycles as a minimum for optimal outcome. We're having to get really creative in the US about how to fix this, because unfortunately, we no longer have access to the drugs that we used to use. And due to a lot of these drugs, truly, a lot of these drugs are drugs that are involved in cycle manipulation that can be used for human abortion. So guess what: it means we probably will never see a lot of these drugs. You guys that are in Canada or overseas, you might have some really nice drugs that we don't have because we can't manipulate cycles without being under scrutiny, or that drug companies flat out just aren't interested in having those drugs because they don't want to fight the political landscape that we are in here. But all those types of hormonal manipulations, whether it be for pro-gestation or trying to get things pregnant or trying to keep things from getting pregnant—they're all the same hormones that we're dealing with, just at different times and using them in different ways. So unfortunately, we're just kind of at a loss currently with how to rest dogs that are doing that. We used to use testosterone to do this. It was a derivative. It's called mibolerone or Cheque Drops. We can't get those in the US anymore. By individual FDA license, we can get a drug that's called Suprelorin. It forces them to cycle now in most cases, but it will make them go out of heat for a period of time. You do have to remove it because it'll last like a year or more to push a dog, kind of out of heat, but it isn't legal to use in the United States in dogs unless you have a special permit. So that's basically the one that we've got that I'll use. Estrogen doesn't work very well. Progesterone will cause them to get cystic disease. Like there's just not really a lot of good drugs that we have access to to address this right now. 

So as far as cystic disease goes, it's totally normal for them to get cysts. And this is a lot of the reason why a lot of older dogs can't get pregnant anymore is because they've developed these cysts. There are certain lines I think that like to do this, breeds that like to do this. They're the same breeds that really like to get pyometra. And it's all considered like the same complex. So when we teach students, there is a pyometra cystic endometrial hyperplasia syndrome. It's all considered a collective like chicken or the egg scenario, where it's all kind of a continuum. This is absolutely heritable. If we address a dog with cysts, it's absolutely a heritable thing. For some dogs, we just can't differentiate if it's because they develop cysts, because they had some infectious process. Infection will help produce this, like, right? So pyometra, if you had history. You have a pyometra for a dog, and you resolved it medically, she's going to be more likely to have these. She might not have them if you manage it well, but it's, I would say, largely heritable. Really strong in my experience: Golden Retrievers, Cavaliers, Bouviers would be another one that I've particularly had some recurrence on finding cysts, and especially in like, four-year-old dogs or so, and it's just not getting pregnant. It's almost always cysts in those breeds for me. So this is just a really extreme version of what those cysts look like. So this is on the inside of the uterine lining; it's basically fileted open. Sorry, it's a little bit graphic on the left. So all of those things that look like bubbles, it looks like bubble wrap. Those are all going to stop an embryo from getting attached to blood supply, right? And there's also thought that embryos have to kind of bounce around back and forth. Well, they're going to kind of obstruct the ability of those embryos to move whenever they're moving around, before they stick to the wall. And then, on the right, it's the same sample. It's just to show you: there's just all these little small and bigger and smaller cysts everywhere. There is blood supply in here. There's not a lot of abnormal tissue otherwise. It's just the fact that there's all these cysts everywhere. It's not helping anything. We can address these. In, say, Australia, where you have access to testosterone, so that mibolerone drug, you can keep them out of heat, and these eventually go away because you kept them out of heat. And that's the approach of many countries, especially countries that do not allow or promote elective surgery for getting your dogs pregnant, that they don't do surgery for dogs in that way. In the US, we certainly do whatever we want, right? But ethically, you know it's a better approach not to do surgery if you don't have to do surgery. So if there's a way to do it with medicine, then we love to do that. What we tend to do, I would say, since we don't have access to that in the US, what we tend to do is you can actually go along—not in this severe of a case—but I can go along and express cysts in surgery whenever I do a surgical insemination. These cysts will show up in droves whenever they're kind of having high estrogen. So it's usually at the same time that their cycle is going that we're going to see them pop up. An anastrous uterus, so when their uterus is quiet in between their cycles, these might completely go away. So just know they might not necessarily show up on an ultrasound that you'd be able to appreciate. This dog, you probably could see it clear as day, and your vet would probably be like, “What is this?” when you're looking at it. Sometimes, some of these pyometra cases, this is what they will look like. They'll look really graphic on ultrasound to us, and really clear. And then they go away and become quiescent when they're not actively hormonal, but they'll come back. So it's tricky. So this inflammatory one was the other one we mentioned earlier. So there's a process called lymphocytic plasmacytic endometritis is what they'll report on our lab work. We get this diagnosis via biopsies. So endoscopic biopsies is how I like to get my biopsies. There are vets that do just like an open laparoscopic, open their midline, just like they're doing a surgical, get the uterus out, take a little sample, close it up. I have seen dogs that had that wedge biopsy kind of approach, just the wall with the endoscope, that doesn't cause a lot of damage. I've had one dog that ended up having to have a C-section; both of her puppies implanted above that scar. We did get her pregnant, but the vet that did the biopsy by, you know, taking that biopsy, it just kind of changed the uterine shape there, and they couldn't make it down the pipes, so they went into distress, and we ended up having to take them surgically. So just know, this can have negative impacts too, and just be, you know, thoughtful of those types of things. We use steroids to fix this problem. So this is usually a six to eight week descending steroid, like you would typically use a steroid for skin, say. And you start them at a higher frequency or a higher dose, and you slowly taper them down over time. We do that usually in ideal scenarios. It's dogs that have very regular cycles, because we have to be able to predict when they're in season. Start them a month or so before they would cycle, or maybe six weeks before they would cycle. If they're a dog, that's totally unpredictable—I have one in my house—this is very difficult, because it's one of those things. Do we keep them indefinitely on every other day, if they're going to, like, take six months to a year to come between their seasons, and we start her presuming she could come in at six months? Do we repeat the series at some point? Do we just do the six weeks and say, like, that's enough and like, we'll just wait for her to come in season, and she didn't come in for another six months? It's a tricky spot to be, and since, again, we don't have a way to induce their cycles very well either, because we don't have access to those drugs—at least in the US—it can be a challenge to manage those scenarios. But I love seeing this on a biopsy, because I can fix this. There's a lot of dogs that this is the reason why they weren't getting pregnant. This is the reason why maybe they had a singleton. Sometimes we do a biopsy while we're in C-section and just take a sliver of like where I did her incision for her C-section for her singleton. And sometimes this is the magic fix to what was going on.

Infection is another biggie. So basically, the pyometra complex—we don't know why some of these dogs will form surface level bacterial infections that are just kind of in the tissues, or just, like, right on the surface, and just preventing fertility, versus the dogs that actually get the pyo. We don't have a way to, like, say why they do that, but there are two different ways that bacteria like to behave in that way. It's not specific to the type of bacteria. It's just two different dynamics and situations. But if she has a history of a pyometra, I absolutely will do a uterine culture after she's done that, when she comes in season for her next cycle after we've managed her. I want to make sure she's totally cleaned up. This is the same approach we take in horses. So it's really identical. As far as how we manage these, we basically copycatted the equine industry, who does this all the time. Super easy for them to get to things, right? So they can do these for a very inexpensive cost. We have to use all of our scopes. Sometimes we have to sedate your dog because we're doing this outside of heat. Sometimes, right? So if they're having some scenarios we might be culturing them, like if they didn't get pregnant this cycle, and you're disappointed, and we go in to get a biopsy with the TCI scope when she's at term, or would have been at term, kind of that timeframe. If I see some gross discharge from her cervix, I want to culture it. So we might culture something at a different stage. A lot of times, it's like the start of their heat cycle when we'd be testing this. The trick, though, is, how quickly will we get the results? If we test them when they first come in heat, will we get the results and be able to treat her before she cycles with drugs that we can use during pregnancy also? So it can be kind of a rush scenario. We try to get these samples out as fast as possible when we do try to do this type of testing. I do these types of tests with both the biopsies and cultures with an endoscope. So it's just the same TCI scope that you guys are used to seeing if you do TCIs. They can have basically a uterine wash, which means we put saline into their uterus. We use the same catheters. We stick the catheter in the cervix. Usually they're awake and they're totally happy to be involved with this, like they don't mind. Most dogs we deal with are super used to being handled and things, and certainly, you know some exceptions to that, but we put in a little bit of saline and then we take it back out. Instead of putting semen in their uterus, we are putting some saline in and pulling the saline back out, and then we leave them alone. You can do a guarded vaginal swab. So guarded meaning we don't just stick a bear swab in through the vulva. We want to protect that vulva opening. They make swabs where you can, like, basically pop the swab through the little shaft that it's in once it's already in the dog, so you're actually getting the sample from way up high. And then you can put that shaft back over it and then pull it back out, and that way you really get a sample that's up there. That's usually what we do for abortions or pyometras if we're doing cultures. But usually if we're doing uterine cultures, we're talking truly uterine samples. 

So is mycoplasma a big deal? We don't think so, but there's still some vague discussion. I think we know it's normal in the vaginal tract. It's normal in the prepuce. It can be a normal cohabit of just your flora down there. It's not supposed to be in your uterus, though. There really should not be mycoplasma in your uterus. There are other bacteria, which they've actually done a study of all of the different bacteria that are commonly found in normal kind of spay tracks and healthy dogs; that was done maybe five or 10 years ago as a study. But mycoplasma is really not one of those. And there are a lot of people who still feel like the uterus should be sterile, but I think that study pretty much just proved that that was the case. We want to use their culture results with also keeping in mind, looking at their cytology from the fluid. So we'll actually look at the sediment on the fluid that we obtain, that we culture, and say, “Is it really active?” If it looks like this, their cytology, this is the sediment cytology—these are tons of white blood cells. This dog is doing something infectious. Like, even if that culture is negative, I'm going to feel inclined to use antibiotics. I hope that it comes back positive, so I know which antibiotic to use. That's really what I'm trying to do.

Fetal loss and resorption. So we're kind of further into the cycle here. They can have similar types of losses. So these are a continuum, right? So infection could still cause loss later. I've seen patients with a pyometra developing on one side while they are pregnant on the other horn. It is possible to do things like that, because they're kind of compartmentalized at that stage. It's tricky, but sometimes we can get those to term, but you can get ascending infections through your cervix. You can have infections associated with things going through your bloodstream. Some dogs will have low level uterine contractions that make—we just call it uterine irritability. We'll manage some of these dogs with the WhelpWise monitors, which are tocodynamometers or little belly band systems, where they will measure uterine contractions. WhelpWise is a company that's kind of taken on the responsibility of measuring those, helping the owners and interpreting them, and they basically ship you a little machine and teach you how to use it. It's a weird problem to have, but there are some lines that just know. So there's certain lines, say, of Portuguese Water Dogs, for example, it's super genetic. And some lines are super heritable in some lines, and it seems like they'll just keep doing it and keep doing it and keep doing it. It's like mother to daughter. Every offspring that they have, they're like, “Okay, well, we're just gonna go ahead and go get a WhelpWise because she's probably gonna be like her mom, and she might need some support.” Some of those dogs with the uterine contractions will end up having a low progesterone. Usually, the contractions themselves, if you manage them, there's a drug that we can use that can kind of suppress the contraction behavior, but those contractions themselves are stimulating. They're basically causing the ovaries not to want to produce as much progesterone. So over time, if you don't manage the contractions, her progesterone will also decline. Some of the times those contractions are not going to lose your pregnancy, but you might need to supplement progesterone. So that's the approach a lot of people end up taking, I think, is the progesterone supplementation route on those. They can also have fetal loss just due to illness. So certainly a traumatic experience. I've seen a super bad dog fight. Two dogs—mom was taking care of them. Grandma came over to watch the dogs while the owner went to the Super Bowl and came home and the dogs had gotten into it. She didn't realize how bad it was, and the dog basically had bites all over its back. The pregnancy was stable for maybe three or four days. She was mid-gestation, but she lost her pregnancy. You wouldn't have known from the outside, like, we already knew she was pregnant at that time, but really big traumas like that can cause it. General illnesses—so like, if you have a super high fever; say you get tick disease, or heat stress scenarios; that type of thing can certainly cause it. Generalized infection. Like, if they had a wound that got infected or something and they had bacteria kind of circulating; there's lots of things that could cause illness and then cause loss. 

Sometimes genetic compromise: they make it to a certain stage when maybe we see them with ultrasound, they start to resorb. That is really common for chromosomal type things, DNA damage, where they'll make it pretty far. But something in the body says, “You know, this puppy was not right,” and they self manage, and it's tough because we can't tell if that's what happened. If we see more than one of them, we start thinking infection, we start thinking like some of these other problems. But if it's just the one-off puppy on the end of a uterine horn, and I see something resorbing, it's not a big red flag for me. If I see like three of them, my eyebrows start to raise. Even if it's a large litter, I go, “Hmm, statistically, what are the odds that we have that many puppies that had something where they didn't want to thrive where they were?” Sometimes it's benign. So things like if two puppies sit down right next to each other and somebody gets the better blood supply, well, eventually one of them is going to will out and do better. 

Alright, I'm going to make some people cranky with this slide, but just want to say out loud that if you are a human and you go to your maternity doctor, you know, you go to your OB, and they're counseling you through your pregnancy, they tell you not to eat raw, right? They don't want you to eat a medium rare hamburger. They don't want you to go have sushi. Not everybody follows these rules, right? And in the dog world too, but in women, I think most people are like, “Okay, yeah, those are rules. We'll change what we currently do, and then we'll go back to it after we're done.” The thing is, the same things that we caution people about in people are the same cautions or the same types of diseases that we caution people about for not feeding raw during pregnancy. I know there's plenty of scenarios and plenty of breeders that absolutely exclusively feed raw, do not feed anything else, and they have conceptions, and they have pregnancies, and they free whelp, and everything's great, and that's great. I'm just here to tell you it is a risk factor that you are volunteering yourself for. If you have a fertility issue in a dog, I wouldn't be like, just rolling the dice like this. Personally, I would be reigning in anything I could to tie up any loose end to promote trying to get her pregnant. And the reality is, bacteria likes to go to the uterus, and bacteria floats around in your body; the other thing would be teeth. Biggie for teeth. I think dogs with bad mouths is like way too common in my practice, where you have a four or five year old dog who is not getting pregnant, and you come in and she's got just horrible dental tartar, and you're throwing everything at it and spending tons of money. That's something super easy to manage that you can manage ahead of time, that you can stay on top of. You can scale yourself sometimes. I mean, some owners will do their own scaling. Totally fine. We don't want to mess with their teeth while they're being bred or pregnant. And like, I'll tell people to take chews away and stuff, even, just because I don't want that dental tartar to liberate into the bloodstream, just like I don't want people to be feeding anything that's going to promote potentially bacterial challenge. Our immune system is different. When we are pregnant, we are immune suppressed on purpose, because the body is trying not to reject its own offspring, because it's not itself, it's produced something that's not its own DNA only, and so that's why they are susceptible, more susceptible to infection during pregnancy. So just to, like, drive that point home: these are the vessels. So this is a uterus. You can see my hand for perspective on the back. This is a uterine vessel. They're absolutely terrifying, right? Like they're bigger than a pencil. Those guys. If you have circulation of any kind of particles, bacterial, fungal, etc, it will preferentially end up in your uterus because there's so much blood flow. This is the most vascular thing that your body can do as a female. It’s estimated that some of these dogs have a third of their blood volume in their uterus. So if we are asking them to be a little bit immune suppressed because they're pregnant, because they're diestrus, and then we challenge them a little bit with something that they can typically handle, and sometimes it can be a recipe for loss. All right, so we already talked a little bit about WhelpWise, so we’ll go and skip this. But this is what the old monitor used to look like. This is a really dated picture. I think I pulled it from their website. This is a litter that I managed in California maybe 10 years ago. That was an example of success with that. It was a dog that she had some uterine kind of contractile issues, and she was struggling to carry and we were able to control her contractions or progesterone, etc, and carry her litter term, which is wonderful.

Dr. Andrea Hesser, DVM, DACT  1:01:34

With low progesterone, some of it is that negative feedback, where we expect, if the uterus is mad, it's going to tell the ovaries. The uterus gets mad whenever their term, right? And that's what makes progesterone go down. So like, you have all these little hormones and triggers that if your uterus is inflamed or causing some change, it's going to send some hormonal feedback to your ovaries that says, “Stop working as well. Make less progesterone.” So if that is happening before they are closer to term, it's happening chronically a little bit as they go through their pregnancy, which is why the curve kind of goes down. But if it happens, kind of suddenly, their progesterone can drop due to almost anything that is causing their irritation or issue internally. So we'll often see that if we have an abortion with an infection, if we have a dog that has trauma, you know, all these types of things that can affect how your body is working—but there's also this complex that people argue about. We don't know if it's really true. We call it hypoleuteoidism. It basically means that genetically, you are not producing progesterone for as long as you should, and it has nothing to do with anything else going on. I think a lot of these are irritable uteruses that are mad, and that's what we say they are, because we didn't know the uterus was contracting with a WhelpWise monitor or something to that effect. We didn't manage it, but we were able to overcome with progesterone. The other scenario, which I'll just mention, is Cavaliers like to have due dates that are shorter. They like to go into labor earlier. Again, it's a little bit of a discussion point from a mentor that's quite respected of mine, who's like, literally written textbooks over similar topics. She is super convinced that this breed has been selected for and survived premature births, but they are normal gestationally. They do not truly have a shorter gestation length. They are still dogs in every other way. If we have a Cavalier that we're planning an elective C-section for, I might check her minus four from her due date, which is way earlier than I might check another dog, but there are a lot of them that go into labor by the time they're four days minus their due date. Some of the times those are super early births, a lot of times it's larger litters, but sometimes we see prematurity evidence and we see loss. So we see some puppies that just don't survive, especially in like a free whelp scenario, when they're really early, but they do tend to make up their own rules. But I don't know that we really understand Cavaliers completely on that note, but it's a debate. There are other boarded theriogenologists who breed Cavaliers who say, no, they definitely have a shorter gestation, and I don't believe that. So I think it's debated. So just a mention on a cool case, not a cool case for the dog, but weird systemic things can happen. So I had a case where a fox tail—I didn't know it, but I basically had a dog that was pregnant at four weeks gestation; we ultrasound her; just under five weeks she came back and was at the hospital. Was fine, but he was like, “Yeah, she's not eating as well.” And we're like, “Well, she's pregnant, so, like, it tracks, it's fine, like, I'm not super worried about it.” And it kept progressing, and she's harder to feed, and she's not eating well. And then she started getting real sick, and she had a fever, and she ended up at the ER, and then she started losing her mobility in her hind end. And then she got to about eight weeks gestation. She's basically paralyzed. We had no idea what was going on. We were trying to decide . . . maybe we should spay her. Maybe she's having some bizarro reaction to herself and her pregnancy, or that something related to the pregnancy is slowly killing this dog. Well, it turns out she had a fox tail, migrated all the way up her spine during pregnancy. So this is a like a grass-on. Basically, it just burrows into your skin and wreaks havoc. You guys that live on the West Coast and some other areas of the US are very familiar with how dangerous these can be, but there's some amazing stuff. This pregnancy, the dog died; the pregnancy lasted to eight weeks and still hung on. So like, sometimes you can have massive disease, and still the pregnancy is really tough. Sometimes. Other times, it'll just be real sensitive, and we'll lose puppies quickly after having something systemic happen to a dog. And just to mention on thyroid, that it is linked as an association. So there are lots of people who feel that thyroid is the magic cure. You know, it's one of those things. I think we over diagnosed thyroid before we did really good thyroid panels, because a lot of dogs are what people will say, low normal, or they're like 0.8 or 0.9. Isn't between one and four on the IDEX scale, right? Or what have you. I mean, a similar lab, but I'm not sure what IDEX’s specific scale is, but almost all dogs are slightly lower than one. Some breeds, it's 100% of their breed will be like that. And unless you send out a really thorough panel, you won't necessarily see that. So there's a lot of people who feel like thyroid disease is the flag that indicates something else is happening, but the thyroid disease itself is not actually causing the problem. But in the same token, there are scenarios with resorptions. Some practitioners have suggested some really positive response to using thyroid when we see resorptions, especially recurrently, like if we have a litter that resorbs and was a surprise, and, you know, we come back and we're shocked, because she's resorbing everything. The next cycle, if she starts to do that again, we throw them on thyroid. Sometimes in that scenario, I think prophylactically, just putting them on thyroid, I would say clinically, we don't see a lot of difference. Usually, the owners that are changing that are also changing 100 other things to try to get their dog pregnant, right? So I'm not convinced that it's the actual thyrotabs that are doing that. 

So just to review, so if I have an “infertile” dog, we'll go over (just like we've talked about) breeding history. We'll talk about what we want to count as real evidence that she did not get pregnant. Were they proven stud dogs? Did we have good data? Were we able to really document everything all the way through? Sometimes the answer is no, in which case, I just don't count those against her. For some owners, it's just expensive. The thing is, is all these tests are very easy to perform, so these like uterine cultures and biopsies and things, they're done at specific time points, but they're just very expensive to do in dogs. So like in a mare and a horse, we don't have to use a scope, we don't have to have that equipment. We don't have to sterilize it. We can, quite literally, get a culture sample in 30 seconds, and prep a mare with a cleaning solution, use a sterile glove and a sterile pipet system, and get the exact same sample quality of what we would get in the dog with extensive measures. So it's just a really challenging species, science wise, for us to get there, to get those samples out. But if the money is there. I hate to say it like that, but if the money's there, and this is really important, and we don't care what it costs, and we want to do everything that we can for this cycle, even if she's missed one time, or maybe she's missed multiple times, but you feel confident on your end that you really did everything right, even if there's some holes in the story, there's nothing wrong with doing them. There's nothing wrong with doing these on a dog that's never been bred. It's just very expensive to do. My rule is usually, if they have one strike, meaning one breeding, that I feel like they really did everything right? She didn't get pregnant. She should have been pregnant. It could have been chance, right? Especially frozen, right? I don't knock anybody that's missed with frozen. I mean, sometimes it's just the handling error, the frozen, any number of things. Two strikes with really good effort, especially with fresh semen or chilled semen . . . I think that that's totally reasonable to approach tests. Other people might just continue to breed, pick a different stud dog, try a different scenario, but I think it's reasonable to do so. Basically, in conclusion, there's lots of different problems that can happen. I would say, you know, the big three, again, are infectious. We do see some dogs that have inflammatory conditions and some dogs that we can manage their cysts, if it's all on her side. If it's something treatable, great. If we run all those tests and we don't get any outcome—that's the toughest situation to be in. Sometimes we do that, and unfortunately, we don't always get an answer. But I think the testing is out there. It's a little bit tricky to find. So I think you know, the thing to mention is that a lot of these services, even if you have a really good reproductive veterinarian, they might not be comfortable doing uterine biopsies or intrauterine testing, and that's okay. I think you know, you can always ask them and explore. Would they be willing to try? Or consider traveling. Some of these things, it's a test. Your vet could then go forward and do the breeding management, even if somebody else was doing the testing for you. Universities in general, I think, are going to be a good option for this. A lot of them have endoscopy and are very comfortable. Not all universities have a small animal theriogenology program. So it depends on where you are, but they're definitely going to have the resources and connections to be able to get the information of how to do this if they haven't, but if you're trying to find this type of approach and service right now, I don't practice anywhere where I have a scope right now consistently. I can consult with your case, in theory, like if you had some questions about a dog that you have, but McKinney Animal Hospital, if you're in the North Texas and Oklahoma area, Dr. Cohen is at McKinney. She's opening a practice at the end of year, but she'll be right around the same area, but right now she's at McKinney Animal Hospital, which is where she can do this testing. I can also help kind of connect you if you guys aren't familiar with that practice or you're kind of not sure if that's the right direction to go, I'm more than happy to help direct you if you want to me at the AMC in Richardson. So that's all I have. I'm sorry I ran over quite a bit there, but if anybody has some questions, I know we probably have some that were already submitted. Maybe you already answered a few, but that's what I got for you.

Dr. Nate Ritter  1:11:13

Thank you so much. Dr. Hesser, that was fantastic. You did answer the vast majority of them. So we'll keep it to one. Do you feel if dogs are collected too often, it can weaken their semen?

Dr. Andrea Hesser, DVM, DACT  1:11:24

Ooh, great question. So it's funny. I would say most people would argue the opposite, right, like, gotta clean them out because it's not new sperm. I think it is not a problem if they're collected regularly. The problem is, is, if you collect them frequently enough, they don't produce enough cells so if you're not doing sperm counts on things, or if you have a smaller breed dog breeding frequently, absolutely. If you had a toy breed dog and he was supposed to service two different girls that week, it might be really challenging to do that if he's being bred to them more than once, say, or even if he's being bred once, and he just doesn't recover as much with his counts. Some dogs, I think older dogs especially, will take some time to kind of build back up from their numbers, but most of them can handle being bred with frequency. We have some dogs where we collect them really, really tightly timeline for things like freezing semen, when they're, say, they're exporting a dog that they own, and they're trying to push to get things done in a short timeline. And we collect them. They board for a week, and we collect them several times. I've never observed a decline in the quality of the semen, because remember that semen takes two months to make so like he can't make more that's not as good. He's just not going to have anything there that's matured to a point where it's at that stage of being able to be ejaculated.

Dr. Nate Ritter  1:12:44

Great. Thank you. We'll end there. Thank you all so much for joining us today. If you aren't a member of our community yet, please apply to join at www.gooddog.com/join so you can stay up to date on all of our future webinars and exclusive events. We do have a sneak peek for you for our next webinar: understanding pet food regulations and labels with Dr. Martha Klein, and that'll be Wednesday, July 9, at 1pm Eastern time. We look forward to seeing you all then. Thanks so much again, Dr. Hesser.

Dr. Andrea Hesser, DVM, DACT  1:13:11

Thank you guys. Have a good rest of your day.

Nicole Engelman  1:13:15

Thank you for listening to the Good Dog Pod. We'll be back in two weeks with another episode, so be sure to subscribe to the Good Dog Pod on your favorite podcast platform.