Episode 195: Infertility in Stud Dogs

Victor Stora DVM, DACT, reviews the the art and science of keeping your stud dog fertile. Dr. Stora covers libido fluctuations, semen collection tips, nutritional support, infection prevention and aging strategies.

Watch the video version of this presentation here.

Transcript

Nicole Engelman  00:00

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

Hello, everybody. We are going to jump right in. My name is Dr. Nate Ritter. I'm Good Dogs’ Medical Director. Thank you so much for joining us today for our presentation on infertility in stud dogs with our guest, Dr. Victor J. Stora. I wanted to share a quick overview of what we'll be focusing on today. Behind every great breeding is more than just chemistry. Today, we'll review the art and science of keeping your stud dog fertile, functional, and fabulous through all life stages, including nutritional support, infection prevention, aging strategies and more. We're so excited to partner with Purina again to bring you this Good Dog 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. We've already hosted a ton of webinars this year, so just wanted to remind everyone that you can always find all recordings in the Good Breeder Center. During the Q&A section of this presentation, we'll be prioritizing the previously submitted questions from our community first. Before we kick things off, we want 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 reading 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 program thrive. If you aren't a member of our community, we invite you to learn more about our mission and apply at www.gooddog.com/join. Before we get this presentation started, I wanted to share a little bit more about Dr. Stora and his amazing background in canine health. Dr. Stora graduated from LSU School of Veterinary Medicine and then completed an internship in small animal medicine at Virginia–Maryland College of Veterinary Medicine, my alma mater. He went on to a residency in reproduction, medical genetics and pediatrics at Ryan Veterinary Hospital at the University of Pennsylvania that was sponsored by the American Kennel Club, AKC Canine Health Foundation and the Theriogenology Foundation. He specializes in canine genetic counseling and andrology, and has special interests in canine and feline internal medicine, critical care, dermatology and behavior. He currently works at Good Vets in downtown Brooklyn. Dr. Stora is a diplomat of the American College of Theriogenology and a member of the American Veterinary Medical Association society for Theriogenology and the American Society for Andrology. He's a longtime breeder of Shetland Sheepdogs under the House Stora kennel name. And with that, I'll pass it off to you, Dr. Stora, to get this presentation started.

Dr. Victor Stora DVM, DACT  02:59

Hello, everyone. So the way I formatted the PowerPoint of the seminar was going to normal first, and then what happens when it's abnormal? Because I feel like that gives the best idea of counseling. So I want to talk about the anatomy of the dog, because if you are cross-species, sometimes a lot of people try to look at cattle or like horses and say they are the exact same thing as dogs, or they all cycle the same, but they really don't. I want to talk about what physiology dogs have; you know, what we consider normal in a breeding soundness exam, and then some genetic pathologies, or genetic disease disorders that you would otherwise render the dog infertile, how to identify infertility, and then just some other pathologies, or like things that can go wrong with the urogenital tract of the male. And then the last thing is about sterilization of the male, which we have stud dogs, but sometimes later on in life, you will hit a crossroads where it's either life or death, and they have to be sterilized or those have got to go. So in the dog, the accessory sex gland is just the prostate, and then they have a muscular, vascular penis, which means that as there are signals to the brain, the actual penis within the sheath will start to become erect, and that is because of the blood vessel dilation. The only accessory sex gland that dogs have is the prostate. Other species have seminal vesicles, other types of secondary sex glands that help with the fluid production for semen or like the vehicle, but dogs don't have that. So when we look at testicular descent, which is like a hot topic, because, as you know, I breed and show Shetland Sheepdogs, you find a good one. And then, like me, you're giving them a bath one day, and then there's only one. And so they descend by three to eight weeks. So that's the time frame you're looking at. And then I don't call them cryptorchid until exactly six months of age, even though I've never really had one change past 16 weeks, and puberty typically hits dogs between six to 24 months of age, depending on size, and then the other parts of like puberty, where normal breeding behavior happens and like sperm ejaculation happens at about the same time, 10 to 12 months of age. 

So cryptorchidism is when there's a lack of descent of the testicle by about six months’ time period. It's about, you know, a one in eleven percent chance incidence. And the most common brief word is the Husky. They have a much higher rate. The problem with leaving a testicle intra-abdominal or inguinal, meaning the testicle is left within the abdomen, or the testicle has not actually gone through the inguinal ring, outside into the scrotum, which that's technically a cryptorchid—what people also don't realize that the testicles, as they descend into the scrotum, they're an extension of what's in the abdomen, so if something happens to them, they can actually cause a peritonitis, meaning they can actually cause an infection of the abdomen, like life threatening septicemia, because they are coming from the back of the kidney and being pulled down. They pull down the lining of this abdomen with it. And so sometimes, after a neuter, they can actually be the scary ones, rather than the actual females. 

If a dog is left intact, the chances of a sertoli cell tumor if the testicle is inside the abdomen, goes to a very high number, about 34%. Sertoli cell tumors can cause secondary side effects. So we care about them, not just because they are cancer. Honestly, the testicular tumor class in general, because I do some oncology genetics, the testicular class of tumors tend not to leave where they are. They don't really like to metastasize. So doing elective castration is almost always curative, but this is—for the reason of the tumor inside the abdomen becoming a sertoli cell tumor—that's why we should go after it instead of just leaving it there. It's also providing no functional health to the dog because it does not make semen that is viable in any like sort of situation. And then, in general, castration will prevent neoplasia, but also remove the individual from breeding. I get a lot of people asking me, “What hormonal treatments can I do that I can make it descend?” There are none. There's none. None have worked for me. I entertained the idea very early on in my residency—it doesn't work. And unfortunately, if I did that, I consider that an ethical boundary, because behind the scenes the dog still has hereditary cryptorchidism, so you would still be propagating that throughout the breed. So it's a catch-22 there, and so I just recommend, like, castrating them and removing them from the breeding pool. It's better. You'll definitely get a good one, another good one, and it's significantly safer for you. This just shows how the hormones in a male work. So in the hypothalamus, which is an area inside of the brain that is in the center that makes hormones—so GNRH is gonadotropin releasing hormone. So gonadotropes are hormones that stimulate the gonads, basically. And then the hypothalamus makes releasing hormones, and then the pituitary gland gets the second shot; they make the stimulating hormones. So we have luteinizing hormone and follicle stimulating hormone. With a high volume of follicle stimulating hormone, the testis release inhibin, which inhibits it from making more and LH as it increases, will increase testosterone levels, and then the testosterone levels as they rise, will inhibit the luteinizing hormone and the GNRH. So this is like a checks and balances system, basically, for how much hormone should be within the body at any given time. I know it's a lot, but this is just basically you could just take out of this that the body has a mechanism of regulating hormones by using how much they're making to have a secondary effect, to maybe shut down certain areas for a little bit so they don't make too much. 

So that's the normal dog for the most part, but that's the normal anatomy of the dog, and then a hereditary disorder that I look for, and then once they pass that, and they're here for a breeding soundness exam because they're older, we look at their signal. It means their age, sex, breed, the body condition. Then we get a general history on them, like, what's going on, what has been happening, general health wise, nothing to do with reproductive health, because reproduction is technically a luxury, and if the animal or the patient is suffering from a secondary disorder or primary disorder, then a reproductive disorder may manifest or it may not work, just because the body's trying to fend off the life threatening issue. I also want to talk about what happens in the reproduction exam, the semen collection, and then what we look at with the morphology and then a general physical exam. Because I think for a lot of my students, I have drilled into them that even though they're coming in for repro, a general physical exam is to be done every time on every dog or cat, no matter what. And unfortunately, if infertility is starting to become diagnosed, or is starting to raise, like a very high index of suspicion, it's very difficult to recover from. Actually, that part of it, like you're noticing it. Preventing it is a little bit easier.

So during ejaculation in a dog, there are three fractions. Actually, there are three fractions in all mammals. But you want to observe the libido of the dog, like, do they want to do this? Is there a will? Are they attracted to the female, or are they, you know, shy, reclusive, like they're not really okay with anything happening, and that can be training or youth or immaturity, or that could be a disorder of hormone manufacturing. The first fraction is extremely hard to see. It happens rapidly. It's 1–4 mLs, which is like a tablespoon. The second fraction is what you want, because that's the sperm. Basically, the first fraction prepares the urethra and the penis for ejaculation, so it kind of pH balances it, and it makes sure that it's lubricated and it has the appropriate environment for sperm to flow. The second fraction is the rich, opaque fraction, which is the sperm rich one; that can be anywhere from 0.1 to 1.5 mLs, depending on dog size. And then the third fraction is seminal fluid, again, from the prostate, but just an extremely large volume, because dogs have a penis that's a muscular, vascular penis with a bulbous glandis, the bulbous glandus here, that is the part of the penis that ties the two female and male together during copulation for fertility. The bulbous glandis we think, or pretty much think, that it blocks the reflux of sperm, and so if it's locked there, the enormous prostate fluid that is ejaculated after the sperm rich fraction—because the dog vaginal canal is very long—it actually starts to push the sperm-rich fraction as far up as it can, even past near the cervix. So that's kind of why they have the certain fractions at different volumes. When I evaluate semen, I'm not very nice, because if you want puppies, you want to know. So you look at the volume that you got from the collection, then you want to look at the color and turbidity. Basically, turbidity is like, can you see through it? Can you not see through it? You want it to be white, cloudy. And when you look at it under the slide, you want to see sperm swimming in a linear pattern—not just in a circle—a linear pattern that is going forward, and it's about 70% is the cut off where below that, I say that's a bad mark. Then we look at the morphology of them, basically under a microscope. We look at what do they look like? Do they look like normal sperm cells. Do they not? Do they have defects that will otherwise cause infertility? Because just because they're moving forward does not mean that they're going to fertilize an egg. You have to take all of these parameters together to understand if that's actually going to happen. Because if you just look at motility, and they have like a proximal droplet, or a distal droplet, meaning, like, there's a part of when the sperm becomes, like, really compact from a bigger cell, it leaves a little bit of cytoplasm, or the innards of the cell on the outside in, like a little ball. And that during maturation in the testicle is supposed to go away. Sometimes it doesn't go away, and that causes infertility, or is a cause of infertility. Then you want to look at the number, the total number that was in your sample, because you know, you want to make sure that it is high enough that it is considered within normal for an AI or TCI or something along those lines. You want greater than 220,000 per kilogram of body weight. That's like the benchmark that you want to achieve. Another thing that we do is we look at a stain slide of the sperm to make sure that there's no, like, when we do an ear cytology or a skin cytology, or any sort of like mass aspirate, it's the same thing. We're looking at it for: Are there a lot of red blood cells? Are there a lot of white blood cells? Do we see a lot of epithelial cells, meaning lining cells, and then is it really inflamed that we need to actually submit this for a culture and the sensitivity to understand, will this antibiotic work or will it not? And the hard thing is that the prostate is extremely difficult to get antibiotics into. So now we'll talk about infertility and pregnancy failure. It should be general history and then reproductive history. You want to know how they're housed. What's the husband you like? Do they travel often? Nutritional data, like, what are they eating? And I always tell my students: make sure you ask about supplementation, because people don't often correlate that with something they have to actually tell the vet, because it seems benign, and so that may or may not have a large impact on what's going on. And then the last parts of medications, like, are there topicals or systemic medications? And then, has the dog undergone anything in the past that would make you concerned for infertility, or that is an ongoing disorder that you need to keep an eye on? That is also very helpful. The passing part of the exam for dogs, and it's not really as rigid as equine, but the abnormal semen you want: azaspermia, or aspermia is meaning there's not sperm inside the ejaculate. We can do a quick test on this, actually, with a chemistry analyzer for blood to see if the testicular fraction was ejaculated, because the ALP will be high. This is a liver marker actually. It also comes from bone, but ALP will be high if ejaculation was actually complete. And in dogs that I'm unsure if that happened or they're shy or they have concurrent disease, and it may be difficult for them to mount because they don't feel well, like their knees bother them, then I will test it, just because this will tell me if that happened or not. Then we look at oligospermia, which is a low concentration of sperm, so less than that 220,000 sperm per kilogram of body weight. This doesn't mean that they can't have puppies, but this just means it's harder to have puppies. 

Teratospermia means that their morphology is not normal. So when you look under the microscope and you're looking at the anatomy of the sperm cells, like, do they look like normal sperm cells? Do they look like abnormal sperm cells? Like, do they have these defects on them that you're worried about in dogs? 60-80% is considered normal. And then asthenospermia is the motility, and it's forward-progressive motility, not in a circle. So a lot of people get hung up on these things. The eye sees things moving, but you have to be able to differentiate. Is this coming from they're actually swimming in a linear line, or are they kind of like swimming in a circle, or not really going in a forward manner? And then the last thing I talked about with the cytology is: do we have any sort of blood or white blood cells in the ejaculate that's showing us maybe there's something else going on that is more important than fertility right now? The causes of infertility can be any part of the anatomy. So it can come from the prepuce; it can come from the penis itself; the prostate, I will say this is usually the culprit. The testis and epididymis, meaning the testis and epididymis is like the highway for semen. And then there are indirect causes, basically behavioral and orthopedic disease kind of go hand in hand, because this means it's painful for the male to actually mount the female, and then behavioral, meaning that they have never done this before, and it's all new, and they have absolutely no idea what’s going on, and so they just like shut down. 

So again, like the most common reason that this happens is because of something called benign prostatic hyperplasia. That means the prostate has enlarged to the point where it's probably causing a problem: 50% of dogs at age five will have a BPH, and then 80% by age six. We have methods of treating that. It's just something that we watch for. I know I had another client come and say that the dog was dripping sperm from the end of his penis, and one of the doctors she went to said that that was normal, and that's not untrue, but that is not true. It doesn't mean we don't treat it. Yes, dogs, as they age, will get BPH if they're intact, but if there's some cystic areas that blood is dripping out, we definitely treat it. That's definitely not normal. This is because there's a long term exposure to active testosterone. It gets bigger. The problem was, when it gets bigger, it loves to make cysts, or little pockets inside of it. The delicate capillaries or the delicate vessels leak into those cysts, and those will cause the blood in the ejaculate like it'll kind of drip out of the tip.

This out here, if you can see. And then around here is the prostate with the urethra in the center. What you're looking for is any bloody urine, bloody penile discharge, if there's blood in the ejaculate that you can't see in the tube, but you can see under the slide and BPH is symmetrical and with or without pain. A lot of people say it's without pain, but I find that sometimes, when I would say 25–30%, it's painful. It's large enough to where it is actually painful. And I think that that's because of the cystic areas that start to happen. They start to become painful, because then the prostate is expanding abnormally. We use X-rays to see it. If it's really big, you'll see it on the X-ray. You may miss it on the X-ray. It's not definitive. The definitive one that we use is ultrasound, because that one can actually give you a cross section of what's going on inside. There are a lot of cysts going on. Do we have to worry about anything? Is there, like a stone or the urethra compromised? All that kind of goes with more of the ultrasound diagnostic. On here, actually, you can see the prostate is this, so that is very large, and what it's doing is it's pulling down the bladder more towards the central abdomen, but this is a very, very large prostate. It's funny, because in dogs, they don't get urinary signs like in humans first. In dogs, most common thing that they get with benign prostatic hyperplasia or BPH is that their feces starts to become more ribbon-like, because it starts to hurt the colon and kind of how that progresses first before affecting the ability to urinate. So if you have BPH, the curative route is castration. That doesn't mean you have to do it. I maintained my stud dog for many years without castrating him. You need to decrease how much active testosterone is present inside the prostate, because you want to inhibit the conversion of testosterone into the active testosterone form, which is dihydrotestosterone. In people, there's finasteride, which we use in dogs, one milligram of finasteride is Propecia, and five is for benign prostatic hyperplasia in humans. I use both. I don't go above five milligrams in any dog, typically, maybe about 40 pounds is kind of the cut-off; I would do, like maybe one or two if they were less than 40, and then five above that. We do that for three months. The sperm cycle is three months. And so for three months, they're on that daily, and then we taper to as long as they need. So that could be twice a week. That doesn't have to be like every other day. It can be twice a week to one time a week, once the prostate is made small enough to continue on. It really has a very benign side effect profile. There are very, very minor sexual side effects of libido. The main thing that is reported in humans or dogs is that it can turn the hair like white or a little bit white. That's about it. When you collect, then you do have to be careful, because now it's going to be weird. Their prostate is going to be very small. So those values of volume that I was talking about before, where they had those enormous kind of levels of prostate fluid, that's not there anymore. So you have to provide that, or the oversight that has to provide that. You collect the male, you'll only collect a little bit. You'll collect maybe a couple mLs at most, and then you slowly use an extender, and then you can do a side by side AI or a TCI. But for the most part, people get upset when they see that it's not this huge volume anymore. But volume doesn't matter. The quantity matters—not the actual how much like volume; the concentration matters, not the volume. And if they naturally breed, what I usually do is I come in afterwards and I will just take, like, moderately warmed extender, and I will put that through an AI with just extender so that the small amount of sperm get a vehicle to swim through and helps them get through the cervix into the uterine tubules like they're supposed to. I've had dogs breed naturally. I just always add that on to kind of make sure it goes where it's supposed to. 

There are treatments for prosthetic hyperplasia, and I would use absolutely none of these, but these are in the literature. Progestins and dogs don't go well together because there are many adverse effects. A lot of them can cause diabetes, hyperthyroidism, other kinds of endocrinopathies. Estrogens can actually wreck the bone marrow. They can cause feminization, and they can cause cancer. So stay away from that one. And then progestogens. Epizane is not in the US, or might start being in the US. But this one's not that bad. There's a profound reduction for four to six months. It's typically like a pulse therapy. You just have to watch again for endocrine disorders and if there are abnormalities with sperm. But other than that . . . Finasteride, though, is my preferred way to go. I've never had a problem with it. It works really well. I manage the dogs pretty easily with that. The problem with the enlargement of the prostate and those leaky vessels is that is what bacteria love. They love the leaky vessels because then it leaves blood inside these cysts, and the bacteria can just go right in and set up shop in these cystic areas and cause an infection. So you want to reduce the size also to prevent that from happening, because that could be life threatening. So using finasteride, I personally have had no issues with that at all. Also on the aside, like using finasteride, the five year/six year BPH is not hard and fast. I've had two year old dogs that have gotten BPH. This seems to correlate with how many intact females are around the male. If there are a lot of intact females that are cycling commonly, the dog has a very high risk of getting this at a younger age. 

This is what you really want to worry about. So the predisposing factor for prostatitis is that there is BPH because there's benign prostatic growth, plus there are those cystic areas. In more the neutered sector, neoplasia or like cancer or abnormalities in the way that the gland enlarges, they tend to get more cancerous types of lesions. But the problem is, once you break down the barrier that the prostate holds, they can become septic, because it's technically an abdominal organ. This is more for acute prostatitis. Chronic is like a very slow, insidious onset that is commonly missed, and it's the more common form of it. The problem with acute prostatitis is that everything goes wrong immediately, and so the fecal bacteria like E. coli can rapidly colonize the prostate and cause massive destruction and problems, and they can get large cysts that need surgical intervention. Also, Brucella canis can do weird things, like they can cause testicular hyperplasia, prostatitis. You always want to test well, we test for that a lot with breeding. You also can get it from your stud dogs. Males are the canary, because if something down there gets really big, that's kind of maybe a clue that's happening.

Acute prostatitis is technically an urgent, almost emergent disease. They get very, very sick. They get a fever, they don't really want to eat, they're lethargic, they have lots of abdominal pain, they don't want to urinate, and then they can go into basically DIC and sepsis. DIC is disseminated intravascular coagulopathy, meaning inside the vessels. Because there's so much inflammation going on, all of the clotting factors are used up, and the blood can't clot normally, so it makes basically embolisms, like little tiny plugs that can hit the lungs and cause, like a pulmonary embolism, and that's automatic death, unfortunately. Sepsis is getting this bacteria to kind of flow around the body in the blood. We diagnose this off, you know, a complete blood count and into the chemistry, which is basically like the very basic, most complete blood work that your veterinarian will perform, and then you do want to culture the prostatic fluid, if you can, because that will give you an idea of what bacteria is going on. It's kind of like 50/50 for me, because there's not many drugs that enter the prostate to begin with, so you're kind of limited on antibiotics to begin with. So it may not be necessary. Usually, I save that for treatment failure, then I'll culture it. 

The chronic one is the more common version. It's a very slow, insidious onset. Usually you have no idea it's going on. The dog is fine. It's not sick. Nothing is wrong. Most people notice at some point in the future that there is like blood dripping down from the end of the penis. This can decrease fertility because it is enlarged. It may have some bacterial infection. If a male dog (intact) has a urinary tract infection, it has a prostate infection. It just goes hand in hand. Male dogs do not need a clean out period like some other species. Male dogs retro-ejaculate into the bladder and then they urinate it out on a daily basis. So if the prostate has bacteria inside, it's going to retrograde ejaculate and inoculate the urine with the bacteria, and they're going to get a concurrent urinary tract infection. So that's kind of also a clue that the prostate is maybe compromised, highly likely compromised. So again, we get a complete blood count. The camera shield. Look at renal kidney, liver function, white blood cells, red blood cells. And then if we have treatment failure, use a culture and sensitivity to make sure that there is no bacterial infection. Again, there are only a handful of antibiotics that actually penetrate inside the prostate. If you have acute prostatitis, again, this is urgent/emergent therapy. They're very, very painful. They need fluid. I usually add non-steroidal, anti-inflammatory drugs, because it is an inflammatory condition. They are painful. This will help, and I don't think it poses a detriment to their health, as long as their kidneys and liver are functioning to some degree of normal. Antibiotics are the staple; you are fighting bacteria from the coliforms, from the colon, from the GI tract. And the issue is that there is a barrier disruption, or a blood prostate barrier, because of the pH of the prostate and how drugs can get in, so they have to be able to cross a fatty membrane and have a high PKA or acid level or acid dissociation, that's not going to destroy your drug. So the only ones that really penetrate are fluoroquinolones, which is like Baytril and Xenoquin and Refloxacin is Baytril. Marblefloxacin is Xenokine. That's like a first line therapy. The sulfa drugs do do it, but most of the time we stick with the fluoroquinolones. I have used clindamycin before. It does work. I do like that one. Chloramphenicol can cause human issues, like it can shut down human bone marrow, so I tend to kind of keep that one in my back pocket unless I absolutely have to. And then the treatment for underlying BPH is either castration and finasteride or finasteride plus an antibiotic for both. You're going to need that, because once acute prostatitis is taken care of, it's going to transform into the chronic form. So you'll need this for life, or if you don't need your male anymore like that, castration is curative as well. 

This is what I talked about when I said it has those tiny cystic areas. They're called micro abscesses, but they can kind of grow large enough to where they start to see each other. And this is what a surgical intervention would be, is if these micro abscesses start to kind of connect together and cause a giant abscess that's kind of like sitting in a cystic cavity inside the abdomen, and then that this ruptures, there's peritonitis and sepsis, which is very difficult to come back from and to treat. We don't know why they get these cysts, or they retain cysts, but it does cause these areas in BPH, commonly with these cystic areas. And then there's like a surgical intervention. I don't do surgeries, but surgical intervention may be the only hope for some of these dogs. 

This one actually: prosthetic neoplasia. Neoplasia means new formation. Prosthetic neoplasia is actually more common in the neutered male than in the intact male, and we don't 100% know why right now, but it is definitely more common in the neutered male. This presents like BPH in an otherwise older castrated dog, typically; during rectal examination, the prostate is usually extremely firm, but it is not symmetrically firm. It is usually asymmetrical, not well defined, firm, painful, and that's what gives us clues. If it's urothelial carcinoma, like TCC bladder cancer, we can do a genetic test on that. If it's just a prosthetic adenocarcinoma, we can’t. We need a sample. I've done small needle biopsies. I haven't really had this one seed, meaning on the tract where I biopsied like little, tiny tumors form that usually that's reserved for the bladder cancer, urothelial carcinoma. And again, this is an increased risk in castrated male dogs. It tends to metastasize or move to the bone, especially like near the lumbar up there, and it becomes extremely painful. Then at that point, there's nothing really you can do. There are some institutions or offices out there that do offer stereotactic radiation. Stereotactic radiation is when it's called a Gamma Knife. It's a very, very high dose of radiation that is administered to a small site by using a CT machine, which is like a 3-D X-ray machine, and it uses that to triangulate where the cancer is. So that tends to require three treatments, whereas definitive course radiation, meaning the standard radiation therapy, has a minimum of 3-5 or four weeks of treatment, and that's Monday through Friday for four weeks, every day, the dog is anesthetized, gets its radiation and then goes back. So the stereotactic radiation is a little bit . . .  It has nice studies now, or it's getting there. And also it's a lot behaviorally more lenient on the dog. It's more acceptable to them, because they get really strange after they're anesthetized every day for four weeks. So I've had one dog go for this, and he didn't really get upset or develop some strange anxieties of leaving and going to a vet's office. And then in chemotherapeutics, this tends not to work. So this is a picture of prostatic adenocarcinoma. This is right here, the lumpy, bumpy look to it. And then the fact that it's not well defined. Looks like a walnut. That will cue you in that that is, or the doctor that that is, you know, a cancerous mass likely. And then more diagnostics need to be done. 

So these are other causes of anatomic infertility: so infectious orchitis, meaning infectious testicular issues, and infectious epididymitis, which is the highway that the sperm leave from the testis and they go into. They can get a bacterial infection there, either by trauma, direct, or if they have blood borne bacteria, they can settle in that area, and they're usually in large, painful testes that are red and then the epididymis, meaning the kind of portion that comes off will be painful. Once it happens, it's painful, but then over time, it becomes less painful because of fibrosis, meaning it shuts down. In these cases, we do the same thing: the blood work, and then we try to culture and see what's going on, like what's growing, and if we can fix it. Treatments are usually the fluoroquinolone class, because hands are tied for what can cross into the prostate or get near there, or near the testis. You can do a hemicastration, but if both are infected, there's really not much you can do, unfortunately. These are two pictures of them, this very swollen testicle with the very swollen epididymis on the side, probably destroying any sperm that's coming from this testicle.

And then this can be caused by trauma, a contact dermatitis, meaning they sit on like hot asphalt or hot flooring. This can then start to, kind of cause an overheating of it. The sperm count will drop, and then the morphology will change rapidly, because the sperm and the testes are meant to be maintained like 1.5 degrees Fahrenheit lower than the core body temperature. And if you start approaching that or higher, it starts to, like melt them, in a way, is the best way to put it. The midsection starts to become crooked, because its scaffold starts to kind of come undone and then redone and undone and redone. And so they get an odd shape to them. So the treatment of this is how severe it happened. If you notice it right away, and we can get in there and we can treat it, then it's great. They'll probably resolve. You have to wait 60 to 180 days, because that's the sperm cycle again, to see if fertility is preserved. If fertility is preserved, then you can kind of go forward from that. They don't tend to have a relapse rate unless the husbandry still puts these demands on the testicles, and then you kind of are stuck there. So just like human men, testicular degeneration can happen because of senescence. So just becoming older or they can be secondary to a primary testicle issue like trauma, orchitis, or endocrine disorders. Orchitis is an inflammation testicle, again. This time if you treat the primary disorder, except for senescence, because that's going to happen no matter what, you may have a return to fertility. However, it usually progresses more from there. 

These are the tumor types. They occur in older males. They tend not to move. Dogs that are intact are very likely to have a testicular tumor sometimes; sometimes I've seen castrations, and they've had all three in the same testicle. Sertoli cell tumors can cause feminization in males, because it starts to make estrogen. Estrogen at high levels can shut the bone marrow down. So you really have to be on top of this. And this is the one that happens commonly in the cryptorchid testicle. A seminoma originates from the germ cells, where sperm comes from. They're, again, an increase in risk in the cryptorchid dog. And then Leydig cells have their own tumor, which are like scaffolding a little bit, and then they have occasionally, a secondary syndrome that comes with them. These are tumors. Leydig cells are typically orange. Sertoli cells, the entire testicle is distorted. There's no normal architecture you can see on the outside.

So another thing is that sperm to the body is not normal because it contains only 50% of the chromosomes that are required for normal cells. So if the body actually realizes that that's going on, or that cells are being made in the testes that are one end, meaning they have half of the genetic material they should, it mounts a heavy duty immune response against it, and it's almost impossible to stop. You put the animal at risk if you try high dose steroids, immunosuppressive agents, it just doesn't really go anywhere. I've tried to treat one or a couple for many years, and it just gets worse and worse over time. When the body sees it, it just reacts very profoundly against it. Some of the main things that I see with infertility is the failure to achieve an erection, and this is almost always because of behavioral and immaturity. This is the biggest one. So dogs can be big babies, especially about the collection bag, and they are not used to that near them; they may shy away or run. And then people who tell the dog to not like hump their leg or like come to the surface or do something like that, you're discouraging male-like behaviors. Yes, it's unwanted, but you have to figure out a way of not scolding them, so that's positive punishment. Give them a redirection or a redirective. 

This is extremely rare: androgen insufficiency, or the hypothalamus, like we talked about in the beginning, is not making those hormones. And if you give the GNRH, you need to diagnose because if they're not making it, then you giving it, may make them make more, because this may have been shut down. Again, behavioral immaturity is the biggest one. Pain is here for arthritic types of pain, not necessarily like pain on ejaculation, which can happen, but usually it's more like bone type pain. And then there are neuropathies or neurologic disorders that cause this, but these are extremely rare. There are also anatomic issues with that. So this is a persistent frenulum, meaning that testosterone was supposed to break this down at some point. It didn't. So this has to be manually resected, and then they're normal. So it's a pretty easy one. Those are the ones you look for. If there's something strange like intersex or an anatomic, then we have those as well. Phimosis is when you can't get the penis out of the sheath. That may be congenital and maybe a stricture formation, or the dog may be obese, and you can't get the penis to come out of the sheath because it's just pushed down. Paraphermosis is when it's flaccid, but it cannot be withdrawn, and this can be an emergency, especially if there's discoloration. I had a dog that was humping a bed, and he had a ton of the bed stuffing all the way in the back of the prepuce, so usually I use, like, an otoscope or a scope, and I go in there and I retrieve what's happening. Priopism or persistent erection is extremely rare. You can use, like a cold compress or something like a high sugar concentration to kind of try and draw off the fluid that's in there to make it go back to normal. And then the most common is trauma. So like humping the bed, doing something like that, trying to breed a female that's not ready. All of those kind of fall in that category. 

This is pile granulomatous balanitis. So like chronic issues or autoimmune issues with the actual penis itself, and so prednisone is what kind of helps them get back to somewhat normal. This is still not normal, but it basically becomes more normal. Trauma happens all the time, like a laceration or something like that. They bleed a lot, especially because if they get an erection, they will rupture the sutures or glue that we use so it usually looks like a bloody mess. Urethral prolapse tends to happen in bull dogs. It kind of looks like a flower or like an outpouching of the tip of the penis. And depending on how bad it is, you want them to have sexual rest, or you may need to take them to surgery to resect it. If the area that's prolapsed has become necrotic and died. Of the penis, TBT, papilloma, adenoma, transitional cell tumors, like this is urothelial carcinoma of the bladder, and squamous cell tumors can happen. This is typically a TBT. This usually comes from the dogs from the islands, and it's easy to get rid of.

This is what I was talking about with anatomic hypospadias. So basically it's a midline defect. There's the penis that's supposed to be here. It's never used together, and they're usually cryptorchid at the same time. This requires surgery. So there's no it's open here, open here, closed, and then open. There's no penis, really in this dog. And the testiculars are in the abdomen. Another picture of it. They usually get urine scald because they're actually urinating on the top of the actual urethra. 

And then the last thing: supplementation. I know everyone loves supplements. We know very little. We know that there was a controlled study to use vitamin E and selenium with some efficacy. I tend to use high doses of fish oils and/or glucosamines. What's the easiest, I think, is putting them on like Purina JM, because it is a very high source of Omega fatty acids. It has glucosamine in it. It is very close to something, a diet that I would recommend for a stud dog. So my stud dogs eat JM, because I don't want to give them a million capsules a day. I'm lazy, and also I want it to have basically everything that has some, you know, evidence in there. In humans, carnitine is promoted for something that's maybe like slower antioxidants, what we're using when we're using kind of these DHA because they are fatty acids, and then your glucosamine is still within the diet. So JM is perfect for it. Well, JD, but I use JM. So the last thing is, if there's a problem, how do you sterilize them? Because older males, most dogs that are left intact, will have some reproductive pathology or reproductive issues sometime in their lifetime. It's very, very high. And some of my older males, I will neuter just because the chances of testicular tumors is very high, or if I don't need them anymore, and I don't want to deal with BPH anymore, I'll neuter them. But they've had all the benefits of testosterone their whole life. They don't need it anymore, they're fine. The surgery goal is still the gold standard. You can do vasectomies, or I've done vasectomies before. There's a lot of counseling that goes with that. Some non-surgical ones we don't really have here as an agonist. So that is an implant that has a very high dose of GNRH that shuts them down chemically. It shuts the hypothalamus down so they can't make stimulating hormones. And then there's Zuterine which is a zinc solution, which will destroy the entire testis. It is supposed to be easier, but it comes with a large needle, and you can't get it in certain areas. It does require sedation, so it doesn't really get you away from having to sedate them. And there's a severe inflammatory reaction, because it's basically causing inflammation to cause fibrosis, which then stops the sperm from generating, but it doesn't change the testosterone, so they're still predisposed to getting tumors. So I usually just wait. These are just, like, maybe possible things, but not really specific that I would want to go over. So you know, I'll take any questions that you have now, but that's kind of like the overview of the stud dog and what we know, basically.

Dr. Nate Ritter  49:28

Amazing. Thank you so much. We have a lot of questions and some pre-submitted, which is fantastic. One of them that I thought was a good one: What are the most common preventable issues you see with canine infertility within your practice?

Dr. Victor Stora DVM, DACT  49:41

Heat. Usually heat damage from dog chosen blow dryers. Be very careful when you're blow drying them, if it's too warm, or if the dogs live in the south, or they live in a warmer climate, and they're out very long. I see a lot of mostly heat related degradation, which can be reversed, which is good, but that's what I see the most of.

Dr. Nate Ritter  50:04

Okay, thank you. Another question that I think was interesting: How important is it to have your stud dog collected on a regular basis, if he's not being used? If this is important, how often should it be done, and how soon should it be done before scheduled live breeding?

Dr. Victor Stora DVM, DACT  50:18

Dogs retro-ejaculate daily. There's no clean out, so you don't have to do it. There's no regular collection or anything that you have to do to make sure that there's no old sperm in there. They retro-ejaculate into their bladder, and then they pee it out every day. So you don't have to do anything like that. They're easy like that.

Dr. Nate Ritter  50:36

There you go. Another kind of general question. I know you touched on this a little bit: Medications that can impact fertility. Are there ones that you would just flag for individuals just so they have that knowledge?

Dr. Victor Stora DVM, DACT  50:48

So the problem is, some of the drugs that may impact fertility are for life-threatening disorders. So you have to kind of weigh the pros and cons. There's nothing I could think of that's like a, oh, benign disorder. Give them this. Like steroids will ruin spermatogenesis. But if the dog has Addison's disease, it has to get some level of steroids. Or if the dog has immune mediated hemolytic anemia, or anemia that's by the immune system, then any of the immunosuppressive agents can start to cause difficulty with fertility. So it's really, really hard, because most of the time we're not putting them on that medication, because it's just a benign disease, like we're medicating them because something serious is really going on wrong. But there's nothing that I can really think of in like a more benign setting that really would cause a lot of problematic issues.

Dr. Nate Ritter  51:41

All right, great. Time for maybe a couple more here. You spoke to cryptorchidism. Previously, we had someone write in: Is there an ideal time to neuter a cryptorchid? You know they were, I think as you just were talking about, weighing pros and cons, possibly thinking about physical development and what have you, is it best to have that done as soon as possible, or is it okay to wait a little while?

Dr. Victor Stora DVM, DACT  52:03

It's okay to wait a little while. That's not an emergency. That's just when it happens. It's good that you know. So sometimes I've dealt with dogs that were rescued or brought up from the south, and they look like they were neutered, but they're not. They're a cryptorchid, and you don't know how old they are. That's when it's kind of—you think that they're neutered. They go to a new family. They show clear signs of high testosterone and behavioral being intact. But it didn't come with the history. But if you're a breeder, and you know, then it's easier, because you can, I would say, at puberty or at maturity—that's when I would neuter them. They're big enough to handle anesthesia. They've gotten any benefits from testosterone that they may have, and then prolonging it is just going to increase your risk of testicular tumors or any sort of issues with BPH.

Dr. Nate Ritter  52:54

Great. Thank you. Then maybe one last question here. We had someone write in: Are there any predisposing factors for testicular degeneration? What are the potential causes for testicular degeneration?

Dr. Victor Stora DVM, DACT  53:04

So the causes of testicular generation, typically, they're senescence. So as they are becoming older, the testicles will degenerate, no matter what. Constant trauma. So like I said, like constant levels of heat, trauma, or something along those lines, that can cause them to start to degrade. And the problem, like I said, is, once your immune system, like, sees there are sperm there, it goes nuts. It's like, “That's not one of us.” And that's the problem, because slowing that down is extremely hard.

Dr. Nate Ritter  53:37

And any difference there between that you've appreciated, whether it's anecdotal or any research that I doubt there is, but between large breed and small breed dogs with testicular degeneration?

Dr. Victor Stora DVM, DACT  53:46

Kind of pretty much the same. It doesn't differentiate. It's usually just that's the most common senescence plus and/or trauma, and you basically don't want it to be traumatized enough to where the immune system can now survey and see it. So if you get like a traumatic event and the immune system never sees it, you're good. They can come back from that. It's if it's chronic, and over time, they get repetitive issues with that. That's when you worry.

Dr. Nate Ritter  54:18

Great. Well, thank you so much. This was really helpful information. I know a really popular topic. I'm sorry. I know we had a lot of questions. We don't have time for all of them. I want to thank everyone for joining us today. Once again, if you aren’t a member of our community, 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 have a sneak peek of our next webinar, Purina Pro Plan, veterinary supplements, achieving optimal health with Dr. Ruth Ann Lobos; that will be Wednesday, September 17, at 1pm Eastern. We look forward to hopefully seeing all of you there. Dr.Sstora, thank you again. Have a good one, everyone. Thank you.

Nicole Engelman  54:54

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