Hello everyone. Thank you to be here today. So we're going to speak together about hormonal analysis interpretation and reproduction fields.
So of course, I will focus mainly on progesterone because it's up to date. The hormone that we are using daily in our clinic, and I will have a very fast, speak about testosterone and estradiol because sometimes you want to do some analysis of these hormones and you don't always know what are the normal values. For the progesterone, I will start with some physiological reminds because it seems to be very important.
If you understand this graph, you understand everything about reproduction. That's why I decided to go in this field as a specialist because it's quite simple. So what are the main infos in this graph?
As you can see, the red line is the progesterone, during the cycle of the beach. So here you are in anest stress at the beginning, then you are in heats, when it starts to rise, you will be in dire stress afterwards and then in anno stress, and you can see also the estradiol in blue line. First, you have to remember that the oestrogen index is increasing only before the ovulation time, so during the first use of the beach, you will have a stronger rise of oestrogen and around the LH peak, you will have an oestrogen peak, then it will decline drastically.
And at time of ovulation and a time of the best time for fertility, the earthra will be in baza value will be very low. So it's always abnormal, a time of ovulation to have a high concentration of. Stradiol in the same time than the high concentration of progesterone and that means it lead to to a suspicion of follicle.
You can also see that during the diastros you will have a slight rise of oestrogen, but very, very small one, so it's not significant. If we focus on progesterone. You will have an increase of the value only in the few days before ovulation, as you heard during the study, and it means that all during the beginning of heat during the pro-tre period, so before the ovulation period.
You will have a very basal value of progesterone. Sometimes some of you are worried because when they are dosing the progesterone, progesterone will say 0.5.
The next day we'll say 1 gramme per millet. The day after we say 0.6, and they feel scary about this variation of progesterone.
You have to understand that until the progesterone rise enough. This is, background sound and it's not, it, it's just a puzzle value. Then at time of peak, you will have a sudden rise of progesterone.
And this progesterone will go to a peak around 5, 10 days after ovulation, then it will be quite elevated and during the diastrose, it is absolutely normal that you start to have a decline of progesterone, a slow decline of progesterone during dios. In this graph, you have a beach that is not pregnant. You will see later on the difference with the bit that is pregnant.
So the rise of progesterone is go to the peak around 5 to 20 days after ovulation. Then during the second half of dioster, we could say the second month of dios, it is normal to have a slight decline of progesterone. Is there a difference in the progesterone curve between medi stress and the pregnancy period?
Yes, you need to understand that of course, if I take one single bit, I don't, I didn't, I never follow a cycle in the previous cycles. I cannot know if when the progesterone is. Elevated like 35 nanograms per millimetre.
I don't know if this value is a pregnant value or a non-pregnant value in the beach. That's why we cannot use the progesterone concentration to know if the beach is pregnant or not. But on the other hand, during dire stress, in a non-pregnant beach, the progesterone.
Is lower for the same beach that's the pregnant progesterone. And if you see these two graphs in the black red, dark red, you have a non-pregnant beach and in the light red, you have the same beach in, that is pregnant. And as you can see, the progesterone value remains higher during the diasis of the pregnancy beach than During the nonpregnant beach, and you will have a sudden drop of progesterone at the end of pregnancy.
So at the end of the diastros in the beach around 2 months after the cycle, you will, you will have a sudden drop of progesterone. But in a non-pregnant beach, you don't have this sudden drop of progesterone, as you can see here. You have a slow drop of progesterone.
That's why. You cannot, when we speak about dios, in fact, we should speak about early diass or late diasis or early antrus or late dios in non-pregnant. We will see that in some clinical cases later.
Why does progesterone date ovulation, but not peak fertility? When we follow up the progesterone during cycle, during osteo cycle to define the best day for mating, for breeding, for insemination, we are not taking care about the value of the progesterone at time of mating or insemination, but we are taking account the progesterone at time of ovulation. That's very important to understand because In the beach before ovulation, in the 2 or 3 days before ovulation, you start to have a utilisation of the follicle.
That's why the progesterone starts to rise before ovulation, and that's why we are able to follow up the progesterone on the beach during the cycle. What we couldn't do in cats, for instance, in cats, the progesterone starts to rise around 3 to 5 days after mating, after ovulation. In the beach, you will have a start rising of progesterone a few days before ovulation, and what is very important to remember is that the progesterone value is always around the same window in any beach that can be a Great Dane or a Chihuahua.
You will always have around the same value, the same. Concentration of progesterone at time of ovulation. Of course, when I say so it means with the same machine, the same analyzer, we will see that later, but at time of insemination and mating, as you can see here, you have a wide variation of progesterone concentration.
You may have bits that are at mm two days after ovulation and some other that will be at 40 or 15 nms per mil at time of ovulation. So there are no sense to really focus on the progesterone value at time of breeding, but it is the key factor is to define the progesterone value at time of ovulation, as you can see here. So to to define the best time of breeding, what are the follic the physiological value of a beach at ovulation.
And that is the key thing to remember during my lecture is that there is no standard value of progesterone in the beach. In fact, no one is able to say in this volume of liquid of plasma or serum, you have physically. 20 nanomo per litre of progesterone.
So we always use an indirect way to do the measurement of the progesterone, and there are many antibodies that are used in the market to fix the progesterone and a lot of technology that are used to enhance the signal of the fixation and to do the measurement of progesterone. Here in green, blue, and red line, I show you the same beach, the same tube. With three different analyzers that are dosing the progesterone.
And as you can see, if I, I look at the minividas, which is for me the gold standard to follow up progesterone in the beach, I will be around ovulation at the end of ovulation around 10 to 15 nanograms per millilitre. So here, for instance, if you look at this. Particular beach we are around 12 nanograms per millilitre, but if I take the same tube and I dose the progesterone with two different automats, you can see that the concentration that is given to me is really lower.
That doesn't mean that one machine is better than the other. There are no, no, that that's not a machine that is. Right and the other are wrong.
It's just that it's a different way to do the measurements, a different enhancement of the signal, and so the concentration at the end is different, and that's a crucial point to remember because you cannot follow up a beach in a cycle with a lot of different analyzers during this cycle because you may do some mistake. Time for insemination is around 1 to 3 days after ovulation, and that depends on the machine. If I use the minididas, I will say that the peak of fertility is around 3 days after the progesterone rise 10 mg per millilitre.
But there are other ways to follow up. Some people are using the progesterone and the peak vaginal cremation. There are many ways to do it.
In this table on the in blue. I show you different machines that are commonly on the market for vets, the minividas, the Ayatozo, the, the Speed reader from near back, the Fuji, the catalyst for IES, and the solos. As you can see, the value of ovulation is not so far from one to the other, but the value before ovulation and after ovulation can have a variation.
So what you have to remember is that the most important thing is not to follow is to follow the progesterone curve and not only a value. Most of people ask me, OK, the beach is at 15 or 10 or 20 nanograms per millilitre. Is she ready or not?
Did she ovulate or not? When did she ovulate? What I need to know is the value before.
If I take for instance the catalyst, the index, which is a machine commonly used on the market nowadays by the vets, if the beach on Monday is at 1 gramme per mil, I know that she's at the basal value. If I repeat the dosage 3 days later and 3 days later, she is at 5 nam permit. And one day later, she's still at 5 or 7 grammes per millilitre.
I know that the ovulation didn't occur yet, but if on Wednesday, the progesterone is at 5 nanograms per millilitre and on Thursday, so the next day, the progesterone is at 20 or 25 grammes per millilitre, I'm sure that she ovulates between the previous day or the day before. So it helps me to focus. To understand why I prefer personally some machine to the other is for this reason of the very slow flap of the curve.
For instance, if you see that's the same pitch with progesterone SA with three different equipments, you can see it's the same graph than just before. If I take the yellow machine as the as the standard for me, I can see that during the cycle. I know that in this speech ovulation occurs around 4 to 6 nanograms per millilitre.
The difficulty for me is that because the curve is quite flat, it's not easy to understand if the previous day or the next day she did ovulate. So the ovulation window determination will be around plus or less 1 day. If I use this automat, which is a little bit more incubated.
It's even a little bit easier to make the distinction between the one day before relation and the day of relation. And if I use, for instance, the minibidas, which has a very strong slope of the curve, I can see that. Before ovulation, value is always below 10 grammes per millilitre.
The next day after ovulation, the progesterone is always over 15 nanograms per millilitre. So it's very easy for me to understand that the day of ovulation is the day when the progesterone is between 10 to 15 grammes per millilitre. So You cannot say that one automat is better than the other.
You just need to adapt your interpretation to the analyzer you are using, and surely to follow up, the more your curve is flat, the more progesterone SA you need to perform. For instance, if you use the fuji, where ovulation is quite low, around 4 to 6 nanograms per millimetre. Sometimes you will need to do blood sample every day or nearly every other day when it starts to rise.
When you use the Edex, most of the time you need to do the blood sample one every other day, because if not, you take the risk to do the blood sample too late. And when you use a minividas, for instance, You can do one essay every 3 to 4 days. So for the client, for the breeder, for instance, it's of course more convenient to use a mini vidas than a fuji.
But for yourself in your clinic, you can use whatever you want. You just need to adapt your interpretation and the number, the, the, the, the number of blood samples you will have to perform. When to be concerned about abnormal progesterone concentration during pregnancy, when to suspect a lethal insufficiency.
We know that during pregnancy, you have a physiological variation up to 20% in 24 hours, and we know that progesterone most of the time is higher in the morning than in the afternoon. That's very crucial for the interpretation of progesterone. As you can see on the curve here, you have variation of progesterone during days and from one day to the other.
So that's something to understand when you want to interpret. The progesterone, you will take that into consideration. So to help you, I will let you know that during the first half of pregnancy, so the first month of pregnancy, you should have a rise of progesterone and then it should remain quite high, quite concentrated.
So a drop over 20% of progesterone from one day to the other is not normal and may lead to a diagnosis of lutein deficiency. After the, the concentration, the progesterone concentration depends the machine you are using. Of course, if you are using an or an IR, the normal progesterone will be lower than with a mini bedas that have a higher concentration analysed.
During the second half of pregnancy, I could say during 30 to 50 days of pregnancy, we will consider that you may have a little insufficiency in regards of the machine you are using, depending on the value I can give you here. So most of the time if it's below 15 to 20 nanograms per millilitre. Then in the last days of pregnancy, you start to have a decline of progesterone and even if it's not really drop, it's not abnormal if it's over 5 to 10 grammes permit.
Take that into for, look for these cases. CC, a 4.5 year old premierous bitch, English bulldog, came to emergency because she had all the signs of stage one of patuition.
She was nesting during, during the cycle. A lot of t. The, the owners let us know that she had milk since nearly a week, and she started since 24 hours to have a lot of boulevard discharge.
So the beach is an English bulldog, so most of the English bulldogs are going for C-section. So the question is, are you doing the forming the C-section immediately? Are you checking for the foetal viability and the suffering?
Do you do any progesterone measurements or any other thing? If we look for the foetus, we had 5 foetuses. The, the cardiac output was Sorry, 160 to 180 bits per minute.
So normally, we are considering that you start to have hypoxia and bradycardia in consequence when it's below 150 bits per minute. But when we look at the progesterone, we see that the progesterone is low. 1.6 nanograms per milli is considered for all the machines as a basal value.
So, the progesterone drops. So would you do the C-section? If you do the C-section without any attention, all the pups will die.
So this speech, we have no information of the ovulation date determination when they were coming to emergency services. So you need always to make sure that the drop of progesterone is something normal and it's not related to a really little insufficiency. If we take this bit, we did the B parietal diameter measurements as I show you here, how to do it, and you have some calculation formula.
That you could use. I suggest you to go on our website, vet reproduction.com, that is free of charge for the vets, and I help you to do this calculation.
So if we take the Bpay diameter of the, of this foetus, we can see that in fact the pregnancy length was around 56 to 58 days of pregnancy. And in fact, we asked the owner because as you saw, it was not the owner that were coming, but the children of the breeder. The breeder was not there because of course he was not expecting a patuition at this time, so he left for the weekend with his wife.
And so the, the children called the, the breeder, her parents, and in fact, they gave us the information that the bitch had a heat follow up. And when we look at the heat follow up, we can see that she ovulates around the 27th to 28th of November, and I repeat that she came to us the 22nd of November. Which means that if we consider that a beach is helping around 63 days after ovulation, we were expecting a delivery around the 28th to the 30th of January, but not the 22nd.
So if we perform a C-section because the progesterone is low, we consider that it's something physiological. Of course all the foetus will be really premature and will die. So in this case you have the diagnosis of a progesterone drop, abnormal progesterone drop, and which is the little insufficiency, and we had to supplement the beach with progesterone and to stop the contraction.
Of the uterus with tocolytic. I don't have the time in this lecture to give all the detail how to treat a little insufficiency and mainly in emergency as it was the case. So please go on our free website and you have all the articles in English.
It's a fast translation, but it should be enough and you have all the details. Just to conclude about a radial evaluation in dogs. And testosterone, we nearly never use estradiol in dogs.
It's very uncommon that we need to dose it. We can do it sometimes when we want to understand if we have a functional ovarian cyst. Sometimes you have pitch with a prolonged stress period without re-ovulation or with a bizarre ovulation that takes time and with the history of an infertile beach, and sometimes we are wondering when we look by ultrasound we can see an ovarian cyst, but we never know if this cyst is functional or not.
One way to have a diagnosis is to do at the time of the supposed ovulation period when the progesterone starts to rise to do the ostradiol. As I remind you in introduction, the estradiol should be low at time of ovulation here. So if you are dosing the estradiol in the plasma of the beach and the estradiol remains high, it means that you have still a production of estradiol which is abnormal at time of ovulation.
It means that you have something abnormal and maybe a cyst. So I give you here what are the normal value in gramme and picool. A litre or litre of a beach in pro and in a.
The testosterone to finish, is nearly never used, we nearly never use the testosterone soundness in dogs and bitch because it's something unusual, use, useful. But if you suspect a hypogonadism, and you, you suspect that this hippogonadism is leading to infertility, to lack of libido, to, poor quality semen. I give you here all the formula, all the the normal concentration that are supposed to be in a physiological dogs.
To be honest, I, I never nearly do it in practise, but it's just to let you this information if you want to do it. And most of the time we are recommending to do HCG stimulation in practise to ensure that you don't have, you don't, you don't have a right. Thank you for your attention.
Thank you for your support to this, event, and I hope the best for all of our colleagues in Ukraine and, cross fingers. Bye-bye.
