Comparative study of treated and non-treated (auto-recovered) clinical endometritis effects on dairy cows’ fertility parameters

Comparative study of treated and non-treated (auto-recovered) clinical endometritis effects on dairy cows’ fertility parameters | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative study of treated and non-treated (auto-recovered) clinical endometritis effects on dairy cows’ fertility parameters Mustapha Adnane Smadi, Bakir Mamache, Houria Ouennes, Feriel Feriel, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4408948/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract In this study, we evaluated the effect of treated and auto-recovered clinical endometritis on fertility as a uterine disease class. We collected data on breeding, diseases, and cyclicity. Regarding the co-affections, cows with auto-recovered clinical endometritis were affected in groups 1 and 2. Cows with treated clinical endometritis represented groups 3 and 4, and cows without clinical endometritis represented Groups 5 and 6. Once the cyclicity recovered, cows were inseminated. Studied fertility parameters were; 1: conception rate; 2: days to first insemination; 3: success rate in the first insemination; 4: days to conception; and 5: days between first insemination and pregnancy. We performed ANOVA-analysis, Chi-square test, and Machine Learning K-means. A significant difference was noted for days to first insemination ( p -value = 0.05), reinforced by a Fisher-LSD post-hoc analysis test that demonstrated significant differences between groups (3 and 5), p -value = 0,006, groups (3 and 1), p -value = 0,019, and groups (3 and 6), p -value = 0,005. However, the conception rate was significantly higher in the groups with non-treated clinical endometritis ( p -value = 0.030). Concerning the other parameters, we did not notice significant differences among groups. Our results showed that auto-recovered cows from clinical endometritis had better fertility outcomes. Dairy cows treated clinical endometritis auto-recovered clinical endometritis fertility parameters Figures Figure 1 1. Introduction The cow's uterus bacterial contamination is unavoidable after calving, leading to an inflammatory immune response of the uterus. Metritis results from dysfunction caused by a deficiency or exasperation of the immune system. Uterine diseases can be classified as puerperal metritis, clinical metritis, clinical endometritis, and subclinical endometritis (Sheldon, Lewis, et al., 2006 ). Clinical endometritis incidence has been reported by many scientists. It significantly varied according to different risk factors, methods, or diagnosis timing. The overall prevalence of endometritis during the early (15–20 days), intermediate (21–28 days), and late (29–60 days) postpartum periods was 67.8%, 40.5%, and 14.4%, respectively (Gautam et al., 2009 ). Otherwise, according to the examination time diagnosis (20 to 26 days in milk (DIM)) and (27 to 33 DIM), the prevalence was 6.6% and 23.5%, respectively (LeBlanc. et al. , 2002a). This disease can negatively affect fertility (Fourichon et al., 2000 ) and reduce milk yield (Coleman et al., 1985 ). However, many studies were conducted in intensively controlled breeding facilities, regularly monitored and managed by veterinarians. Most of these studies did not mention whether or not sick cows were treated. Moreover, many treatment trials have suffered from a lack of negative controls. Some studies excluded cows treated for endometritis from reproductive performance analyses (Gautam et al., 2009 ). Some experiments focused more on clinical and bacteriological recovery than economic aspects, such as days to conception and conception rate (LeBlanc, 2008 ). Generally, untreated sick animals are used as comparison lots with treated animals in experimental protocols to compare the efficacy of treatments, like the study of LeBlanc et al. (LeBlanc. et al. , 2002b). The comparison between the results on fertility and the economic impact remains missing in several studies. In the field, however, we have observed that not treating cows with clinical endometritis; is a common practice among a local breeders group. Especially when the general condition of the animals is apparently correct, with no signs of fever and a preserved appetite. The farmers call this situation "the cow is draining its womb." The use of antibiotics as a treatment for endometritis is a systematic practice that generates different types of losses. Moreover, a few studies had showed the effect of antibiotics on hormonal activity in cows but comparative studies for fertility results and the economic impact of metritis remain missing. Furthermore, the interaction with other pathologies in the postpartum period leads us to wonder if treatments did not influence endometritis problems and fertility outcomes. The present study was conducted in Algerian farm conditions, where monitoring is almost absent or irregular, and veterinarian intervention is performed only when a serious health problem occurs. The question that arises from all the above is: "What are the effects of clinical endometritis, whether treated or not, on cow fertility or health?" 2. Materials and methods We used an experimental approach to determine the impact of clinical endometritis on fertility. 2.1 Study region The present experimentation was realized in areas known for their dairy farming in eastern Algeria. It included four governorates: Batna, Setif, Souk Ahras, and Mila. 2.2 Animals 133 cows were included in the study. The animals’ stables were correct, and their nutrition was similar. It consists of concentrate, green feed, roughage, and silage. We did not use any estrus or ovulation synchronization programs. The milk production level of the visited farms was estimated at 6750 ± 1277 Kg per cow per lactation cycle. 2.3 Data collection The study was carried out for more than a year. In the presence of the farm veterinarians and the breeders, farms were visited every 14 days. While the same investigator performed cow enrollment, clinical examination, and evaluation (Plöntzke et al., 2010 ) These visits began from day 0 (the day of calving) until the moment of the final positive or negative pregnancy diagnosis (day 90 post-artificial insemination (AI)). Farmers and farm veterinarians closely monitored the cows between the two visits. They clearly registered disease treatment, estrus, and artificial insemination until the next visit. During each visit, we noted findings, asked questions, and registered data for all the diagnosed diseases. Farms did not apply any vaccination program except for the state-sponsored vaccinations against rabies and foot-and-mouth disease. Furthermore, screenings for bovine brucellosis and tuberculosis were applied. It should be emphasized that no infectious diseases were reported during the present study. 2.4 Diagnosis The farms' veterinarians, who were monitoring the cows, diagnosed the pathologies between every two visits. And the pathologies to look for were placental retention, vitular fever, acute puerperal metritis, clinical endometritis, digestive problems, mastitis, and lameness. These listed pathologies were diagnosed easily by the farms' veterinarians. Therefore, we did not have difficulties with diagnosis during the study, but we had to diagnose reproductive pathologies by ourselves and confirm the farm veterinarians' diagnosis. Whereas diagnosed clinical endometritis cases were classified following this definition: The presence of purulent or mucopurulent uterine discharge after 21 DIM; the presence of liquid in the uterus; feverless (Sheldon, Lewis, et al., 2006 ) and a cervical diameter greater than 5 cm; using ultrasound, we found a specific image of the uterine liquid content. We installed a correct and controlled method of estrus detection and AI for all the cows in the study, established a fertility assessment from the monitoring sheets and calculated fertility parameters with the "Excel" software. 2.5 Examination During each visit, we asked farmers about: the progress of calving diseases, heat, inseminations, sale, culling, reform, and mortalities. Afterward, we proceeded to individual clinical examinations, searching for pathologies. We looked for signs of fresh discharge on the vulva, perineum, tail, or even on the ground. Following this step, we moved to the rectal search for the presence of pneumovagina or urovagina. We had squatted adhesion, and the cervix was grasped with the hand to estimate its size in centimeters (cm). We also caught the inter-hornual bifurcation and palpated each horn to determine its diameter, length, and contents (liquid presence). Then, the ovaries were probed, determining their physiological or pathological stage. We also use ultrasound to confirm the condition of the uterus and ovaries. After that, we performed the vaginoscopy. The ano-vulvar region was washed and dried thoroughly to avoid introducing feces and germs into the vagina. We cleaned and disinfected the speculum with a mild disinfectant before being introduced into the vagina. We inspected the vaginal wall entirely and appreciated its color and moisture. We also examined the uterine cervix to note the nature of discharge, if there was any. Sometimes, we find an urovagina. We recorded the conditions identified by the farms' veterinarians. Breeders and inseminators recorded heat and insemination dates by themselves. As soon as we performed the first insemination, we stopped the practice of trans-rectal searching and vaginoscopy. But heats and inseminations continued to be recorded, noting that the conception route was AI. We performed genital tract ultrasounds to confirm the uterus' condition and to diagnose clinical endometritis at each visit. Between days 35 and 45 post-insemination, we performed an ultrasound check to diagnose a possible pregnancy or even cases of late embryonic mortality. We reviewed the cow again to determine the gestational state on days 60 and 90 post-insemination. The treatment protocol for clinical endometritis in this study was the same for all cases(Constable et al., 2009 ): Antibiotics: Oxytetracycline Non-steroidal anti-inflammatory drugs: Flunixin Meglumine For local genital treatment, we used Cephapirin. We have initiated a rigorous monitoring program for cows with untreated clinical endometritis (grp.1 and grp.2). We should mention that cows did not have complications during the entire study. Besides the clinical endometritis, the most noted diseases in this study were: mastitis, lameness, digestive problems, retained placenta, and milk fever (hypocalcemia). Antibiotics were the most commonly used treatment for these diseases. 2.6 Data processing 2.6.1 Groups’ formation The cows suffering from clinical endometritis with or without other simultaneous diseases from the list above, which we treated, form a group apart. A single cow having acute puerperal metritis (with deterioration of the general condition) was recorded. Therefore, from clinical data, we have formed groups (grps) as shown in Table 01 . Table 01 Groups’ formation Groups Treated Clinical Endometritis Not Treated Clinical Endometritis Treatment For The Diseases Effective Grp.1 NO YES YES 11 Grp.2 NO YES NO 12 Grp.3 YES NO NO 08 Grp.4 YES NO YES 07 Grp.5 NO NO YES 15 Grp.6 NO NO NO 80 • Grp. 1: Cows with non-treated clinical endometritis and other treated pathologies • Grp. 2: Cows with non-treated clinical endometritis and without other pathologies • Grp. 3: Cows with treated clinical endometritis and without other pathologies • Grp. 4: Cows with treated clinical endometritis and other treated pathologies • Grp. 5: Cows without clinical endometritis and with other treated pathologies • Grp. 6: healthy cows without clinical endometritis and without other pathologies Table 2 Effect of treatments on reproductive parameters Groups Number of cows Days to first insemination Days to conception interval First service to conception interval Conception rate Success rate in 1st insemination Grp.1 11 75.70 ± 38.00 b 97.20 ± 41.40 a 21.45 ± 25.31 a 100% 45.45% Grp.2 12 89.60 ± 39.70 ab 104.3 ± 44.80 a 14.75 ± 23.02 a 100% 58.33% Grp.3 8 107.50 ± 17.50 a 115.8 ± 30.50 a 17.60 ± 27.90 a 62.50% 37.50% Grp.4 7 87.10 ± 35.80 ab 87.7 ± 34.00 a 3.50 ± 8.57 a 85.71% 71.42% Grp.5 15 72.50 ± 23.50 b 102.4 ± 31.04 a 6.90 ± 20.71 a 60.00% 13.00% Grp.6 80 76.80 ± 26.60 b 91.1 ± 38.00 a 17.70 ± 34.55 a 66.25% 47.50% 95% confidence interval 2.6.2 Calculated fertility parameters Once the cyclicity recovered, inseminators inseminated the cows and recorded dates. Later, we proceeded with the pregnancy diagnosis. The calculation of the fertility parameters according to the international formula (Rethmeier et al., 2019 ) ; (Rutten et al., 2016 ) and (Touchberry et al., 1959 ) was as follows: $$\text{C}\text{o}\text{n}\text{c}\text{e}\text{p}\text{t}\text{i}\text{o}\text{n} \text{r}\text{a}\text{t}\text{e} \left(\text{%}\right)=\frac{\text{P}\text{r}\text{e}\text{g}\text{n}\text{a}\text{n}\text{t} \text{c}\text{o}\text{w}\text{s} \text{n}^\circ }{\text{I}\text{n}\text{s}\text{e}\text{m}\text{i}\text{n}\text{a}\text{t}\text{e}\text{d} \text{c}\text{o}\text{w}\text{s} \text{n}^\circ \text{i}\text{n} \text{a} \text{d}\text{e}\text{f}\text{i}\text{n}\text{e}\text{d} \text{t}\text{i}\text{m}\text{e} \text{p}\text{e}\text{r}\text{i}\text{o}\text{d}} \times 100$$ 01 • \(\text{S}\text{u}\text{c}\text{c}\text{e}\text{s}\text{s} \text{r}\text{a}\text{t}\text{e} \text{i}\text{n} 1\text{s}\text{t} \text{i}\text{n}\text{s}\text{e}\text{m}\text{i}\text{n}\text{a}\text{t}\text{i}\text{o}\text{n}\left(\text{%}\right)=\frac{\text{P}\text{r}\text{e}\text{g}\text{n}\text{a}\text{n}\text{t} \text{c}\text{o}\text{w}\text{s} \text{a}\text{f}\text{t}\text{e}\text{r} \text{F}\text{i}\text{r}\text{s}\text{t} \text{i}\text{n}\text{s}\text{e}\text{m}\text{i}\text{n}\text{a}\text{t}\text{i}\text{o}\text{n}}{\text{I}\text{n}\text{s}\text{e}\text{m}\text{i}\text{n}\text{a}\text{t}\text{e}\text{d} \text{c}\text{o}\text{w}\text{s} \text{i}\text{n} \text{a} \text{d}\text{e}\text{f}\text{i}\text{n}\text{e}\text{d} \text{t}\text{i}\text{m}\text{e} \text{p}\text{e}\text{r}\text{i}\text{o}\text{d}}\times 100\) (02) Days to first insemination = number of days from calving to first insemination • Days to conception or Days open = number of days from calving to day of conception • First services to conception interval = number of days from the first service to pregnancy All cows returned to their cyclicity (reproductive activity). Cows inseminated and not diagnosed for pregnancy were removed from the study. Therefore, we considered only those with positive or negative pregnancy results. We also excluded from the study all cows with missing information. Applying inclusion criteria, we eliminated from the study one batch of animals consisting of 44 cows with poor nutrition due to a poor management. Finally, only 133 cows were kept from the 557 initially introduced in the study. 2.6.3 Statistical analysis The results were expressed as a mean ± standard deviation (µ ± SD) for day intervals and as a percentage (%) for conception and success rates. We performed comparisons between the studied groups by using the one-way analysis of variance (ANOVA) followed by a Fisher (LSD) multiple comparisons (post-hoc) test. For count data, we used the Chi-square test. A p-value equal to or less than 0.05 was considered significant. The k-means clustering algorithm (MacQueen, 1967 ) follows an easy way to classify a given object through a certain number of fixed clusters (k). The k-means clustering results were obtained in the present study to control the data division. We analyzed the 133 cows' data set by assigning different values (1–6) to the variable k. We performed the statistical analyses with R Software, version 3.4.2 (R Core Team, 2020). 3. Results As a fact, there was no voluntary waiting period in our study. Our survey focused on clinical endometritis. Hence, we have calculated its prevalence. And its value was 28.57%, where 17.29% represented non-treated ones. Indeed, it corresponded to 60.52% of the total number of clinical endometritis cases. Table 02 represents the results of reproductive performance. We did not detect significant differences among groups for these parameters (days to conception interval, days from the first service to conception, and success rate at first insemination). However, we have noticed a significant difference between groups regarding (days to first insemination and conception rate). 3.1 Days to first insemination Concerning the studied groups, the minimum mean recorded for (days to the first insemination) was 72.47 days for (grp.5) with a range (of 44 to 126 days). However, (grp.3) had the longest days to the first insemination interval (107.5 days) with a range of (82 to 130 days). (Grp.1 and grp.2) had respectively recorded mean values of (75.7 and 89.6 days). For groups 4 and 6, this parameter was (87.1 and 76.8 days) respectively, with a p -value of 0.05. For Fisher (LSD) test post hoc analyses, the p-values between groups (3and 5, p-value = 0,006), (3 and 1 p-value = 0,019) (3and 6 p-value = 0,005) were statistically highly significant. The Dunnett two-sided test confirmed the difference between (grp.3) and the control group (grp.6) with a p-value of 0,024. 3.2 Days to conception interval This interval was slightly longer for (grp.3), with a mean of 115.8 days and a range of (82 to 157 days). But it was not very far from the other groups: grp.1 (97.2 days), grp.5 (102.4 days), and grp.6 (91.13 days). The minimal mean recorded was 87.7 days in grp.4, with a range of (34 to 122 days). Therefore, there was no significant difference among all these groups ( p-value = 0.654). 3.3 First service to conception interval For the interval between the first service and conception, we have recorded the maximum mean of 21.45 days (grp.1) with a range of (0 to 71 days), as well the minimum mean of 3.50 days (grp.4) with a range of (0 to 21 days). For this element, we recorded a trend reversal in favor of groups 3 and 4. This situation is due to the limitations of this parameter, which hides other pieces of information, such as the negative pregnancy diagnosis. Indeed, we did not observe a significant difference among groups ( p-value = 0.843). 3.4 Conception rate For the conception rate, we recorded a significant difference among groups ( p -value = 0.03) in favor of the cows with non-treated clinical endometritis (grps.1 and 2), which had a pregnancy rate of 100%. The other groups could be classified into two tendencies; where group 4 is the first one (85.71%), and groups (3, 5, and 6) are the second one (62.5%, 60%, and 66.25%), respectively. 3.5 Success rate in first insemination The success rate after the first insemination varied between 13% (grp.5) and 71.42% (grp.4). No significant difference had been recorded among all the groups ( p-value = 0.098). 3.6 Results confirmation using K-means clustering Figure 1 shows the obtained K-means results. As depicted, our data can be included in one or two clusters with high performance clustering results. These findings highlight the consistency of the clinical data, which supports the ANOVA results. 4. Discussion In the present research, all the cows enrolled in the study had finally regained their cyclicity. We compared cows having clinical endometritis with healthy cows. We noted significantly greater intervals between calving to the first AI, for treated clinical endometritis cows than the other groups, contrary to the expectations. The study of intervals (days to first AI) revealed that non-treating cows with clinical endometritis did not influence the recovery of ovarian activity, as in healthy cows. On the contrary, treated cows had longer intervals between calving and first insemination, which suggests that the use of antibiotics is the explanation for this prolongation. After cyclicity recovery, all cow categories had the same histological profile (with no endometrial damage) (Chapwanya. et al. , 2010). This can explain the indifference in our statistical results for both parameters (the first service to conception interval and days to conception). This situation may also, be explained by a correct PGF/PGE ratio, which simultaneously reinforces the elimination of uterine contents with an uterotonic effect and re-launches the sexual cycle. The suggestion is that non-treated clinical endometritis may not influence this ratio. Le Blanc et al.(2002) found that moderately purulent uterine discharge up to day 33 postpartum was not linked to a lower pregnancy rate, which is similar to our results (LeBlanc. et al. , 2002a). However, an increase in purulent discharge has the most significantly negative effect on pregnancy. Uterine diseases causing lesions on the uterus and ovaries induce a reduction in fertility (Bonnett et al., 1993 ). Uterine inflammation causes endometrial dysfunction (Sheldon and Dobson, 2004 ), and blocks embryonic development (Soto et al., 2003 ). Several authors have linked uterine diseases to lower conception rates, longer intervals to conception, higher culling, and economic losses ((Hill. and Gilbert., 2008); (Bartlett et al., 1986 ); (Sheldon and Dobson, 2004 ); (Gilbert et al., 2005 ); (Galvão et al., 2009 ) ; (Overton. and Fetrow., 2008) and (Galvão, 2013 ). Other authors found that; uterine diseases can negatively affect the time to insemination and conception rates ((Galvão, 2013 ); (I Martin Sheldon et al., 2002 ) and (Williams et al., 2008 )). This can be done by decreasing the luteinizing hormone, size and growth of the first dominant follicle, as well as the ability to secrete follicular œstradiol, affecting the ovulation capacity. After ovulation resumes, cows with uterine disease present a prolongation of the luteal phase (Opsomer et al., 2000 ). The previously mentioned issues were investigated without specifying the real cases involved (puerperal metritis, clinical endometritis, or subclinical ones). Other works, like (Bell and Roberts, 2007 ) studied the effects of uterine diseases on fertility, focusing on puerperal metritis. In our study, we focused specifically on clinical endometritis, and we did not find any effect on fertility interval parameters for non-treated clinical endometritis, which differs from all the previously stated findings. In fact, treated cows had longer days to the first AI intervals, and there was a better conception rate for non-treated clinical endometritis cases. In this work, we did not find a clear difference in the days to conception intervals between cows with treated and non-treated clinical endometritis, whether detected early or not. Our approach was to do a systematic follow-up without considering the herd's history. Unlike (Fourichon et al., 2000 ), we found that clinical endometritis may not affect fertility by increasing the calving to conception interval. Indeed, the previous study showed either slighter effects of early metritis on: days to first estrous, days to the first service, and conception at the first service; and a comparable or higher effect of late metritis on: days to conception, and services per conception). Reproduction management has a significant influence on dairy farm profitability. Cows with poor reproductive performance are more likely to be examined for metritis than their herdmates. Herds under a fertility program are systematically examined to promote optimal reproductive performance, and thus metritis are detected and treated early, as confirmed by its lower effects in studies reporting routine examination of cows (Inchaisri et al., 2010 ). In the present work, where we used moderately productive cows, we noticed that the influence of pathologies on some reproductive parameters (days to 1st insemination, days to conception, and days between first services and conception) was not obvious, reinforcing Wathes’ suggestion that the most important factors affecting fertility are the metabolic more than the pathological ones (Wathes et al., 2007 ). Rethmeier et al. ( 2019 ) had not found a significant difference in the days to first insemination and the days open, according to the milk yield nor in the conception and pregnancy rates, with a noticeable tendency that the higher the milk yield is, the higher the pregnancy rate is noted (Rethmeier et al., 2019 ). Nonetheless, the average production level of their study differs from ours, which does not exceed 22 kg/day. The metabolic balance of our cows, with an average of reduced production, allowed a resumption of quickly recovered energy balance, with better and more correct bodily functions like sexual and hormonal activities, earlier than that of higher-yielding cows (Sheldon, Wathes, et al. , 2006). Breeds used in this research were supposed to be highly productive, with a yield of 9291 kg/lactation in Germany or 11472 kg/lactation for the USA breed (Foksha and Konstandoglo, 2019 ). However, their average level was 6750 ± 1277 Kg, probably due to the nutritional ration, individual variability, or herd management. This situation can be more or less contradicted by the availability and quality of food distributed to animals, either by the effect of the environment and the hotter climate comparing to the dairy breeds original countries; namely the European regions, which are visibly colder than our studied area. The last suggestion can be contradicted by the fact that dairy farms exist in the Arabian peninsula countries lime countries and have production levels similar to European farms, with the least square means of 9870 to 10146 liters for Saudi farms (Ali et al., 2000 ). Fourichon et al.(2000) compared the effects of clinical and puerperal metritis and concluded that puerperal metritis has a much greater negative impact on reproduction outcomes than clinical metritis (Fourichon et al., 2000 ). Concordant to our results, Giuliodori et al. ( 2013 ) stated that puerperal metritis harmed pregnancy rates and increased calving to conception intervals, but not clinical metritis, which had the same results as healthy cows (Giuliodori et al., 2013 ). Likewise, for the calving to conception interval, cows with puerperal metritis had longer intervals than cows with clinical metritis or being healthy, without specifying if cows were treated or not. This effect could have a variety of actions on fertility, including increasing days to first heat (prolonged anoestrus and luteal phases) ((Mateus et al., 2002 ) and (I. M. Sheldon et al., 2002 )), and causing a net disturbance in the uterine environment ((Bondurant, 1999 ); (Sheldon and Dobson, 2004 ) and (Giuliodori et al., 2013 )). Unfortunately, the effective treatment options for endometritis remain limited, but the disease can persist even after treatment and recovery (Nyabinwa et al., 2020 ). Escandón et al. ( 2020 )used a negative control group but only for subclinical endometritis (Escandón et al., 2020 ). The use of antibiotics could indeed disrupt the balance of the uterine flora, promoting the development of resistant germs (Appiah et al., 2020 ). In general, there is an agreement on using systemic antibiotics in cases of puerperal metritis (accompanied by fever). However, the treatment of clinical endometritis (without fever) using local antibiotics, prostaglandins, and non-steroidal anti-inflammatory drugs is still controversial to some extent (Bartolome et al., 2014 ). This was reinforced by our study. Kasimanickam et al. ( 2005 ) had a different strategy for treatment and different results; they chose to treat cows at 20–33 DIM to allow sufficient time for uterine repair in order to increase the chance of conception (Kasimanickam et al., 2005 ). Although the untreated control cows also had an equal chance of receiving cloprostenol treatment, Cows with clinical endometritis (treated once with intrauterine cephapirin 31 days before the planned spring mating) had better reproductive performance than the untreated controls. Our results showed a different impact on fertility because we probably didn’t use cloprostenol after clinical healing. The use of medication during the postpartum period to treat another disease (digestive, metabolic, respiratory, locomotor, or other problems) did not affect reproductive performance. However, treating clinical endometritis may negatively influence the days to insemination intervals. Despite these noted differences, all the groups did not come out of the recommended and observed standard target values ​​in dairy farms which are: conception rate (%) > 50, service rate (%) > 80, pregnancy rate (%) > 35, days to 1st insemination < 85, days open 35, service rate (%) > 60, pregnancy rate (%) > 24. except for days to the first insemination, where groups (2, 3, and 4) recorded an extension of (89, 107, and 87 days) sequentially, and days to the conception interval, where (grp.3) recorded a slight extension of 115 days. We also noticed that the treated groups performed the worst. There is a significant lack of scientific information on the observed phenomenon (not treating clinical endometritis has a better outcome than treating it), as well as the capacity of practitioner veterinarians in the field to estimate the correct status of the uterus. But the experience in this reflection is grounded in the same context. It is about placental retention, where manual removal and antibiotic treatment have been practiced by veterinarians for a long time. Surprisingly; in recent years, comparisons of different treatment approaches have led to conclude that not intervening was better for the cow's health and reproductive future (Beagley. et al. , 2010). The benefits of this approach for clinical endometritis would be indisputable: reduction of treatment strokes; better management of breeding; avoiding the use of antibiotics, which presents multiple risks (elimination of a considerable amount of milk (the waiting period); new antimicrobial resistance; teratogenic effects of treatment; and developing a complete immunity in individuals). This approach, therefore, requires rigorous monitoring to avoid complications (which were not observed in this study), generating additional costs to measure and compare with the benefits gained from this practice. Our results clearly showed that the treatment of clinical endometritis had no influence on the reproductive outcome of cows; on the contrary, the untreated ones had slightly better fertility results. 5. Conclusions Our results showed significant differences between auto-recovered cows from clinical endometritis and other groups of cows for some reproductive parameters. Unlike the expected; auto-recovered cows from clinical endometritis had better fertility results compared to the treated ones. From these findings, new questions arise: about postpartum cow immunity in general and uterine immunity in particular; about the characterization of clinical endometritis when it occurs; about its definition as a specific case that requires special monitoring and surveillance without using antibiotics; or about the decision whether or not to treat it. The findings of our study may open the way for further research in this area. Fertility is a determinant of the cow's lifetime performance, and the decision to leave the treatment of a disease like clinical endometritis is hard to make, whether from moral, ethical, medical, or economic viewpoints. Both the veterinarian and the breeder must agree to such a decision. Declarations Credit authorship contribution statement Mustapha Adnane. Smadi: Project design, methodology, project management investigation, clinical examination, analysis and interpretation of data, writing – original draft, review & editing. Bakir. Mamache: project management, Project design, Data curation, Writing – review & editing, paper revision, final approval. Houria. Ouennes: Data curation, Investigation, Writing – review & editing. Feriel. Sellam : paper revision, Writing – review & editing. Rahla. Meziane: investigation, Writing – review. Mohammed. El Hadef ElOkki: Data curation, statistical analysis, writing – review & editing. Farid. Boughris: investigation, clinical examination, Artificial insemination, farmer recruitment. Mostefa. Benhadid: investigation, clinical examination, Artificial insemination, farmer recruitment. Conflict of interest statement All authors declare no conflict of interest in this paper. And they have no relevant financial or non-financial interests to disclose. Funding and Acknowledgements The authors are grateful to farmers for their availability and collaboration. We appreciate the veterinary practitioners’ help for the success of this work especially; Mostefa Behadid and Farid Boughris Our thanks to: Professor Halima Benbouza; former Director of C.R.Bt for facilitating this work. Our thanks to: Dr. Khalid Bouhedjar and Dr. Abdelbasset Boukelia for their appreciated data analysis help. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethical authorization From locale Ethical Comity of C.R.Bt (CCE): authorization reference number (03/C.R.Bt/2021). References Ali A.K.A., Al-Haidary A., Alshaikh M.A., Gamil M.H. & Hayes E. 2000. Effect of Days Open on the Lactation Curve of Holstein Cattle in Saudi Arabia. Appiah M.O., Wang J. & Lu W. 2020. Microflora in the reproductive tract of cattle: A review. Agric , 10 , 1–27. Bartlett P.C., Kirk J.H. & Mather E.C. 1986. Repeated insemination in Michigan Holstein-Friesian cattle: Incidence, descriptive epidemiology and estimated economic impact. Theriogenology , 26 , 309–322. Bartolome J.A., Khalloub P., Luzbel R., Sota D. & Drillich M. 2014. Strategies for the treatment of dairy cows at high risk for postpartum metritis and for the treatment of clinical endometritis in Argentina. Trop Anim Heal Prod , 46 , 79–85. Beagley. J.C., Whitman. K.J., Baptiste. K.E. & Scherzer. J. 2010. Physiology and Treatment of Retained Fetal Membranes in Cattle. Vet Intern Medicne , 261–268. Bell M.J. & Roberts D.J. 2007. The impact of uterine infection on a dairy cow ’ s performance. Theriogenology , 68 , 1074–1079. Bondurant R.H. 1999. Inflammation in the bovine female reproductive tract. J Anim Sci , 77 Suppl 2 , 101–110. Bonnett B.N., Wayne Martin S. & Meek A.H. 1993. Associations of clinical findings, bacteriological and histological results of endometrial biopsy with reproductive performance of postpartum dairy cows. Prev Vet Med , 15 , 205–220. Chapwanya. A., Meade. K.G., Narciandi. F., Stanley. P., Mee. J.F., Doherty. M.L., et al. 2010. Endometrial biopsy: a valuable clinical and research tool in bovine reproduction. Theriogenology , 73 , 988–994. Coleman D.A., Thayne W. V. & Dailey R.A. 1985. Factors Affecting Reproductive Performance of Dairy Cows. J Dairy Sci , 68 , 1793–1803. Constable P.D., Pyörälä S. & Smith G.W. 2009. Guidelines for Antimicrobial Use in Cattle. In Guide to Antimicrobial Use in Animals (L. B. J. and H. K. Luca Guardabassi, ed). 2008 Blackwell Publishing Ltd, 143–160. Escandón B.M., Espinoza J.S., Perea F.P., Quito F., Ochoa R., López G.E., et al. 2020. Intrauterine therapy with ozone reduces subclinical endometritis and improves reproductive performance in postpartum dairy cows managed in pasture-based systems. Trop Anim Health Prod , 52 , 2523–2528. Foksha V. & Konstandoglo A. 2019. Dairy productivity of holstein cows and realization of their genetic potential. Bulg J Agric Sci , 25 , 31–36. Fourichon C., Seegers H. & Malher X. 2000. Effect of disease on reproduction in the dairy cow: A meta-analysis. Theriogenology , 53 , 1729–1759. Galvão K.N. 2013. Uterine diseases in dairy cows : understanding the causes and seeking solutions. In Animal Reproduction, 228–238. Galvão K.N., Frajblat M., Brittin S.B., Butler W.R., Guard C.L. & Gilbert R.O. 2009. Effect of prostaglandin F2α on subclinical endometritis and fertility in dairy cows. J Dairy Sci , 92 , 4906–4913. Gautam G., Nakao T., Yusuf M. & Koike K. 2009. Prevalence of endometritis during the postpartum period and its impact on subsequent reproductive performance in two Japanese dairy herds. Anim Reprod Sci , 116 , 175–187. Gilbert R.O., Shin S.T., Guard C.L., Erb H.N. & Frajblat M. 2005. Prevalence of endometritis and its effects on reproductive performance of dairy cows. Theriogenology , 64 , 1879–1888. Giuliodori M.J., Magnasco R.P., Becu-Villalobos D., Lacau-Mengido I.M., Risco C. a & de la Sota R.L. 2013. Metritis in dairy cows: risk factors and reproductive performance. J Dairy Sci , 96 , 3621–31. Hill. J. & Gilbert. R. 2008. Reduced quality of bovine embryos cultured in media conditioned by exposure to an inflamed endometrium. Aust Vet J , 86 , 312–316. Inchaisri C., Jorritsma R., Vos P.L.A.M., van der Weijden G.C. & Hogeveen H. 2010. Economic consequences of reproductive performance in dairy cattle. Theriogenology , 74 , 835–846. Kasimanickam R., Duffield T.F., Foster R. a., Gartley C.J., Leslie K.E., Walton J.S., et al. 2005. The effect of a single administration of cephapirin or cloprostenol on the reproductive performance of dairy cows with subclinical endometritis. Theriogenology , 63 , 818–830. LeBlanc. S.J., Duffield. T.F., Leslie. K.E., Bateman. K.G., Keefe. G.P., Walton. J.S., et al. 2002a. Defining and diagnosing postpartum clinical endometritis and its impact on reproductive performance in dairy cows. J Dairy Sci , 85 , 2223–2236. LeBlanc. S.J., Duffield. T.F., Leslie. K.E., Bateman. K.G., Keefe. G.P., Walton. J.S., et al. 2002b. The effect of treatment of clinical endometritis on reproductive performance in dairy cows. J Dairy Sci , 85 , 2237–49. LeBlanc S.J. 2008. Postpartum uterine disease and dairy herd reproductive performance: A review. Vet J , 176 , 102–114. MacQueen J.B. 1967. Some Methods for Classification and Analysis of Multivariate Observations. (http://projecteuclid.org/euclid.bsmsp/1200512992 accessed on). Mateus L., Lopes Da Costa L., Bernardo F. & Robalo Silva J. 2002. Influence of puerperal uterine infection on uterine involution and postpartum ovarian activity in dairy cows. Reprod Domest Anim , 37 , 31–35. Nyabinwa P., Kashongwe O.B., Hirwa A. & Bebe B.O. 2020. Perception of farmers about endometritis prevention and control measures for zero- grazed dairy cows on smallholder farms in Rwanda. BMC Vet Res , 16 , 1–11. Opsomer G., Gröhn Y.T., Hertl J., Coryn M., Deluyker H. & De Kruif A. 2000. Risk factors for post partum ovarian dysfunction in high producing dairy cows in Belgium: A field study. Theriogenology , 53 , 841–857. Overton. M. & Fetrow. J. 2008. Economics of Postpartum Uterine Health. In Dairy Cattle- Reproduction council convention, 39–43. Plöntzke J., Madoz L. V, Sota R.L. De, Drillich M. & Heuwieser W. 2010. Subclinical endometritis and its impact on reproductive performance in grazing dairy cattle in Argentina. Anim Reprod Sci J , 122 , 52–57. Rethmeier J., Wenzlau M., Wagner M., Wiedemann S. & Bachmann L. 2019. Fertility parameters in German dairy herds: Associations with milk yield and herd size. Czech J Anim Sci , 64 , 459–464. Rutten C.J., Steeneveld W., Vernooij J.C.M., Huijps K., Nielen M. & Hogeveen H. 2016. A prognostic model to predict the success of artificial insemination in dairy cows based on readily available data. J Dairy Sci , 99 , 6764–6779. Sheldon I.M. & Dobson H. 2004. Postpartum uterine health in cattle. Anim Reprod Sci , 82 – 83 , 295–306. Sheldon I.M., Lewis G.S., Leblanc S. & Gilbert R.O. 2006. Defining postpartum uterine disease in cattle. Theriogenology , 65 , 1516–1530. Sheldon I Martin, Noakes D.E. & Dobson H. 2002. Effect of the regressing corpus luteum of pregnancy on ovarian folliculogenesis after parturition in cattle. Biol Reprod , 66 , 266–271. Sheldon I. M., Noakes D.E., Rycroft A.N., Pfeiffer D.U. & Dobson H. 2002. Influence of uterine bacterial contamination after parturition on ovarian dominant follicle selection and follicle growth and function in cattle. Reproduction , 123 , 837–845. Sheldon I.M., Wathes D.C. & Dobson H. 2006. The management of bovine reproduction in elite herds. Vet J , 171 , 70–78. Soto P., Natzke R.P. & Hansen P.J. 2003. Identification of possible mediators of embryonic mortality caused by mastitis: Actions of lipopolysaccharide, prostaglandin F2α, and the nitric oxide generator, sodium nitroprusside dihydrate, on oocyte maturation and embryonic development in cattle. Am J Reprod Immunol , 50 , 263–272. Touchberry R.W., Rottensten K. & Andersen H. 1959. Associations Between Service Interval, Interval from First Service to Conception, Number of Services per Conception, and Level of Butterfat Production. J Dairy Sci , 42 , 1157–1170. Wathes D.C., Fenwick M., Cheng Z., Bourne N., Llewellyn S., Morris D.G., et al. 2007. Influence of negative energy balance on cyclicity and fertility in the high producing dairy cow. Theriogenology , 68 , 232–241. Williams E.J., Herath S., England G.C.W., Dobson H., Bryant C.E. & Sheldon I.M. 2008. Effect of Escherichia coli infection of the bovine uterus from the whole animal to the cell. Animal , 2 , 1153–1157. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4408948","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":311040516,"identity":"9be177e4-4b36-416e-a96b-7f63703259d3","order_by":0,"name":"Mustapha Adnane Smadi","email":"","orcid":"","institution":"University of Hadj","correspondingAuthor":false,"prefix":"","firstName":"Mustapha","middleName":"Adnane","lastName":"Smadi","suffix":""},{"id":311040517,"identity":"1f65993d-d1fc-4c33-9c93-060132e895d9","order_by":1,"name":"Bakir Mamache","email":"","orcid":"","institution":"University of 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15:08:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4408948/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4408948/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":57846850,"identity":"8f6f2c8d-c647-4a7a-833a-32772683258e","added_by":"auto","created_at":"2024-06-06 10:59:35","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":40651,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4408948/v1/78c5b378f702b751ac93682d.jpg"},{"id":57981023,"identity":"8834d330-2f15-4185-bcfa-6cba6680b3a8","added_by":"auto","created_at":"2024-06-08 15:05:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":770469,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4408948/v1/b094ca2d-dc16-428a-b44e-18fe86a9d4c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative study of treated and non-treated (auto-recovered) clinical endometritis effects on dairy cows’ fertility parameters","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe cow's uterus bacterial contamination is unavoidable after calving, leading to an inflammatory immune response of the uterus. Metritis results from dysfunction caused by a deficiency or exasperation of the immune system. Uterine diseases can be classified as puerperal metritis, clinical metritis, clinical endometritis, and subclinical endometritis (Sheldon, Lewis, et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinical endometritis incidence has been reported by many scientists. It significantly varied according to different risk factors, methods, or diagnosis timing. The overall prevalence of endometritis during the early (15\u0026ndash;20 days), intermediate (21\u0026ndash;28 days), and late (29\u0026ndash;60 days) postpartum periods was 67.8%, 40.5%, and 14.4%, respectively (Gautam et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2009\u003c/span\u003e). Otherwise, according to the examination time diagnosis (20 to 26 days in milk (DIM)) and (27 to 33 DIM), the prevalence was 6.6% and 23.5%, respectively (LeBlanc. \u003cem\u003eet al.\u003c/em\u003e, 2002a).\u003c/p\u003e \u003cp\u003eThis disease can negatively affect fertility (Fourichon et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2000\u003c/span\u003e) and reduce milk yield (Coleman et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). However, many studies were conducted in intensively controlled breeding facilities, regularly monitored and managed by veterinarians. Most of these studies did not mention whether or not sick cows were treated. Moreover, many treatment trials have suffered from a lack of negative controls. Some studies excluded cows treated for endometritis from reproductive performance analyses (Gautam et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2009\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSome experiments focused more on clinical and bacteriological recovery than economic aspects, such as days to conception and conception rate (LeBlanc, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGenerally, untreated sick animals are used as comparison lots with treated animals in experimental protocols to compare the efficacy of treatments, like the study of LeBlanc et al. (LeBlanc. \u003cem\u003eet al.\u003c/em\u003e, 2002b). The comparison between the results on fertility and the economic impact remains missing in several studies. In the field, however, we have observed that not treating cows with clinical endometritis; is a common practice among a local breeders group. Especially when the general condition of the animals is apparently correct, with no signs of fever and a preserved appetite. The farmers call this situation \"the cow is draining its womb.\"\u003c/p\u003e \u003cp\u003eThe use of antibiotics as a treatment for endometritis is a systematic practice that generates different types of losses. Moreover, a few studies had showed the effect of antibiotics on hormonal activity in cows but comparative studies for fertility results and the economic impact of metritis remain missing. Furthermore, the interaction with other pathologies in the postpartum period leads us to wonder if treatments did not influence endometritis problems and fertility outcomes.\u003c/p\u003e \u003cp\u003eThe present study was conducted in Algerian farm conditions, where monitoring is almost absent or irregular, and veterinarian intervention is performed only when a serious health problem occurs. The question that arises from all the above is: \"What are the effects of clinical endometritis, whether treated or not, on cow fertility or health?\"\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003eWe used an experimental approach to determine the impact of clinical endometritis on fertility.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study region\u003c/h2\u003e \u003cp\u003eThe present experimentation was realized in areas known for their dairy farming in eastern Algeria. It included four governorates: Batna, Setif, Souk Ahras, and Mila.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Animals\u003c/h2\u003e \u003cp\u003e133 cows were included in the study. The animals\u0026rsquo; stables were correct, and their nutrition was similar. It consists of concentrate, green feed, roughage, and silage. We did not use any estrus or ovulation synchronization programs.\u003c/p\u003e \u003cp\u003eThe milk production level of the visited farms was estimated at 6750\u0026thinsp;\u0026plusmn;\u0026thinsp;1277 Kg per cow per lactation cycle.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Data collection\u003c/h2\u003e \u003cp\u003eThe study was carried out for more than a year. In the presence of the farm veterinarians and the breeders, farms were visited every 14 days. While the same investigator performed cow enrollment, clinical examination, and evaluation (Pl\u0026ouml;ntzke et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2010\u003c/span\u003e) These visits began from day 0 (the day of calving) until the moment of the final positive or negative pregnancy diagnosis (day 90 post-artificial insemination (AI)).\u003c/p\u003e \u003cp\u003eFarmers and farm veterinarians closely monitored the cows between the two visits. They clearly registered disease treatment, estrus, and artificial insemination until the next visit.\u003c/p\u003e \u003cp\u003eDuring each visit, we noted findings, asked questions, and registered data for all the diagnosed diseases.\u003c/p\u003e \u003cp\u003eFarms did not apply any vaccination program except for the state-sponsored vaccinations against rabies and foot-and-mouth disease. Furthermore, screenings for bovine brucellosis and tuberculosis were applied. It should be emphasized that no infectious diseases were reported during the present study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Diagnosis\u003c/h2\u003e \u003cp\u003eThe farms' veterinarians, who were monitoring the cows, diagnosed the pathologies between every two visits. And the pathologies to look for were placental retention, vitular fever, acute puerperal metritis, clinical endometritis, digestive problems, mastitis, and lameness. These listed pathologies were diagnosed easily by the farms' veterinarians. Therefore, we did not have difficulties with diagnosis during the study, but we had to diagnose reproductive pathologies by ourselves and confirm the farm veterinarians' diagnosis.\u003c/p\u003e \u003cp\u003eWhereas diagnosed clinical endometritis cases were classified following this definition: The presence of purulent or mucopurulent uterine discharge after 21 DIM; the presence of liquid in the uterus; feverless (Sheldon, Lewis, et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) and a cervical diameter greater than 5 cm; using ultrasound, we found a specific image of the uterine liquid content.\u003c/p\u003e \u003cp\u003eWe installed a correct and controlled method of estrus detection and AI for all the cows in the study, established a fertility assessment from the monitoring sheets and calculated fertility parameters with the \"Excel\" software.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Examination\u003c/h2\u003e \u003cp\u003eDuring each visit, we asked farmers about: the progress of calving diseases, heat, inseminations, sale, culling, reform, and mortalities. Afterward, we proceeded to individual clinical examinations, searching for pathologies. We looked for signs of fresh discharge on the vulva, perineum, tail, or even on the ground.\u003c/p\u003e \u003cp\u003eFollowing this step, we moved to the rectal search for the presence of pneumovagina or urovagina. We had squatted adhesion, and the cervix was grasped with the hand to estimate its size in centimeters (cm). We also caught the inter-hornual bifurcation and palpated each horn to determine its diameter, length, and contents (liquid presence). Then, the ovaries were probed, determining their physiological or pathological stage. We also use ultrasound to confirm the condition of the uterus and ovaries.\u003c/p\u003e \u003cp\u003eAfter that, we performed the vaginoscopy. The ano-vulvar region was washed and dried thoroughly to avoid introducing feces and germs into the vagina. We cleaned and disinfected the speculum with a mild disinfectant before being introduced into the vagina. We inspected the vaginal wall entirely and appreciated its color and moisture. We also examined the uterine cervix to note the nature of discharge, if there was any. Sometimes, we find an urovagina.\u003c/p\u003e \u003cp\u003eWe recorded the conditions identified by the farms' veterinarians. Breeders and inseminators recorded heat and insemination dates by themselves.\u003c/p\u003e \u003cp\u003eAs soon as we performed the first insemination, we stopped the practice of trans-rectal searching and vaginoscopy. But heats and inseminations continued to be recorded, noting that the conception route was AI.\u003c/p\u003e \u003cp\u003eWe performed genital tract ultrasounds to confirm the uterus' condition and to diagnose clinical endometritis at each visit. Between days 35 and 45 post-insemination, we performed an ultrasound check to diagnose a possible pregnancy or even cases of late embryonic mortality.\u003c/p\u003e \u003cp\u003eWe reviewed the cow again to determine the gestational state on days 60 and 90 post-insemination.\u003c/p\u003e \u003cp\u003eThe treatment protocol for clinical endometritis in this study was the same for all cases(Constable et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2009\u003c/span\u003e):\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAntibiotics: Oxytetracycline\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNon-steroidal anti-inflammatory drugs: Flunixin Meglumine\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFor local genital treatment, we used Cephapirin.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eWe have initiated a rigorous monitoring program for cows with untreated clinical endometritis (grp.1 and grp.2).\u003c/p\u003e \u003cp\u003eWe should mention that cows did not have complications during the entire study.\u003c/p\u003e \u003cp\u003eBesides the clinical endometritis, the most noted diseases in this study were: mastitis, lameness, digestive problems, retained placenta, and milk fever (hypocalcemia).\u003c/p\u003e \u003cp\u003eAntibiotics were the most commonly used treatment for these diseases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Data processing\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.6.1 Groups\u0026rsquo; formation\u003c/h2\u003e \u003cp\u003eThe cows suffering from clinical endometritis with or without other simultaneous diseases from the list above, which we treated, form a group apart. A single cow having acute puerperal metritis (with deterioration of the general condition) was recorded.\u003c/p\u003e \u003cp\u003eTherefore, from clinical data, we have formed groups (grps) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e01\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 01\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGroups\u0026rsquo; formation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroups\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTreated Clinical Endometritis\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eNot Treated Clinical Endometritis\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eTreatment For The Diseases\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eEffective\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eYES\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 1: Cows with non-treated clinical endometritis and other treated pathologies\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 2: Cows with non-treated clinical endometritis and without other pathologies\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 3: Cows with treated clinical endometritis and without other pathologies\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 4: Cows with treated clinical endometritis and other treated pathologies\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 5: Cows without clinical endometritis and with other treated pathologies\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u0026bull; Grp. 6: healthy cows without clinical endometritis and without other pathologies\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect of treatments on reproductive parameters\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eGroups\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eNumber of cows\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eDays to first insemination\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eDays to conception interval\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eFirst service to conception interval\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eConception rate\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eSuccess rate in 1st insemination\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.70\u0026thinsp;\u0026plusmn;\u0026thinsp;38.00\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.20\u0026thinsp;\u0026plusmn;\u0026thinsp;41.40\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.45\u0026thinsp;\u0026plusmn;\u0026thinsp;25.31\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e45.45%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.60\u0026thinsp;\u0026plusmn;\u0026thinsp;39.70\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104.3\u0026thinsp;\u0026plusmn;\u0026thinsp;44.80\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.75\u0026thinsp;\u0026plusmn;\u0026thinsp;23.02\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e58.33%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107.50\u0026thinsp;\u0026plusmn;\u0026thinsp;17.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115.8\u0026thinsp;\u0026plusmn;\u0026thinsp;30.50\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.60\u0026thinsp;\u0026plusmn;\u0026thinsp;27.90\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e62.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e37.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.10\u0026thinsp;\u0026plusmn;\u0026thinsp;35.80\u003csup\u003e\u003cem\u003eab\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.7\u0026thinsp;\u0026plusmn;\u0026thinsp;34.00\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.50\u0026thinsp;\u0026plusmn;\u0026thinsp;8.57\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e71.42%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.50\u0026thinsp;\u0026plusmn;\u0026thinsp;23.50\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102.4\u0026thinsp;\u0026plusmn;\u0026thinsp;31.04\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.90\u0026thinsp;\u0026plusmn;\u0026thinsp;20.71\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrp.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76.80\u0026thinsp;\u0026plusmn;\u0026thinsp;26.60\u003csup\u003e\u003cem\u003eb\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91.1\u0026thinsp;\u0026plusmn;\u0026thinsp;38.00\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.70\u0026thinsp;\u0026plusmn;\u0026thinsp;34.55\u003csup\u003e\u003cem\u003ea\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66.25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e47.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e95% confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \n\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e2.6.2 Calculated fertility parameters\u003c/h2\u003e\n \u003cp\u003eOnce the cyclicity recovered, inseminators inseminated the cows and recorded dates. Later, we proceeded with the pregnancy diagnosis. The calculation of the fertility parameters according to the international formula (Rethmeier et al., \u003cspan class=\"CitationRef\"\u003e2019\u003c/span\u003e) ; (Rutten et al., \u003cspan class=\"CitationRef\"\u003e2016\u003c/span\u003e) and (Touchberry et al., \u003cspan class=\"CitationRef\"\u003e1959\u003c/span\u003e) was as follows:\u003c/p\u003e\n \u003cdiv id=\"Equ1\" class=\"Equation\"\u003e\n \u003cdiv class=\"mathdisplay\" id=\"FileID_Equ1\" name=\"EquationSource\"\u003e$$\\text{C}\\text{o}\\text{n}\\text{c}\\text{e}\\text{p}\\text{t}\\text{i}\\text{o}\\text{n} \\text{r}\\text{a}\\text{t}\\text{e} \\left(\\text{%}\\right)=\\frac{\\text{P}\\text{r}\\text{e}\\text{g}\\text{n}\\text{a}\\text{n}\\text{t} \\text{c}\\text{o}\\text{w}\\text{s} \\text{n}^\\circ }{\\text{I}\\text{n}\\text{s}\\text{e}\\text{m}\\text{i}\\text{n}\\text{a}\\text{t}\\text{e}\\text{d} \\text{c}\\text{o}\\text{w}\\text{s} \\text{n}^\\circ \\text{i}\\text{n} \\text{a} \\text{d}\\text{e}\\text{f}\\text{i}\\text{n}\\text{e}\\text{d} \\text{t}\\text{i}\\text{m}\\text{e} \\text{p}\\text{e}\\text{r}\\text{i}\\text{o}\\text{d}} \\times 100$$\u003c/div\u003e\u003cdiv class=\"EquationNumber\"\u003e01\u003c/div\u003e\u003c/div\u003e\u003cp\u003e\u0026bull; \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{S}\\text{u}\\text{c}\\text{c}\\text{e}\\text{s}\\text{s} \\text{r}\\text{a}\\text{t}\\text{e} \\text{i}\\text{n} 1\\text{s}\\text{t} \\text{i}\\text{n}\\text{s}\\text{e}\\text{m}\\text{i}\\text{n}\\text{a}\\text{t}\\text{i}\\text{o}\\text{n}\\left(\\text{%}\\right)=\\frac{\\text{P}\\text{r}\\text{e}\\text{g}\\text{n}\\text{a}\\text{n}\\text{t} \\text{c}\\text{o}\\text{w}\\text{s} \\text{a}\\text{f}\\text{t}\\text{e}\\text{r} \\text{F}\\text{i}\\text{r}\\text{s}\\text{t} \\text{i}\\text{n}\\text{s}\\text{e}\\text{m}\\text{i}\\text{n}\\text{a}\\text{t}\\text{i}\\text{o}\\text{n}}{\\text{I}\\text{n}\\text{s}\\text{e}\\text{m}\\text{i}\\text{n}\\text{a}\\text{t}\\text{e}\\text{d} \\text{c}\\text{o}\\text{w}\\text{s} \\text{i}\\text{n} \\text{a} \\text{d}\\text{e}\\text{f}\\text{i}\\text{n}\\text{e}\\text{d} \\text{t}\\text{i}\\text{m}\\text{e} \\text{p}\\text{e}\\text{r}\\text{i}\\text{o}\\text{d}}\\times 100\\)\u003c/span\u003e\u003c/span\u003e (02) Days to first insemination\u0026thinsp;=\u0026thinsp;number of days from calving to first insemination\u003c/p\u003e\n \u003cp\u003e\u0026bull; Days to conception or Days open\u0026thinsp;=\u0026thinsp;number of days from calving to day of conception\u003c/p\u003e\n \u003cp\u003e\u0026bull; First services to conception interval\u0026thinsp;=\u0026thinsp;number of days from the first service to pregnancy\u003c/p\u003e\n \u003cp\u003eAll cows returned to their cyclicity (reproductive activity). Cows inseminated and not diagnosed for pregnancy were removed from the study. Therefore, we considered only those with positive or negative pregnancy results. We also excluded from the study all cows with missing information. Applying inclusion criteria, we eliminated from the study one batch of animals consisting of 44 cows with poor nutrition due to a poor management. Finally, only 133 cows were kept from the 557 initially introduced in the study.\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\n \u003ch2\u003e2.6.3 Statistical analysis\u003c/h2\u003e\n \u003cp\u003eThe results were expressed as a mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u0026micro;\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) for day intervals and as a percentage (%) for conception and success rates. We performed comparisons between the studied groups by using the one-way analysis of variance (ANOVA) followed by a Fisher (LSD) multiple comparisons (post-hoc) test. For count data, we used the Chi-square test.\u003c/p\u003e\n \u003cp\u003eA \u003cem\u003ep-value\u003c/em\u003e equal to or less than 0.05 was considered significant.\u003c/p\u003e\n \u003cp\u003eThe k-means clustering algorithm (MacQueen, \u003cspan class=\"CitationRef\"\u003e1967\u003c/span\u003e) follows an easy way to classify a given object through a certain number of fixed clusters (k). The k-means clustering results were obtained in the present study to control the data division. We analyzed the 133 cows\u0026apos; data set by assigning different values (1\u0026ndash;6) to the variable k.\u003c/p\u003e\n \u003cp\u003eWe performed the statistical analyses with R Software, version 3.4.2 (R Core Team, 2020).\u003c/p\u003e\n \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eAs a fact, there was no voluntary waiting period in our study. Our survey focused on clinical endometritis. Hence, we have calculated its prevalence. And its value was 28.57%, where 17.29% represented non-treated ones. Indeed, it corresponded to 60.52% of the total number of clinical endometritis cases. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e02\u003c/span\u003e represents the results of reproductive performance.\u003c/p\u003e \u003cp\u003eWe did not detect significant differences among groups for these parameters (days to conception interval, days from the first service to conception, and success rate at first insemination). However, we have noticed a significant difference between groups regarding (days to first insemination and conception rate).\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Days to first insemination\u003c/h2\u003e \u003cp\u003eConcerning the studied groups, the minimum mean recorded for (days to the first insemination) was 72.47 days for (grp.5) with a range (of 44 to 126 days). However, (grp.3) had the longest days to the first insemination interval (107.5 days) with a range of (82 to 130 days). (Grp.1 and grp.2) had respectively recorded mean values of (75.7 and 89.6 days).\u003c/p\u003e \u003cp\u003eFor groups 4 and 6, this parameter was (87.1 and 76.8 days) respectively, with a \u003cem\u003ep\u003c/em\u003e-value of 0.05. For Fisher (LSD) test post hoc analyses, the p-values between groups (3and 5, p-value\u0026thinsp;=\u0026thinsp;0,006), (3 and 1 p-value\u0026thinsp;=\u0026thinsp;0,019) (3and 6 p-value\u0026thinsp;=\u0026thinsp;0,005) were statistically highly significant. The Dunnett two-sided test confirmed the difference between (grp.3) and the control group (grp.6) with a p-value of 0,024.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Days to conception interval\u003c/h2\u003e \u003cp\u003eThis interval was slightly longer for (grp.3), with a mean of 115.8 days and a range of (82 to 157 days). But it was not very far from the other groups: grp.1 (97.2 days), grp.5 (102.4 days), and grp.6 (91.13 days). The minimal mean recorded was 87.7 days in grp.4, with a range of (34 to 122 days). Therefore, there was no significant difference among all these groups (\u003cem\u003ep-value\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.654).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.3 First service to conception interval\u003c/h2\u003e \u003cp\u003eFor the interval between the first service and conception, we have recorded the maximum mean of 21.45 days (grp.1) with a range of (0 to 71 days), as well the minimum mean of 3.50 days (grp.4) with a range of (0 to 21 days). For this element, we recorded a trend reversal in favor of groups 3 and 4. This situation is due to the limitations of this parameter, which hides other pieces of information, such as the negative pregnancy diagnosis. Indeed, we did not observe a significant difference among groups (\u003cem\u003ep-value\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.843).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Conception rate\u003c/h2\u003e \u003cp\u003eFor the conception rate, we recorded a significant difference among groups (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.03) in favor of the cows with non-treated clinical endometritis (grps.1 and 2), which had a pregnancy rate of 100%. The other groups could be classified into two tendencies; where group 4 is the first one (85.71%), and groups (3, 5, and 6) are the second one (62.5%, 60%, and 66.25%), respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Success rate in first insemination\u003c/h2\u003e \u003cp\u003eThe success rate after the first insemination varied between 13% (grp.5) and 71.42% (grp.4). No significant difference had been recorded among all the groups (\u003cem\u003ep-value\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.098).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Results confirmation using K-means clustering\u003c/h2\u003e \u003cp\u003eFigure\u0026nbsp;1 shows the obtained K-means results. As depicted, our data can be included in one or two clusters with high performance clustering results. These findings highlight the consistency of the clinical data, which supports the ANOVA results.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eIn the present research, all the cows enrolled in the study had finally regained their cyclicity. We compared cows having clinical endometritis with healthy cows.\u003c/p\u003e \u003cp\u003eWe noted significantly greater intervals between calving to the first AI, for treated clinical endometritis cows than the other groups, contrary to the expectations.\u003c/p\u003e \u003cp\u003eThe study of intervals (days to first AI) revealed that non-treating cows with clinical endometritis did not influence the recovery of ovarian activity, as in healthy cows. On the contrary, treated cows had longer intervals between calving and first insemination, which suggests that the use of antibiotics is the explanation for this prolongation. After cyclicity recovery, all cow categories had the same histological profile (with no endometrial damage) (Chapwanya. \u003cem\u003eet al.\u003c/em\u003e, 2010). This can explain the indifference in our statistical results for both parameters (the first service to conception interval and days to conception). This situation may also, be explained by a correct PGF/PGE ratio, which simultaneously reinforces the elimination of uterine contents with an uterotonic effect and re-launches the sexual cycle. The suggestion is that non-treated clinical endometritis may not influence this ratio. Le Blanc et al.(2002) found that moderately purulent uterine discharge up to day 33 postpartum was not linked to a lower pregnancy rate, which is similar to our results (LeBlanc. \u003cem\u003eet al.\u003c/em\u003e, 2002a). However, an increase in purulent discharge has the most significantly negative effect on pregnancy.\u003c/p\u003e \u003cp\u003eUterine diseases causing lesions on the uterus and ovaries induce a reduction in fertility (Bonnett et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e1993\u003c/span\u003e). Uterine inflammation causes endometrial dysfunction (Sheldon and Dobson, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2004\u003c/span\u003e), and blocks embryonic development (Soto et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2003\u003c/span\u003e). Several authors have linked uterine diseases to lower conception rates, longer intervals to conception, higher culling, and economic losses ((Hill. and Gilbert., 2008); (Bartlett et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e1986\u003c/span\u003e); (Sheldon and Dobson, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2004\u003c/span\u003e); (Gilbert et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2005\u003c/span\u003e); (Galv\u0026atilde;o et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2009\u003c/span\u003e) ; (Overton. and Fetrow., 2008) and (Galv\u0026atilde;o, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Other authors found that; uterine diseases can negatively affect the time to insemination and conception rates ((Galv\u0026atilde;o, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2013\u003c/span\u003e); (I Martin Sheldon et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and (Williams et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2008\u003c/span\u003e)). This can be done by decreasing the luteinizing hormone, size and growth of the first dominant follicle, as well as the ability to secrete follicular œstradiol, affecting the ovulation capacity. After ovulation resumes, cows with uterine disease present a prolongation of the luteal phase (Opsomer et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). The previously mentioned issues were investigated without specifying the real cases involved (puerperal metritis, clinical endometritis, or subclinical ones).\u003c/p\u003e \u003cp\u003eOther works, like (Bell and Roberts, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) studied the effects of uterine diseases on fertility, focusing on puerperal metritis. In our study, we focused specifically on clinical endometritis, and we did not find any effect on fertility interval parameters for non-treated clinical endometritis, which differs from all the previously stated findings. In fact, treated cows had longer days to the first AI intervals, and there was a better conception rate for non-treated clinical endometritis cases. In this work, we did not find a clear difference in the days to conception intervals between cows with treated and non-treated clinical endometritis, whether detected early or not. Our approach was to do a systematic follow-up without considering the herd's history. Unlike (Fourichon et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2000\u003c/span\u003e), we found that clinical endometritis may not affect fertility by increasing the calving to conception interval. Indeed, the previous study showed either slighter effects of early metritis on: days to first estrous, days to the first service, and conception at the first service; and a comparable or higher effect of late metritis on: days to conception, and services per conception).\u003c/p\u003e \u003cp\u003eReproduction management has a significant influence on dairy farm profitability. Cows with poor reproductive performance are more likely to be examined for metritis than their herdmates. Herds under a fertility program are systematically examined to promote optimal reproductive performance, and thus metritis are detected and treated early, as confirmed by its lower effects in studies reporting routine examination of cows (Inchaisri et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2010\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present work, where we used moderately productive cows, we noticed that the influence of pathologies on some reproductive parameters (days to 1st insemination, days to conception, and days between first services and conception) was not obvious, reinforcing Wathes\u0026rsquo; suggestion that the most important factors affecting fertility are the metabolic more than the pathological ones (Wathes et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRethmeier et al. (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) had not found a significant difference in the days to first insemination and the days open, according to the milk yield nor in the conception and pregnancy rates, with a noticeable tendency that the higher the milk yield is, the higher the pregnancy rate is noted (Rethmeier et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Nonetheless, the average production level of their study differs from ours, which does not exceed 22 kg/day. The metabolic balance of our cows, with an average of reduced production, allowed a resumption of quickly recovered energy balance, with better and more correct bodily functions like sexual and hormonal activities, earlier than that of higher-yielding cows (Sheldon, Wathes, \u003cem\u003eet al.\u003c/em\u003e, 2006).\u003c/p\u003e \u003cp\u003eBreeds used in this research were supposed to be highly productive, with a yield of 9291 kg/lactation in Germany or 11472 kg/lactation for the USA breed (Foksha and Konstandoglo, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). However, their average level was 6750\u0026thinsp;\u0026plusmn;\u0026thinsp;1277 Kg, probably due to the nutritional ration, individual variability, or herd management. This situation can be more or less contradicted by the availability and quality of food distributed to animals, either by the effect of the environment and the hotter climate comparing to the dairy breeds original countries; namely the European regions, which are visibly colder than our studied area. The last suggestion can be contradicted by the fact that dairy farms exist in the Arabian peninsula countries lime countries and have production levels similar to European farms, with the least square means of 9870 to 10146 liters for Saudi farms (Ali et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2000\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFourichon et al.(2000) compared the effects of clinical and puerperal metritis and concluded that puerperal metritis has a much greater negative impact on reproduction outcomes than clinical metritis (Fourichon et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2000\u003c/span\u003e). Concordant to our results, Giuliodori et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e) stated that puerperal metritis harmed pregnancy rates and increased calving to conception intervals, but not clinical metritis, which had the same results as healthy cows (Giuliodori et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Likewise, for the calving to conception interval, cows with puerperal metritis had longer intervals than cows with clinical metritis or being healthy, without specifying if cows were treated or not. This effect could have a variety of actions on fertility, including increasing days to first heat (prolonged anoestrus and luteal phases) ((Mateus et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) and (I. M. Sheldon et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2002\u003c/span\u003e)), and causing a net disturbance in the uterine environment ((Bondurant, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e1999\u003c/span\u003e); (Sheldon and Dobson, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2004\u003c/span\u003e) and (Giuliodori et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2013\u003c/span\u003e)). Unfortunately, the effective treatment options for endometritis remain limited, but the disease can persist even after treatment and recovery (Nyabinwa et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Escand\u0026oacute;n et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e)used a negative control group but only for subclinical endometritis (Escand\u0026oacute;n et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe use of antibiotics could indeed disrupt the balance of the uterine flora, promoting the development of resistant germs (Appiah et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). In general, there is an agreement on using systemic antibiotics in cases of puerperal metritis (accompanied by fever). However, the treatment of clinical endometritis (without fever) using local antibiotics, prostaglandins, and non-steroidal anti-inflammatory drugs is still controversial to some extent (Bartolome et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). This was reinforced by our study. Kasimanickam et al. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) had a different strategy for treatment and different results; they chose to treat cows at 20\u0026ndash;33 DIM to allow sufficient time for uterine repair in order to increase the chance of conception (Kasimanickam et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). Although the untreated control cows also had an equal chance of receiving cloprostenol treatment, Cows with clinical endometritis (treated once with intrauterine cephapirin 31 days before the planned spring mating) had better reproductive performance than the untreated controls. Our results showed a different impact on fertility because we probably didn\u0026rsquo;t use cloprostenol after clinical healing.\u003c/p\u003e \u003cp\u003eThe use of medication during the postpartum period to treat another disease (digestive, metabolic, respiratory, locomotor, or other problems) did not affect reproductive performance. However, treating clinical endometritis may negatively influence the days to insemination intervals.\u003c/p\u003e \u003cp\u003eDespite these noted differences, all the groups did not come out of the recommended and observed standard target values ​​in dairy farms which are: conception rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;50, service rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;80, pregnancy rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;35, days to 1st insemination\u0026thinsp;\u0026lt;\u0026thinsp;85, days open\u0026thinsp;\u0026lt;\u0026thinsp;115 days (De Kruif et al., 2014) cited and proposed by (Rethmeier et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e); conception rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;35, service rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;60, pregnancy rate (%)\u0026thinsp;\u0026gt;\u0026thinsp;24. except for days to the first insemination, where groups (2, 3, and 4) recorded an extension of (89, 107, and 87 days) sequentially, and days to the conception interval, where (grp.3) recorded a slight extension of 115 days. We also noticed that the treated groups performed the worst.\u003c/p\u003e \u003cp\u003eThere is a significant lack of scientific information on the observed phenomenon (not treating clinical endometritis has a better outcome than treating it), as well as the capacity of practitioner veterinarians in the field to estimate the correct status of the uterus. But the experience in this reflection is grounded in the same context. It is about placental retention, where manual removal and antibiotic treatment have been practiced by veterinarians for a long time. Surprisingly; in recent years, comparisons of different treatment approaches have led to conclude that not intervening was better for the cow's health and reproductive future (Beagley. \u003cem\u003eet al.\u003c/em\u003e, 2010).\u003c/p\u003e \u003cp\u003eThe benefits of this approach for clinical endometritis would be indisputable: reduction of treatment strokes; better management of breeding; avoiding the use of antibiotics, which presents multiple risks (elimination of a considerable amount of milk (the waiting period); new antimicrobial resistance; teratogenic effects of treatment; and developing a complete immunity in individuals). This approach, therefore, requires rigorous monitoring to avoid complications (which were not observed in this study), generating additional costs to measure and compare with the benefits gained from this practice.\u003c/p\u003e \u003cp\u003eOur results clearly showed that the treatment of clinical endometritis had no influence on the reproductive outcome of cows; on the contrary, the untreated ones had slightly better fertility results.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eOur results showed significant differences between auto-recovered cows from clinical endometritis and other groups of cows for some reproductive parameters. Unlike the expected; auto-recovered cows from clinical endometritis had better fertility results compared to the treated ones.\u003c/p\u003e \u003cp\u003eFrom these findings, new questions arise: about postpartum cow immunity in general and uterine immunity in particular; about the characterization of clinical endometritis when it occurs; about its definition as a specific case that requires special monitoring and surveillance without using antibiotics; or about the decision whether or not to treat it. The findings of our study may open the way for further research in this area.\u003c/p\u003e \u003cp\u003eFertility is a determinant of the cow's lifetime performance, and the decision to leave the treatment of a disease like clinical endometritis is hard to make, whether from moral, ethical, medical, or economic viewpoints. Both the veterinarian and the breeder must agree to such a decision.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCredit authorship contribution statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMustapha Adnane. Smadi:\u003c/strong\u003e Project design, methodology, project management investigation, clinical examination, analysis and interpretation of data, writing \u0026ndash; original draft, review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBakir. Mamache:\u003c/strong\u003e project management, Project design, Data curation, Writing \u0026ndash; review \u0026amp; editing, paper revision, final approval.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHouria. Ouennes:\u003c/strong\u003e Data curation, Investigation, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeriel. Sellam\u003c/strong\u003e: paper revision, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRahla. Meziane:\u003c/strong\u003e investigation, Writing \u0026ndash; review.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMohammed. El Hadef ElOkki:\u003c/strong\u003e Data curation, statistical analysis, writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFarid. Boughris:\u003c/strong\u003e investigation, clinical examination, Artificial insemination, farmer recruitment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMostefa. Benhadid:\u003c/strong\u003e investigation, clinical examination, Artificial insemination, farmer recruitment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors declare no conflict of interest in this paper. And they have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding and Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to farmers for their availability and collaboration.\u003c/p\u003e\n\u003cp\u003eWe appreciate the veterinary practitioners\u0026rsquo; help for the success of this work especially; Mostefa Behadid and Farid Boughris\u003c/p\u003e\n\u003cp\u003eOur thanks to: Professor Halima Benbouza; former Director of C.R.Bt for facilitating this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur thanks to: Dr. Khalid Bouhedjar and Dr. Abdelbasset Boukelia for their appreciated data analysis help.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical authorization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom locale Ethical Comity of C.R.Bt (CCE): authorization reference number (03/C.R.Bt/2021).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAli A.K.A., Al-Haidary A., Alshaikh M.A., Gamil M.H. \u0026amp; Hayes E. 2000. Effect of Days Open on the Lactation Curve of Holstein Cattle in Saudi Arabia.\u003c/li\u003e\n\u003cli\u003eAppiah M.O., Wang J. \u0026amp; Lu W. 2020. Microflora in the reproductive tract of cattle: A review. \u003cem\u003eAgric\u003c/em\u003e, \u003cstrong\u003e10\u003c/strong\u003e, 1\u0026ndash;27.\u003c/li\u003e\n\u003cli\u003eBartlett P.C., Kirk J.H. \u0026amp; Mather E.C. 1986. Repeated insemination in Michigan Holstein-Friesian cattle: Incidence, descriptive epidemiology and estimated economic impact. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e26\u003c/strong\u003e, 309\u0026ndash;322.\u003c/li\u003e\n\u003cli\u003eBartolome J.A., Khalloub P., Luzbel R., Sota D. \u0026amp; Drillich M. 2014. Strategies for the treatment of dairy cows at high risk for postpartum metritis and for the treatment of clinical endometritis in Argentina. \u003cem\u003eTrop Anim Heal Prod\u003c/em\u003e, \u003cstrong\u003e46\u003c/strong\u003e, 79\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eBeagley. J.C., Whitman. K.J., Baptiste. K.E. \u0026amp; Scherzer. J. 2010. Physiology and Treatment of Retained Fetal Membranes in Cattle. \u003cem\u003eVet Intern Medicne\u003c/em\u003e, 261\u0026ndash;268.\u003c/li\u003e\n\u003cli\u003eBell M.J. \u0026amp; Roberts D.J. 2007. The impact of uterine infection on a dairy cow \u0026rsquo; s performance. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e68\u003c/strong\u003e, 1074\u0026ndash;1079.\u003c/li\u003e\n\u003cli\u003eBondurant R.H. 1999. Inflammation in the bovine female reproductive tract. \u003cem\u003eJ Anim Sci\u003c/em\u003e, \u003cstrong\u003e77 Suppl 2\u003c/strong\u003e, 101\u0026ndash;110.\u003c/li\u003e\n\u003cli\u003eBonnett B.N., Wayne Martin S. \u0026amp; Meek A.H. 1993. Associations of clinical findings, bacteriological and histological results of endometrial biopsy with reproductive performance of postpartum dairy cows. \u003cem\u003ePrev Vet Med\u003c/em\u003e, \u003cstrong\u003e15\u003c/strong\u003e, 205\u0026ndash;220.\u003c/li\u003e\n\u003cli\u003eChapwanya. A., Meade. K.G., Narciandi. F., Stanley. P., Mee. J.F., Doherty. M.L., et al. 2010. Endometrial biopsy: a valuable clinical and research tool in bovine reproduction. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e73\u003c/strong\u003e, 988\u0026ndash;994.\u003c/li\u003e\n\u003cli\u003eColeman D.A., Thayne W. V. \u0026amp; Dailey R.A. 1985. Factors Affecting Reproductive Performance of Dairy Cows. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e68\u003c/strong\u003e, 1793\u0026ndash;1803.\u003c/li\u003e\n\u003cli\u003eConstable P.D., Py\u0026ouml;r\u0026auml;l\u0026auml; S. \u0026amp; Smith G.W. 2009. Guidelines for Antimicrobial Use in Cattle. \u003cem\u003eIn\u003c/em\u003e Guide to Antimicrobial Use in Animals (L. B. J. and H. K. Luca Guardabassi, ed). 2008 Blackwell Publishing Ltd, 143\u0026ndash;160.\u003c/li\u003e\n\u003cli\u003eEscand\u0026oacute;n B.M., Espinoza J.S., Perea F.P., Quito F., Ochoa R., L\u0026oacute;pez G.E., et al. 2020. Intrauterine therapy with ozone reduces subclinical endometritis and improves reproductive performance in postpartum dairy cows managed in pasture-based systems. \u003cem\u003eTrop Anim Health Prod\u003c/em\u003e, \u003cstrong\u003e52\u003c/strong\u003e, 2523\u0026ndash;2528.\u003c/li\u003e\n\u003cli\u003eFoksha V. \u0026amp; Konstandoglo A. 2019. Dairy productivity of holstein cows and realization of their genetic potential. \u003cem\u003eBulg J Agric Sci\u003c/em\u003e, \u003cstrong\u003e25\u003c/strong\u003e, 31\u0026ndash;36.\u003c/li\u003e\n\u003cli\u003eFourichon C., Seegers H. \u0026amp; Malher X. 2000. Effect of disease on reproduction in the dairy cow: A meta-analysis. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e53\u003c/strong\u003e, 1729\u0026ndash;1759.\u003c/li\u003e\n\u003cli\u003eGalv\u0026atilde;o K.N. 2013. Uterine diseases in dairy cows : understanding the causes and seeking solutions. \u003cem\u003eIn\u003c/em\u003e Animal Reproduction, 228\u0026ndash;238.\u003c/li\u003e\n\u003cli\u003eGalv\u0026atilde;o K.N., Frajblat M., Brittin S.B., Butler W.R., Guard C.L. \u0026amp; Gilbert R.O. 2009. Effect of prostaglandin F2\u0026alpha; on subclinical endometritis and fertility in dairy cows. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e92\u003c/strong\u003e, 4906\u0026ndash;4913.\u003c/li\u003e\n\u003cli\u003eGautam G., Nakao T., Yusuf M. \u0026amp; Koike K. 2009. Prevalence of endometritis during the postpartum period and its impact on subsequent reproductive performance in two Japanese dairy herds. \u003cem\u003eAnim Reprod Sci\u003c/em\u003e, \u003cstrong\u003e116\u003c/strong\u003e, 175\u0026ndash;187.\u003c/li\u003e\n\u003cli\u003eGilbert R.O., Shin S.T., Guard C.L., Erb H.N. \u0026amp; Frajblat M. 2005. Prevalence of endometritis and its effects on reproductive performance of dairy cows. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e64\u003c/strong\u003e, 1879\u0026ndash;1888.\u003c/li\u003e\n\u003cli\u003eGiuliodori M.J., Magnasco R.P., Becu-Villalobos D., Lacau-Mengido I.M., Risco C. a \u0026amp; de la Sota R.L. 2013. Metritis in dairy cows: risk factors and reproductive performance. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e96\u003c/strong\u003e, 3621\u0026ndash;31.\u003c/li\u003e\n\u003cli\u003eHill. J. \u0026amp; Gilbert. R. 2008. Reduced quality of bovine embryos cultured in media conditioned by exposure to an inflamed endometrium. \u003cem\u003eAust Vet J\u003c/em\u003e, \u003cstrong\u003e86\u003c/strong\u003e, 312\u0026ndash;316.\u003c/li\u003e\n\u003cli\u003eInchaisri C., Jorritsma R., Vos P.L.A.M., van der Weijden G.C. \u0026amp; Hogeveen H. 2010. Economic consequences of reproductive performance in dairy cattle. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e74\u003c/strong\u003e, 835\u0026ndash;846.\u003c/li\u003e\n\u003cli\u003eKasimanickam R., Duffield T.F., Foster R. a., Gartley C.J., Leslie K.E., Walton J.S., et al. 2005. The effect of a single administration of cephapirin or cloprostenol on the reproductive performance of dairy cows with subclinical endometritis. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e63\u003c/strong\u003e, 818\u0026ndash;830.\u003c/li\u003e\n\u003cli\u003eLeBlanc. S.J., Duffield. T.F., Leslie. K.E., Bateman. K.G., Keefe. G.P., Walton. J.S., et al. 2002a. Defining and diagnosing postpartum clinical endometritis and its impact on reproductive performance in dairy cows. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e85\u003c/strong\u003e, 2223\u0026ndash;2236.\u003c/li\u003e\n\u003cli\u003eLeBlanc. S.J., Duffield. T.F., Leslie. K.E., Bateman. K.G., Keefe. G.P., Walton. J.S., et al. 2002b. The effect of treatment of clinical endometritis on reproductive performance in dairy cows. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e85\u003c/strong\u003e, 2237\u0026ndash;49.\u003c/li\u003e\n\u003cli\u003eLeBlanc S.J. 2008. Postpartum uterine disease and dairy herd reproductive performance: A review. \u003cem\u003eVet J\u003c/em\u003e, \u003cstrong\u003e176\u003c/strong\u003e, 102\u0026ndash;114.\u003c/li\u003e\n\u003cli\u003eMacQueen J.B. 1967. Some Methods for Classification and Analysis of Multivariate Observations. (http://projecteuclid.org/euclid.bsmsp/1200512992 accessed on).\u003c/li\u003e\n\u003cli\u003eMateus L., Lopes Da Costa L., Bernardo F. \u0026amp; Robalo Silva J. 2002. Influence of puerperal uterine infection on uterine involution and postpartum ovarian activity in dairy cows. \u003cem\u003eReprod Domest Anim\u003c/em\u003e, \u003cstrong\u003e37\u003c/strong\u003e, 31\u0026ndash;35.\u003c/li\u003e\n\u003cli\u003eNyabinwa P., Kashongwe O.B., Hirwa A. \u0026amp; Bebe B.O. 2020. Perception of farmers about endometritis prevention and control measures for zero- grazed dairy cows on smallholder farms in Rwanda. \u003cem\u003eBMC Vet Res\u003c/em\u003e, \u003cstrong\u003e16\u003c/strong\u003e, 1\u0026ndash;11.\u003c/li\u003e\n\u003cli\u003eOpsomer G., Gr\u0026ouml;hn Y.T., Hertl J., Coryn M., Deluyker H. \u0026amp; De Kruif A. 2000. Risk factors for post partum ovarian dysfunction in high producing dairy cows in Belgium: A field study. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e53\u003c/strong\u003e, 841\u0026ndash;857.\u003c/li\u003e\n\u003cli\u003eOverton. M. \u0026amp; Fetrow. J. 2008. Economics of Postpartum Uterine Health. \u003cem\u003eIn\u003c/em\u003e Dairy Cattle- Reproduction council convention, 39\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003ePl\u0026ouml;ntzke J., Madoz L. V, Sota R.L. De, Drillich M. \u0026amp; Heuwieser W. 2010. Subclinical endometritis and its impact on reproductive performance in grazing dairy cattle in Argentina. \u003cem\u003eAnim Reprod Sci J\u003c/em\u003e, \u003cstrong\u003e122\u003c/strong\u003e, 52\u0026ndash;57.\u003c/li\u003e\n\u003cli\u003eRethmeier J., Wenzlau M., Wagner M., Wiedemann S. \u0026amp; Bachmann L. 2019. Fertility parameters in German dairy herds: Associations with milk yield and herd size. \u003cem\u003eCzech J Anim Sci\u003c/em\u003e, \u003cstrong\u003e64\u003c/strong\u003e, 459\u0026ndash;464.\u003c/li\u003e\n\u003cli\u003eRutten C.J., Steeneveld W., Vernooij J.C.M., Huijps K., Nielen M. \u0026amp; Hogeveen H. 2016. A prognostic model to predict the success of artificial insemination in dairy cows based on readily available data. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e99\u003c/strong\u003e, 6764\u0026ndash;6779.\u003c/li\u003e\n\u003cli\u003eSheldon I.M. \u0026amp; Dobson H. 2004. Postpartum uterine health in cattle. \u003cem\u003eAnim Reprod Sci\u003c/em\u003e, \u003cstrong\u003e82\u003c/strong\u003e\u0026ndash;\u003cstrong\u003e83\u003c/strong\u003e, 295\u0026ndash;306.\u003c/li\u003e\n\u003cli\u003eSheldon I.M., Lewis G.S., Leblanc S. \u0026amp; Gilbert R.O. 2006. Defining postpartum uterine disease in cattle. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e65\u003c/strong\u003e, 1516\u0026ndash;1530.\u003c/li\u003e\n\u003cli\u003eSheldon I Martin, Noakes D.E. \u0026amp; Dobson H. 2002. Effect of the regressing corpus luteum of pregnancy on ovarian folliculogenesis after parturition in cattle. \u003cem\u003eBiol Reprod\u003c/em\u003e, \u003cstrong\u003e66\u003c/strong\u003e, 266\u0026ndash;271.\u003c/li\u003e\n\u003cli\u003eSheldon I. M., Noakes D.E., Rycroft A.N., Pfeiffer D.U. \u0026amp; Dobson H. 2002. Influence of uterine bacterial contamination after parturition on ovarian dominant follicle selection and follicle growth and function in cattle. \u003cem\u003eReproduction\u003c/em\u003e, \u003cstrong\u003e123\u003c/strong\u003e, 837\u0026ndash;845.\u003c/li\u003e\n\u003cli\u003eSheldon I.M., Wathes D.C. \u0026amp; Dobson H. 2006. The management of bovine reproduction in elite herds. \u003cem\u003eVet J\u003c/em\u003e, \u003cstrong\u003e171\u003c/strong\u003e, 70\u0026ndash;78.\u003c/li\u003e\n\u003cli\u003eSoto P., Natzke R.P. \u0026amp; Hansen P.J. 2003. Identification of possible mediators of embryonic mortality caused by mastitis: Actions of lipopolysaccharide, prostaglandin F2\u0026alpha;, and the nitric oxide generator, sodium nitroprusside dihydrate, on oocyte maturation and embryonic development in cattle. \u003cem\u003eAm J Reprod Immunol\u003c/em\u003e, \u003cstrong\u003e50\u003c/strong\u003e, 263\u0026ndash;272.\u003c/li\u003e\n\u003cli\u003eTouchberry R.W., Rottensten K. \u0026amp; Andersen H. 1959. Associations Between Service Interval, Interval from First Service to Conception, Number of Services per Conception, and Level of Butterfat Production. \u003cem\u003eJ Dairy Sci\u003c/em\u003e, \u003cstrong\u003e42\u003c/strong\u003e, 1157\u0026ndash;1170.\u003c/li\u003e\n\u003cli\u003eWathes D.C., Fenwick M., Cheng Z., Bourne N., Llewellyn S., Morris D.G., et al. 2007. Influence of negative energy balance on cyclicity and fertility in the high producing dairy cow. \u003cem\u003eTheriogenology\u003c/em\u003e, \u003cstrong\u003e68\u003c/strong\u003e, 232\u0026ndash;241.\u003c/li\u003e\n\u003cli\u003eWilliams E.J., Herath S., England G.C.W., Dobson H., Bryant C.E. \u0026amp; Sheldon I.M. 2008. Effect of Escherichia coli infection of the bovine uterus from the whole animal to the cell. \u003cem\u003eAnimal\u003c/em\u003e, \u003cstrong\u003e2\u003c/strong\u003e, 1153\u0026ndash;1157.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dairy cows, treated clinical endometritis, auto-recovered clinical endometritis, fertility parameters","lastPublishedDoi":"10.21203/rs.3.rs-4408948/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4408948/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn this study, we evaluated the effect of treated and auto-recovered clinical endometritis on fertility as a uterine disease class. We collected data on breeding, diseases, and cyclicity. Regarding the co-affections, cows with auto-recovered clinical endometritis were affected in groups 1 and 2. Cows with treated clinical endometritis represented groups 3 and 4, and cows without clinical endometritis represented Groups 5 and 6. Once the cyclicity recovered, cows were inseminated. Studied fertility parameters were; 1: conception rate; 2: days to first insemination; 3: success rate in the first insemination; 4: days to conception; and 5: days between first insemination and pregnancy. We performed ANOVA-analysis, Chi-square test, and Machine Learning K-means. A significant difference was noted for days to first insemination (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.05), reinforced by a Fisher-LSD post-hoc analysis test that demonstrated significant differences between groups (3 and 5), \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0,006, groups (3 and 1), \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0,019, and groups (3 and 6), \u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0,005. However, the conception rate was significantly higher in the groups with non-treated clinical endometritis (\u003cem\u003ep\u003c/em\u003e-value\u0026thinsp;=\u0026thinsp;0.030). Concerning the other parameters, we did not notice significant differences among groups. Our results showed that auto-recovered cows from clinical endometritis had better fertility outcomes.\u003c/p\u003e","manuscriptTitle":"Comparative study of treated and non-treated (auto-recovered) clinical endometritis effects on dairy cows’ fertility parameters","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-06 10:59:31","doi":"10.21203/rs.3.rs-4408948/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"193c1897-0cd3-4dc1-85da-03550b1d8fee","owner":[],"postedDate":"June 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-08T14:57:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-06 10:59:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4408948","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4408948","identity":"rs-4408948","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}