From the Guidelines
Treatment for retrograde ejaculation should prioritize medications that strengthen the bladder neck muscles, such as pseudoephedrine, imipramine, or chlorpheniramine, to improve fertility outcomes and quality of life. The goal of treatment is to address the underlying cause of retrograde ejaculation and improve fertility outcomes, if desired. According to the most recent guidelines, including the 2021 AUA/ASRM guideline part II 1, treatment options for retrograde ejaculation may include:
- Medications to strengthen the bladder neck muscles, such as pseudoephedrine (30-60 mg taken 2-3 hours before intercourse), imipramine (25-50 mg taken twice daily), or chlorpheniramine (4 mg taken twice daily)
- Sperm retrieval from post-ejaculation urine samples for use in assisted reproductive techniques, if medication is unsuccessful and fertility is desired
- Better blood sugar control for men with retrograde ejaculation due to diabetes
- Sperm retrieval rather than correcting the retrograde flow, if the cause is surgical damage or certain irreversible conditions Additionally, the 2024 NCCN guidelines insights: survivorship 1 suggest that treatment of sexual dysfunction, including retrograde ejaculation, requires a multidimensional treatment plan that addresses the underlying issues, and may include referrals to specialists, such as psychotherapy, sexual/couples counseling, urology, or sexual health specialist. It is essential to note that retrograde ejaculation is not harmful to health, and men who are not concerned about fertility may not need treatment at all, although they should be aware of potential symptoms such as dry orgasms or cloudy urine after sexual activity. Overall, the treatment approach should prioritize the patient's fertility goals, underlying cause of retrograde ejaculation, and overall quality of life, with a focus on the most recent and highest-quality evidence, including the 2021 AUA/ASRM guideline part II 1 and the 2024 NCCN guidelines insights: survivorship 1.
From the Research
Treatment Options for Retrograde Ejaculation
The treatment for retrograde ejaculation can vary depending on the underlying cause. Some possible treatment options include:
- Medications such as ephedrine sulfate or imipramine hydrochloride to help convert retrograde ejaculation into anterograde ejaculation 2
- Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation to preserve the viability of the sperm 3
- Bladder washing and intrauterine insemination to retrieve sperm 4
- Imipramine in a new ovarian cycle-dependent dose regime for reversal of retrograde ejaculation 5
- The alpha1-adrenergic agonist methoxamine, self-administered intramuscularly by the patients 30 min prior to intercourse or masturbation 6
Efficacy of Treatment Options
The efficacy of these treatment options can vary. For example:
- A study found that 5 out of 17 patients (29.3%) with diabetes and retrograde ejaculation achieved anterograde ejaculation with ephedrine or imipramine treatment 2
- Another study reported that 3 out of 7 patients (42.8%) with retroperitoneal lymphadenectomy and diabetes achieved anterograde ejaculation with imipramine treatment 2
- A case study found that two patients with retrograde ejaculation achieved substantial increases in sperm count with methoxamine treatment, with one patient's partner becoming pregnant twice 6
- A study found that imipramine treatment induced antegrade ejaculation in all 11 patients with retrograde ejaculation following retroperitoneal surgery, with two patients inducing spontaneous pregnancy 5
Considerations for Treatment
When considering treatment for retrograde ejaculation, it is essential to: