From the Guidelines
Retrograde ejaculation is a condition where semen flows backward into the bladder instead of exiting through the urethra during ejaculation, leading to reduced fertility. This condition is characterized by the semen entering the bladder instead of being ejaculated out of the body, which can be caused by various factors such as diabetes, certain medications, nerve damage, or surgeries involving the prostate or bladder 1.
Key Characteristics
- Semen flows backward into the bladder during ejaculation
- Reduced fertility due to improper delivery of sperm
- May be caused by diabetes, certain medications, nerve damage, or surgeries
- Can be treated with medication adjustments or fertility procedures to retrieve sperm from urine
According to the updates to male infertility: AUA/ASRM guideline (2024) 1, retrograde ejaculation is a specific condition that affects fertility, and it is essential to understand its definition and causes to provide appropriate treatment and management. The guideline provides a comprehensive overview of various conditions related to male infertility, including retrograde ejaculation, and emphasizes the importance of accurate diagnosis and treatment to improve fertility outcomes.
Diagnosis and Treatment
- Diagnosis involves physical examination and laboratory tests to rule out other conditions
- Treatment depends on the cause and may include medication adjustments or fertility procedures
- Fertility procedures may involve retrieving sperm from urine to achieve pregnancy
In clinical practice, it is crucial to prioritize the patient's fertility goals and overall health when managing retrograde ejaculation, and treatment should be tailored to address the underlying cause and improve fertility outcomes 1.
From the Research
Definition of Retrograde Ejaculation
Retrograde ejaculation (RE) is a condition where the semen enters the urinary bladder instead of emerging through the penis after orgasm 2. It can be characterized by the reflux of the ejaculate backwards into the bladder during the emission phase of ejaculation, resulting in a total or partial absence of sperm emission 3.
Causes and Types of Retrograde Ejaculation
RE can result from anatomic, neurological, or pharmacological conditions 4. It may be partial or complete, resulting in either low seminal volume or complete absence of the ejaculate (dry ejaculate) 4. Diabetes mellitus is also a known complication that can lead to RE 5.
Diagnosis of Retrograde Ejaculation
The diagnosis of RE is based on the detection of spermatozoa in post-ejaculatory urine (PEU) in patients with aspermia or oligozoospermia and low or normal seminal volume 3. Evaluating the ejaculate may not be sufficient for identifying RE in some patients, and the management of infertility may involve the use of invasive methods such as epididymal fluid retrieval or testicular biopsy 3.
Treatment and Management of Retrograde Ejaculation
Different therapeutic approaches are present for the treatment of RE, including medical and surgical methods 5. Medical treatment using drugs such as imipramine and pseudoephedrine has shown promising results in establishing antegrade ejaculate in cases with complete RE and improving semen quality in cases of partial RE 5. Assisted reproductive techniques (ART) such as intrauterine insemination, in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) can also be used to treat infertility due to RE 2, 6. Alkalinizing urinary pH with oral medications or by adding sperm wash media into the bladder prior to ejaculation may preserve the viability of the sperm 4.