Midwest Reproductive Center

Retrograde Ejaculation

Undersatnding retrograde ejaculation (RE)

In nearly half of infertility cases, male factor infertility is the cause. As part of the initial fertility work up, Dr. Gehlbach will order a semen analysis. Depending on the results, he may suggest an appointment with a urologist to further investigate potential problems, including retrograde ejaculation.

Normal ejaculation and pregnancy

During ejaculation, semen, a mixture of sperm and fluids added from the seminal vesicles and prostate gland, is expelled through the urethra. Sphincter muscles act to close off the bladder, which allows the semen to move forward out of the penis and into the vagina to eventually cause fertilization of an egg in the fallopian tube.

What is retrograde ejaculation?

Retrograde ejaculation occurs when the sphincter muscles of the bladder fail to respond appropriately, causing semen to travel backwards into the bladder instead of out of the body. Some ejaculation may still occur normally; however, the majority of sperm becomes trapped in the bladder and is unable to cause a pregnancy.

Conditions such as diabetes, medications (especially hypertension and some mood-altering medicines) or surgery to the prostate or urethra can result in retrograde ejaculation. Depending on the cause, this condition may or may not be reversible.

How is  retrograde ejaculation diagnosed?

Typically, semen analysis results will indicate possible retrograde ejaculation. Men with this condition will have a low volume of semen in addition to low sperm counts in the ejaculate. Testing for retrograde ejaculation requires a collection of two specimens: one specimen at ejaculation, which is immediately followed by a collection of urine. The urine is then assessed for the presence of sperm, confirming or ruling out the diagnosis of RE.

How is retrograde ejaculation caused infertility treated?

Retrograde ejaculation does not make getting spontaneously pregnant impossible, but the number of available sperm is decreased, so the chances of pregnancy are lower. Sometimes, treatment of retrograde ejaculation is as simple as stopping a certain medication; however, this solution is not always possible.

Generally, treatment of RE often involves special preparation of the sperm prior to use. Collection of a semen specimen for use is exactly the same as during testing. Two specimens are collected: one at ejaculation and a urine collection immediately following. If sperm is found in the urine, it will be separated from the urine sample.

The sperm will then undergo a special sperm wash, removing dead sperm, debris normally present in a specimen and urine. The andrology lab at Midwest Reproductive Center then prepares the cleaned sperm sample for use during an intrauterine insemination (IUI) or with assisted reproductive technology (ART) such as IVF.