retrograde ejaculation surgery

Overview of Retrograde Ejaculation

 A condition where the semen enters the bladder instead of emerging through the penis during orgasm is known as Retrograde Ejaculation. 

Though the man may sexually climax, he might ejaculate very little or not at all. This is also called a dry orgasm.

Though not harmful, retrograde ejaculation can cause male infertility as there is not enough semen to fertilize eggs and the treatment of this condition is only required to restore fertility.

Retrograde Ejaculation Symptoms

Though retrograde ejaculation doesn’t affect the man’s ability to get an erection or have an orgasm, at the time of climax the semen goes into the bladder instead of coming out of the penis. 

The signs and symptoms of Retrograde include:

• Orgasms with very little or no ejaculation 
•  Cloudy Urine after the orgasm because of the presence of the semen
• Male infertility or Inability of the man to get his partner pregnant.

Retrograde Ejaculation Causes

A tube called the vas deferens transports sperm to the prostate during an orgasm. The sperm mixes with other fluids there to produce liquid semen.

There is a muscle at the opening of the bladder known as bladder neck muscle that tightens to prevent ejaculate (semen) from entering the bladder while it passes from the prostate into the tube inside the penis known as the urethra. This same muscle holds urine in the bladder until the man urinates.

In retrograde ejaculation, the bladder neck muscle fails to tighten properly resulting in the sperm entering the bladder instead of being ejected out of the man’s body through the penis.

The problem with the muscle that closes the bladder during ejaculation can be caused by:

• Surgery of the bladder neck, testicles, colon, rectum, bladder, or the lower spine, retroperitoneal lymph node dissection surgery for testicular cancer
• Side effects of certain medications that are used to treat high blood pressure, prostate enlargement & depression, and some antipsychotic drugs.
• Certain injuries and illnesses that cause damage to the nervous system and muscles of the bladder such as multiple sclerosis, Parkinson’s, or a spinal cord injury.
• Prolonged uncontrolled blood sugar can cause damage to the organs and nerves, affecting the muscles of the bladder.
• Removal of part of the prostate through surgery because of damage to the muscles and nerves of the bladder.

Effect on fertility

Retrograde ejaculation is known to impair a man’s fertility. However, it’s not a common cause of infertility as it causes only about 0.3 to 2 percent of infertility problems.

Retrograde ejaculation also does not mean that the man’s sperm is not viable. It causes  infertility as the sperm does not make it to his partner

When to See a Doctor for Retrograde Ejaculation?

As Retrograde Ejaculation is neither dangerous nor painful, it does not usually require treatment. However, it can be a symptom of another underlying medical condition.

However one should seek medical assistance when

• There is no ejaculation following an orgasm
• Consistent less ejaculate than usual following an orgasm
• Inability to get the partner pregnant even after a year of trying

Some studies have also shown retrograde ejaculation to be the first and only symptom of type 1 diabetes so men who experience retrograde ejaculation should consult the doctor to discuss the concern.

Diagnosis for Retrograde Ejaculation

Retrograde ejaculation usually requires treatment only if the man is wanting to father a child. Dry orgasms are an indication to consult a doctor and make sure that the condition is not caused by an underlying condition that needs attention.

The doctor is most likely to perform a physical examination to check for obvious abnormalities. Further evaluation of conditions done by accessing signs and symptoms like:

• Absence of ejaculate during orgasm
• cloudy urine following orgasm
• infertility

One must tell the doctor that:

• For how long and how often have they been having dry orgasms
• any other symptoms that may have been noticed
• Any preexisting chronic illnesses or injuries
• Any medications being taken.
• Previous treatment for cancer and type of treatment

A urine test is usually done to find out if the lack of ejaculate is due to retrograde ejaculation. The patient may be asked to masturbate before providing a urine sample.

The presence of a high amount of sperm in the urine sample is the diagnosing factor for retrograde ejaculation.

For the patients facing infertility, the absence of semen in urine indicates an issue with semen production or some other problem. In such cases, a consultation with an infertility specialist and further testing are advised.

Retrograde Ejaculation Treatment

Though Orgasms without ejaculation, present no serious risks to health or necessarily interfere with the sex life, they are still reason enough to consult the doctor to examine the cause and rule out any underlying disease.

Treatment isn’t usually needed unless one is trying to father a child. In that case, a consultation with a fertility specialist becomes a necessity.

Though Retrograde Ejaculation does not pose any threat to health or sexual gratification, there are some remedies available that can be tried.

1. If caused by some medication, stopping to take the medicine should resolve the issue. However one should not stop taking prescription medications without speaking to the doctor. however and do so after ensuring safety.
2. The doctor considers the overall health, including other conditions one may have before changing or prescribing medication for Retrograde Ejaculation. The medications that help keep the bladder neck muscle constricted during ejaculation include:

• brompheniramine
• chlorpheniramine
• Polaramine
• ephedrine
• imipramine (Tofranil)
• midodrine
• phenylephrine 
• pseudoephedrine or phenylephrine

However, medications are usually not effective for severe nerve or muscle injury due to surgery.

Dr. Shivani Bhutani at Eva Hospital says that for the couples facing fertility problems due to Retrograde Ejaculation and where medications fail to help, it may be possible for a fertility specialist to retrieve sperm for artificial insemination or in vitro fertilization.

 The fertility specialist begins the treatment by removing the sperm after ejaculation. If the medicines fail to help the man to ejaculate, the doctor tries to extract sperm without requiring the man to ejaculate with surgical procedures which include:

• Testicular sperm aspiration (TESA): Performed under local anesthesia, a needle is used to remove sperm from the testicles.
• Percutaneous epididymal sperm aspiration (PESA): Also done under local anesthesia, this procedure relies on a needle to remove sperm from the duct that connects to the testes known as epididymis.
• Testicular sperm extraction (TESE): TESE also removes sperm directly from the testicles under sedation just like TESA. However, it requires an incision in the testicle.

After the Semen has been successfully removed, the doctor tries to help a man’s partner to get pregnant in one of two ways:

• In vitro fertilization (IVF): An egg is removed from the woman and then fertilized in a petri dish. Once the embryo grows, the doctor implants it into the woman’s uterus.
• Intrauterine insemination (IUI):  Semen is injected directly into a woman’s uterus while she is ovulating.

Prevention

Though Retrograde ejaculation is not entirely preventable, a few things can be kept in mind:

1. The men needing treatment for enlarged prostate should opt for less invasive surgeries, less likely to cause nerve and muscle damage, such as transurethral microwave thermotherapy of the prostate. 

• Controlling medical conditions that can cause nerve damage may also help prevent retrograde ejaculation. 
• Men with diabetes should manage their sugar levels with the medications their doctors prescribe and appropriate lifestyle changes as recommended by a doctor.

The takeaway from Retrograde Ejaculation

Ejaculation is mostly associated with orgasm, but not all orgasms involve ejaculation. Retrograde Ejaculation is not a disease or a serious threat to man’s health.

One must learn to accept the condition and adjust expectations to live comfortably with retrograde ejaculation.

However, sometimes Retrograde ejaculation may also be a sign of enlarged prostate, diabetes, or prostate surgery,

So the symptoms like painful ejaculation, blood in the ejaculate, frequent urination, or erectile dysfunction should be reported to a doctor, even if the man has no wish of fathering a child. 

Retrograde ejaculation or dry organism is not always reversible, but infertility caused by it is treatable. Even for men who cannot ejaculate at all, a fertility specialist can help Dr. Shivani Bhutani at Eva Hospital has a wide experience in sperm retrieval and artificial fertility methods that can help couples facing fertility issues to have a healthy baby of their own.