Retrograde Ejaculation: Causes, Diagnosis and Fertility Options
Retrograde Ejaculation: Causes, Diagnosis and Fertility Options
Retrograde ejaculation is harmless to your health, but it can stop a pregnancy from happening, and it is often treatable. If you reach orgasm but little or no semen comes out, this may be the cause. This guide explains what it is, why it happens, how doctors diagnose it and which fertility options can help you become a father.
This article is general information and does not replace personal medical advice.
What is retrograde ejaculation?
Retrograde ejaculation happens when semen goes back into the bladder during orgasm instead of out through the penis. Orgasm still occurs, but little or no semen is released. This is often called a "dry orgasm".
A muscle at the neck of the bladder normally closes during ejaculation to send semen forward. In retrograde ejaculation this muscle does not close properly. Erections and the feeling of orgasm are usually not affected. It is an uncommon cause of male infertility, accounting for roughly 0.3% to 2% of cases.
What causes retrograde ejaculation?
The main causes are:
Surgery. Bladder neck surgery, prostate surgery, and removal of lymph nodes in the abdomen (sometimes needed in testicular cancer treatment) can damage the muscle or its nerves. Radiotherapy to the pelvis can also affect ejaculation.
Nerve damage. Conditions such as diabetes, multiple sclerosis, Parkinson's disease and spinal cord injury can disrupt the nerves that control the bladder neck. See our guide on fertility after spinal cord injury.
Medicines. Some drugs for high blood pressure, an enlarged prostate and depression can cause it. Our guide on prostate enlargement (BPH) covers its symptoms and treatment options.
Never stop a prescribed medicine on your own. Speak to your doctor first.
Symptoms and diagnosis
Common signs:
dry orgasms, with little or no semen
cloudy urine after orgasm, caused by semen in the bladder
difficulty getting your partner pregnant
How doctors diagnose it:
History and examination. The doctor asks about surgery, cancer, diabetes and medicines, and examines you.
A post-orgasm urine test. You empty your bladder, ejaculate, then give a urine sample. A high number of sperm in the urine (for example, more than 1 million sperm in the sample) supports the diagnosis. Sperm in the urine is not definitive on its own, so doctors read it together with your history and semen analysis.
Other tests if the urine test is negative. The problem may be reduced semen production rather than retrograde flow, for example after pelvic surgery or radiation.
A semen analysis is also usually needed. Read about what to expect at a first male fertility appointment.
How is retrograde ejaculation treated?
Treatment is usually only needed if you want to father a child, because the condition is not harmful in itself.
Reviewing your medicines. If a medicine is the cause, your doctor may change or pause it.
Medicines that help keep the bladder neck closed. These can work when nerve problems are the cause, but they are less effective after permanent changes such as bladder neck surgery or TURP. They can raise blood pressure and heart rate, so they must only be used under medical supervision. In studies, one type of medicine worked for about 22% of men, rising to about 39% when two types were combined, but the studies were small.
If medicine does not restore normal ejaculation, assisted conception is the next step.
Fertility options
Many men with retrograde ejaculation do achieve pregnancy with treatment. The main options are:
Sperm recovered from the urine. After orgasm, sperm can be collected from the urine, washed and prepared in the laboratory, and used for intrauterine insemination (IUI), IVF or ICSI. Your doctor may ask you to take alkaline fluids beforehand, because acidic urine can harm sperm. A review of 15 studies reported a pregnancy rate of about 15% per cycle with this approach. Another method, in which the bladder is emptied with a catheter and rinsed, has reported a live birth rate of about 28% in IVF and ICSI. Results vary between clinics and couples.
IVF or ICSI. More advanced techniques are sometimes needed, for example when few or poor-quality sperm are recovered. See ICSI after surgical sperm retrieval.
Surgical sperm retrieval or electroejaculation. A specialist may consider these if sperm cannot be obtained any other way. Read about electroejaculation and surgical sperm retrieval.
If you are due to have surgery that could affect ejaculation, ask your surgeon about the risk beforehand, and ask about preserving sperm if you may want children later.
When to see a specialist
See a doctor if you notice dry orgasms or cloudy urine after orgasm, or if you have been trying to conceive for a year without success, especially if you produce little or no semen. A male fertility specialist can confirm the cause and plan treatment, ideally with your partner involved.
Also read when to see a male fertility specialist.
Frequently asked questions
Is retrograde ejaculation dangerous? No. Semen in the bladder is not harmful and is passed in the urine. The main effect is on fertility.
Does retrograde ejaculation affect erections or orgasm? Erections and orgasm are usually not affected, although some men find orgasm less satisfying.
Can I still father a child? Often yes. Many men achieve pregnancy with medical treatment or assisted conception.
How is it different from no semen at all? In retrograde ejaculation, sperm are produced but go into the bladder. A post-orgasm urine test shows which problem you have.
Can it go away on its own? If a medicine is the cause, it may improve after your doctor changes it. Permanent causes, such as surgery, usually need treatment.
Book a male fertility consultation
If you think you may have retrograde ejaculation, book a consultation online with The Male Factor Fertility Clinics London, Barnby St, London NW1 1AA.
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