Dr Richa Sharma, Dr Amit Basnotra
Fertility can be affected by both male and female parameters. Normally a basic work up can point out the causative factor.
Problem adds on when other factors are involved in making the delay in diagnosis and planning the things in the correct way.Here is one such condition called Retrograde ejaculation in males.Its also termed as Dry Orgasm.
Retrograde ejaculation occurs when semen, which would, in most cases, be ejaculated via the urethra, is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation forcing the semen to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur.
So dilemma is that the patient is actually having sperm production but directed in opposite way leading to difficulty in availability of sperms leading to infertility.
Signs and symptoms
Retrograde ejaculation is one cause of male infertility.
Men often notice during masturbation that they do not have semen release but there is an orgasm
Causes
A malfunctioning bladder sphincter, leading to retrograde ejaculation, may be a result either of:
* Ejaculatory duct obstruction
* Neuropathies especially in diabetes- Retrograde ejaculation can also be a complication of diabetes, especially in cases of diabetics with long term poor blood sugar control. This is due to neuropathy of the bladder sphincter.
* Also in multiple sclerosis, spinal cord injury
* Operation on the prostate. It is a common complication of transurethral resection of the prostate, a procedure in which prostate tissue is removed, slice by slice, through a resectoscope passed along the urethra.
* Underlying prostatic pathology
* Surgery on the bladder neck accounted for about ten percent of the cases of retrograde ejaculation or anejaculation reported in a literature review.
* Side effect of medications, such as tamsulosin, that are used in treating conditions such as benign prostatic hyperplasia.
* Side effects of antidepressant and antipsychotic medication
* Birth defects like associated with urethral strictures
How to know the disease-
Clinical examination ,Urine test can speak all.
What next ?
Take opinion of Urologist along with Infertility Specialist for future pregnancy to decide the line of action
Medications
* Tricyclic antidepressants
* Antihistamines
* Decongestants
These medications tighten the bladder neck muscles and prevent semen from going backwards into the bladder.
Infertility treatments
If a couple is experiencing infertility as a result of retrograde ejaculation and medications are not helping, the male’s ejaculate may be centrifuged and the isolated sperm injected directly into the woman through the use of intrauterine insemination. In more severe cases, in-vitro fertilization with intracytoplasmic sperm injection may be used
(The authors are Senior IVF Consultant Mumbai and Senior Gastroentrologist Delhi)
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