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Retrograde Ejaculation and Effects on Infertility

Obviously, urine and sperm share a common exit conduit. During ejaculation, a valve must close to prevent the semen from going into the bladder. This valve may not work in a number of situations, including prior pelvic surgery, prior poorly controlled diabetes (due to nerve damage), and certain medications.

We suspect retrograde ejaculation whenever the semen volume is less than one milliliter (1 ml or 1 cc). To diagnose retrograde ejaculation, it is necessary to evaluate urine after an ejaculation.

There is a range of treatments for men with retrograde ejaculation. The simplest treatment is asking men to ejaculate with a full bladder. A full bladder may exert enough pressure on the valve into the bladder to prevent loss of semen into the bladder. Sometimes simple medication regimens, such as taking pseudofed, may be adequate. Other times, it may be desirable to improve the environment in the bladder to make it more hospitable to sperm by changing the pH of the urine or by placing sperm media in the bladder before ejaculation.