Retrograde ejaculation (RE) is suspected if the ejaculate (sample) volume is measured as being extremely low. A low ejaculate volume is thought to be less than 1.5ml (less than half a teaspoon) but in reality we rarely consider RE unless the volume is under 0.5ml and usually it is a lot less. Sometimes there no semen at all, even the patient may have had an orgasm and has sensation of ejaculation. This is because most, if not all of the semen has gone into the bladder instead.
What causes RE?
RE usually occurs due to a weakness of the neck of the bladder. At the time of ejaculation, the bladder neck normally closes off to ensure that the semen comes out of the urethra and penis. However, nerve damage to the bladder neck can prevent this closure and results in semen going into the bladder. The most common causes are nerve damage caused by surgery to anywhere in the same area, for example the bladder itself, the prostate, or even spinal surgery. Other causes include the nerve damage caused by chronic disease including diabetes
How do we diagnose RE?
We normally ask the patient to produce a specimen by masturbation (or intercourse into a collection sheath) and collect any fluid that comes out. Then we ask for a urine specimen immediately after. Sometimes we see ‘clots’ of semen in the urine and they can be removed with a fine pipette and examined under the microscope. We can then centrifuge (spin very fast) the rest of the urine in a tube and see any sperm form a pellet at the bottom. However the sperm retrieved are often dead or immotile due to the environment of the bladder, which is usually acidic and lacks the correct salt concentration.
Can normal sperm be retrieved from the bladder?
Yes – if we change the composition of the urine. This is done by taking a solution of sodium chloride and bicarbonate and to a specific schedule of about 2 hours. This has been named ‘the Liverpool solution’ because it was developed by a group at Liverpool Women’s Hospital. Although ‘rescuing’ sperm from the bladder does require some trial and error, we can rescue high quality sperm using this method, and either freeze them for later use (see sperm banking) or use them for IUI or IVF.
For information on using the ‘Liverpool solution’ to retrieve sperm for the the bladder please see below. Remember however that clinic staff will be on hand to guide you through this