What are the causes of Ejaculation problems?
The problem may be due to some previous surgery (in the prostate gland, hernia, in the abdomen for cancer), diabetes neurological problems, spinal cord injury, diseases of prostate, some obstruction in the sperm conducting ducts etc
What is the next step?
Please do not hesitate to inform your doctor. He/ she will ask some questions and examine you to find out the cause. Some blood tests (like sugar) may be advised. Urine test is commonly advised. In few men, the problem may be retrograde ejaculation (Semen going into bladder instead of moving forward). In that case, sperms can be found in the urine immediately after masturbation. Scrotal ultrasound examines the details of your scrotum (testes and the organs surrounding them). TRUS (Transrectal ultrasound) is advised to see the problems in the prostate gland and around, here the ultrasound probe is inserted inside the anus.
What are the treatment options?
In very few cases, some medicines can help to improve ejaculation. These can help, particularly in retrograde ejaculation. However, in most cases, medicines are not helpful. Nevertheless, pregnancy is possible and you can become the biological father of your kids.
Vibro-ejaculator can sometimes be helpful. It is a small device applied on the front part of the penis ("Glans Penis") to discharge the semen. You can collect the semen in this way and use it at home.
How sperms can be collected?
- Non-toxic condom- If you have nocturnal emission (“Night fall”) you can use this condom over penis while sleeping and collect the semen and carry it to the laboratory. The sperms can be frozen for furture use by IUI/ ICSI.
- Vibro-ejaculator- can help to collect the sperms, which can be frozen for future IUI/ ICSI.
- Testing urine- The sperms can be retrieved from urine and can be used for IUI/ ICSI. However, you need special preparation to reduce the normal acidity of the urine.
- Prostatic message- If urine test shows no sperms, inserting lubricated gloved fingers inside your anus to message your prostate gland can sometimes help.
- Electroejaculation- If prostatic message fails, your prostate gland can be stimulated using a small probe inserted through the anus under general anaesthesia. However, it is not widely available.
- Testicular biopsy- If all of the above method fails, sperms can be collected from the epididymis (small gland above the testis) by small needle (PESA- Percutaneous Epididymal Sperm Aspiration) or and or sometimes, by a small cut (MESE Microsurgical Epididymal Sperm Extraction). All these are done under anaesthesia. If these fail, TESA (Testicular Sperm Aspiration- a small needle is inserted inside the testes) or TESE (Testicular Sperm Extraction- a small cut is made) can be done. Sperms collected by this way, can only be used for ICSI.
In all cases, sperms can be frozen for future use.
What should be the option- IUI or ICSI?
If your wife's results are satisfactory (At least one Fallopian Tube is open, adequate number of eggs in the ovaries), IUI (Intrauterine Insemination) can be a suitable option. In IUI, your sperms can be used, if your sperm count is satisfactory.
In IUI, the sperms are inserted through a small tube, inside the uterus. IUI is cheaper, but the success rate is 10-15% per cycle (out of 100 couples doing IUI, 10-15 can conceive in one month).
However, ICSI is to be done if your sperm count is very low and sperms are collected by TESA/ TESE/ MESA/ PESA. ICSI (Intracytoplasmic Sperm Injection) should also be considered if your wife's reports are not satisfactory (both the Fallopian Tubes blocked, ovaries have less number of eggs) and you have done 4-6 cycles of IUI.
ICSI is a special type of IVF (In Vitro Fertilization). In standard IVF, your wife will be given some injections to mature her eggs, which will be collected through the vagina. These eggs are then mixed with the sperms in the laboratory to produce the embryos.
In ICSI, the sperms collected from your body are directly injected, under the microscope, inside the eggs. The success rate of ICSI is 40% per cycle but it's expensive.
When Donor sperms should be used?
If a couple cannot afford ICSI but IUI using husband's sperm is not possible, Donor-Sperm-IUI is the option, if the wife's reports are satisfactory. Again if TESE sample fails to retrieve adequate amount of good quality sperms, IUI/ICSI should be done with donor sperms.