Retrograde ejaculation related infertility in Ile-Ife, Nigeria

Abstract

Background: Globally, the incidence of male infertility is on the increase1,2. However, the contribution of retrograde ejaculation to this increasing incidence of male infertility is not known locally.
Objectives:1. To determine the incidence of retrograde ejaculation by using the WHO criterion among male partners of patients who were being managed for infertility at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between 1st of February and 31st of August 2006 . 2. To determine the Retrograde-ejaculation ratio (RER) of each subject by a proposed formula as an extension of the WHO criterion.
3. To highlight the risk factors and the management options available for the treatment of retrograde ejaculation.
Subjects and methods: During the study period, 71 male partners of consecutive female patients who reported at the Infertility clinic were recruited. However, the specimens of 70 male partners were analyzed
because one of them inadvertently spilled his post-ejaculatory urine specimen and consequently was excluded from the study. Prior to the collection of ejaculatory fluid and post-ejaculatory urine specimens for
analysis, they were instructed to abstain from sexual intercourse for at least 3 days and to collect the first post-ejaculatory urine specimen for analysis. The WHO criterion 1 states that a cloudy urine specimen with the presence of a total number of spermatozoa in urine equal to or exceeding the number of spermatozoa in semen, strongly supports the diagnosis of retrograde ejaculation. The sperm counts in seminal fluid and urine for each subject were determined. Thereafter, the sperm concentration in urine (SCU) and sperm concentration in seminal fluid(SCSF) were determined
respectively thus: sperm count in urine/volume of urine; sperm count in seminal fluid/ volume of seminal fluid. The Retrograde ejaculation ratio (RER) was calculated thus: sperm count in urine / sperm count in
seminal fluid. A questionnaire containing the bio-data and risk factors associated with retrograde ejaculation was completed for each subject.
Results: Of the 70 cases included in the analysis, 32(45.7%) had primary infertility while 38(54.3%) had secondary infertility. The age range was 28-65(mean for primary and secondary infertility were 36 and 42.1
respectively) years. The duration of infertility ranged from 1-16 years (mean4+ 2.92). Based on the WHO criterion previously stated, only 1/70(1.42%) of the cases was positive with a retrograde ejaculatory ratio
(RER) of infinity as he had azoospermia. This was in a 47 year old man with secondary infertility who had no identifiable risk factor prior to the study. There were 8/70(11.42%) of the cases studied with azoospermia but only 1/8 (12.5%) of those azoospermic had retrograde ejaculation.
Conclusion: To make a diagnosis of male factor infertility, semen analysis remains the cornerstone of all the laboratory assays. However, to make a
categorical diagnosis of retrograde ejaculation, focused laboratory testing is imperative. The incidence of retrograde ejaculation appeared low (1.42%) in our environment but this is in consonance with studies elsewhere. It is strongly advisable that cases of azoospermia and severe oligozoospermia be screened for retrograde ejaculation as there are many
modalities of therapy to aid the affected males fulfil their wishes of becoming fathers. Lastly, when the retrograde ejaculation ratio (RER) is > 1 with the presence of a cloudy urine, the diagnosis is highly probable.

Key words: Retrograde ejaculation, azoospermia, male infertility.