Fertility: Dealing With Ejaculation Problems

Male infertility is increasing by the day. Many men discover that they have a fertility problem and that they are the ones responsible for their wives not being able to get pregnant. Among the couples who visit fertility clinics with infertility problems, around 30% of them suffer solely from a condition of male infertility.

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Ejaculation

Anejaculation is a problem in which a man finds that he is not able to ejaculate during intercourse even if he has plenty of stimulation. Sometimes, an ejaculation is confused with erectile dysfunction.

But the two problems are distinctly different. A man suffering from anejaculation has normal arousal and orgasm. The only difference is that there is no ejaculation during the orgasm. He gets what is better known as a ‘dry orgasm’.

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Types of Ejaculation

The lack of ejaculation during intercourse could be based on various factors. These have been categorised under two different heads. There are, namely, two types of anejaculation:

Situational Anejaculation

This is a problem that depends on the current situation and prevents a man from being able to expel semen during an orgasm. It is usually psychological and could be out of the fear of making his partner pregnant or some other trauma.

A man may find that he is able to ejaculate with some partners but not with others. Some men are not able to ejaculate during intercourse but can ejaculate while masturbating. Ejaculation depends on the situation.

Total Anejaculation

This is a condition in which a man is not able to ejaculate at all, whether through intercourse or through masturbation. Irrespective of his state of mind or location, no ejaculate is present during the orgasm.

Some men with Anorgasmic Anejaculation are not even able to reach an orgasm, while men with Orgasmic Anejaculation are able to get an orgasm but have no ejaculate.

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What Causes OF Premature Ejaculation

The causes of anejaculation have been categorised as psychological and medical. Many men have psychological conditioning at a younger age, which affects their ability to ejaculate. Anejaculation is also caused due to stress. Men who work under stressful conditions or live in stressful environments may find that they are not able to ejaculate during an orgasm.

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Premature Ejaculation Treatment

Treatment for anejaculation depends on the cause.

Situational anejaculation may be addressed by changing location.

Viagra may be prescribed for erection issues, aiding ejaculation after masturbation.

For assisted reproductive techniques, sperm retrieval may be recommended.

Sperm aspiration is used when no sperm is found in semen, or there's no ejaculate.

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Retrograde Ejaculation

Cause: Bladder neck doesn't function properly, allowing semen to flow backward.

Symptoms

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Causes of Retrograde Ejaculation

There are several reasons associated with retrograde ejaculation.The most common cause are damage to the nerve, which controls the muscles. This damage can be caused due to conditions such as diabetes, multiple sclerosis, spinal cord injury and nerve degenerative diseases like Parkinson’s.

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Delayed Ejaculation

Delayed ejaculation is when a man is not able to ejaculate even after stimulation for an extended period of time, which may stretch to 30 minutes or even longer. In some cases, he does not ejaculate at all.

In most cases, the arousal and erection are normal, but he is not able to orgasm. Delayed ejaculation is classified as a male orgasmic disorder and becomes a cause for concern when it leads to infertility.

Causes of Delayed Ejaculation

Delayed ejaculation could be due to a psychological problem, or it could be a physical condition. Factors such as stress and depression could lead to delayed ejaculation or dry ejaculation. Other psychological causes could be due to trauma during the early years or abuse during childhood.

Delayed ejaculation can be caused by:

Treatment options:

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Fertility Solutions for Ejaculations Problems

There are many fertility options for men with ejaculation problems. Specialised fertility clinics like Medicover Fertility are experts in handling all kinds of male and female infertility conditions.

Some of the common fertility treatments recommended for men who are not able to ejaculate during intercourse and make their partners pregnant are:

The IUI treatment involves the male partner providing a semen sample, which is then inserted into the female partner’s uterus. The procedure takes about 5 minutes and is typically done a few days before ovulation.

While it is a popular option for male infertility, the success rate of IUI is relatively low, and multiple attempts may be needed to achieve pregnancy.

In Vitro Fertilisation (IVF)

The IVF treatment is recommended in cases where the IUI technique is unsuccessful for 3 or more attempts. Since the male partner is facing a problem in ejaculating sperm, the IVF procedure is a quicker way to get pregnant and less tiresome for the male partner to undergo treatment to ejaculate semen.

The eggs and sperm are fertilised in the lab, and the embryo is transferred to the mother’s uterus when it is ready.

Intracytoplasmic Sperm Injection (ICSI)

The ICSI treatment is recommended in cases where the male partner is unable to ejaculate sperm, and the sperm has to be surgically retrieved from the epididymis. In these cases, the quantity of sperm is limited, and hence, the ICSI technique is used for fertilisation.

Intracytoplasmic sperm injection is a process in which one good sperm is selected and injected into the female egg. The sperm is injected just under the outer covering. The egg and sperm fuse to produce an embryo.

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What Is Intrauterine Insemination (IUI)?

IUI (Intrauterine insemination), also called artificial insemination, is a type of fertility treatment. During the process, a semen sample from a male is washed and processed, and the motile and immotile sperm are separated.

Then, sperm of higher motility are placed inside a woman’s uterus through a catheter during ovulation to facilitate fertilisation. The motive is to increase the number of sperm reaching the fallopian tube, thereby increasing the chances of fertilisation. It takes a few minutes for the procedure and does not cause much discomfort.

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When Is IUI Recommended?

The most common reasons for doing IUI are:

A Low Sperm Count

After washing the sperm, the count should be more than 10 million. IUI is usually recommended for men with low sperm counts.

Decreased Sperm Motility

For a successful IUI, the total motile sperm count should at least be 10 million post-washing of the semen.

Ejaculation Problem

IUI can also be recommended when a male has ejaculation dysfunction.

Unexplained Infertility

IUI is also done in cases of unexplained infertility.

Hostile Cervical Mucus

Sperm needs to stay for as sperm needs to stay for a couple of days within the cervical mucus. So, if a woman has hostile cervical mucus, it becomes acidic, and the change in pH can restrict the sperm’s survival in the cervix.

IUI is not recommended in severe male infertility cases and when a woman has a tubal blockage, endometriosis, or a previous history of pelvic infections.

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What Is The Reason For IUI Failure?

The success rate of IUI is not that great, though success would depend on the cause of infertility, the age of the woman, and the time since the couple is trying to conceive.

Studies have shown that the pregnancy rate for each natural cycle is about 4-5%, and when the cycle is stimulated with fertility drugs, the pregnancy rate is 7-16%. The possible reasons why IUI fails might depend on person to person, their age, egg quality and a number of other factors.

Here are some of the IUI failure reasons or for unsuccessful IUI are:

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Symptoms Of IUI Failure?

There are no specific symptoms of IUI failure. An IUI failure will lead to an abortion, or if the treatment hasn’t worked, it will bring in your periods. If the quality of egg and sperm is not good, they may have some chromosomal abnormality, which will result in spontaneous abortion.

And in 85% of cases, this is the reason for early pregnancy losses. But one should look out for any unusual vaginal discharge and consult a doctor immediately in any case of severe cramping or discomfort.

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Next Step After Failed IUI

If a woman has had 3–4 failed IUI cycles, has low ovarian reserve, and is above 35 years of age, considering IVF or ICSI is recommended as the next step. IVF has been shown to significantly increase the chances of conception.

While IUI may be less expensive, its success rate after multiple failed attempts is low. It is advisable to consult with an IVF specialist after 3–4 failed attempts.

Frequently Asked Questions