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.

Getting pregnant requires the male partner to ejaculate inside the female partner. The active sperm from the ejaculate will travel from the cervix to the fallopian tubes in search of the female egg. It all sounds nice and easy, but what happens when the male partner is not able to ejaculate? There are some men who suffer from medical or psychological conditions which prevent them from ejaculating. Other ejaculation problems are premature ejaculation, which causes them to ejaculate too soon. But this does not hamper fertility, and these men are still able to father children.

Sexual problems pertaining to ejaculation only become a problem when fertility is concerned. Ejaculation is essential for pregnancy, and hence, when a man faces some problem with ejaculation, it becomes a concern for fertility.

There are a number of conditions which lead to ejaculation problems. Occasionally it may be psychological or due to some emotional trauma, but in most cases, it is a medical condition which prevents ejaculation. The lack of ejaculation or dry orgasm is a worry for all couples. Some female partners tend to feel that they are responsible for their partner not being able to ejaculate. The greatest apprehension for ejaculation problems occurs when the couple wants to have a baby. No ejaculation means – no sperm and hence no pregnancy.

There are several types of ejaculation problems which result in the lack of an ejaculate. However, there are medical procedures to retrieve the sperm directly from the testes if the need should arise. The retrieved sperm, along with fertility treatment, can help a couple to get pregnant and have a baby.


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 anejaculation 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 ejaculate during the orgasm. He gets what is better known as a ‘dry orgasm’.


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.


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 a stressful environment may find that they are not able to ejaculate during an orgasm. Sometimes men are not able to ejaculate in the clinic when they have to give a semen sample, yet they have no problem ejaculating at home. This is a psychological problem induced by self-consciousness or the tension of having to ejaculate. There are also instances where a man is able to ejaculate during intercourse but cannot ejaculate into the sample cup at the clinic. These are situational anejaculation cases and will change with the surrounding or state of mind.

In some cases, a man may require a great amount of stimulation to reach an orgasm and ejaculate. He may not get the required amount of stimulation during intercourse and hence, he is not able to ejaculate. Yet in other condition with increased stimulation, he is able to ejaculate.

Some men are not able to ejaculate due to medical conditions where there may be a blockage in the tubes which transports the semen to the ejaculatory duct. In this case, the orgasm might take place, but no ejaculate will come as the passageway is blocked, not allowing the flow of semen. Ejaculatory duct obstruction is not a very common condition but should not be ruled out as a possible cause of dry orgasm.


The treatment for anejaculation is determined according to the cause of the problem. If the anejaculation is situational, the doctor may suggest a change of location. This is especially the case when a semen sample is required, or a couple are trying to get pregnant.

Viagra is prescribed for some men who may have a problem getting an erection. Viagra will not induce ejaculation but will help a man to get an erection which will help him to ejaculate after masturbation.

For cases of assisted reproductive technique fertility treatment, the doctor may recommend a sperm retrieval procedure when a male is not able to ejaculate. This is a minor non-invasive surgical procedure in which the sperm is removed from the testes directly. With the help of a hollow needle, sperm are retrieved from the epididymis. This is the region where the mature sperm is stored ready to be ejaculated. This procedure is conducted under anaesthesia. Sperm aspiration is conducted in cases where no sperm is found in the semen or due to a lack of ejaculate.


Retrograde ejaculation is a condition in which the male partner does not ejaculate any semen. The semen goes back into the bladder instead of being expelled out during an orgasm. Later this semen is removed by the bladder along with the urine. This does not cause any problem to the male anatomy as the semen causes no damage in the bladder and is cleared out completely. The problem arises when the couple wants to have a child. The lack of semen being ejaculated prevents conception. Instead of the semen with the sperm being ejaculated into the cervix, it is being drained back into the male bladder.

The retrograde ejaculation happens the bladder neck, which tightens itself during an orgasm is not functioning correctly and allows the semen to flow backwards into the bladder instead of outward. There are two medical reasons for this condition, and they are the weakness of the neck muscles of the bladder, which is not able to squeeze shut or damage of the nerves which controls these muscles. Nerve damage prevents the muscles from functioning properly and could lead to retrograde ejaculation.

The main symptom of retrograde ejaculation is a dry orgasm. There may be very little semen expelled out or no semen at all. Another clear indication of retrograde ejaculation is cloudy urine after intercourse. The urine is mixed with the semen and hence will not be clear. Infertility is another symptom. The inability to get a woman pregnant is caused due to the lack of sperm being ejaculated.


There are several reasons associated with retrograde ejaculation.The most common causes 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.

Surgery can be another cause for retrograde ejaculation. Surgery to areas like the testes, prostate, bladder neck surgery or the retroperitoneal lymph node dissection surgery which is performed for testicular cancer, all of these surgeries and any other surgical procedures in the vicinity can affect the nerves and the muscles of the bladder neck. Removal of the bladder or prostate also increases the chances of retrograde ejaculation. Radiation therapy for cancer treatment in the pelvic area can also lead to retrograde ejaculation.

Some medication like blood pressure medication or medication prescribed for depression or prostate enlargement are also known to cause retrograde ejaculation as one of the side effects.

Treatment for retrograde ejaculation is only recommended in a situation where a couple wants to have a baby. The presence of the semen and sperm in the bladder is not harmful. Treatment for fertility usually means sperm retrieval from the epididymis.

Case Study

Suraj suffered from retrograde ejaculation due to which they could not have a baby. Someone advised Suraj and his wife Kajol to visit a fertility clinic for treatment. They went to a clinic in their locality. It was a small clinic and was run by a doctor in a part of his residence. The location was close by so they thought this would be a good choice. The couple were told that they would have to have IVF and there was no alternate option for them. Over and above that Suraj was advised that he would have to go for special treatment sessions for his ejaculation problem. Some of it involved 6 sessions of psychological counselling and some sessions of a kind of physiotherapy. The following week Kajol was scheduled for egg retrieval, which was followed by the IVF procedure after 3 days. The IVF implantation did not take place, and the doctor said that there was nothing they could do because Suraj’s condition was very bad and they were not able to get any sperm. After a few months, the couple visited Medicover for a free consultation. It was here they learned that for IVF Suraj would have to undergo sperm retrieval, which he didn’t have for their previous treatment. They began wondering about their previous treatment and how the doctor intended to get the sperm for the IVF! The couple was glad to be having their treatment at Medicover, which was cheaper than their previous experience. Medicover assured them that they could have a DNA test of the foetus just to put their mind at rest regarding the paternity of the baby.


Delayed ejaculation is when a man is not able to ejaculate even after stimulation for a long 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 become a cause for concern when it leads to infertility.


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 cause could be due to trauma during the early years, or abuse during childhood.

Other reasons which could lead to delayed ejaculation are Type I diabetes, multiple sclerosis, injury to the spinal cord, surgery in the pelvic area or advanced age. The side effects of medicines can also lead to delayed ejaculation. The most commonly known medicines with an ejaculation problem as a side effect are blood pressure medication, strong pain killers, muscle relaxants, among various others. Anti-depressants can also cause delayed ejaculation.

The use of harmful drugs and excessive alcohol consumption can also be the cause of delayed ejaculation. Smoking and anti-smoking medication can lead to delayed ejaculation.

Treatment for delayed ejaculation could include psychological counselling in the case of a psychological problem. If the delayed ejaculation is caused due to the side effects of medicines, the medication may be changed to one that does not affect erectile function.


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. Couples have experienced specialised fertility treatment at Medicover, which pertains to their specific problem. Fertility consultants are highly qualified and eager to assess the problem before presenting diagnosis and a fertility solution. In most cases, a dry ejaculation or inability to ejaculate would require sperm retrieval. However, the treatment is prescribed after conducting several tests to determine the exact problem and the best course of treatment.

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

  • Intra-Uterine Insemination (IUI): The IUI treatment requires the male partner to produce semen in a sample cup. This is usually done through masturbation. The semen is then inseminated into the female partner’s uterus. This is a simple and painless procedure which takes about 5 minutes. The IUI treatment is performed a few days prior to ovulation to ensure that the sperm will meet the female egg in time. IUI treatment is a popular procedure for conditions of male infertility, including low sperm count. The success rate of IUI is not very high, and a couple may have to try IUI several times before they are able to get pregnant. The probability of getting pregnant with IUI increases with each subsequent try.
  • 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 getting 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 was unable to ejaculate sperm, and the sperm had 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. The 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 together to produce an embryo.

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, 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.

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 to men with low sperm count.
  • 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 – A sperm needs to stay for as a 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.

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 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:

  • Poor Quality Eggs Poor egg quality symptoms can be related to chromosomal problems and are thus related to one of the reasons for failed IUI.
  • Age Increasing maternal age decreases the quality of the egg. And the deteriorated egg quality impacts the embryo and its implantation. This, in turn, becomes one of the major reasons why IUI fails.
  • The quality of sperm Poor quality sperm will not be able to fertilise an egg, resulting in one of the IUI failure reasons.
  • Timing After ovulation the egg stays in the fallopian tube for 12-24 hours, if there is no sperm present at that time to fertilise the egg, then it will disintegrate. So, the timing should be perfect.
  • Endometrial lining Another possible reasons IUI fails might be if the endometrial lining is not proper, and the fertilised egg cannot get embedded in the cavity.
  • Ovulation There might be a mild ovulation problem.
  • Progesterone Deficiency in progesterone may also be one of the failed IUI reasons as it is initially necessary to support a pregnancy.

Are there any 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 are 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.

Next step after failed IUI!

If a woman has a history of 3-4 failed IUI cycles, has low ovarian reserve, and is above 35 years of age, then as the very next step after failed IUI, she should consider IVF in that case as a significant treatment. It has been proved through various researches and studies that IVF (In-Vitro Fertilisation) and in case of severe male factor infertility, ICSI (Intracytoplasmic Sperm Injection) can considerably increase the chances of conception and overcome IUI Failure.

It must also be kept in mind that IUI might be less expensive than IVF, but it’s not inexpensive by any means. The cost with the number of tries and medications keeps increasing, along with the impact of IUI failure on infertility. Moreover, pregnancy symptoms after failed IUI also has low success rate as compared to that of other ART procedures. Therefore, it is highly recommended that after 3-4 failed attempts, a couple should not keep continuing on trying for their babies naturally after IUI pregnancy symptoms if nil, rather should consult an IVF Specialist.

Frequently Asked Questions

My semen ejaculation is very little and we want to have a baby. What is the best treatment for us?
I have retrograde ejaculation. What is the best fertility option for us?
I have delayed ejaculation and sometimes do not ejaculate. Will my wife be able to get pregnant?
Does dry ejaculation mean that I cannot have a child?