The management of retrograde ejaculation: a systematic review and update.

OBJECTIVE

To determine the best management of retrograde ejaculation to optimize the chance of conception.

DESIGN

Systematic review.

SETTING

Tertiary reproductive medicine center.

PATIENT(S): Subfertile men with retrograde ejaculation.

METHOD(S): Systematic search of studies using search terms "management" or "therapy" or "treatment" and "retrograde ejaculation." We excluded case reports and papers not in English.

MAIN OUTCOME MEASURE(S): Pregnancy and live birth rates and rates of achievement of antegrade ejaculation.

RESULT(S): Thirty-four studies met our criteria. Studies were mostly observational. Descriptions of predictive and confounding variables were often insufficient. The treatment options included urinary sperm retrieval and medical management with anticholinergics and sympathomimetics. Successful pregnancies and live births were also achieved using surgical techniques and electroejaculation; however, numbers were small.

CONCLUSION(S): Many treatment options exist in the management of retrograde ejaculation; however, current literature is insufficient to allow firm comparisons between interventions. Treatment should be tailored, therefore, to the individual. Our findings support the need for further research in this area-including large randomized controlled trials. However, these would be difficult logistically and may not be possible.