Infertility From Retrograde Ejaculation in a Diabetic Patient: a Case Report in Delta State, Nigeria

Infertility From Retrograde Ejaculation in a Diabetic Patient: a Case Report in Delta State, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Infertility From Retrograde Ejaculation in a Diabetic Patient: a Case Report in Delta State, Nigeria Prince Chidiebube Ubani, Unuakpotovo Oyefia-Emakpo, Tahir Aloaye Ibrahim, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5881766/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Retrograde ejaculation is an infrequent medical condition that is mostly seen in men who have undergone surgeries like transurethral resection of the prostate (TURP), in people who have diabetes mellitus or caused by some medications used in the treatment of high blood pressure or depression.This could lead to issues like infertility and more indirectly a reduced sense of sexual pleasure. Case Presentation: Retrograde ejaculation is an uncommon cause of infertility, dry orgasm, and psychological distress. This is a case report of a 34-year-old diabetic man with a history of ejaculatory dysfunction (anejaculation) who was initially treated with Tablet Chlorpheniramine and subsequently a combination of Chlorpheniramine and Imipramine to which he achieved Anterograde Ejaculation. Conclusion: Retrograde ejaculation is a common presentation among men with diabetes mellitus and antegrade ejaculation can be achieved with Tablet Chlorpheniramine with enhanced effectiveness when combined with Tablet Imipramine. Retrograde Ejaculation Diabetes Mellitus Chlorpheniramine Imipramine Antegrade Ejaculation INTRODUCTION Retrograde Ejaculation (RE), a subtype of ejaculatory dysfunction, is described as the abnormal backward (retrograde) directional flow of semen into the urinary bladder as opposed to the normal forward outlet of semen through the urethra following ejaculation after climax, resulting in reduced seminal volume and most cases dry ejaculation.[ 1 ] This study aims to highlight the link between diabetes and retrograde ejaculation, with a focus on how early diagnosis can aid in preventing infertility. CASE PRESENTATION A 34-year-old man presented with a four-year history of absent ejaculation and difficulty conceiving with his wife. He initially noticed a gradual reduction in semen volume, which eventually led to a complete absence of ejaculation despite reaching orgasm. However, he had no issues with libido, erection, or sexual satisfaction. One year after these symptoms began, he was diagnosed with Type 2 Diabetes Mellitus (T2DM) and started on oral medication. His brother also has diabetes. He has no history of pelvic surgery, cancer, radiation exposure, spinal injury, or mumps. He has not experienced symptoms of hormonal imbalance, such as headaches, thyroid issues, or breast enlargement. He does not smoke or use recreational drugs and drinks alcohol only occasionally. The patient fathered a child in a previous relationship and now wishes to have children with his wife. After visiting multiple fertility clinics without receiving a clear diagnosis, he sought a second opinion at our facility. On examination, he was 1.75 meters tall and weighed 65 kg (143.3 lbs). His genitalia appeared normal, with a circumcised penis and typical male hair distribution. There were no scars, masses, or abnormalities. His testes were normal in size and texture, and his urethra opened at the tip of the penis without additional openings. Diagnostic assessment and Management The patient underwent a series of diagnostic tests. At presentation, his random blood glucose was 391 mg/dL (21.72 mmol/L), which improved to 191 mg/dL (10.61 mmol/L) after dietary and medication adjustments. His HbA 1c was 12%, indicating poor long-term glycemic control. Routine blood tests, including full blood count (FBC) which was within normal limits, however electrolyte, urea, and creatinine (EUCr) had a slight elevation in sodium and creatinine suspected to be from dehydration as patient was in a habit of not inadequate hydration. (Table 1.0) Hormonal assay including Follicle stimulating hormone(FSH),Testosterone and Thyrotropin(TSH) were also within normal limits.(Table 1.0) Imaging studies, including abdominopelvic and penoscrotal ultrasound, showed no abnormalities. Urinalysis revealed glucosuria (+++), but there were no ketones present. Urine culture and sensitivity yielded no bacterial growth. A post-ejaculatory urine microscopy, performed after 72 hours of abstinence, showed a high concentration of sperm cells (+++) of about 32 X 10 6 mls in the urine and fructose was also found in urine. The World Health Organization(WHO) criteria for retrograde ejaculation were met (with retrograde ejaculation ratio(RER) of infinity) and the patient was clinically diagnosed as having retrograde ejaculation secondary to uncontrolled diabetes mellitus. The Patient was counseled on the above findings, on the need for strict adherence to oral glycaemic control medications with advice on Kegel‘s exercises before the commencement of medication. The patient was then placed on Tab Chlorpheniramine 4 mg 12 hourly and 4 days post drug initiation, he was able to achieve antegrade ejaculation (AE) with about 1 ml. Tab Imipramine 50mg daily was added on day 5 and the ejaculate achieved was 2 mls on day 10, which was subjected to Semen Analysis and the results were unremarkable following WHO 2010 parameters for semen analysis. The patient was subsequently tried on Tab Imipramine alone from day 12 - day 16 and in the end, was unable to achieve an adequate amount of ejaculate being only able to achieve 0.9mls of ejaculate. Following the cessation of medications, the patient failed to achieve AE. However, when recommenced on medication (Tab Chlorpheniramine + Tab Imipramine), the patient was able to do so making about 2.5mls, however this was not analyzed. The patient was then counselled on the need to have his spouse examined for possible female factors that could also play a role in preventing pregnancy while being counselled on the need to look out for possible side effects associated with the combination of both drug regimens,however spouse could not be evaluated and she failed to report at the facility. He was also counseled on alternative to achieving pregnancy via Assisted Reproductive Technologies. Table 1.0 Investigations Result Normal Range Full blood count Packed Cell Volume 35% 34 - 54% White Blood Cell Count 7000cells/mm 3 3,500 - 10,000mm 3 Neutrophil 50% 40 - 60% Lymphocyte 42% 20 - 40% Eosinophil 03% 1 - 4% Monocyte 05% 2 - 8% Basophil 00% 0.5 - 1% Electrolyte Urea and Creatinine Urea 54 11 - 55mg/dl Creatinine 1.2 0.3 - 1.5mg/dl Sodium 155 135 - 150mmol/l Potassium 5.3 3.4 - 5.3mmol/l Chloride 109 96 - 106mmol/l Hormonal Assay Follicle stimulating Hormone 4.485 1 - 13mIU/ml Testosterone 2.939 2.2 - 10.5nmol/l Thyrotropin 1.475 0.3 - 4.5uIU/ml DISCUSSION This case highlights retrograde ejaculation (RE) in a patient with longstanding Type 2 Diabetes Mellitus (T2DM), a well-documented but often underrecognized complication of diabetic autonomic neuropathy.[ 2 ] A few studies in Nigeria have reported RE as a known contributor to male-factor infertility, although its occurrence seems to be rare.[ 3 , 4 ] The patient presented with infertility concerns, and RE was confirmed through post-ejaculatory urinalysis. The case aligns with existing literature, which reports that RE is a known consequence of autonomic dysfunction in diabetics and a contributor to male infertility.[ 5 ] Given the high HbA1c level (12%), it is evident that poor glycemic control played a significant role in the pathophysiology of this condition. RE results from failure of the bladder neck to close during ejaculation, leading to the backflow of semen into the bladder. This is predominantly mediated by sympathetic nervous dysfunction, which is a known complication of diabetes-related autonomic neuropathy.[ 6 ] Studies have shown that RE is more prevalent in long-standing diabetes cases with poor glycemic control.[ 7 ] Mao et al. reported a similar case where RE was the initial presenting symptom of T2DM. Our patient had a history of non-compliance with oral glucose-lowering agents (OGLAs) and poorly controlled diabetes, reinforcing the link between hyperglycemia and autonomic dysfunction.[ 2 ] The diagnosis of RE was established based on semen analysis and post-ejaculatory urinalysis, with findings consistent with established diagnostic criteria. [ 8 , 9 ] Brugh and Lipshultz emphasize that semen volume < 1.5 mL with significant sperm presence in post-ejaculatory urine confirms the diagnosis.[ 10 ] Additionally, investigations to rule out structural causes such as transrectal ultrasound and vasography were deemed unnecessary in this case, as no prior pelvic surgeries were reported. The management of RE in diabetic patients focuses on achieving glycemic control, as case reports have demonstrated reversal of RE following improved diabetes management.[ 7 ] Kam et al. documented a case where RE was resolved after achieving optimal HbA1c levels, reinforcing the need for aggressive diabetes management in our patient.[ 7 ] The American Diabetes Association (ADA) guidelines recommend a stepwise approach for glycemic control, targeting HbA1c < 7% and fasting blood glucose of 80–130 mg/dL.[ 11 ] The patient was already on Galvumet and was counseled on the need to comply with the medication regimen. Lifestyle modifications, including dietary adjustments and increased physical activity, were also emphasized.[ 11 ] Alpha-adrenergic agonists such as pseudoephedrine and imipramine have been reported to improve bladder neck closure and semen expulsion.[ 1 , 12 ] However, their efficacy in diabetic RE is variable due to underlying autonomic dysfunction.[ 13 ] However, following a trial of chlorpheniramine and imipramine, the patient achieved ejaculation. He was unable to achieve ejaculation following temporary cessation of the medications, but was again able to ejaculate when the medications were resumed. This suggests the medications played a major role in achieving ejaculation in this patient. For patients with persistent RE despite medical therapy, assisted reproductive techniques (ART) such as intrauterine insemination (IUI) or in-vitro fertilization (IVF) with sperm retrieval may be necessary.[ 1 , 14 ] Given the patient’s infertility concerns, sperm retrieval from post-ejaculatory urine followed by ART was discussed as a potential option. The prognosis of RE in diabetic patients is largely dependent on glycemic control. Studies indicate that achieving normoglycemia can lead to significant improvement or resolution of RE in some cases.[ 7 ] Regular follow-up with HbA1 c monitoring every three months, lifestyle adherence, and potential ART consultation remain key components of long-term management. CONCLUSION This case highlights retrograde ejaculation as a potential complication of poorly controlled Type 2 Diabetes Mellitus, emphasizing the impact of diabetic autonomic neuropathy on male fertility. The successful response to chlorpheniramine and imipramine in the patient suggests that combination therapy can be an effective pharmacological approach. However, strict glycemic control remains the cornerstone of management, as evidence indicates that improved diabetes control can lead to significant symptom resolution. Given the growing prevalence of diabetes, clinicians should actively screen for retrograde ejaculation in diabetic men presenting with infertility. For cases resistant to medical therapy, assisted reproductive techniques (ART) should be considered to improve fertility outcomes. A multidisciplinary approach involving endocrinologists, urologists, and fertility specialists is crucial for optimizing patient care. RECOMMENDATIONS Retrograde ejaculation doesn’t cause pain or lead to serious health complications. The major complication is infertility. - For patients trying to conceive, consider assisted reproduction techniques like semen retrieval from the bladder or testicular sperm extraction. Intrauterine insemination (IUI) can be done or in-vitro fertilization if IUI is unsuccessful. - Early diagnosis and management is recommended in male subjects who have noticed a reduction in seminal fluid volume and especially if associated with infertility. - All diabetic patients with complaints of infertility should be properly screened for retrograde ejacualtion. - Combination therapy with Tab Imipramine + Tab chlorpheniramine is recommended for the medical management of retrograde ejaculation seeing the synergistic effect it had on our patient. - Further research is needed to understand the underlying causes of retrograde ejaculation. Declarations Ethics Approval and Consent to partcipate Ethics approval were not required for this case report in accordance with institutional guidelines however consent to partcipate was obtained from the patient and a copy of the written is available for review by the editor of this journal. Consent for publication Written informed consent was obtained from the patient to publish this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution UP was the primary health care giver of the patient and conceived the original idea, OU, WN, OC, IT, SE, PS, AG, RC and IJ worked on the first draft of the manuscript. IT, ES, OS, EG, RC, OJ and AF reviewed the first draft of the manuscript.AF reviewed and edited the final manuscript.All authors reviewed and approved the final manuscript for submission. References Mayo Clinic. Retrograde Ejaculation. Mayo Clinic 2022. https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/symptoms-causes/syc-20354890 Accessed on Oct 11th,2024. Mao Y, Fang N, Sheng Z, Mai Y. Retrograde ejaculation as an initial presenting symptom of type 2 diabetes mellitus: a case report and literature review.Journal of Men's Health [Internet]. 2021 [cited 2024 Oct 4];18(3):1.Available from: Makinde, O., Salako, A., Loto, O., Fasubaa, O., Ogunniyi, S., Onwudiegwu, U., & Dare, F. (2012). Retrograde ejaculation related infertility in Ile-Ife, Nigeria. Tropical Journal of Obstetrics and Gynaecology, 29(1), 126–130. https://www.ajol.info/index.php/tjog/article/download/85565/75490 Hm, N. A., & M, N. A. (2020). Primary infertility due to retrograde ejaculation: Case series. Ibom Medical Journal, 13(1), 50–54. https://doi.org/10.61386/imj.v13i1.177 Yavetz H,Yogev L, Hauser R, et al, : Retrograde ejaculation Human Reproduction 1994,9:381-386 Louis Revenig, Andrew Leung, Wayland Hsiao. Ejaculatory physiology and pathophysiology: assessment and treatment of male infertility. Translational Andrology and Urology, 2014. https://tau.amegroups.org/article/view/3515/4361 Accessed on Oct 19th,2024. Kam J, Tsang VH, Chalasani V. Retrograde Ejaculation: a Rare Presenting Symptom of Type 1 Diabetes Mellitus. Urology Case Reports.2016;10:9-10. American Diabetes Association. Standards of Care in Diabetes-2024 the Journal of Clinical and Applied Research and Education [Internet].2024[cited 2024 Oct 5]. Available from: https://ada.silverchair-cdn.com/ada/contentpublic/journal/care/issue/47/supplement 1/16/standards-of-care-2024.pdf Muammer K, Wanye JG; Retrograde ejaculation; Etiology, diagnosis and management, Current Sexual Health 2006,3:133-138 Hershlag A, Schiff SF, DeCherney AH: Retrograde ejaculation; Human reproduction 1991,6:255-258 Brugh VM 3rd, Lipshultz LI: Male factor infertility evaluation and management, Med Clin North Am 2004, 88,367-385 American Diabetes Association. Standards of Care in Diabetes-2024 The Journal Of Clinical And Applied Research And Education [Internet].2024 [cited 2024 Oct 5]. Available from: https://ada.silverchair-cdn.com/ada/contentpublic/journal/care/issue/47/supplement 1/16/standards-of-care-2024.pdf Kamischke A, Nieschlag E: Treatment of retrograde ejaculation and anejaculation, Human reproduction update 1999,5:448-474 Tomasi,P., Fanciulli, G. & Delitala,G. Successful treatment of retrograde ejaculation with the al-adrenergic agonist methoxamine: case study. Int J Impot Res 17, 297-299 (2005).https://doi.org/10.1038/sj.ijir.3901253 Merck Manual.Retrograde Ejaculation [Internet].Merck Manual;2024 [cited 2024 Oct 9]. Available from: https://www.merckmanuals.com/home/male-reproductive-disorders/ejaculation-disorders/retrograde-ejaculation Additional Declarations No competing interests reported. Supplementary Files CAREchecklistforinfertility.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5881766","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":437666936,"identity":"19c20b21-a1dd-4ca4-b81e-bf6e7547c7cd","order_by":0,"name":"Prince Chidiebube Ubani","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Prince","middleName":"Chidiebube","lastName":"Ubani","suffix":""},{"id":437666938,"identity":"85e7e867-a8de-41c4-8118-f410ad25bd92","order_by":1,"name":"Unuakpotovo 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03:02:30","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":24862,"visible":true,"origin":"","legend":"","description":"","filename":"CAREchecklistforinfertility.docx","url":"https://assets-eu.researchsquare.com/files/rs-5881766/v1/f9cac34bb13acad3a04c3436.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eInfertility From Retrograde Ejaculation in a Diabetic Patient: a Case Report in Delta State, Nigeria\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eRetrograde Ejaculation (RE), a subtype of ejaculatory dysfunction, is described as the abnormal backward (retrograde) directional flow of semen into the urinary bladder as opposed to the normal forward outlet of semen through the urethra following ejaculation after climax, resulting in reduced seminal volume and most cases dry ejaculation.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] This study aims to highlight the link between diabetes and retrograde ejaculation, with a focus on how early diagnosis can aid in preventing infertility.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 34-year-old man presented with a four-year history of absent ejaculation and difficulty conceiving with his wife.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHe initially noticed a gradual reduction in semen volume, which eventually led to a complete absence of ejaculation despite reaching orgasm. However, he had no issues with libido, erection, or sexual satisfaction.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne year after these symptoms began, he was diagnosed with Type 2 Diabetes Mellitus (T2DM) and started on oral medication. His brother also has diabetes. He has no history of pelvic surgery, cancer, radiation exposure, spinal injury, or mumps. He has not experienced symptoms of hormonal imbalance, such as headaches, thyroid issues, or breast enlargement. He does not smoke or use recreational drugs and drinks alcohol only occasionally.\u003c/p\u003e\n\u003cp\u003eThe patient fathered a child in a previous relationship and now wishes to have children with his wife. After visiting multiple fertility clinics without receiving a clear diagnosis, he sought a second opinion at our facility.\u003c/p\u003e\n\u003cp\u003eOn examination, he was 1.75 meters tall and weighed 65 kg (143.3 lbs). His genitalia appeared normal, with a circumcised penis and typical male hair distribution. There were no scars, masses, or abnormalities. His testes were normal in size and texture, and his urethra opened at the tip of the penis without additional openings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic assessment and Management\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe patient underwent a series of diagnostic tests. At presentation, his random blood glucose was 391 mg/dL (21.72 mmol/L), which improved to 191 mg/dL (10.61 mmol/L) after dietary and medication adjustments. His HbA\u003csub\u003e1c\u0026nbsp;\u003c/sub\u003ewas 12%, indicating poor long-term glycemic control. Routine blood tests, including full blood count (FBC) which was within normal limits, however electrolyte, urea, and creatinine (EUCr) had a slight elevation in sodium and creatinine suspected to be from dehydration as patient was in a habit of not inadequate hydration. (Table 1.0)\u003c/p\u003e\n\u003cp\u003eHormonal assay including Follicle stimulating hormone(FSH),Testosterone and Thyrotropin(TSH) were also within normal limits.(Table 1.0)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImaging studies, including abdominopelvic and penoscrotal ultrasound, showed no abnormalities. Urinalysis revealed glucosuria (+++), but there were no ketones present. Urine culture and sensitivity yielded no bacterial growth.\u003c/p\u003e\n\u003cp\u003eA post-ejaculatory urine microscopy, performed after 72 hours of abstinence, showed a high concentration of sperm cells (+++) of about 32\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eX 10\u003csup\u003e6\u003c/sup\u003emls \u0026nbsp;in the urine and fructose was also found in urine.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe World Health Organization(WHO) criteria for retrograde ejaculation were met (with retrograde ejaculation ratio(RER) of infinity) and the patient was clinically diagnosed as having retrograde ejaculation secondary to uncontrolled diabetes mellitus.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Patient was counseled on the above findings, on the need for strict adherence to oral glycaemic control medications with advice on Kegel\u0026lsquo;s exercises before the commencement of medication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe patient was then placed on Tab Chlorpheniramine 4 mg 12 hourly and 4 days post drug initiation, he was able to achieve antegrade ejaculation (AE) with about 1 ml.\u003c/p\u003e\n\u003cp\u003eTab Imipramine 50mg daily was added on day 5 and the ejaculate achieved was 2 mls on day 10, which was subjected to Semen Analysis and the results were\u0026nbsp;unremarkable\u0026nbsp;following WHO 2010 parameters for semen analysis.\u003c/p\u003e\n\u003cp\u003eThe patient was subsequently tried on Tab Imipramine alone from day 12 - day 16 and in the end, was unable to achieve an adequate amount of ejaculate being only able to achieve 0.9mls of ejaculate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing the cessation of medications, the patient failed to achieve AE. However, when recommenced on medication (Tab Chlorpheniramine + Tab Imipramine), the patient was able to do so making about 2.5mls, however this was not analyzed. The patient was then counselled on the need to have his spouse examined for possible female factors that could also play a role in preventing pregnancy while being counselled on the need to look out for possible side effects associated with the combination of both drug regimens,however spouse could not be evaluated and she failed to report at the facility. He was also counseled on alternative to achieving pregnancy via Assisted Reproductive Technologies.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1.0\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInvestigations\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNormal Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull blood count\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003ePacked Cell Volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e35%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e34 - 54%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eWhite Blood Cell Count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e7000cells/mm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e3,500 - 10,000mm\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eNeutrophil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e40 - 60%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eLymphocyte\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e42%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e20 - 40%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eEosinophil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e03%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e1 - 4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eMonocyte\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e05%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e2 - 8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eBasophil\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e00%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e0.5 - 1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eElectrolyte Urea and Creatinine\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eUrea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e11 - 55mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eCreatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e0.3 - 1.5mg/dl\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eSodium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e135 - 150mmol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003ePotassium\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e5.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e3.4 - 5.3mmol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eChloride\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e96 - 106mmol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHormonal Assay\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eFollicle stimulating Hormone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e4.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e1 - 13mIU/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eTestosterone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e2.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e2.2 - 10.5nmol/l\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 38.7821%;\"\u003e\n \u003cp\u003eThyrotropin\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 32.6923%;\"\u003e\n \u003cp\u003e1.475\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.5256%;\"\u003e\n \u003cp\u003e0.3 - 4.5uIU/ml\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis case highlights retrograde ejaculation (RE) in a patient with longstanding Type 2 Diabetes Mellitus (T2DM), a well-documented but often underrecognized complication of diabetic autonomic neuropathy.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] A few studies in Nigeria have reported RE as a known contributor to male-factor infertility, although its occurrence seems to be rare.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe patient presented with infertility concerns, and RE was confirmed through post-ejaculatory urinalysis. The case aligns with existing literature, which reports that RE is a known consequence of autonomic dysfunction in diabetics and a contributor to male infertility.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Given the high HbA1c level (12%), it is evident that poor glycemic control played a significant role in the pathophysiology of this condition.\u003c/p\u003e \u003cp\u003eRE results from failure of the bladder neck to close during ejaculation, leading to the backflow of semen into the bladder. This is predominantly mediated by sympathetic nervous dysfunction, which is a known complication of diabetes-related autonomic neuropathy.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Studies have shown that RE is more prevalent in long-standing diabetes cases with poor glycemic control.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Mao et al. reported a similar case where RE was the initial presenting symptom of T2DM. Our patient had a history of non-compliance with oral glucose-lowering agents (OGLAs) and poorly controlled diabetes, reinforcing the link between hyperglycemia and autonomic dysfunction.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe diagnosis of RE was established based on semen analysis and post-ejaculatory urinalysis, with findings consistent with established diagnostic criteria. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Brugh and Lipshultz emphasize that semen volume\u0026thinsp;\u0026lt;\u0026thinsp;1.5 mL with significant sperm presence in post-ejaculatory urine confirms the diagnosis.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Additionally, investigations to rule out structural causes such as transrectal ultrasound and vasography were deemed unnecessary in this case, as no prior pelvic surgeries were reported.\u003c/p\u003e \u003cp\u003eThe management of RE in diabetic patients focuses on achieving glycemic control, as case reports have demonstrated reversal of RE following improved diabetes management.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Kam et al. documented a case where RE was resolved after achieving optimal HbA1c levels, reinforcing the need for aggressive diabetes management in our patient.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe American Diabetes Association (ADA) guidelines recommend a stepwise approach for glycemic control, targeting HbA1c\u0026thinsp;\u0026lt;\u0026thinsp;7% and fasting blood glucose of 80\u0026ndash;130 mg/dL.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] The patient was already on Galvumet and was counseled on the need to comply with the medication regimen. Lifestyle modifications, including dietary adjustments and increased physical activity, were also emphasized.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAlpha-adrenergic agonists such as pseudoephedrine and imipramine have been reported to improve bladder neck closure and semen expulsion.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] However, their efficacy in diabetic RE is variable due to underlying autonomic dysfunction.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] However, following a trial of chlorpheniramine and imipramine, the patient achieved ejaculation. He was unable to achieve ejaculation following temporary cessation of the medications, but was again able to ejaculate when the medications were resumed. This suggests the medications played a major role in achieving ejaculation in this patient.\u003c/p\u003e \u003cp\u003eFor patients with persistent RE despite medical therapy, assisted reproductive techniques (ART) such as intrauterine insemination (IUI) or in-vitro fertilization (IVF) with sperm retrieval may be necessary.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Given the patient\u0026rsquo;s infertility concerns, sperm retrieval from post-ejaculatory urine followed by ART was discussed as a potential option.\u003c/p\u003e \u003cp\u003eThe prognosis of RE in diabetic patients is largely dependent on glycemic control. Studies indicate that achieving normoglycemia can lead to significant improvement or resolution of RE in some cases.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Regular follow-up with HbA1\u003csub\u003ec\u003c/sub\u003e monitoring every three months, lifestyle adherence, and potential ART consultation remain key components of long-term management.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis case highlights retrograde ejaculation as a potential complication of poorly controlled Type 2 Diabetes Mellitus, emphasizing the impact of diabetic autonomic neuropathy on male fertility. The successful response to chlorpheniramine and imipramine in the patient suggests that combination therapy can be an effective pharmacological approach. However, strict glycemic control remains the cornerstone of management, as evidence indicates that improved diabetes control can lead to significant symptom resolution.\u003c/p\u003e \u003cp\u003eGiven the growing prevalence of diabetes, clinicians should actively screen for retrograde ejaculation in diabetic men presenting with infertility. For cases resistant to medical therapy, assisted reproductive techniques (ART) should be considered to improve fertility outcomes. A multidisciplinary approach involving endocrinologists, urologists, and fertility specialists is crucial for optimizing patient care.\u003c/p\u003e"},{"header":"RECOMMENDATIONS","content":"\u003cp\u003eRetrograde ejaculation doesn\u0026rsquo;t cause pain or lead to serious health complications. The major complication is infertility.\u003c/p\u003e\n\u003cp\u003e- For patients trying to conceive, consider assisted reproduction techniques like semen retrieval from the bladder or testicular sperm extraction. Intrauterine insemination (IUI) can be done or in-vitro fertilization if IUI is unsuccessful.\u003c/p\u003e\n\u003cp\u003e- Early diagnosis and management is recommended in male subjects who have noticed a reduction in seminal fluid volume and especially if associated with infertility.\u003c/p\u003e\n\u003cp\u003e- All diabetic patients with complaints of infertility should be properly screened for retrograde ejacualtion.\u003c/p\u003e\n\u003cp\u003e- Combination therapy with Tab Imipramine + Tab chlorpheniramine is recommended for the medical management of retrograde ejaculation seeing the synergistic effect it had on our patient.\u003c/p\u003e\n\u003cp\u003e- Further research is needed to understand the underlying causes of retrograde ejaculation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eEthics Approval and Consent to partcipate\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eEthics approval were not required for this case report in accordance with institutional guidelines however consent to partcipate was obtained from the patient and a copy of the written is available for review by the editor of this journal.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eConsent for publication\u0026nbsp;\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient to publish this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eFunding\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eUP was the primary health care giver of the patient and conceived the original idea, OU, WN, OC, IT, SE, PS, AG, RC and IJ worked on the first draft of the manuscript. IT, ES, OS, EG, RC, OJ and AF reviewed the first draft of the manuscript.AF reviewed and edited the final manuscript.All authors reviewed and approved the final manuscript for submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMayo Clinic. Retrograde Ejaculation. Mayo Clinic 2022. https://www.mayoclinic.org/diseases-conditions/retrograde-ejaculation/symptoms-causes/syc-20354890 Accessed on Oct 11th,2024.\u003c/li\u003e\n\u003cli\u003eMao Y, Fang N, Sheng Z, Mai Y. Retrograde ejaculation as an initial presenting symptom of type 2 diabetes mellitus: a case report and literature review.Journal of Men\u0026apos;s Health [Internet]. 2021 [cited 2024 Oct 4];18(3):1.Available from:\u003c/li\u003e\n\u003cli\u003eMakinde, O., Salako, A., Loto, O., Fasubaa, O., Ogunniyi, S., Onwudiegwu, U., \u0026amp; Dare, F. (2012). Retrograde ejaculation related infertility in Ile-Ife, Nigeria. Tropical Journal of Obstetrics and Gynaecology, 29(1), 126\u0026ndash;130. https://www.ajol.info/index.php/tjog/article/download/85565/75490\u003c/li\u003e\n\u003cli\u003eHm, N. A., \u0026amp; M, N. A. (2020). Primary infertility due to retrograde ejaculation: Case series. Ibom Medical Journal, 13(1), 50\u0026ndash;54. https://doi.org/10.61386/imj.v13i1.177\u003c/li\u003e\n\u003cli\u003eYavetz H,Yogev L, Hauser R, et al, : Retrograde ejaculation Human Reproduction 1994,9:381-386\u003c/li\u003e\n\u003cli\u003eLouis Revenig, Andrew Leung, Wayland Hsiao. Ejaculatory physiology and pathophysiology: assessment and treatment of male infertility. Translational Andrology and Urology, 2014. https://tau.amegroups.org/article/view/3515/4361 Accessed on Oct 19th,2024.\u003c/li\u003e\n\u003cli\u003eKam J, Tsang VH, Chalasani V. Retrograde Ejaculation: a Rare Presenting Symptom of Type 1 Diabetes Mellitus. Urology Case Reports.2016;10:9-10. \u003cbr\u003eAmerican Diabetes Association. Standards of Care in Diabetes-2024 the Journal of Clinical and Applied Research and Education [Internet].2024[cited 2024 Oct 5].\u003cbr\u003e Available from: https://ada.silverchair-cdn.com/ada/contentpublic/journal/care/issue/47/supplement 1/16/standards-of-care-2024.pdf\u003c/li\u003e\n\u003cli\u003eMuammer K, Wanye JG; Retrograde ejaculation; Etiology, diagnosis and management, Current Sexual Health 2006,3:133-138\u003c/li\u003e\n\u003cli\u003eHershlag A, Schiff SF, DeCherney AH: Retrograde ejaculation; Human reproduction 1991,6:255-258\u003c/li\u003e\n\u003cli\u003eBrugh VM 3rd, Lipshultz LI: Male factor infertility evaluation and management, Med Clin North Am 2004, 88,367-385\u003c/li\u003e\n\u003cli\u003eAmerican Diabetes Association. Standards of Care in Diabetes-2024 The Journal Of Clinical And Applied Research And Education [Internet].2024 [cited 2024 Oct 5]. Available from: https://ada.silverchair-cdn.com/ada/contentpublic/journal/care/issue/47/supplement 1/16/standards-of-care-2024.pdf\u003c/li\u003e\n\u003cli\u003eKamischke A, Nieschlag E: Treatment of retrograde ejaculation and anejaculation, Human reproduction update 1999,5:448-474\u003c/li\u003e\n\u003cli\u003eTomasi,P., Fanciulli, G. \u0026amp; Delitala,G. Successful treatment of retrograde ejaculation with the al-adrenergic agonist methoxamine: case study. Int J Impot Res 17, 297-299 (2005).https://doi.org/10.1038/sj.ijir.3901253\u003c/li\u003e\n\u003cli\u003eMerck Manual.Retrograde Ejaculation [Internet].Merck Manual;2024 [cited 2024 Oct 9]. Available from: https://www.merckmanuals.com/home/male-reproductive-disorders/ejaculation-disorders/retrograde-ejaculation\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Retrograde Ejaculation, Diabetes Mellitus, Chlorpheniramine, Imipramine, Antegrade Ejaculation","lastPublishedDoi":"10.21203/rs.3.rs-5881766/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5881766/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrograde ejaculation is an infrequent medical condition that is mostly seen in men who have undergone surgeries like transurethral resection of the prostate (TURP), in people who have diabetes mellitus or caused by some medications used in the treatment of high blood pressure or depression.This could lead to issues like infertility and more indirectly a reduced sense of sexual pleasure.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrograde ejaculation is an uncommon cause of infertility, dry orgasm, and psychological distress. This is a case report of a 34-year-old diabetic man with a history of ejaculatory dysfunction (anejaculation) who was initially treated with Tablet Chlorpheniramine and subsequently a combination of Chlorpheniramine and Imipramine to which he achieved Anterograde Ejaculation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRetrograde ejaculation is a common presentation among men with diabetes mellitus and antegrade ejaculation can be achieved with Tablet Chlorpheniramine with enhanced effectiveness when combined with Tablet Imipramine.\u003c/p\u003e","manuscriptTitle":"Infertility From Retrograde Ejaculation in a Diabetic Patient: a Case Report in Delta State, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-24 03:02:25","doi":"10.21203/rs.3.rs-5881766/v1","editorialEvents":[{"type":"communityComments","content":2}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"01d11d9d-5b32-4f0a-8385-e13f9044e5a1","owner":[],"postedDate":"April 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T13:41:35+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-24 03:02:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5881766","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5881766","identity":"rs-5881766","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}