Efficacy of treatment with pseudoephedrine in men with retrograde ejaculation

Andrology. 2017 Jul;5(4):744-748. doi: 10.1111/andr.12361. Epub 2017 Apr 5.


The use of pseudoephedrine, an alpha agonist, for the treatment of retrograde ejaculation is well-known, however, there is no clear consensus from the literature regarding its efficacy and treatment protocol. We evaluated the efficacy of pseudoephedrine treatment in patients with retrograde ejaculation, utilizing a yet undescribed short-period treatment protocol. Twenty men were medically treated with pseudoephedrine for retrograde ejaculation between January 2010 and May 2016 (12 with complete retrograde ejaculation and 8 with partial retrograde ejaculation). All patients had a semen analysis and post-ejaculatory urinalysis before and after treatment. The treatment protocol consisted of 60 mg of pseudoephedrine every 6 h on the day before semen analysis and two more 60 mg doses on the day of the semen analysis. Diabetes was the most common etiology for complete retrograde ejaculation (60%), whereas an idiopathic cause was the most common etiology for partial retrograde ejaculation (82%). Of the 12 complete retrograde ejaculation patients treated with pseudoephedrine prior to semen analysis, 7 (58.3%) recovered spermatozoa in the antegrade ejaculate, with a mean total sperm count of 273.5 ± 172.5 million. Of the eight patients with partial retrograde ejaculation, five (62.5%) had a ≥50% increase in the antegrade total sperm count. In this group, the mean total sperm count increased from 26.9 ± 8.5 million before treatment to 84.2 ± 24.6 million after treatment, whereas the percentage of spermatozoa in the urine declined from 43.2 ± 9% to 17 ± 10%, respectively (both p < 0.05). Overall, in men with retrograde ejaculation treated with a pseudoephedrine regimen prior to ejaculation, some improvement in seminal parameters occurred in 14 (70%) patients, with 10 patients (38.5% of all patients) achieving antegrade total sperm counts over 39 million.

Keywords: male infertility; post-ejaculatory urinalysis; pseudoephedrine; retrograde ejaculation.

MeSH terms

  • Adrenergic alpha-Agonists / administration & dosage*
  • Adrenergic alpha-Agonists / adverse effects
  • Adult
  • Databases, Factual
  • Drug Administration Schedule
  • Ejaculation / drug effects*
  • Humans
  • Infertility, Male / diagnosis
  • Infertility, Male / drug therapy*
  • Infertility, Male / physiopathology
  • Male
  • Pseudoephedrine / administration & dosage*
  • Pseudoephedrine / adverse effects
  • Retrospective Studies
  • Sexual Dysfunction, Physiological / diagnosis
  • Sexual Dysfunction, Physiological / drug therapy*
  • Sexual Dysfunction, Physiological / physiopathology
  • Sperm Count
  • Sperm Motility / drug effects
  • Time Factors
  • Treatment Outcome


  • Adrenergic alpha-Agonists
  • Pseudoephedrine