Imipramine for successful treatment of retrograde ejaculation caused by retroperitoneal surgery

Abstract

Retrograde ejaculation is a known complication following retroperitoneal lymph node dissection. Without further therapy, achieving paternity may be impossible. We evaluated the use of the tricyclic antidepressant imipramine in a new ovarian cycle-dependent dose regime for reversal of retrograde ejaculation in 11 patients desiring fertility. Ten patients with retroperitoneal lymph node dissection performed because of testicular cancer, and one with aortic surgery (thromboendarterectomy) were treated in an open, uncontrolled study with imipramine given at a daily oral dose increasing from 25 to 50 mg for 7 days prior to the planned ejaculation or the expected ovulation of the female partner. In all 11 patients, antegrade ejaculation could be induced (sperm counts: 3.9-276.0 x 10(6)/mL). Major side-effects were not observed, but half of the patients complained of minor degrees of dizziness, weakness, nausea or sweating during medication. Under treatment, two patients with normal sperm concentrations induced a spontaneous pregnancy. One ICSI cycle each was performed in 2 patients, with successful fertilization, out no pregnancy. In conclusion, temporary oral intake of imipramine is an effective and safe treatment to re-establish antegrade ejaculation in patients with retrograde ejaculation following retroperitoneal surgery, thus providing possibilities for paternity either through intercourse or by assisted fertilization.

Steps in the investigation and management of low semen volume in the infertile man

“…The two agents most commonly used are pseudoephedine and imipramine; they can be used individually or in combination. [34][35][36] These agents have sympathomimetic properties and increase the tone at the bladder neck, and can also stimulate seminal emission. Imipramine can be taken (25 mg orally daily, escalated to 50 mg orally daily if no response) for 7 days prior to attempted ejaculation, and pseudoephedrine (30 mg orally) may be taken daily or 30 to 60 minutes prior to ejaculation.…”

Randomized crossover trial of amoxapine versus vitamin B12 for retrograde ejaculation

“…The adverse effects of imipramine were reported to be mild and included dizziness, weakness, palpitation, nausea and sweating. The overall rates of adverse effects in two studies were 45.45% (22) and 36.36% (7), respectively.…”

“…Imipramine was found to be effective and safe for the treatment of RE due to anatomic and physiologic causes (4-7, 22, 23). However, the overall success rate did not exceed 50% (4-7).…”

“…However, the overall success rate did not exceed 50% (4-7). Although the success rates for treating RE due to post-retroperitoneal lymph node dissection were reported to be nearly 100% (22, 23), these studies lacked controls and the sample sizes were small. The adverse effects of imipramine were reported to be mild and included dizziness, weakness, palpitation, nausea and sweating.…”

Medical Treatment of Retrograde Ejaculation in Diabetic Patients: A Hope for Spontaneous Pregnancy

“…Drugs used were either sympathomimetics or parasympatholytics [14]. Imipramine is a tricyclic antidepressant that also has a-adrenergic action and can thus lead to increase of pressure profile in posterior urethra [2]. It is one of the most popular drugs used for treatment of RE; however, only a few studies were conducted to evaluate its efficacy in diabetic patients with RE.…”