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68years Old Male Sudden Drop In My Semen Volume During Strict Morphology Analysis, It Was Observed That Majority Of The Observed Sperm Had No Tail. If Tail Was Present, It Was Either Curled Or Bent What Should I Do About My Semen Problem?
Question: I am a 68 year old male, jog 4 miles a day (45 minutes) and have had BPH for about 5 years. My blood pressure has always been around 110/70 and called “perfect”.
A few years ago there was a sudden drop in my semen volume from about a teaspoon when I was young to 1/4 of that. It was said to be retrograde ejaculation. I was taking doxazosin 2MG daily. A recent ultrasound showed “no blockage of semen”.
In January of this year the doxazosin was suspended to see if there were any adverse effects. There were none and I haven’t taken it since (30 doses remain.) A semen analysis showed a concentration of 114 million/ML, 37% motility, 4% normal morphology by Kruger strict criteria. I have 5 semen samples cryopreserved.
In March, a new urologist prescribed tamsulosin .4 MG daily. Since then my semen volume again dropped, to only a few drops and occasionally 1/8 teaspoon. A semen analysis a week ago was my worst ever: concentration of 8 million/ML, motility N/A, Grade of Motility 3-4 (out of 1 to 4), Strict Morphology 0% normal. The Comment: “Only non-progressive sperm observed in original specimen. During strict morphology analysis, it was observed that majority of the observed sperm had no tail. If tail was present, it was either curled or bent.” My blood pressure has now occasionally reached 120/70.
My 32 year old wife and I are trying to conceive and are considering a recommended IVF with ICSI. I sent messages to my urologist regarding the semen problem but he is slow to respond. He finally wrote, “your surgery is the issue” without explanation and I replied that I have never had surgery.
What should I do about my semen problem? I plan to see another urologist but want to know of good options when I see him.
A few years ago there was a sudden drop in my semen volume from about a teaspoon when I was young to 1/4 of that. It was said to be retrograde ejaculation. I was taking doxazosin 2MG daily. A recent ultrasound showed “no blockage of semen”.
In January of this year the doxazosin was suspended to see if there were any adverse effects. There were none and I haven’t taken it since (30 doses remain.) A semen analysis showed a concentration of 114 million/ML, 37% motility, 4% normal morphology by Kruger strict criteria. I have 5 semen samples cryopreserved.
In March, a new urologist prescribed tamsulosin .4 MG daily. Since then my semen volume again dropped, to only a few drops and occasionally 1/8 teaspoon. A semen analysis a week ago was my worst ever: concentration of 8 million/ML, motility N/A, Grade of Motility 3-4 (out of 1 to 4), Strict Morphology 0% normal. The Comment: “Only non-progressive sperm observed in original specimen. During strict morphology analysis, it was observed that majority of the observed sperm had no tail. If tail was present, it was either curled or bent.” My blood pressure has now occasionally reached 120/70.
My 32 year old wife and I are trying to conceive and are considering a recommended IVF with ICSI. I sent messages to my urologist regarding the semen problem but he is slow to respond. He finally wrote, “your surgery is the issue” without explanation and I replied that I have never had surgery.
What should I do about my semen problem? I plan to see another urologist but want to know of good options when I see him.
Brief Answer:
All this problem is due to side effect of Tomsulosin and age related
Detailed Answer:
Hello,
Based on the facts that you have posted the abnormal parameters that have been noted in Semen analysis are age related and mainly due to retrograde ejaculation that is a known side effect of Tomsulosin .
I shall be happy if you can post me more details to help me in making precise comments
1) are you taking Dutasteride along with Tomsulosin ?
2) What is the size of your Prostate as reported in Ultrasound Scanning report and what is the volume of Post Void Residual Urine (PVR)?
3) Can you upload report of recent ultrasound Scan ?
4) Have you done Uroflowmetry and jf so upload report of the the same
5) Upload recent semen Analysis report .
In a given situation since you desire to have a child I would suggest you to stop these medication and to repeat Semen analysis to observe for any change in semen parameters .However you will have to compromise and bear obstructive voiding symptoms due to Enlarged Prostate like frequency for urination ,urgency .nocturia etc .
Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.
All this problem is due to side effect of Tomsulosin and age related
Detailed Answer:
Hello,
Based on the facts that you have posted the abnormal parameters that have been noted in Semen analysis are age related and mainly due to retrograde ejaculation that is a known side effect of Tomsulosin .
I shall be happy if you can post me more details to help me in making precise comments
1) are you taking Dutasteride along with Tomsulosin ?
2) What is the size of your Prostate as reported in Ultrasound Scanning report and what is the volume of Post Void Residual Urine (PVR)?
3) Can you upload report of recent ultrasound Scan ?
4) Have you done Uroflowmetry and jf so upload report of the the same
5) Upload recent semen Analysis report .
In a given situation since you desire to have a child I would suggest you to stop these medication and to repeat Semen analysis to observe for any change in semen parameters .However you will have to compromise and bear obstructive voiding symptoms due to Enlarged Prostate like frequency for urination ,urgency .nocturia etc .
Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
1=No. 2,3,5=Uploaded file - if I can find where to do that. 4=No. Original question contains latest and previous semen analysis which is also copied in file I will upload if I can see where to upload it. Where is that?
What caused my terrible last semen analysis - the tamsulosin?
How do I fix my semen so the semen analysis is good again?
What is the chance that I will be able to fix it?
How long would it take to fix it?
I have uploaded a pdf of everything.
How do I fix my semen so the semen analysis is good again?
What is the chance that I will be able to fix it?
How long would it take to fix it?
I have uploaded a pdf of everything.
Brief Answer:
Detailed Answer:
Hello
Thanks for follow up and uploading reports .
I would explain the reason for abnormal semen analysis .
Under normal circumstances during process of ejaculation bladder neck gets closed tightly and urethral sphincter muscle relaxes which helps to (move)propel the semen to move forward into urethra to be expelled outside penis However this scenario is disturbed in patients who are taking Tomsulosin. Tomsulosin is a drug that belongs to alpha blocker which relaxes smooth muscles in bladder neck and prostatic part of urethra keeping bladder neck wide open .This leads to entire semen to move backwards into bladder instead of moving forward into penile urethra which gets mixed up with urine hence very little quantity of semen is being ejaculated outside through the penis This is called as Retrograde Ejaculation or Dry Ejaculation .This explains the reason for abnormal semen parameters.
This will get recovered back to normal when one stops taking Tomsulosin .Hence you can stop taking Tomsulosin for a while ( for few months) when you are planning for conception and repeat Semen Analysis and you will find all the parameters of semen being recovered to normal levels which can help to result in to conception provided there are no fertility issues with your wife ...
Hope this will allay your anxiety ,Do write if you have any more questions .I would be glad to address your concern. .
Thanks and Regards.
Dr Patil.
Detailed Answer:
Hello
Thanks for follow up and uploading reports .
I would explain the reason for abnormal semen analysis .
Under normal circumstances during process of ejaculation bladder neck gets closed tightly and urethral sphincter muscle relaxes which helps to (move)propel the semen to move forward into urethra to be expelled outside penis However this scenario is disturbed in patients who are taking Tomsulosin. Tomsulosin is a drug that belongs to alpha blocker which relaxes smooth muscles in bladder neck and prostatic part of urethra keeping bladder neck wide open .This leads to entire semen to move backwards into bladder instead of moving forward into penile urethra which gets mixed up with urine hence very little quantity of semen is being ejaculated outside through the penis This is called as Retrograde Ejaculation or Dry Ejaculation .This explains the reason for abnormal semen parameters.
This will get recovered back to normal when one stops taking Tomsulosin .Hence you can stop taking Tomsulosin for a while ( for few months) when you are planning for conception and repeat Semen Analysis and you will find all the parameters of semen being recovered to normal levels which can help to result in to conception provided there are no fertility issues with your wife ...
Hope this will allay your anxiety ,Do write if you have any more questions .I would be glad to address your concern. .
Thanks and Regards.
Dr Patil.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. Your explanation explains why the latest semen analysis has a low volume. But why is the concentration down from 114 million to 8 million, motility down from 37% to N/A, and morphology down from 4% normal to 0% normal (the worst ever)?
Also, isn’t the tamsulosin for my BPH? Then what would be best to replace the tamsulosin, especially since we wish to conceive?
When I stop taking tamsulosin, would my prostate enlarge again and cause retrograde ejaculation?
Also, isn’t the tamsulosin for my BPH? Then what would be best to replace the tamsulosin, especially since we wish to conceive?
When I stop taking tamsulosin, would my prostate enlarge again and cause retrograde ejaculation?
Brief Answer:
Stopping Tomsulosin will make you free from Retrograde ejaculation
Detailed Answer:
Hello
Thanks for follow up .
Tomsulosin has selective action on smooth muscles in bladder neck and prostatic part of urethra which relax and helps to improve urine flow .It has no action on process of increasing size of prostate .Increasing the prostate size is a ageing process .
As regards your query about concentration and mobility of sperms since semen is mixed up with urine and being in a very small quantity does not represent the real values which are calculated based on the entire volume of the normal semen being presented for analysis .
I would suggest you to stop taking Tomsulosin and repeat your semen analysis once you resume normal ejaculation (Say after a week) and try for conception .You will have slight difficulty in passing urine and poor urine flow which you have to bear .You may restart taking Tomsulosin once your wife conceives.
There is no substitute to Tomsulosin as all the medicines have the same side effect of Retrograde ejaculation .
Thanks and Regards.
Dr Patil.
Stopping Tomsulosin will make you free from Retrograde ejaculation
Detailed Answer:
Hello
Thanks for follow up .
Tomsulosin has selective action on smooth muscles in bladder neck and prostatic part of urethra which relax and helps to improve urine flow .It has no action on process of increasing size of prostate .Increasing the prostate size is a ageing process .
As regards your query about concentration and mobility of sperms since semen is mixed up with urine and being in a very small quantity does not represent the real values which are calculated based on the entire volume of the normal semen being presented for analysis .
I would suggest you to stop taking Tomsulosin and repeat your semen analysis once you resume normal ejaculation (Say after a week) and try for conception .You will have slight difficulty in passing urine and poor urine flow which you have to bear .You may restart taking Tomsulosin once your wife conceives.
There is no substitute to Tomsulosin as all the medicines have the same side effect of Retrograde ejaculation .
Thanks and Regards.
Dr Patil.
Note: Consult a Urologist online for consultation about prostate and bladder problems, sexual dysfunction, kidney stones, prostate enlargement, urinary incontinence, impotence and erectile dysfunction - Click here.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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