Retrograde ejaculation (retrograde ejaculation) refers to ejaculation during sexual intercourse with ejaculatory action and pleasure, orgasm, semen is not ejaculated, but flowed into the bladder in the reverse direction, which can cause male infertility. Normal ejaculation is coordinated by bladder neck closure and relaxation of the external urethral sphincter under nerve innervation. Retrograde ejaculation can be caused by any disruption of bladder neck function due to anatomical damage, neurological disorders, and the effects of medications, as well as urethral strictures. Diagnostic points are normal duration of sexual intercourse, ejaculatory action and pleasure, orgasm, no ejaculation of semen, spermatozoa and fructose in the urine after sexual intercourse; ultrasound can clearly observe the process of retrograde flow of semen into the bladder during ejaculation. The current status of treatment of male infertility due to retrograde ejaculation is summarized as follows: I. Restore the retrograde ejaculation to make his spouse conceive naturally According to the different etiology of retrograde ejaculation patients, economic and convenient medication or surgical treatment for the cause of retrograde ejaculation should be used first to restore the retrograde ejaculation to make his spouse conceive naturally. 1, surgical treatment: bladder neck into the line of surgery for the bladder neck mouth relaxation, enlargement, transurethral resection of the prostate, bladder neck obstruction after incision, but prohibited for diabetes mellitus and urethral stenosis patients; transurethral resection of spermatozoa for spermatozoa hyperplasia caused by mechanical obstruction of patients. Retrograde ejaculation caused by bladder neck diverticulum, after excision of the diverticulum to restore the retrograde ejaculation; retrograde ejaculation caused by seminal mound hyperplasia, transurethral laser resection, after 3 months to restore the retrograde ejaculation, after 7 months their spouses pregnancy. 2, drug therapy: adrenaline drugs can excite adrenaline α receptor, increase bladder neck tension and promote vasovaginal peristalsis. Ephedrine (ephedrine) 50mg, oral 30~60min before sexual intercourse; phenylpropanolamine (phenylpropanolamine), daily oral 30mg; midodrine (midodrine, methotrexate), daily oral 2.5~20mg or a single intravenous injection of 25~50mg; synephrine ( synephrine, oxedrine, para-hydroxyforine) 60 mg intravenously 1 hour before intercourse. Anticholinergic drugs decrease parasympathetic excitation and relatively increase bladder neck tone. Brompheniramine (Brompheniramine), 16~24mg orally per day. tricyclic antidepressant Imipramine (Imipramine), 25~75mg orally per day, Ochsenkuhn et al. reported that starting 7 days before the female ovulated, the oral dose of Imipramine was increased from 25 to 50 mg per day, and the treatment of retrograde ejaculation induced by retroperitoneal surgery was completed in all 11 patients, and all of them recovered the ejaculation. patients, all of whom resumed ejaculation in passing, and 2 spouses had spontaneous pregnancies without serious adverse effects.Ichiyanagi et al. reported the use of the antihypertensive drug aminomethylphenazine (amezinium) 10 mg once daily in the treatment of 3 patients with retrograde ejaculation, all of whom resumed ejaculation in passing, and 2 spouses became pregnant within 6 months without adverse effects.Kamischke et al. summarized the 36 papers Kamischke et al. summarized 36 papers, pointing out that there is no significant difference in the efficacy of various drugs for different etiologies; ephedrine, promethazine, phenylpropanolamine + chlorophenylpyridine has a higher rate of restoration of retrograde ejaculation than other drugs. 3.Chinese medicine treatment: Chinese medicine has certain advantages, but need to recognize the evidence to have good results. It is reported that 87 cases of retrograde ejaculation caused by infectious factors were treated with ephedra and forsythia and azuki bean soup (69 cases with no ejaculation of semen from urethra at all, 18 cases with a very small amount of semen ejaculated from the urethra), with 10 days as a course of treatment, 3 courses in total, 56 cases of restoring the retrograde ejaculation, 25 cases of basic restoration of retrograde ejaculation with an effective rate of 93.1% (81/87). Xiao Yuanhui [9] reported that acupuncture and acupuncture with the liver and kidney, remove blood stasis to promote the treatment of functional retrograde ejaculation of 25 cases, acupuncture and moxibustion once a day, the drugs every day 1 dose of decoction of water, 15 days for a course of treatment, a total of 2 courses of treatment, the restoration of ejaculation in 17 cases, the effective rate of 68%. Second, collecting sperm for assisted reproduction For those who failed drug treatment or did not accept surgical treatment and those who failed surgical treatment, sperm could be recovered from the vas deferens fluid or bladder for assisted reproduction.Saito[10] et al. reported that 2 cases of retrograde ejaculation patients underwent vasovasal intubation, and pulsed electrical stimulation of the epididymis or vas deferens was performed to collect the vas deferens sperms, which were diluted with culture fluid to do intrauterine insemination (IUI), and 1 of them had recovered the vas deferens sperms in two cycles respectively. In one case, 10-40 ml of vas deferens fluid was recovered in each of the two cycles, with a sperm count of (31.4-75.9) × 106 and 88.4%-93.2% motile spermatozoa, and a pregnancy was obtained and a healthy baby was born in the 2nd IUI cycle. There are invasive and non-invasive methods to retrieve sperm from the bladder. The former is to replace the urine by inserting a catheter and injecting a small amount of isotonic buffer to replace the urine before masturbation, and then inserting a catheter again to retrieve sperm suspension after masturbation or emptying the bladder to retrieve sperm suspension, which is easy to lead to injury, infection, and pain due to the insertion of catheter and is difficult to accept by the patients, and is now less commonly used. Currently, the main non-invasive method is to collect sperm from the urine, but the high osmolarity and low pH value of the urine is harmful to the sperm. Sperm in contact with urine for 5 min, the vitality is reduced by about 50%, and if the time is prolonged, irreversible damage is caused; neutralization of urinary pH does not protect urine from sperm vitality unless the osmolality is adjusted at the same time; Kim et al. further pointed out that, when adjusting the urinary pH to 7.5 and the osmolality to 340SOsm/kg, the higher the urinary concentration, the worse the sperm vitality, and that, of the nitrogenous components, only urinary ammonia has a negative effect on sperm. , only urinary ammonia was detrimental to sperm viability. Therefore, reducing the contact time between sperm and urine, adjusting the osmolality and pH value of urine and reducing the ammonia content in urine are the keys to recovering high quality sperm and improving the fertilization rate. Therefore, a low-protein diet can be started 1 week before assisted reproduction, 1g of sodium bicarbonate can be taken orally the night before and in the morning of the same day, a large amount of water can be consumed (1000-1200ml) 1h before, the bladder can be emptied twice after 1h, and the urine can be drained into a sterile collector with culture medium immediately after ejaculation and centrifuged immediately. Depending on the quality of sperm collected from the urine, IUI or intracytoplasmic single sperm injection (ICSI) was performed; if a sufficient amount of viable sperm could be collected, IUI should be performed first; otherwise, ICSI was performed.The culture fluids used were low-electrolyte solution (0.32 mol/L dextrose solution), BWW fluid, Hams-F-10 with and/or without albumin, Earle`s fluid, modified Earle`s fluid with hepes, and the culture fluids of the culture fluids were used. hepes, modified Earle`s balanced salt solution, simplified transfusion fluid (STF fluid), and human tubal fluid with hepes (HTF-hepes fluid). Chen Huaibo reported 3 cases of retrograde ejaculation patients took sodium bicarbonate orally to alkalize the urine, masturbated after emptying the bladder, urinated immediately after ejaculation in a sterile container containing 10 ml of STF fluid, washed twice with STF fluid and then formulated into 1 ml of sperm suspension to perform IUI, a total of 5 cycles, each cycle was done 3 times, and the spouses were pregnant in 1 cycle in 1 case, and in 2 cycles in 2 cases. Wang Jing et al. reported 3 cases of retrograde ejaculation patients took sodium bicarbonate orally to alkalize the urine, drank a lot of water 1h before sperm collection, urinated in a sterilized container immediately after ejaculation by masturbation, washed sperms with Earle’s liquid twice, added 1.5ml Earle’s liquid and swam upstream for 40min, adjusted the density of sperms to be 50×109/L, and then performed IUI for a total of 5 cycles, and the spouses got pregnant in 1 cycle for 1 case, and 2 cases in 2 cycles for 2 cases. There were 5 cycles of IUI, 1 pregnancy in 1 cycle and 2 pregnancies in 2 cycles. Zheng Jufen et al. reported a case of retrograde ejaculation in which the patient took sodium bicarbonate orally to alkalize the urine, and started to drink a lot of water a week ago, urinated immediately after ejaculation by masturbation, washed three times with HTF-hepes solution, and underwent ICSI, and the woman used a long protocol to stimulate ovulation, and the pregnancy was successfully achieved in the second time. Sulan et al. reported a case of retrograde ejaculation patients alkalizing urine, urinating immediately after ejaculation, centrifuging, using upstream method to obtain active spermatozoa to perform ICSI, the female partner used a short regimen to promote ovulation, a successful pregnancy after applying spermatozoa recovered from the urine to freeze and perform IUI can still be pregnant and give birth to healthy babies. In summary, the authors believe that the diagnosis should be clear before choosing an effective treatment. For drug-induced retrograde ejaculation, other drugs can be replaced or discontinued if the condition permits; if not, sperm collection can be used for assisted reproduction; for retrograde ejaculation caused by anatomical changes in the bladder neck and urethra, surgical treatment should be adopted, but those who are afraid of surgery can directly use sperm collection to perform assisted reproduction; in cases of diabetes mellitus (the diabetes mellitus should be controlled first), neurological damage, or idiopathic retrograde ejaculation, both Western and Chinese medications should be used first. For diabetes (diabetes should be controlled first), nerve damage or idiopathic retrograde ejaculation, both western and Chinese medications should be used first, and sperm collection can be used for assisted reproduction if it fails. Among the methods of assisted reproduction, the choice depends on the specific factors of each couple, but IUI should be considered first.