Combined use of phosphodiesterase-5 inhibitors and
selective serotonin reuptake inhibitors for temporary
ejaculation failure in couple undergoing assisted
Shaoming Lu, M.D., Yueran Zhao, Ph.D., Jingmei Hu, M.D., Xiao Li, M.D., Haobo Zhang, M.D.,
Li You, M.B., and Zi-jiang Chen, M.D., Ph.D.
Andrology Unit, Center For Reproductive Medicine, Provincial Hospital, Shandong University, Jinan, Shandong, People’s
Republic of China
tive technologies (ART).
Design: Case report.
Setting: Andrology unit, center for reproductive medicine.
Patient (s): Five patients suffering from temporary ejaculation failure during ART.
Intervention(s): Assistedreproductivetechnology.Semensamples werecollected bymasturbation.Thecombined
use of phosphodiesterase-5 inhibitor (PDE5-I; vardenafil, 10 mg) and selective serotonin reuptake inhibitor (SSRI;
sertraline, 50 mg) to treat patients who failed to collect semen on the day of egg retrieval.
Result(s): Five patients with unexpected ejaculation failure during ART treatments were identified; two patients
10 mg) plus SSRI (sertraline, 50 mg) enabled them to provide spermatozoa successfully. It suggested that the com-
bined protocol could be more efficient for temporary ejaculation failure than sildenafil alone. On the day of the egg
difficulty 2 h later.
Conclusion(s): The results indicate that the combined protocol of vardenafil plus sertraline could resolve the
unpredictable ejaculation failure during ART. We presume that it might be helpful for attenuating the patients’
stress and anxiety. (Fertil Steril?2009;91:1806–8. ?2009 by American Society for Reproductive Medicine.)
Key Words: Phosphodiesterase-5 inhibitor, selective serotonin reuptake inhibitor, assisted reproductive technolo-
gies, temporary ejaculation failure, anxiety
During assisted reproductive technologies (ART) treatment,
oocyteretrieval commonly follows pituitary down-regulation
band to produce fresh spermatozoa on demand for fertiliza-
tion. Unfortunately, sometimes the husband fails to collect
a semen sample on the day of egg retrieval because of psy-
chologic stress and anxiety. To our knowledge, reports about
such cases and management are scarce. The methods for
sperm recovery in this situation include taking medicine
such as phosphodiesterase-5 inhibitors (PDE5-Is; sildenafil
tatic massage (6), and invasive procedures such as rectal
probe electroejaculation (7, 8), vasal sperm aspiration (9),
percutaneous epididymal sperm aspiration (10), and testicu-
lar sperm aspiration (11, 12). These techniques, however,
are not always able to overcome the problem of sperm recov-
ery. If no sperm is available, the patients have to cancel the
treatment cycle or cryopreserve their oocytes.
We describe, for the first time, the successful combination
of PDE5-I and selective serotonin reuptake inhibitor (SSRI)
during ART treatments for unexpected ejaculation failure.
It is an efficient and noninvasive method to prevent a delay
in insemination which may compromise the ART results.
The first casewas a 29-year-old patient, 180 cm in height and
81 kg in weight. His wife was 28 years old. They were
referred for IVF because of fallopian obstruction. They de-
scribed their sexual function as regular and harmonious.
The sperm analyses were normal and the man never had dif-
the day of egg retrieval he had temporary ejaculation failure
because of stress, and we prescribed sildenafil for him. Three
hours later, the medicine had on effect and the patient asked
Received February 5, 2008; revised and accepted March 3, 2008; pub-
lished online April 28, 2008.
S.L. has nothing to disclose. Y.Z. has nothing to disclose. J.H. has nothing
to disclose. X.L. has nothing to disclose. H.Z. has nothing to disclose.
L.Y. has nothing to disclose. Z.C. has nothing to disclose.
Supported by National Basic Research Program of China, Beijing (973
Program; 2006CB944004), and National Natural Science Foundation
of China, Beijing (30670777).
Repint requests: Dr. Zi-jiang Chen, Center for Human Reproduction,
Shandong Provincial Hospital, Shandong University, 324 Jing-5-Wei-7
86-531-87068226; E-mail: firstname.lastname@example.org).
Republic of China.(FAX:
Fertility and Sterility?Vol. 91, No. 5, May 2009
Copyright ª2009 American Society for Reproductive Medicine, Published by Elsevier Inc.