Researchers in a 2023 study found that men with ejaculation failure on the day of egg retrieval are prone to psychological distress and neuroticism, and psychological intervention may help to prevent this from happening.
Ejaculation failure on the day of egg retrieval is uncommon but prevents the collection of a semen sample, and this may force the freezing of eggs, which is not ideal. Although some studies may suggest that fresh and frozen eggs have comparable outcomes, generally a percentage of thawed eggs do not survive the process.
Zhang et al. (2023), in their prospective study, examined psychological factors associated with men who experience ejaculation failure on the day of egg retrieval. The study involved 70 men with ejaculation failure, and 79 without, and took place at a single IVF center in China between 2020 and 2021.
Key points for this study:
- A series of questionnaires were used to assess the men’s psychological and social background.
- Men were excluded if they had a history of sexual dysfunction, or were taking antidepressants, hormones, or antihypertensive drugs.
- Men were excluded if they had a history of mental illness, serious illnesses or major life (traumatic) events.
- Men were included if they had normal sexual function and had ejaculation failure on the day of the egg retrieval.
- Average age was 35.4
There were no differences in the baseline characteristics of the two groups (age, BMI, residence, educational level, occupation, have children or not, years of infertility, treatment duration and masturbation history).
🔗 Original studies are referenced in this post or within the linked Remembryo posts.
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Questionnaires used to evaluate ejaculation failure on the day of egg retrieval
The men in this study were asked to fill out a series of questionnaires the day after sperm collection.
There were four different questionnaires, and I’ve linked them below (except one that I couldn’t find) so you can go and complete them yourself if you’d like.
Psychological distress levels
The first questionnaire evaluated psychological distress levels using the Kessler10 scale.
This questionnaire is made up of 10 questions that evaluate anxiety and depressive symptoms on a scale of 1 to 5 (“none” to “all the time”). The total points are added up to give the score. The higher the score, the more psychologically distressed a person is.
Examples: During the last 30 days, about how often do you feel nervous?; During the last 30 days, about how often do you feel hopeless?
Cognitive reappraisal and expression inhibition
The second questionnaire evaluated two separate mindsets: cognitive reappraisal and expression inhibition. This was based on the Emotion Regulation Questionnaire on a scale from 1 to 7 (“strongly disagree” to “strongly agree”). The total points are added up to give the score. The higher the score, the more a person’s mindset aligns with cognitive reappraisal or expression inhibition.
Cognitive reappraisal is the tendency of someone to “look on the bright side” and reinterpret a negative situation to make it more positive. Example: When I’m faced with a stressful situation, I make myself think about it in a way that helps me stay calm.
Expression inhibition is when someone suppress their emotions. Example: When I am feeling positive emotions, I am careful not to express them.
Neuroticism
The third questionnaire examined neuroticism using the Big five inventory on a scale from 1 to 5 (“strongly disagree” to “strongly agree”). The total points are added up to give the score (note that this one has a reversal scoring for some questions, where “strongly disagree” is a 5 instead of a 1). The higher the score, the more neurotic someone is.
Neuroticism is the tendency to have negative emotions such as anxiety, anger and depression, along with a sensitivity to stress. Neurotic people can easily get overwhelmed by minor frustrations. Examples: Can be moody; Gets nervous easily; Worries a lot.
Quality of sexual relationship
The last questionnaire used the ENRICH marital inventory (the “sexual relationship” section). This was a revised Chinese version that I couldn’t access, but it assessed feelings and attitudes about sexual behavior and fidelity with one’s partner. Examples: Talking about sex with my spouse is easy and relaxing for me; Sometimes, I worry that my spouse will want to seek sex outside of the marriage.
Psychological distress, emotional regulation, neuroticism and sexual relationship were associated with ejaculation failure
Men with ejaculation failure on the day of egg retrieval had higher scores on the psychological distress questionnaire compared to men who ejaculated normally (22.71 vs 16.18). This means these men were more likely to have symptoms of anxiety or depression.
They also had lower cognitive reappraisal scores (27.63 vs 33.56), so men with ejaculation failure tend to wallow in their negative emotions, instead of changing their perspective to a more positive one.
There was no change in the expression inhibition scores.
Men with ejaculation failure were more neurotic (22.59 vs 16.23), so in general they were more anxious and nervous about situations, and tended to worry more.
Sexual relationship scores were lower in men with ejaculation failure (17.34 vs 22.04).
All of these results were statistically significant.
Conclusions
This study found that men who experienced ejaculation failure on the day of the egg retrieval were more likely to be neurotic and exhibit psychological distress. They were also more likely to have lower sexual relationship and cognitive reappraisal scores.
In general, men who are more susceptible to negative emotions were more likely to suffer from ejaculation failure. The authors note that this is consistent with other research, for example one study found that neurotic people are more likely to experience sexual dysfunction.
The authors suggest that the use of these questionnaires may be useful to screen for men who are prone to ejaculation failure before collection, and that psychological intervention may benefit them.
As a man who is probably neurotic (I did the questionnaire!), I’ll add my two cents here.
The egg retrieval day is very stressful, for both partners. It’s the culmination of months or more of preparation, emotions and expenses, and all this pressure can be overwhelming when it’s semen collection time.
When I was an embryologist, I witnessed many cases of ejaculation failure and I always felt terrible. Performance anxiety can cause erectile dysfunction, and there really isn’t anything that can be done about it except to go somewhere comfortable and try again. Even then, I’ve seen patients go back to their home and try for hours with no luck. The anxiety the man is feeling may be too much. It’s not their fault — their brain is literally blocking their ability to have an erection or ejaculate.
So if you suspect your partner might have trouble collecting, it’s a fantastic idea to collect a sample ahead of time and either have them collect a sample before the retrieval, or have it frozen in advance. There’s nothing wrong with having backup frozen sperm, but freezing eggs is not ideal!
Reference
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About Embryoman
Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.
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