Dear David,

Thank you for your question.

Semen, also called seminal fluid, is the name for the penile ejaculate. Semen is composed of sperm (the motile cells that contain the man’s genetic material (DNA)) and the secretions of various glands (like the seminal glands, bulbourethral glands, and prostate). The secretions of the glands make up the majority of the semen.

Risperidone can cause, in some people, a cluster of symptoms called “ejaculatory dysfunction.” It may manifest as normal arousal and orgasm but a decreased volume of semen ejaculated. The explanation for this is that risperidone affects many hormones, like prolactin, as well as the tonus in the special musculature around the urethra. The result is “retrograde ejaculation” –so called because some or all of the semen destined for ejaculation goes up the urethra and into the bladder, instead of going down the urethra and out of the body. Some people who have retrograde ejaculation also find that after orgasm their urine is cloudy (because of the semen that is in it). On the other hand, risperidone has not been reported to change the transparency or color of semen. However, if retrograde ejaculation is present, it can definitely affect your fertility.

It is important to remember that changes in colour and consistency of semen may change with time and that these changes may be completely normal.

Infertility is related to multiple factors. So-called sperm quality can be assessed by a doctor who has to evaluate such factors as sperm motility and quantity by looking at the semen under the microscope. So it is not possible for me to comment on your fertility from the information I have here.

It is important to remember that the ability to achieve pregnancy depends on multiple complex factors like timing as well as the anatomy and physiology of both members of the couple. Fertility is a couple issue.

In addition, even if both partners are completely fertile, it may require a few months of regular unprotected intercourse in order for someone to become pregnant. After 1 year of regular unprotected intercourse, about 90% of couples will have achieved pregnancy. So the best advice for a young healthy couple is that they should be patient.

However this is a blanket statement and may not apply to your particular situation so it would be best to discuss the issue with your doctor. He or she may feel that there are sufficient grounds to refer you and your partner to a fertility clinic. These clinics are composed of teams of specialists (endocrinologists, gynecologists, sexologists, etc) that have the expertise to assess fertility in both members of the couple.

In summary, your question is definitely pertinent and your concerns understandable; however, a doctor who knows you well and who is able to ask the appropriate questions and run any necessary tests will be best placed to answer your questions in detail. Risperidone consta is a medication which has many benefits, but it also has side-effects.

I would suggest you discuss any concerns you have regarding side-effects with your doctor (or another qualified member of your healthcare team). This conversation is very important since the amount and type of side-effects you experience will effect your desire to keep up with your treatment. There may be some things that you and your doctor may do to decrease the effects of some of the side-effects you are experiencing.You could also bring up your concerns regarding the changes you have noticed in your semen. The doctor would then be able to ask appropriate questions, run any necessary tests, and refer you, if necessary, to another specialist, e.g. a urologist (this is a doctor who specialises in the reproductive system of folks with penises) or to a fertility clinic.

I hope this answer has been helpful. All the best and please feel free to write back if you have any other questions.

Rimma, for AlterHeroes