A recent study1 by the Women’s Health Institute at Rutgers Robert Wood Johnson Medical School, USA reviewed the effects of paternal age on fertility, pregnancy and the health of children. While women are known to have a ticking clock for reproduction, men are not subject to a similar timeline. Dr Ameya Sirsat, a leading Fertility Specialist from Mumbai guides us through these recent study results and what it means for men in relation to their reproductive health.
Is there a “biological clock” for men?
Whereas a woman’s clock typically slows in her 30s and runs down by age 45 or so, it can go on ticking almost indefinitely for a man. Although, genetic make-up of sperm may be affected with advancing age.
When is paternal age considered advanced?
Sperm production is limitless unless affected by other factors; however from genetic counseling point of view it would be 40 years.
Aging is related to decreased testosterone levels in men; can you explain how physiologically this affects reproduction and increase complication risks?
With decreasing levels of testosterone, there is decrease in a hormone called FSH (follicle stimulating hormone) which is responsible for sperm production. Hence, semen quality diminishes, volume lessens with age and the motility and shape of sperm decline a little.
What are the risks associated with aging fathers for pregnancies?
There are potentially harmful effects of advanced paternal age on a baby’s risk of gene mutation, prematurity, low birth weight, low Apgar score and risk of seizures, as well as the mother’s chances of developing gestational diabetes.
How has assisted reproduction affected this issue?
It has helped in great deal in infertile couples with a cumulative pregnancy rate of 50-60 %.
What medical conditions (for the unborn child) are associated with advanced paternal age?
There is increased risk of babies born with congenital diseases like dwarfism or developing psychiatric disorders like schizophrenia and bipolar disorder and developmental ones like autism with an increased risk of nearly six fold.
In your clinical practice, have you noticed any trends in male infertility related to age?
They are most certainly associated with other environmental factors - addictions like smoking, tobacco chewing & chronic alcoholism and pathologies like varicocoeles (enlargement of veins in the scrotum).
What is your advice to couples with older men (say >45 years of age) who want to conceive?
I often quote Dr. Eisenberg who aptly said, “Fertility is a team sport, and the runway for men is not unlimited”.
Are there any tests to prevent adverse risks to the pregnancy and the foetus?
Pre-conceptionally, sperm DNA fragmentation tests can be done for men to indicate sperms with fragmented DNA that can lead to reduced chances of a successful pregnancy. The genetic material of a sperm is crucial for a successful and normal pregnancy. If there is any genetic abnormality, it can lead to male subfertility, fertilization failure or miscarriage. Regular semen analysis tests can evaluate the sperm concentration, morphology and motility but are unable to detect any DNA fragmentations. Hence several DNA fragmentation tests are now available for precise detection and prevention of subfertility.2
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Subfertility is a term used to indicate low fertility possibly due to prolonged time of no conception. A subfertile couple is one that has risk factors that make conception difficult. |
In pregnancy, every mother should be ascribed to the same evaluation & care as that of advanced maternal age, which is screening for chromosomal abnormality, anomaly scan, predictors for hypertension and diabetes.
What fertility options are there for men who want to delay fatherhood?
Men can freeze their semen samples up to 10 years and more. Semen characterized with low motility can be used in an IVF procedure called ICSI (intra-cytoplasmic spermatozoa injection) where one single fine quality sperm is identified and used individually to fertilise an egg. This vastly increases the success rate of the IVF.
References:
- G. Bachmann et al. Maternal, infant and childhood risks associated with advanced paternal age: The need for comprehensive counseling for men. Maturitas 2019;
https://doi.org/10.1016/j.maturitas.2019.03.020 - Reproductive Health Group: Sperm DNA Fragmentation test. https://www.reproductivehealthgroup.co.uk/fertility-treatments/assessments/men/dna-fragmentation/
Dr Ameya J Sirsat, Consultant Fertility Specialist & Endoscopic Surgeon, Consulting Obstetrician & Gynaecologist, Rotunda Blue Fertility Clinic & Keyhole Surgery Center, Parel; Halani Healthcare Polyclinic, Sion; Tilak Hospital, Worli, Mumbai
