HIS age and YOUR Fertility

It is well known that as a woman ages, her ability to have a child with her own eggs declines and eventually ceases altogether. What has not been well studied nor as widely discussed is the impact that paternal age has upon fertility. With a growing number of couples delaying marriage or remarrying, there are more men in their forties, fifties and sixties that are trying to father a child. In the USA, the birthrate of children to men between 35 and 54 years of age has gone up by over 30% between 1980 and 2000[g1] . There is evidence that this trend is continuing to rise.

Advanced paternal age has been associated with a higher risk miscarriage in at least one study. Other studies suggest that women with an older partner are at higher risk of pregnancy complications. But the data on the chance of actually conceiving is more difficult to interpret.

As men a man becomes older the volume of semen that he produces declines. We know also that the number of sperm producing cells and the production of testosterone decreases as well. We also know that the hormone signal from his brain to the sperm producing cells increases suggesting that they are less sensitive to this signal. But the factors that we typically evaluate to assess male fertility--sperm count, sperm motility and sperm shape (morphology)--do not predictably decline as a man reaches his 50’s or 60’s. So to answer the question of male fertility and aging, we get the most predictable information by looking at the results of IVF treatment.

When pregnancies are created through advanced reproductive techniques like IVF; we are able to directly observe the ability of sperm to fertilize an egg and then track how the embryo develops. Better still, we can then follow the outcome of those embryos in order to determine how well they implant and how often the result in the birth of a healthy baby. Recently, a review [g2] was published that tried to gather and quantify all of the studies published so far that could help answer this question. Here is what they found:

·       Fertilization Rate—this is defined by the ability of a sperm to penetrate an egg and initiate embryo development. The existing studies do not show a decline in this critical step associated with aging in men.

·       Embryo Development—is the critical stage that an egg must go through before it can implant into a woman's uterus. This is a process that typically takes place over 5-6 days. The first three days are not impacted by sperm quality and therefore are not impacted by the age of the male. Studies do suggest that there is a greater decline in embryo quality between day 3 and day 6 as men age suggesting that sperm quality may be impacted by age.

·       Implantation Rate—this is determined by the positive pregnancy rate following embryo transfer. The data suggests that the implantation rate does decline with paternal age but this does not become a noticeable impact upon success until a man is older than 60 years of age.

·       Birth Rate—the data on live birth rate is conflicted. Some studies show a lower birth rate after implantation as a man ages while others found no higher risk of miscarriage. Typically, such inconsistent results suggest that it is not strictly an age related phenomenon and may in fact be impacted by other factors.

 

 

2 thoughts on “HIS age and YOUR Fertility

  1. Hello Dr. Just going thro the net and found your interestng website and informatn. Pls Dr. I will like ur advice here. My story: am juliet from Nigeria. 29yrs. Married 4yrs ago. Was diagonised of PCOS. Which make it diffcult for me to get pregnant. Have bn on treatment on clomid often and on. Cant really say how more months i have taken it. My Dr. Sent me for hormonal test and found out that i have low progestron. Took provra to induce period and was given aventis clomid. Fortunately i was pregnant after trying for more than three yrs. But unfortunately had a missed misscarriage at 8wks and 6days. Had the evacuation on 1st August 2011. Pls Dr. I will like to kn the vitamins that i should be taken in order to have a health pregnacy next time i concive. Also because of me having PCO, should i be taking metformin during the first trimester in order to hold the pregnacy. My Dr refused putting me on metformine saying that my sugar level is normal. But sometimes i do take metformin on my own because it helps me to reduce weight. And i also took it with the clomid and conceivd then i stopd it because i was scared. I didnt want anything to happen to my baby but still i lost my first baby. Pls advice me, my dr. Told me to wait for my period to come before trying again. Am desperate. So sorry for many questions

    1. Dear Juliet,
      I am so sorry to learn of your difficulties. PCOS is a very common problem and there is not a simple and uniform recommendation on how best to treat this condition. Unfortunately, I cannot provide specific recommendations for you on how to treat your condition because there are many factors that should be discussed and considered. Without knowing your complete medical history, I cannot risk causing you harm by advising you based upon incomplete information. That said, you may wish to check out my previous blog posts on PCOS. In one them I both summarize and post a link to the latest guidelines on the use of metformin from the American College of Obstetrics & Gynecology. If you do check that out; you will find that they state quite clearly that the decision of whether or not to include this treatment need not be based upon blood sugar assessments. There are too many inaccuracies encountered with such a treatment approach. I do hope that you find this information both helpful and empowering.
      Best thoughts,

      ~Robert
      Robert Greene, MD, FACOG

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