Advanced paternal age can also influence fertility potential and pregnancy outcomes. Know about the impact of male age on infertility and reproductive health.
In recent years, there has been a growing awareness of the significant role that male age plays in infertility and reproductive outcomes. While much attention has historically been focused on female fertility and age, research now indicates that advanced paternal age can also influence fertility potential and pregnancy outcomes.
In an interview with HT Lifestyle, Dr Parul Agarwal, Director –
Department of Fertility at Cloudnine Group of Hospitals in Noida, delved into
the various aspects of male infertility associated with ageing and highlighted –
1. Changes in Sexual Functions
Studies have consistently demonstrated that increasing male age is
correlated with changes in sexual function, which can impact fertility.
Diminished sexual functioning, including erectile dysfunction (ED), becomes
more prevalent with age. Between the ages of 40 and 70, the probability of
severe ED triples, while moderate ED doubles.
2. Spermatogenesis and Age
Spermatogenesis, the process by which spermatozoa are produced, is
intricately regulated by hormonal factors. However, as men age, hormonal
changes can adversely affect this process. The number of Sertoli cells which
are very important for the spermatogenesis process, decreases with age, leading
to reduced spermatozoa production. This decline in sperm quality can contribute
to difficulties in achieving pregnancy.
3. Altered Semen Parameters
Advancing age also impacts semen quality. Age-related changes can
result in lower sperm concentration (oligospermia), reduced sperm motility
(asthenospermia), and abnormal sperm morphology (teratospermia). These
alterations in semen parameters pose challenges for natural conception.
However, decline in testosterone levels may also impact fertility through
sexual dysfunction (low libido, erectile dysfunction, difficulty in achieving
ejaculation). Men > 70 years old tend to have serum testosterone levels that
are about one half to two thirds of those of men in their 20s.
4. DNA Fragmentation
Aging is associated with increased oxidative stress, which can
lead to DNA damage in sperm cells. Studies indicate a higher rate of DNA fragmentation
in sperm with advancing age. This can affect the genetic integrity of sperm and
potentially impact embryo development and pregnancy outcomes.
5. Altered Testicular Volume
Testicular volume gradually decreases with age, particularly from
around 60 years onwards. This decline is accompanied by higher levels of
gonadotrophins and lower bioavailable testosterone, which can further impair
fertility potential.
6. Medical Conditions and Environmental Factors
As men age, the risk of developing medical conditions increases,
and exposure to environmental toxins also rises. Medical conditions requiring
medications such as antihypertensives and antiandrogens can negatively impact
sperm quality and fertility. It's crucial for men experiencing infertility to
undergo appropriate screening for these factors.
7. Hormonal Changes
Testosterone levels decline with age, a phenomenon known as
andropause. This decline can lead to sexual dysfunction, including low libido,
erectile dysfunction, and difficulty achieving ejaculation. Although
spermatogenesis persists into old age, hormonal changes can still affect
fertility outcomes.
8. Miscarriages
Advanced paternal age has been linked to an increased risk of
first-trimester spontaneous abortions. The risk of spontaneous abortion rises
significantly for paternal ages of 35 years and older, independent of maternal
age. For paternal age ≥ 35 years, the risk of spontaneous abortion between 6
and 20 weeks of gestation was 1.27. This elevated risk was seen even when evaluating
only those couples where the maternal age was < 30 years.
9. Assisted Reproductive Techniques
Advanced paternal age can impact the success of assisted
reproductive techniques (ART). Lower fertilisation rates and compromised
laboratory performance indicators have been observed with increasing male age,
affecting outcomes such as blastocyst formation and embryo quality.
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