Adapted from Medscape The Male Biological Clock- How to Tell the Time by Mark Trolice MD
Most women know that their fertility declines from the age of 30 onwards. From then on it will become more difficult to become pregnant and there will be an increase in the rate of miscarriage and in infants with chromosomal abnormalities. Yet, due to our modern lifestyles, the availability of contraception and the economic situation, first births in women aged 35 to 39 has increased six fold. To give an increased chance of conception women are increasingly freezing their eggs in their late twenties and early thirties.
Men are also becoming fathers for the first time at later ages. Over the last 40 years this has increased by 3.5 years.
Men over 45 years need five times longer to achieve a pregnancy than men under 25 after their female partner’s age is adjusted for. Sperm counts start to decline from the age of 41 and sperm motility decreases. Chromosomal abnormalities in sperm also increase.
At all ages, being overweight, alcohol consumption, cigarette and e cigarette smoking, can lead to impaired semen production.
The first treatment will be to correct lifestyle factors and then consider ovulation induction and intrauterine insemination. Men over 45 have lower pregnancy rates and higher miscarriage rates with Intrauterine Insemination Treatment.
During IVF cycles injecting the sperm into the egg can improve fertilization rates but in men over 45 there is still reduced fertilization rates and decreased embryo development to the blastocyst stage.
The offspring of older men have higher rates of stillbirth, low birth weight, preterm birth and birth defects. Men older than 40 to 45 have twice the risk of having an autistic child and three times the rate of schizophrenia.
A consideration is that men consider sperm freezing at younger ages, similar to what women do. Another way to tackle the problem is pre-implantation genetic testing of embryos from older men.