Review ArticleFertility Concerns for the Aging Male
Section snippets
Overview of Animal Models of Declining Reproductive Function with Aging
At the level of the testis, rodent models have documented significant histologic changes with aging. These changes include a decrease in numbers of germ cells, a thinning of the seminiferous tubule epithelium, the presence of testicular atrophy, a decrease in sperm motility, and a significantly reduced total sperm production.3, 4, 5
Aging may also contribute to infertility via increased preimplantation losses. These preimplantation losses may indicate a decreased ability of sperm to fertilize
Considerations for Declining Reproductive Function with Aging
Medical comorbidities increase with aging. Their presence, as well as side effects of their treatments, can affect fertility (Table 1). For example, medical therapy for the common condition of benign prostatic hyperplasia (BPH) consists of alpha blockers and/or 5-alpha-reductase inhibitors, which can both lead to sexual dysfunction and declines in ejaculatory function. Similarly, treatments for prostate cancer, such as surgery, radiation, and hormone therapy, can cause sexual dysfunction and
Increased Risk of Abnormalities in the Offspring
There is an increased risk of chromosomal and genetic abnormalities in the offspring of aging women, but it is difficult to advise couples on the magnitude of risk for offspring for the aging male. For the aging male, there appears to be some risk for offspring. However, the age at which the risk develops and the magnitude of risk on the fetus is poorly defined. Although specific conditions (eg, autism, schizophrenia, autosomal dominant diseases) appear to be increased in the offspring of
Counseling the Older Father-To-Be
Regarding the increased risk of abnormalities in the offspring of older men, it is difficult to advise couples on the magnitude of the potential risk. There is some risk, but the age at which the risk develops is poorly defined. Although specific conditions appear to be increased with advance paternal age, the absolute degree of increased risk appears to be small. Furthermore, guidelines for evaluation of older potential fathers have not been developed. The American Society for Reproductive
Conclusion
The aging male population is rapidly increasing, and infertility issues will likely be encountered more frequently. Reproductive function gradually declines with advanced paternal age from multifactorial causes. Increased paternal age has some risk for offspring, but the age at which the risk develops and the magnitude of the risk are poorly defined. There is a distinct lack of well-designed studies on this subject. Guidelines for evaluation of older potential fathers have not yet been
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