Effect of advanced paternal age on fertility and pregnancy
- Isiah D Harris, MD, MSc
Isiah D Harris, MD, MSc
- Department of Obstetrics and Gynecology
- Center for Reproductive Health
- Santa Clara Medical Center/Kaiser Permanente
Women are generally aware of the reproductive issues related to advanced maternal age, typically defined as 35 years of age or older on the estimated date of confinement. These issues include higher risks of infertility, fetal aneuploidy, gestational diabetes, preeclampsia, and stillbirth . (See "Effects of advanced maternal age on pregnancy".)
Although reproductive concerns related to advanced paternal age are less well defined, this topic reviews the available data . Additional information on age and fertility can be found elsewhere. (See "Optimizing natural fertility in couples planning pregnancy" and "Management of pregnancy in women of advanced age" and "Fertility preserving options for women of advancing age".)
The probability of conception is primarily dependent upon maternal age, and to a lesser extent, paternal age. In contrast to oogenesis, which appears to be limited to the fetus in humans, spermatogenesis continues even in elderly men. Since the adult male's germ cells have passed through more mitotic replications than the adult female's germ cells, there is a greater opportunity for error. Increasing age has been associated with more breaks in sperm DNA, loss of apoptosis, and a higher frequency of point mutations [3,4]. (See "Male reproductive physiology".)
A review on the association between male age and semen quality compared 30-year-old men to 50-year-old men and found decreases in semen volume (3 to 22 percent), sperm motility (3 to 37 percent), and percent of normal sperm (4 to 18 percent), but not sperm concentration, with age . Similar findings were noted in a subsequent series that evaluated men age 22 to 80 years . However, standard sperm parameters do not correlate perfectly with fertilizing capacity and achievement of pregnancy.
Studies have consistently shown that increasing male age is associated with an increased time to pregnancy and decreased pregnancy rates [7-10]. However, only a few studies have examined these outcomes adjusted for female age.
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- SEMEN QUALITY
- Sexual function and coital frequency
- AUTOSOMAL DOMINANT DISEASE
- CONGENITAL ANOMALIES AND DISEASES
- NEURODEVELOPMENT OF OFFSPRING
- Cognitive ability
- Autism spectrum disorder
- X LINKED DISEASE
- IMPACT ON PREGNANCY
- Preconception counseling
- Fetal growth restriction, preterm birth, and stillbirth
- SUMMARY AND RECOMMENDATIONS