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In recent years, there has been growing awareness of the important role of male age in infertility and reproductive outcomes. While historically much attention has been focused on female fertility and age, research now indicates that advanced paternal age may also impact fertility and pregnancy outcomes.
In an interview with HT Lifestyle, Dr Parul Agarwal, Director, Fertility Department, Cloudnine Group of Hospitals, Noida, elaborates on various aspects of male infertility associated with ageing and explains –
1. Changes in sexual functions
Studies have consistently shown that increasing age in men is associated with changes in sexual function, which may affect fertility. Decreased sexual function, including erectile dysfunction (ED), becomes more prevalent with age. Between the ages of 40 and 70, the likelihood of severe ED increases threefold, while the likelihood of moderate ED doubles.
2. Spermatogenesis and age
Spermatogenesis, the process by which sperm 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 sperm production. This decline in sperm quality may contribute to difficulties conceiving.
3. Altered semen parameters
Increasing age also affects semen quality. Age-related changes can result in low sperm concentration (oligospermia), reduced sperm motility (asthenospermia), and abnormal sperm morphology (teratospermia). These changes in semen parameters create challenges for natural conception. However, a drop in testosterone levels can also affect fertility through sexual dysfunction (low libido, erectile dysfunction, difficulty achieving ejaculation). Serum testosterone levels in men over 70 years of age range between half and two-thirds of those in men in their 20s.
4. DNA fragmentation
Oxidative stress increases with age, which can lead to DNA damage in sperm cells. Studies show that the rate of DNA fragmentation in sperm is higher with increasing age. This can affect the genetic integrity of sperm and potentially affect fetal development and pregnancy outcomes.
5. Changes in testicular volume
Testicular size gradually decreases with age, especially after age 60. This decline is accompanied by increased gonadotrophin levels and decreased bioavailable testosterone, which may further decrease fertility.
6. Medical conditions and environmental factors
As men age, their risk of developing medical problems increases, and the likelihood of exposure to environmental toxins also increases. Medical conditions requiring medications such as antihypertensives and antiandrogens can negatively impact sperm quality and fertility. It is important for men experiencing infertility to get appropriate screening for these factors.
7. Hormonal changes
Testosterone levels decline with age, a condition known as andropause. This decline can cause sexual dysfunction, including low libido, erectile dysfunction, and difficulty achieving ejaculation. Although spermatogenesis continues into old age, hormonal changes can still affect reproductive outcomes.
8. Miscarriage
Increasing father’s age has been associated with an increased risk of spontaneous abortion in the first trimester. Independent of the mother’s age, the risk of spontaneous abortion increased significantly for fathers aged 35 years or older. For fathers older than 35 years, the risk of spontaneous abortion between 6 and 20 weeks of pregnancy was 1.27. This increased risk was also seen when evaluating only couples where the mother was <30 years old.
9. Assisted reproductive technology
Increasing age of the father may affect the success of assisted reproductive technologies (ART). Decreased fertilization rates and compromised laboratory performance indicators have been observed with increasing age of men, affecting outcomes such as blastocyst formation and embryo quality.
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