Societal changes, financial concerns and advances in reproductive technologies mean more people are delaying parenthood until later in life. While it's commonly accepted that women have limited time in which to start their families, many patients and providers assume that men can delay fatherhood for as long as they wish. But should they?
Recent research indicates the male biological clock is an important factor in fetal success and maternal health. There is no one definition of advanced paternal age (APA), but many doctors consider this patient population as men aged 40 and older. Learning more about health risks to older fathers — and to their partners and offspring — can help you counsel patients appropriately about their family planning decisions.
Risks to Older Fathers
Older men should be educated about and monitored for potential health changes stemming from having a child. Already, men over 40 years old deal with the effects of the normal aging process. Having a child later in life is a tremendous life change; evidence is emerging that men, too, can suffer from postpartum depression at any age.
While there is little evidence of physical health risks for older fathers, doctors should monitor them for age-related conditions resulting from genetics and lifestyle choices, such as high blood pressure and high cholesterol.
Fetal and Maternal Risks Associated With Older Fathers
The male biological clock directs physiological changes that occur inside a man's body as he gets older. In general, fertility declines as men experience decreased testosterone levels, sperm degradation and reduced semen quality. Some research indicates that genetic mutations occurring in sperm are more likely in older men. As a result, there are certain risks to the child's health.
Children born to older fathers are particularly at risk for certain childhood cancers, including non-Hodgkins lymphoma and retinoblastoma, according to the Journal of Oncology. They also experience higher rates of birth defects such as cleft palate and certain cardiac anomalies, notes Fertility and Sterility. A study published in JAMA Psychiatry that examined a large population cohort in Sweden found a rise in autism spectrum disorder, attention deficit/hyperactivity disorder and bipolar disorder among children of older fathers.
Women also increase their risk for certain complications when they conceive with older men. Studies show it may be much harder to conceive in the first place, even with the use of assistive reproductive technologies. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) in particular are much less successful when a man is in his 40s or 50s.
Additionally, APA increases a woman's risk for spontaneous abortion. Other research indicates APA may increase a woman's risk of preterm delivery and low birth weight, although some studies dispute these findings.
Using Ultrasound to Evaluate the Older Male Patient
When a couple is unable to conceive, their provider must evaluate both people to help determine the cause of infertility. Obtaining a thorough medical history and physical examination is important, but further diagnostic testing may be necessary. Scrotal and transrectal ultrasound are both important during initial assessments of older men who struggle with fertility. These tests allow for assessment of the testes, prostate, seminal vesicles and vas deferens. Identification of any abnormalities can direct further diagnostic testing or treatment.
The male biological clock is an important contributing factor to several risks associated with APA and fertility. While men may not be greatly affected by becoming fathers later in life, their partners and offspring are at an increased risk for problems during and after pregnancy. Doctors should be prepared to discuss these risks with all older men who are considering having children.
