Risks associated with men's biological clocks may be similar to women's.
By Elizabeth Heubeck, MA
Reviewed By Brunilda Nazario, MD
On playgrounds across the country, it's getting tougher to tell who's watching the kids -- dad or granddad. Experts predict the trend of older fathers will continue creeping upward. Why the rise and, more importantly, at what cost?
"The women set the baby-making agenda," says Harry Fisch, MD, director of the Male Reproductive Center at Columbia-Presbyterian Medical Center in New York and author of The Male Biological Clock: the Startling News about Aging and Fertility in Men. As more and more women wait to have children, their spouses are forced to postpone parenthood, too. Back in 1970, less than 15% of all men fathering children were over 35. Today, that percentage has risen to almost one-quarter. Even among men in the 50 to 54 age group, there's been a notable increase in fatherhood.
While it has become more socially acceptable to put off fatherhood, experts caution that the decision is not without risks.
"The role of the male in infertility has been grossly overlooked by lay and professionals alike," says Peter Schlegel, MD, urologist-in-chief at New York-Presbyterian Hospital/ Weill Cornell Medical Center, and president of the Society for Male Reproduction and Urology.
Effects of Age on Male Fertility
Whereas most women realize that their biological clock ticks as they age, the same cannot be said for men. "Not only are men not aware of the impact their age has on infertility, they deny it. They walk around like they're 18 years old," Fisch tells WebMD. It's no wonder.
Until recently, popular belief held that men could father children as easily at 78 as they could at 18. But a mounting body of evidence is showing otherwise.
In one study of couples undergoing high-tech infertility treatments, researchers concluded that a man's chances of fathering a child decrease with each passing year. In the study, the odds of a successful pregnancy fell by 11% every year; their chances for obtaining a successful live birth declined even farther. The study was reported in a 2004 issue of the American Journal of Gynecology.
As sure as men age, so too do their sperm. German researchers compiling the most recent data on aging sperm reported that the volume, motility (ability to move toward its destination, an awaiting egg), and structure of sperm all decline with age. They published this update in a 2004 issue of Human Reproduction Update.
Rise of Other Reproductive Risks
For aging men, the risks extend beyond reduced fertility. "The original view that men's contribution to normal reproduction stopped at fertilization needs to be completely revamped," Schlegel tells WebMD. A broader and more accurate view would acknowledge the significant impact of aging sperm on birth outcomes.
We know that once women reach their mid-30s, their risk of having a child with a genetic abnormalities increases sharply. Now we know that the age of fathers can also contribute to that risk. In the most revealing study on this topic to date, Fisch and his colleagues evaluated more than 3,400 cases of Down syndrome. They found the father's age played a significant role when both parents were over 35 at the time of conception. The effect was most pronounced when the woman was over 40. In those cases, says Fisch, "We found the incidence of Down syndrome is related to sperm approximately 50% of the time." These findings appeared in the June 2003 issue of The Journal of Urology.
Children born to older men also run a higher risk of developing schizophrenia, a devastating mental disorder. In one study on the subject, researchers discovered that men between the ages of 45 to 49 were twice as likely to have children with schizophrenia as were men 25 and younger. That risk tripled for men over the age of 50. Investigators, reporting in a 2001 issue of the Archives of General Psychiatry, drew their results from a sample of more than 85,000 people.
A 'Paternalistic' Urge?
Will knowing that their reproductive risks rise with age cause childless men in their 30s and 40s to develop paternalistic pangs?
"Inwardly, we understand that something is going on. We might express it by showing a desire to initiate a family. Some men, on the other hand, express the biological changes by buying a hot sports car," Fisch tells WebMD.
Not everyone agrees on the existence of such an inward connection.
"I'm suspicious of the maternal aspect of the biological clock, let alone the paternal part," says Michael Kimmel, PhD, a sociology professor at Stony Brook University. Even acknowledging that they have a biological clock would be a leap for men.
"For millennia, men would have been thrilled to deny any biological clock," Kimmel tells WebMD. Admitting such a 'weakness' is antithetical to our male culture. Ironically, this attitude of invincibility has been detrimental to men's health. "It's led to higher rates of HIV, stress-related disease, etc.," Kimmel tells WebMD.
This attitude can also have a negative impact on men's fertility. Poor lifestyle habits may hasten the inevitable decline of a male's fertility.
Slowing the Decline
But improving one's lifestyle can help slow the decline. For men wanting to maintain their maximum fertility, Fisch offers these suggestions: "Maintain optimal weight, cut out recreational drugs, and stop smoking." Taking care of seemingly unrelated conditions may help too. High cholesterol is one of them. A recent study in the Journal of Urology showed that, for men with high cholesterol and erectile dysfunction, the regular use of a cholesterol-lowering drug improved both problems: It lowered cholesterol and improved erectile function in eight of nine people.
Fisch also urges men who suspect fertility problems to get tested. "First, make sure you don't have a physical problem," he says. "Some men walk around with testicular cancer and don't even know it."
The bottom line, says Fisch, is this: "Infertility is not just a woman's problem."
Published May 30, 2005.
SOURCES: Harry Fisch, MD, director, Male Reproductive Center, Columbia-Presbyterian Medical Center, New York. Peter Schlegel, MD, urologist-in-chief, NewYork-Presbyterian Hospital/ Weill Cornell Medical Center; president, Society for Male Reproduction and Urology. Michael Kimmel, PhD, professor of sociology, Stony Brook University.
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