Focusing on male fertility

An article on the impact on male fertility on slate.com draws attention to the increasing male factor in infertile couples.

Male fertility is a new epidemic, at least if you’ve seen the news coverage. This burgeoning crisis seems to be related to the effects of age, inspiring headlines such as: “Men Also Suffer Age-Related Infertility,” “Too Old to Be a Dad,” “High Manxiety: Thirtysomething Men Are the New Neurotic Singles,” and my favorite, “The Male Biological Clock—It’s Tick-Tick-Ticking Too.”

Is it true? Do men have biological clocks like women? Is male infertility an epidemic? And why does everyone seem so excited by this? “On playgrounds across the country, it’s getting tougher to tell who’s watching the kids—dad or granddad,” begins a WebMD feature. “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.”

There’s a smidgen of Schadenfreude in these mostly female-penned articles, a smug unspoken undertone: That’s right, men. Aging women are not the only ones with fertility problems … you guys have it, too.

Studies do show that it takes longer for older men to conceive. For men older than 45, there was a fivefold increase in the time to pregnancy relative to men younger than 25, according to a 2003 study in Fertility and Sterility.

“In the past we thought men’s fertility was not affected by age,” says Natan Bar-Chama, director of male reproductive medicine and surgery at Mount Sinai Medical Center. “Now we’ve learned there is a component to paternal age to try to conceive, and certain conditions, such as schizophrenia and Down syndrome, could have increased risk as men get older.”

A number of recent studies link older fathers to increases in the risk of autism and schizophrenia, inspiring headlines such as NBC’s “Older Dads at Risk for Passing Along Mental Disorders.”

“But when you look at the numbers, you have to separate what the absolute risk and the increased risk is,” Bar-Chama notes. “The absolute risk is still really very small.”

Overall, the whole “men have a biological clocks which tick inexorably and then at a certain point it’s all over” is a “media thing,” says Marc Goldstein, surgeon-in-chief of male reproductive medicine and surgery at the Cornell Institute for Reproductive Medicine and New York–Presbyterian Hospital/Weill Cornell Medical Center. “There’s a slow, gradual decline in testicular function in men—but it’s not dramatic.” He adds, “There is no sudden drop. If a man is otherwise healthy—no diabetes, heart disease, is not obese—those men can maintain reasonable fertility in old age.”

Goldstein wants there to be increased awareness about male infertility, which accounts for problems in about one-third of couples having trouble conceiving, although others put it at 15 to 20 percent.

At Reproductive Partners we are witnessing this trend leading to an increased need for IVF with ICSI.