In June/2015, in Fertility & Sterility journal, Ramasamy et al published a review about the impact of the advanced paternal age on the reproductive medicine treatments.

Lots of papers have shown the high impact that maternal age has on reproductive outcomes. In older women that use own eggs, there are lower pregnancy rates, higher miscarriage rates and higher chromosomal abnormalities in their babies. Besides, pregnancy outcomes related to maternal age include low birth weight and premature birth. In fact, many women after the age of 40-42 choose doing egg donation to have better success rates.

In contrast to menopause, which marks the cessation of ovarian function, spermatogenesis continues throughout life. Although an increase of the paternal age presents no absolute barrier to conception, there are greater risks and complications that patients should know and doctors should tell.

Nature and effects of advanced paternal age are less studied. However, there is some evidence showing the following:

• Time to pregnancy seems to be longer: a large study published in 2000 by Ford et al showed that men over 35 years old have 50% of chances of getting a pregnancy than men below 25 years old (adjustments have been done for this analysis).
• Sperm parameters are worse: volume, motility and morphology are worse in older men, and they also have higher DNA fragmentation index.
• Miscarriage rate: there is some evidence showing that miscarriage rate is increased in couples with older men. The Danish National Birth Cohort study showed that fetal loss was doubled in couples where men are over 50 years old.
• Birth defects associated with single gene mutations and chromosomal abnormalities: as sperm in older men come from cells with much more mutations than sperm in younger men, there are more chances of mutations that often arise as a result of uncorrected errors in DNA replication. Andersen et al published a paper in 2004 showing a list of genetic conditions that are increased in the offspring: for example, achondroplasia from 1/15,000 to 1/1,923, epilepsia from 1/100 to 1/77 and Childhood central nervous system tumor from 1/36,000 to 1/21,302.

Currently, the American College of Medical Genetics does not specify an upper age limit for men who are seeking to initiate a pregnancy. Although there is no agreement on the existence of a discrete point at which advanced paternal age begins, the risks of disorders in offspring increase continuously over time. The current body of knowledge does not justify dissuading older men from trying to initiate a pregnancy, but we doctors must do a better job of communicating to couples the current understanding of the risks of conception with advanced paternal age.