While women discuss whether to freeze their eggs while contemplating their biological clock, the conversation around the lasting power of male fertility receives far less attention. Female patients often ask this question when we meet, but is this an issue that men need to be concerned about too?
The short answer: it depends.
For women, we know fertility is better the younger you are and optimal before age 35. For men, the subject of fertility isn’t so black and white. Unlike women, there is no definite age when fertility changes and many can be fertile late into life. Alec Baldwin had his fifth child at age 60 (with a much younger partner) and Charlie Chaplin had a child at age 73.
Female fertility is delicate and complex – after all, women are tasked with growing a fertilized egg into a baby for nine months. While the male component is vital in the process, it requires a smaller physical commitment.
Monitoring and analyzing male fertility is fundamentally more straightforward. A sperm analysis can be done quickly and easily while analyzing egg health is a more complicated and nuanced process. While women are born with all the eggs they will ever have, men regenerate sperm every 10 weeks. This means that any positive lifestyle habits such as losing weight, improving diet and quitting smoking, vaping and cannabis have a short three-month turnaround to see potential fertility improvement, which can be tracked via semen analysis.
While men don’t see a dramatic shift in fertility with age, there are many men over 45 who have medical conditions that affect fertility. As men get older, other health issues develop such as obesity, diabetes, cardiovascular disease, and high blood pressure. These conditions and other medical issues can affect fertility, as can the medications used to treat them. Older men also tend to have more issues with sexual dysfunction such as difficulty maintaining an erection or having an ejaculation.
Mostly we hear about increasing maternal age increasing the risk for genetic problems, but there are also some autosomal dominant conditions that are increased with growing paternal age. The most well-known is achondroplasia, a common cause of dwarfism.
Regardless of age, the majority of male infertility diagnoses are a result of genetic, hormonal, anatomic or environmental factors:
- Genetic can be an extra X chromosome or a mutation with the Y chromosome called AZF mutation or Y microdeletion.
- Hormonal issues may include difficulty with too much prolactin produced in the pituitary or a problem with the pituitary or hormonal function of the testes.
- Anatomic factors can be a result of an obstruction in the “plumbing” or a varicose vein in the scrotum. This varicose vein is called a varicocele and can heat up the testicles with the extra blood flow, causing disordered sperm and hormone production.
- Environmental factors can include exposure to toxins and chemicals, whether introduced through work or electively ingested such as alcohol, tobacco or marijuana. Other chemicals such as BPA, or Bisphenol A, are found in most disposable plastic water bottles and can affect sperm production.
Another important factor to consider – I often see men taking workout enhancements or testosterone either prescribed by a doctor or taken recreationally. These supplements shut the sperm-making machinery in the testicles down and often these patients have no sperm at all. Sometimes doctors who don’t know much about fertility will see a low testosterone level, put patients on testosterone supplementation, and these patients present with infertility due to no sperm. This is usually reversible but can take three months or more to recover.
If you’re curious about how male fertility is tested, learn more in this blog: How Male Fertility is Evaluated.
Medical contribution by Allison K. Rodgers, M.D.
Dr. Rodgers’ approach to care has been influenced by her own infertility and pregnancy loss. She has published many original research articles in top medical journals. She also writes for her blog, Destination: Parenthood, on many fertility related subjects.
