We constantly are hearing about the “biological“ clock. While we have heard a great deal about the “biological” clock and female fertility, there is also the male side to consider. What we do throughout our lives will have an effect on our future fertility and the ability to have a healthy child. Consider the following sampling of things we need to consider:
- Reproductive tract surgery/injury
- Family planning – when/how many?
- Let’s consider what we know.
We know that a woman’s fertility declines due to the normal age-related decrease in the number of eggs within the ovaries. For some women, this may occur at an earlier age than expected. With age, it is also observed that miscarriage rates rise as well as the risk for having a child with an abnormal number of chromosomes.
As an average we expect:
- A fertile 30-year-old woman has a 20% monthly chance of getting pregnant.
- By age 40, a woman’s chances fall to 5-10% per month.
- Miscarriage rates at age 30 are 10-15% while rates after age 40 may be as high as 30-50%.
- After age 44, very few successful pregnancies occur in women with their own eggs.
- Even with fertility treatments, the reduction in pregnancy rates related to the woman’s age is seen.
According to the CDC, 1 in 33 children are born in the United States with a birth defect. With increasing maternal age, there is an increase in chromosomal abnormalities such as Down’s syndrome. As an example, a 30 year-old woman has a 1 in 365 (0.3%) chance of delivering a live born child with a chromosomal abnormality. At age 40, the risk is 1 in 66 (1.5%).
Blood tests such as FSH, Estradiol and AMH and the antral follicle count (ultrasound) are helpful tools for evaluating ovarian reserve. At RSC, we now offer Fertility Check – a blood test draw on cycle day 2-3 for FSH, Estradiol and AMH. Once the results are obtained, one of our Reproductive Endocrinologists will call the patient and review the results. These tests can be useful in predicting current egg quantity. At this time, we have no tests that can accurately predict egg quality. A woman’s age is the best overall predictor of egg quality.
We know there is a decline in sperm production with age. The observed changes include reduced semen volume and sperm motility (movement) with an increase in abnormally shaped sperm (morphology). As testosterone levels decrease with age, issues with reduced libido and erectile function become more common.
Older fathers are more likely to pass along new genetic mutations to their children. For each year after age 35, the number of new gene mutations increases by about two per year. It has been observed that children of older fathers are at increased risk for autism, schizophrenia and new single gene disorders such as achondroplasia, a type of dwarfism, and Apert syndrome. Gene mutations appear to account for 15-30% of autism cases and may also contribute to the development of schizophrenia. Erectile dysfunction does increase in frequency as men age.
While autism and other new single gene conditions are seen in an increasing frequency in the children of older fathers, we must keep in mind that the vast majority of children born to older fathers are healthy.
A formal Semen analysis will provide basic information on a man’s ejaculate volume, sperm count, motility and shape (morphology).
What should you do?
Plan and think ahead now. Maximize your health and protect your reproductive options for the future. There are many factors that go into determining when the best time to start a family may be. Remember that the chances of a successful pregnancy for women and men increasing in age, esp. beyond age 35 can be more difficult.
Talk with your PCP or OB-GYN about your options and possible screening tests such as fertility check for women and a semen analysis for men. You may even want to schedule a consultation with a reproductive endocrinologist.
Here are options if childbearing needs to be delayed:
- Egg freezing
- Sperm freezing
- Embryo banking