The effect of paternal age on assisted reproduction outcome

The Effect of Paternal Age on Oocyte Donation Outcomes

IMPORTANCE

In recent decades, a trend toward delayed childbearing is noted in developed countries. Whereas the effects of maternal age on fertility, pregnancy complications, and postnatal outcomes have been thoroughly explored, consequences of advanced paternal age are less well known. Oocyte donation cycles can be used as an optimal model to analyze the association between male ageing and reproductive outcomes with minimal confounding.

OBJECTIVE

The purpose of this work was to summarize the updated and relevant literature dealing with the effect of paternal age on oocyte donation outcomes.

RESULTS

According to the available evidence from oocyte donation cycles, it seems that no significant association exists between advanced paternal age and fertility. However, this evidence is based on few studies, many of which are of low quality, yielding conflicting results. In addition, the emerging evidence clearly indicates an increased risk of adverse postnatal manifestations of pregnancies conceived by older fathers, including de novo autosomal dominant disorders, impaired neurocognitive development, and increased risk of malignancy.

CONCLUSIONS AND RELEVANCE

This review may be of aid to medical practitioners in counseling couples on the risks of delayed childbearing.

Epigenetic Influences During the Periconception Period and Assisted Reproduction

The periconception period starts 6 months before conception and lasts until the tenth week of gestation. In this chapter, we will focus on epigenetic modifications to DNA and gene expression within this period and during assisted reproduction. There are two critical times during the periconception window when significant epigenetic 'reprogramming' occur: one during gametogenesis and another during the pre-implantation embryonic stage. Furthermore, assisted conception treatments, laboratory protocols and culture media can affect the embryo development and birth weights in laboratory animals. There is, however, an ongoing debate as to whether epigenetic changes in humans, causing embryo mal-development, placenta dysfunction and birth defects, result from assisted reproductive technologies or are consequences of pre-existing medical and/or genetic conditions in the parents. The periconception period starts from ovarian folliculogenesis, through resumption of oogenesis, fertilisation, peri-implantation embryo development, embryogenesis until the end of organogenesis. In men, it is the period from spermatogenesis to epididymal sperm storage and fertilisation. Gametes and developing embryos are sensitive to environmental factors during this period, and epigenetic modifications can occur in response to adverse lifestyles and environmental factors. We now know that lifestyle factors such as advanced parentage age, obesity or undernutrition, smoking, excessive alcohol and caffeine intake and recreational drugs used during gamete production and embryogenesis could induce epigenetic alterations, which could impact adversely on pregnancy outcomes and health of the offspring. Furthermore, these can also result in a permanent and irreversible effect in a dose-dependent manner, which can be passed on to the future generations.

Effects of maternal age on embryo quality and pregnancy outcomes using testicular sperm with intracytoplasmic sperm injection

Objective

The aim of this study was to evaluate the influence of maternal age on fertilization, embryo quality, and clinical pregnancy in patients undergoing intracytoplasmic sperm injection (ICSI) using testicular sperm from partners with azoospermia.

Methods

A total of 416 ICSI cycles using testicular spermatozoa from partners with obstructive azoospermia (OA, n=301) and non-obstructive azoospermia (NOA, n=115) were analyzed. Female patients were divided into the following age groups: 27 to 31 years, 32 to 36 years, and 37 to 41 years. The rates of fertilization, high-quality embryos, clinical pregnancy, and delivery were compared across maternal age groups between the OA and NOA groups.

Results

The rates of fertilization and high-quality embryos were not significantly different among the maternal age groups. Similarly, the clinical pregnancy and delivery rates were not significantly different. The fertilization rate was significantly higher in the OA group than in the NOA group (p<0.05). Age-group analysis revealed that the fertilization and high-quality embryo rates were significantly different between the OA and NOA groups in patients aged 27 to 31 years old, but not for the other age groups. Although the clinical pregnancy and delivery rates differed between the OA and NOA groups across all age groups, significant differences were not observed.

Conclusion

In couples using testicular sperm from male partners with azoospermia, pregnancy and delivery outcomes were not affected by maternal age. However, women older than 37 years using testicular sperm from partners with azoospermia should be advised of the increased incidence of pregnancy failure.

Pregnancy outcomes in oocyte recipients with fibroids not impinging uterine cavity

OBJECTIVE

To examine the effects of fibroid uterus on pregnancy outcomes and endometrial features in ovum donation recipients.

METHODS

Retrospective analysis of 744 ovum donation cycles was conducted in two private IVF centers between 2005 and 2012. All the recipients underwent transvaginal ultrasound examination, including endometrial thickness and grade measurements. Clinical pregnancy, spontaneous miscarriage, and live birth rates were regarded as the primary outcomes.

RESULTS

Leimyomas not distorting the uterine cavity were diagnosed in 264 (35.5%) of the cycles. This group exhibited lower endometrial thickness (8.33 ± 1.8 vs. 8.73 ± 2.03 mm, p = 0.009), lower rates of Grade A (16.1 vs. 30.1%, p < 0.0001), and higher rates of grade C endometrium (10.2 vs. 5.5%, p < 0.0001), compared to the group with sonographically normal uterine cavity. In addition, significantly higher spontaneous miscarriage rates were found in fibroid uteri group (25 vs. 14.5%, p = 0.036).

CONCLUSION

Our study results suggest that uterine fibroids not distorting the uterine cavity could constitute a risk factor for spontaneous miscarriage in oocyte donation cycles, possibly via their adverse effect on endometrial receptivity. Further well-designed trials should widely explore this subject, particularly focusing on impact of myomectomy on fertility rates in these patients.

The impact of male age on embryo quality: a retrospective study using time-lapse imaging

OBJECTIVE

This study aimed to correlate male age with embryo morphokinetic parameters on D3 considering the timing and the exact moment of embryo cleavage.

METHODS

Time-lapse imaging was used to produce an ideal cleavage curve for the embryos analyzed. The percentage of embryos under the curve was analyzed and correlated with male age.

RESULTS

32.6% of the embryos from patients aged 28-33 years were under the curve; 36.2% of the embryos from patients aged 34-39 years were under the curve; 41.3% of the embryos from patients aged 40-45 years were under the curve; and 26.3% of the embryos fro patients aged 46-57 years were under the curve.

CONCLUSIONS

a statistically non-significant decrease was observed in the percentage of embryos under the optimal cleavage curve on D3 in the group of men aged between 40 and 45 years. Further studies looking into embryos in the blastocyst stage (D5 or D6) are required.

Effect of male age on oxidative stress markers in human semen

This study conducted a comprehensive analysis of oxidative stress markers in human semen within the context of assisted reproductive technology (ART) and investigated if these markers varied according to male age. 148 semen samples were collected from 139 men presenting at Concept Fertility Centre, Western Australia, from 2009 to 2012. Semen analyses were performed and demographic information including smoking status and abstinence period was collected. Reactive oxygen species production, lipid peroxidation, oxidative DNA damage (8-hydroxy-2′-deoxyguanosine (8-OHdG)), total antioxidant capacity and DNA fragmentation ( terminal deoxynucleotidyl transferase-mediated deoxyuridine diphosphate nick-end labelling) were measured as markers of oxidative stress. Semen parameters and oxidative stress markers were compared against age as a continuous variable, and between males <40 and males ≥40 years of age. Older males aged ≥40 years exhibited higher levels of sperm oxidative DNA damage (8-OHdG) compared to younger males ( p = 0.029), but no other oxidative stress marker significantly varied with age. An age-related decrease in sperm concentration ( p = 0.011) and motility ( p = 0.015) was observed after processing. Lower sperm concentration and reduced motility pre- and post-semen processing were significantly correlated with elevated oxidative DNA damage (all p < 0.001). Our results suggest that oxidative stress may be an important mediator between male age and fertility. This is concerning within the context of an ageing ART cohort, as sperm oxidative DNA damage is associated with a range of suboptimal fertility outcomes.

Variation of DNA Fragmentation Levels During Density Gradient Sperm Selection for Assisted Reproduction Techniques: A Possible New Male Predictive Parameter of Pregnancy?

Predicting the outcome of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is one main goal of the present research on assisted reproduction. To understand whether density gradient centrifugation (DGC), used to select sperm, can affect sperm DNA integrity and impact pregnancy rate (PR), we prospectively evaluated sperm DNA fragmentation (sDF) by TUNEL/PI, before and after DGC. sDF was studied in a cohort of 90 infertile couples the same day of IVF/ICSI treatment. After DGC, sDF increased in 41 samples (Group A, median sDF value: 29.25% [interquartile range, IQR: 16.01-41.63] in pre- and 60.40% [IQR: 32.92-93.53] in post-DGC) and decreased in 49 (Group B, median sDF value: 18.84% [IQR: 13.70-35.47] in pre- and 8.98% [IQR: 6.24-15.58] in post-DGC). PR was 17.1% and 34.4% in Group A and B, respectively (odds ratio [OR]: 2.58, 95% confidence interval [CI]: 0.95-7.04, P = 0.056). After adjustment for female factor, female and male age and female BMI, the estimated OR increased to 3.12 (95% CI: 1.05-9.27, P = 0.041). According to the subgroup analysis for presence/absence of female factor, heterogeneity in the association between the Group A and B and PR emerged (OR: 4.22, 95% CI: 1.16-15.30 and OR: 1.53, 95% CI: 0.23-10.40, respectively, for couples without, n = 59, and with, n = 31, female factor).This study provides the first evidence that the DGC procedure produces an increase in sDF in about half of the subjects undergoing IVF/ICSI, who then show a much lower probability of pregnancy, raising concerns about the safety of this selection procedure. Evaluation of sDF before and after DGC configures as a possible new prognostic parameter of pregnancy outcome in IVF/ICSI. Alternative sperm selection strategies are recommended for those subjects who undergo the damage after DGC.

Effects of aging on the male reproductive system

The study aims to discuss the effects of aging on the male reproductive system. A systematic review was performed using PubMed from 1980 to 2014. Aging is a natural process comprising of irreversible changes due to a myriad of endogenous and environmental factors at the level of all organs and systems. In modern life, as more couples choose to postpone having a child due to various socioeconomic reasons, research for understanding the effects of aging on the reproductive system has gained an increased importance. Paternal aging also causes genetic and epigenetic changes in spermatozoa, which impair male reproductive functions through their adverse effects on sperm quality and count as, well as, on sexual organs and the hypothalamic-pituitary-gonadal axis. Hormone production, spermatogenesis, and testes undergo changes as a man ages. These small changes lead to decrease in both the quality and quantity of spermatozoa. The offspring of older fathers show high prevalence of genetic abnormalities, childhood cancers, and several neuropsychiatric disorders. In addition, the latest advances in assisted reproductive techniques give older men a chance to have a child even with poor semen parameters. Further studies should investigate the onset of gonadal senesce and its effects on aging men.

In-vitro fertilization and spontaneous pregnancies: matching outcomes in Douala, Cameroon

BACKGROUND

Couples are considered infertile if they do not conceive over a 12-month period of unprotected intercourse. Studies have shown that female causes accounted for between 25 to 37 percent of infertility worldwide (with larger proportions in sub-Saharan Africa and Southeast Asia) and male causes accounted for between 8 to 22 percent. Both male and female causes accounted for between 21 to 38 percent. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30 % of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. The aim of this study was to evaiuate the outcome of pregnancies conceived by In-vitro fertilisation compared to those conceived naturally in two hospitals in Douala, Cameroon.

METHODS

This was a prospective study carried out from October 1, 2011 to September 30, 2012. Participants were recruited from two hospitals: the Douala General Hospital (DGH) and the Clinique de l' Aéroport (CDA), also in Douala. A total of 102 women were recruited for study: 51 who conceived by IVF (cases) and 51 who conceived naturally (controls). Of the 102 women, 52.9 % were between 31 - 39 years of age, while 21.6 % were above 40.

RESULTS

Participants who conceived through IVF-ET were 4.1 times more likely to undergo cesarean delivery than those who conceived naturally [OR 4.10, 95 % CI 1.78-9.42]. Similarly, a higher percentage of patients in the IVF group than those in the control group have never given birth (33.3 % vs 2.0 %) (P < 0.0001). The percentage of multiple pregnancies was 7.5 times higher in the IVF group than in the control group (14.7 % vs.1.96 %) (P = 0.000). The leading indication for cesarean delivery was advanced maternal age (27.3 %) followed by IVF or precious pregnancy (18.2 %).

CONCLUSIONS

Cesarean delivery was more frequent amongst the IVF group than in the control group. The leading indications for cesarean delivery were advanced maternal age and IVF or precious pregnancy. The long-term neonatal outcomes of IVF babies beyond 5-min Apgar scores should be studied in Cameroon and follow-up beyond 1 year encouraged.

DEFINING ELIGIBILITY CRITERIA FOR FUNDING POLICIES AROUND IN VITRO FERTILIZATION

Objectives: This review aims to assess the state of the science around the potential impact of certain patient characteristics on the safety and effectiveness of in vitro fertilization (IVF).

Methods: Following Cochrane Collaboration guidelines and the PRISMA statement, a comprehensive systematic review of reviews and recent primary studies examining the impact of paternal age and maternal age, smoking, and body mass index (BMI) on the safety and effectiveness of IVF was performed. Papers, published between January 2007 and June 2014, were independently reviewed and critically appraised by two researchers using published quality assessment tools for reviews and primary studies. Due to heterogeneity across papers (different study designs and patient selection criteria), a qualitative analysis of extracted information was performed.

Results: Seventeen papers (ten systematic reviews and seven primary studies) were included. They comprised evidence from retrospective observational studies in which maternal age, BMI, and smoking status were explored as part of secondary analyses of larger studies. The majority of papers found that the likelihood of achieving a pregnancy was lower among women who were >40 years, had a BMI ≥ 25 and smoked. Advanced maternal age and BMI were also associated with higher rates of preterm birth and low birth weight.

Conclusions: Based on available evidence, it may be appropriate to consider “maternal age” and “morbid obesity” in public funding policies that aim to maximize the effectiveness of IVF. However, given inconsistencies in the effect of smoking across different pregnancy-related outcomes, support for incorporating it into funding conditions appears weak.

The results of pregnancies after gender selection by pre implantation genetic diagnosis and its relation with couple's age

BACKGROUND

Non-medical utilization of pre-implantation genetic diagnosis (PGD), like sex selection, is increasing, therefore it is necessary to follow-up the health and outcome of fertilization and newborn's birth followed PGD. The aim of this study was to evaluate the outcome of fertilization after sex selection by PGD and the relation between the age of parents and the outcome of fertilization.

MATERIALS AND METHODS

This was a retrospective descriptive correlative study conducted on 218 couples in Isfahan. Samples were selected through convenience sampling. The rate of chemical and clinical pregnancy and abortion, the frequency of success in achieving the desired sex, and the mean of gestational age and weight of newborns were gathered through reviewing medical files and phone interviews. Data was analyzed using independent t test and Pearson correlation test.

RESULTS

The rate of chemical and clinical pregnancy was 30.7% and 30.3% respectively, the rate of abortion was 26.9%, the frequency of success in achieving the desired sex was 100%, and the mean of gestational age and weight of newborns was 3260 (616) kg and 37.7 (2.07) weeks respectively. There was no significant relation between the age of parents and the rate of abortion, the rate of chemical and clinical pregnancy and newborn's gestational weight. But there was a significant relation between the age of men and gestational age of newborns (P = 0.04).

CONCLUSIONS

PGD method was 100% successful in achieving the desired sex, but relatively high rate of abortion could indicate the effect of PGD on the embryo development process.

Effects of increased paternal age on sperm quality, reproductive outcome and associated epigenetic risks to offspring

Over the last decade, there has been a significant increase in average paternal age when the first child is conceived, either due to increased life expectancy, widespread use of contraception, late marriages and other factors. While the effect of maternal ageing on fertilization and reproduction is well known and several studies have shown that women over 35 years have a higher risk of infertility, pregnancy complications, spontaneous abortion, congenital anomalies, and perinatal complications. The effect of paternal age on semen quality and reproductive function is controversial for several reasons. First, there is no universal definition for advanced paternal ageing. Secondly, the literature is full of studies with conflicting results, especially for the most common parameters tested. Advancing paternal age also has been associated with increased risk of genetic disease. Our exhaustive literature review has demonstrated negative effects on sperm quality and testicular functions with increasing paternal age. Epigenetics changes, DNA mutations along with chromosomal aneuploidies have been associated with increasing paternal age. In addition to increased risk of male infertility, paternal age has also been demonstrated to impact reproductive and fertility outcomes including a decrease in IVF/ICSI success rate and increasing rate of preterm birth. Increasing paternal age has shown to increase the incidence of different types of disorders like autism, schizophrenia, bipolar disorders, and childhood leukemia in the progeny. It is thereby essential to educate the infertile couples on the disturbing links between increased paternal age and rising disorders in their offspring, to better counsel them during their reproductive years.

Male biological clock: a critical analysis of advanced paternal age

Extensive research defines the impact of advanced maternal age on couples' fecundity and reproductive outcomes, but significantly less research has been focused on understanding the impact of advanced paternal age. Yet it is increasingly common for couples at advanced ages to conceive children. Limited research suggests that the importance of paternal age is significantly less than that of maternal age, but advanced age of the father is implicated in a variety of conditions affecting the offspring. This review examines three aspects of advanced paternal age: the potential problems with conception and pregnancy that couples with advanced paternal age may encounter, the concept of discussing a limit to paternal age in a clinical setting, and the risks of diseases associated with advanced paternal age. As paternal age increases, it presents no absolute barrier to conception, but it does present greater risks and complications. The current body of knowledge does not justify dissuading older men from trying to initiate a pregnancy, but the medical community must do a better job of communicating to couples the current understanding of the risks of conception with advanced paternal age.

Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages

The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1-5. Results were collected from 66 men with different CKD stages (age 18-50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, α-glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, α-glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual-hormone-binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age-related decrease of testosterone level and BMI.

Infertile men older than 40 years are at higher risk of sperm DNA damage

BACKGROUND

The effect of paternal age on semen quality is controversial. In this retrospective study, the aim was to investigate the effects of advancing age on sperm parameters including reactive oxygen species (ROS), total antioxidant capacity (TAC) and sperm DNA damage in infertile men. We also examined whether paternal age >40 y is associated with higher risk of sperm DNA damage.

METHODS

A total of 472 infertile men presenting for infertility were divided into 4 age groups: group A: patients ≤ 30 y; group B: patients 31- 40 y, group C: ≤ 40 y and group D: patients >40 y. The following tests were performed - semen analysis according to WHO 2010 criteria, seminal ROS by chemiluminescence, TAC by colorimetric assay and sperm DNA damage by TUNEL assay - and the results were compared amongst the 4 age groups.

RESULTS

There was no statistical difference in conventional semen parameters, TAC and ROS with advancing paternal age as well as between different age groups. However, a significant negative association was noted between sperm DNA damage and advancing paternal age. Men >40 y showed higher levels of sperm DNA damage (24.4 ± 18.5%) compared to younger men (<30 y; 16.7 ± 11.2%; p <0.05).

CONCLUSIONS

Infertile men over the age of 40 y have a greater percentage of sperm DNA fragmentation compared to infertile men aged 40 y and below. Advanced paternal age (>40 y) may increase the risk of sperm DNA damage in infertile men.

The effect of father's age in fertile, subfertile, and assisted reproductive technology pregnancies: a population based cohort study

PURPOSE

To compare ages of mothers and of fathers at delivery in couples who are fertile, subfertile, and subfertile treated with assisted reproductive technology (ART) and to characterize birth outcomes in the ART population according to paternal age.

METHODS

Live birth deliveries in Massachusetts between July, 2004 and December, 2008 were identified from vital records and categorized by maternal fertility status and treatment as ART, subfertile or fertile. The ART births were linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database to obtain cycle-specific treatment data. Parental ages were obtained from birth certificates. Age of mothers and fathers were compared using ANOVA for continuous measures and χ (2) for categories. Risks of prematurity (<37 weeks), low birthweight (<2,500 g), and low birthweight z-score (small for gestatational age, SGA) were modeled using logistic regression by categories of paternal age as adjusted odds ratios and 95 % CI.

RESULTS

The study population included 9,092 ART, 6,238 subfertile, and 318,816 fertile deliveries. Paternal ages in the ART and subfertile groups were similar and differed significantly from those of the fertile group. Maternal age in the ART and subfertile groups averaged 5-6 years older than their fertile counterparts and fathers averaged 4-5 years older with twice as many being older than 37. The risks for prematurity, low birthweight and SGA did not increase with increasing paternal age.

CONCLUSIONS

Fathers in ART- treated and subfertile couples are older than in their fertile counterparts. Older paternal age was not assoicated with increased risk for prematurity, low birthweight, or SGA.

Paternal age and assisted reproductive outcomes in ICSI donor oocytes: is there an effect of older fathers?

STUDY QUESTION

Does paternal age affect semen quality and reproductive outcomes in oocyte donor cycles with ICSI?

SUMMARY ANSWER

Paternal age is associated with a decrease in sperm quality, however it does not affect either pregnancy or live birth rates in reproductive treatments when the oocytes come from donors <36 years old and ICSI is used.

WHAT IS KNOWN ALREADY

The weight of evidence suggest that paternal age is associated with decreasing sperm quality, but uncertainty remains as to whether reproductive outcomes are affected. Although developed to treat severe sperm factor infertility, ICSI is gaining popularity and is often used even in the presence of mild male factor infertility.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study spanning the period between February 2007 and June 2010. A total of 4887 oocyte donation cycles were included.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Fertilization was carried out by ICSI in all cycles included, and the semen sample used was from the male partner in all cases. The association of male age with semen parameters (volume, concentration, percentage of motile spermatozoa) was analyzed by multiple analysis of covariance. The association of male age with reproductive outcomes (biochemical pregnancy, miscarriage, ongoing pregnancy and live birth rate) was modeled by logistic regression, where the following covariates were introduced: donor age, recipient age, semen state (fresh versus frozen) and number of transferred embryos (3 and 2 versus 1).

MAIN RESULTS AND THE ROLE OF CHANCE

We identified a significant relationship between paternal age and all sperm parameters analyzed: for every 5 years of age, sperm volume decreases by 0.22 ml (P < 0.001), concentration increases by 3.1 million sperm/ml (P = 0.003) and percentage motile spermatozoa decreases by 1.2% (P < 0.001). No differences were found in reproductive outcomes (biochemical pregnancy, miscarriage, clinical pregnancy, ongoing pregnancy and live birth) among different male age groups.

LIMITATIONS, REASONS FOR CAUTION

The use of donor oocytes, while extremely useful in highlighting the role of male age in reproductive outcomes, limits the generalization of our results to a population of young women with older male partners. No data were available on perinatal and obstetrical outcomes of these pregnancies. Most (75%) cycles used frozen/thawed sperm samples which might have introduced a bias owing to loss of viability after thawing. ICSI was performed in all cycles to control for fertilization method; this technique could mask the natural fertilization rate of poorer sperm samples. Furthermore, we did not use stringent ICSI indications; and our data are therefore not generalizable to cases where only severe male factor is considered. However, male patients were of different racial background, thus allowing generalizing our results to a wider patient base.

WIDER IMPLICATIONS OF THE FINDINGS

Our study suggests that paternal age does not affect reproductive outcomes when the oocyte donor is <36 years of age, indicating that ICSI and oocyte quality can jointly overcome the lower reproductive potential of older semen.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported in part by Fundació Privada EUGIN. The authors have no conflicts of interest to declare.

Delayed fatherhood

Birth data from developed countries indicates that the average paternal age is increasing. As the trend to older fatherhood has become established, concerns have been raised that this may be linked to adverse outcomes, such as pregnancy complications, congenital anomalies, and long-term health implications for the child. Since the sperm of older fathers may be impaired due to the general effects of ageing, their offspring may be at risk due to defects in sperm quality at conception. A literature search was performed to identify pregnancy complications, fetal anomalies and health issues for the child when the father is in an older age bracket. Evidence for impairment in the sperm and genetic material of older fathers was reviewed. With an older father, there is evidence of an increase in stillbirths and a slightly increased risk of autism, bipolar disorder and schizophrenia in the offspring later in life. The increased risk of achondroplasia has long been recognised. For the mother, there is an increased rate of Caesarean section. Investigations of other possible adverse outcomes have produced mixed findings. Further robust and longitudinal studies are needed to clarify these issues.

Paternal factors in spontaneous first trimester miscarriage

Objectives: To determine whether paternal factors i.e., age, tobacco use and genital tract infection increase the risk for spontaneous first trimester miscarriage.

Methodology: This case control study was conducted in the Department of Obstetrics & Gynaecology, Unit V / IV, Dow Medical College & Lyari General Hospital, Dow University of Health Sciences, Karachi, Pakistan. Duration of study was two and half years, from Nov, 2007 to Apr, 2010. Inclusion criteria were pregnant women with age 20 – 35 years irrespective of parity. Exclusion criteria were known medical illness in either partner, induced abortion and recurrent miscarriages. Studied paternal factors were age, tobacco use and genital tract infection. Data was computed using SPSS version 16. Significance of paternal factors was determined by Logistic Regression Analysis.

Results: Total cases studied were 200, while there were 400 controls. Mean maternal age was 27.6±4.9 years in cases and 26.5±4.5 years in controls. Mean paternal age was 35.5±6.2 years in cases and 32.3±5.4 years in controls. Paternal age was >35 years in 54.5% cases and 16.8% controls. Spearman Bivariate correlation revealed paternal age > 35 years (p=0.000) and genital tract infection (p=0.043) as significant factors. Only paternal age >35 years (p=0.000) remained significant in Final Model after entering into logistic regression.

Conclusion: Paternal age beyond 35 years was found to be significantly related to first trimester spontaneous miscarriages.

The effects of advanced paternal age on fertility

Modern societal pressures and expectations over the past several decades have resulted in the tendency for couples to delay conception. While women experience a notable decrease in oocyte production in their late thirties, the effect of age on spermatogenesis is less well described. While there are no known limits to the age at which men can father children, the effects of advanced paternal age are incompletely understood. This review summarizes the current state of knowledge regarding advanced paternal age and its implications on semen quality, reproductive success and offspring health. This review will serve as a guide to physicians in counseling men about the decision to delay paternity and the risks involved with conception later in life.

A comparison of pregnancy rate before and after the administration of HCG in intrauterine insemination

PURPOSE

Intrauterine insemination (IUI) is one of the first treatments of infertility. In natural cycles, women conceive when an intercourse takes place during a 6-day period ending on the day of ovulation. The current practice in IUI cycles is to perform IUI 24-36 h after the HCG administration, when the ovulation already took place. In this study, HCG was administered after IUI, which more closely resembles the fertilization process in natural cycles. The aim of the present study is to compare the fertility rates in an IUI protocol in women who took an HCG injection before and after the IUI.

METHODS

This study was conducted on 100 infertile couples who referred to the infertility research center of Shahid Sadoughi University of Medical Sciences. They were divided into two groups: HCG injection before IUI and HCG injection after IUI. The main outcome measure was the result of a β HCG test that was done two weeks after the IUI; if it was positive, transvaginal sonography would be performed in the seventh week for clinical confirmation of pregnancy.

RESULTS

The analysis included 50 cycles with HCG administered before and 50 cycles with HCG administered after the IUI. The pregnancy rates were 10 and 12 % (P = 0.85), respectively. Independent factor affected the cycle outcome was the time of infertility.

CONCLUSION

HCG administration after IUI brought about no improvement in the pregnancy rate. Therefore, HCG can be administered either before or after IUI.

Effects of age on male fertility

Later parenting is considered by many to have advantages, parents-to-be may feel themselves more stable to rear children. In addition, many men start a second family later in life. Thus, paternal age becomes an emerging issue. Aging affects male fertility by a scope of factors, which are not fully understood to date. Generally, the amount of produced sperm cells as well as their motility decreases with age, as testicular histological architecture deteriorates. Decreased fecundity and an increased risk for disturbed pregnancies occur with advancing paternal age. Some rare autosomal dominant pathologies are clearly related to paternal age. Altered patterns of epigenetics/gene expression in aging sperm seem to affect a range of neurocognitive disorders and also metabolic dyshomeostasis across generations. Such effects refer to men older than 40 years and may have impact on socio-economic issues. Nevertheless, councelling of older men seeking paternity should be patient-oriented and weigh statistical probabilities against the right for individual life-planning.

Paternal age, placental weight and placental to birthweight ratio: a population-based study of 590,835 pregnancies

STUDY QUESTION

Is the age of the father associated with placental weight or the ratio of placental weight to birthweight?

SUMMARY ANSWER

Placental weight and placental to birthweight ratio increased according to increasing paternal age, also after adjustment for maternal age.

WHAT IS KNOWN ALREADY

High paternal age and also high placental to birthweight ratio have been associated with adverse pregnancy outcome.

STUDY DESIGN, SIZE AND DURATION

We performed a population-based study and included all singleton births after 22 weeks of gestation in the Medical Birth Registry of Norway (n = 590,835) during the years 1999-2009.

PARTICIPANTS/MATERIALS, SETTING, METHODS

We compared mean placental weight and placental to birthweight ratio between paternal age groups. The association of paternal age with placental weight was estimated by linear regression analyses, and adjustments were made for maternal age, birthweight, parity, offspring sex, gestational age at birth, maternal smoking, pre-eclampsia, maternal diabetes mellitus and pregnancy after assisted reproductive technology (ART).

MAIN RESULTS AND THE ROLE OF CHANCE

In pregnancies with fathers aged 20-24 years old, the mean placental weight was 656.2 g [standard deviation (SD) 142.8], whereas it was 677.8 g (SD 160.0) in pregnancies with fathers aged 50 years or older (P < 0.001). The mean offspring birthweight in pregnancies with fathers aged 20-24 year old was 3465.0 g (SD 583.8), and it was 3498.9 g (SD 621.8) when the father was 50 years or older (P < 0.001). The placental to birthweight ratio in the corresponding paternal age groups were 0.191 (SD 0.039) and 0.196 (SD 0.044) (P < 0.001). In multivariable linear regression analysis the placentas in pregnancies fathered by a man of 50 years or older were estimated to weigh 13.99 g [95% confidence interval (CI) 10.88-17.10] more than in pregnancies with a 20-24-year-old father (P < 0.001) after adjustment for maternal age, birthweight, parity, offspring sex, gestational age at birth, maternal smoking, pre-eclampsia, maternal diabetes mellitus and pregnancy after ART.

LIMITATIONS, REASONS FOR CAUTION

Paternal age explains only a small proportion of the total variation in placental weight.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings may increase the understanding of the father's role in human pregnancy.

STUDY FUNDING/ COMPETING INTEREST(S)

Norwegian Resource Centre for Women's Health, Norway. No conflict of interest.

TRIAL REGISTRATION NUMBER

N/A.

Aging sperm negatively impacts in vivo and in vitro reproduction: a longitudinal murine study

OBJECTIVE

To investigate the impact of paternal aging on reproductive success.

DESIGN

Animal study.

SETTING

Research facility.

ANIMAL(S)

Outbred CF1 mice.

INTERVENTION(S)

Ten young male mice with proven fertility were mated routinely over 15 months with superovulated young females to assess in vivo and in vitro reproductive outcome.

MAIN OUTCOME MEASURE(S)

In vivo fertilization, in vivo fetal development, in vitro embryo morphology, and developmental outcome were assessed.

RESULT(S)

There were no differences observed for any reproductive end point until the paternal age of 12 months. At 12-15 months, in vivo fertilization was significantly decreased (35% vs. 78% at <12 months). Natural matings with males ≥ 12 months revealed significantly smaller fetuses (11.36 mm vs. 14.73 mm <12 months) and placental weight (0.10 g vs. 0.13 g at <12 months). In vitro blastocyst development showed a significant decline at ≥ 12 months, and in vitro blastocyst transfer resulted in a significant increase in pregnancy loss with males ≥ 12 months (61.5% vs. 0% at <12 months). In addition, the expression levels of Ace-1, Prm1, Prm2, and Smcp were observed to be decreased in sperm from males ≥ 12 months compared with young male control subjects.

CONCLUSION(S)

Results from this study indicate an abrupt reproductive deterioration at paternal midlife, with an adverse effect observed on natural conception, in vitro blastocyst development, implantation potential, and fetal viability.

Pregnancy after percutaneous epididymal sperm aspiration in an 81-year-old man with obstructive azoospermia

There has been observed a trend to delay childbearing, reflecting couple's desire to have children at older ages. Maternal age is a well-known factor that influences the achievement of a pregnancy. In contrast, there are few studies examining the effect of paternal age on the outcomes of assisted reproductive technologies (ART), and results are conflicting. Our patient was vasectomised at the age of 60 years, and his wife was 38 years old. A total of four metaphase II oocytes were inseminated 4 h later (day 0) by intracytoplasmic sperm injection using spermatozoa from percutaneous epididymal sperm aspiration. On day 2, the three resulting embryos were transferred (two had four cells, and one had two cells). Two healthy infants were born at the 37th gestational week by caesarean section. Although the effect of paternal age on ART outcomes and results are conflicting, this case report contributes to point out that advanced age of the man has probably lesser negative influence in the reproductive function.

Effect of male age on the outcome of in vitro fertilization: oocyte donation as a model

PURPOSE

To assess the influence of male age on the outcome of oocyte donation cycles.

MATERIALS AND METHODS

A total 103 oocyte donation cycles of 70 couples (male aged 26 to 57) were examined, all of which were performed with conventional in vitro fertilization using fresh ejaculation sperm. Main outcome measures were fertilization rate, clinical pregnancy, live birth rates and pregnancy loss.

RESULTS

A total 122 cryopreserved embryo transfer were performed, resulting in 34 cycles resulted in clinical pregnancy and 27 live births. No significant correlation was found between male age and fertilization rate. No significant difference was found in male age between the patients who achieved clinical pregnancy and live birth and those who did not. All the pregnancy loss occurred in cycles where the male was older than 37, however, when the cycles were divided into two groups according to whether or not male age older than 37, no statistically significant difference was not found in pregnancy loss rate.

CONCLUSIONS

Aging of the male has no significant impact on fertilization, pregnancy or live birth in oocyte donation cycles, but may be associated with pregnancy loss.

Advanced paternal age and reproductive outcome

Women have been increasingly delaying the start of motherhood in recent decades. The same trend is seen also for men. The influence of maternal age on fertility, chromosomal anomalies, pregnancy complications, and impaired perinatal and post-natal outcome of offspring, has been thoroughly investigated, and these aspects are clinically applied during fertility and pregestational counseling. Male aging and reproductive outcome has gained relatively less attention. The purpose of this review is to evaluate updated and relevant literature on the effect of paternal age on reproductive outcome.

[Pregnancy predictive factors in case of double embryo transfer during "Top Quality" attempts]

OBJECTIVES

To identify IVF±ICSI pregnancy predictive factors during "Top Quality" attempts in case of double embryo transfer.

PATIENTS AND METHODS

Three years retrospective study (2007, 2008 and 2009) on parameters and results obtained during IVF±ICSI defined as "Top Quality" attempts: first or second attempts on less than 35years old women (age inferior or equal to) with one or two "Top Quality" embryo transfer.

RESULTS

In case of double embryo transfer, pregnancy predictive factors are (OR [IC 95%], P): average endometrial thickness on start (4.6 [2.9-5.5], P<0.01), women smoking (4.2 [3.5-4.9], P<0.01), average stimulation duration (3.4 [2.7-3.9], P<0.01), average men age (2.2 [1.7-2.5], P<0.05), gonadotrophins total dose (2.1 [1.1-3.2], P<0.05) and first rank's attempts (1.6 [1.2-2.5], P<0.05).

DISCUSSION AND CONCLUSION

Age patient, rank attempts and quality embryo are criteria, which used to guide to a single embryo transfer. Our results incite us to consider other parameters, in particular men age and women smoking status.

Demographic and medical consequences of the postponement of parenthood

BACKGROUND Across the developed world couples are postponing parenthood. This review assesses the consequences of delayed family formation from a demographic and medical perspective. One main focus is on the quantitative importance of pregnancy postponement. METHODS Medical and social science databases were searched for publications on relevant subjects such as delayed parenthood, female and male age, fertility, infertility, time to pregnancy (TTP), fetal death, outcome of medically assisted reproduction (MAR) and mental well-being. RESULTS Postponement of parenthood is linked to a higher rate of involuntary childlessness and smaller families than desired due to increased infertility and fetal death with higher female and male age. For women, the increased risk of prolonged TTP, infertility, spontaneous abortions, ectopic pregnancies and trisomy 21 starts at around 30 years of age with a more pronounced effects >35 years, whereas the increasing risk of preterm births and stillbirths starts at around 35 years with a more pronounced effect >40 years. Advanced male age has an important but less pronounced effect on infertility and adverse outcomes. MAR treatment cannot overcome the age-related decline in fecundity. CONCLUSIONS In general, women have partners who are several years older than themselves and it is important to focus more on the combined effect of higher female and male age on infertility and reproductive outcome. Increasing public awareness of the impact of advanced female and male age on the reproductive outcome is essential for people to make well-informed decisions on when to start family formation.