In this session, Dr Ana Puigvert, Andrologist at Reproclinic (Fertty International), Barcelona, Spain, discussed how age can affect male infertility.
The spermatogenesis is the mechanics in which the sperm is the final product. It’s produced in the testicles and, it takes approximately two to three months for stem cells to mature into a mature spermatozoon.
The hypothalamus helps to secrete FSH (Follicle-Stimulating Hormone), which activates the Sertoli cells within the seminiferous tubules of the testicles, initiating spermatogenesis. Additionally, the testosterone aids the production of the spermatozoa.
Therefore, FSH, Sertoli cells, and testosterone collectively contribute to the production of mature spermatozoa.
Reproductive capacity begins in adolescence, marked by hormonal changes that enable individuals to attain fertility. At 14 years old, we have the first sexual response with a 30% capacity for fertilization.
Signs that indicate when an adolescent matures to produce spermatozoa and fertilize:
Between the ages of 20-35, it is the optimal moment to have the highest fertile capacity. After 40 years old, the concept of male old age becomes important to consider.
Men have the best sperm quality to fertilize an oocyte from the ages of 20–35 years. Despite men maintaining their fertility throughout their lives due to continuous sperm production, the genetic integrity of sperm begins to decline around the age of 40.
The seminiferous tubules contain a lot of stem cells producing mature spermatids with the capacity to fertilize. As men age, these tubules become thinner because they reduce the capacity to produce stem cells.
As males age, they continue to produce spermatozoa, but in lesser quantity and quality. Furthermore, their sexual capacity may diminish over time.
Study: HUTTERITE POPULATION
The American Neurological Association conducted studies with the Hutterite population, who have lived in similar conditions since the 19th century.
It involved 8559 couples and, it was observed that there was a 30% decrease in pregnancy rates for couples over 40 years old compared to those under 30 years old. Therefore, older age correlates with lower pregnancy rates.
In a study of Massachusetts Ageing Male Study, the sexual aspect’s function plays a crucial role in maintaining good pregnancy rates. However, as men age there is a decrease in exposure to pregnancy due to factors such as erectile dysfunction, lower intercourse frequency (approximately 2 times per month), and, delayed ejaculation.
As males age, they continue to produce spermatozoa, but in lesser quantity and quality. Furthermore, their sexual capacity may diminish over time.
Decrease the volume of ejaculation:
Men over 50 years old will have partial or total testosterone deficit syndrome:
Aneuploidies: studied with a testicular biopsy for meiosis. This explains infertility and non-fertilization in IVF and, recurrent miscarriages associated with miscellaneous chromosome abnormalities.
Rates in uterine insemination
Birth defects caused by older men’s sperm.
Associated pathologies:
In father over 45 years:
In mothers over 35 years:
Epigenetic alteration associated with age:
When one person is more than 45–50 years old men who want to have kids must be visited by an andrologist to evaluate:
The most important thing when you make any kind of treatment of DNA fragmentation is to have time because people must understand how a stem cell becomes a spermatozoid. We need time to produce millions of spermatozoa, but only a few are good to fertilize.
Nowadays, all of us are exposed to toxic products and endocrine disruptors which are the several causes of the production of DNA fragmentation and, to change that condition, an antioxidant support is important. This one must be chosen based on the clinical history, diet, and dietary habits.
I prefer doing the seminal screening after six months of antioxidants because then, you can confirm if it’s best to try spontaneous fertilization or IVF techniques.
Yes, sure. My recommendation is always to know in which situation we are, I like male patients to do sperm screening to know what could happen in the future even, when they make an IVF to achieve a pregnancy.
When we have a patient with severe teratozoospermia you must give him a very good clinical history because surely you will find the reason for it.
One little recommendation: no abstention days before giving the sperm screening. Because in the epididymis there is a high concentration of toxic products that can change the morphology of the spermatozoon.
Another point to take into account is to check if the patient has varicocele, one of the most important reasons for infertility in men and alteration of the spermatozoon morphology.
Yes. Men’s male factors are the same for everyone.
I suggest you make a study of infections of the genital area in the urine and in the sperm. The bacteria can break the external part of the membrane of the spermatozoa, which could be the cause.
Sure, you can achieve a natural pregnancy. It’s the thing that all andrologists must try and, if it is not possible, try reproductive techniques.
Smoking is bad. I haven’t seen any kind of studies that demonstrate directly the impact on the fertility rate in men or, even, spermatogenesis. I think we need more time to get more information about it.
There are some papers, but they’re not statistically well done so, sometimes they can have batting opinions.
At the age of 45, it is very important to know exactly what the first condition of this man is, and then you can recommend it or not. With 50 years old, sure.
We must see their toxic habits and quality of life he has, the quality of spermatozoids, and hormones situation. The history of medicine is important.
The sperm screening is not the same as in other sperm screening. You must see the global seminal analysis of screening.
We need 15-20 million per millilitre; 50% with a very good movement; more or less 15 of normal morphology; and 50% of alive spermatozoa. But when you have, for example, 70 million per millilitre or 200 million of totality and, you have a lower quantity of motility doesn’t happen anything because you have a lot of spermatozoa.
If you have less than 45% of dead sperm, nothing. If you have a lower quantity but very good quality, it compensates one thing with another.
Another important thing is to have one more than sperm screening because, as I mentioned, men produce millions and millions, but they never stop. So, we have to know how the normal sperm the person has.
Not all the medications are good. Not having so many quantity medications is also not good, but you can choose the kind of medication by the sperm screening and the lifestyle.
It depends on the patient and the medical history.
Not only in Africa but in all the world, we have terrible problems with toxic and environmental factors. We must tell the governments to stop killing human rights because human men are in a really difficult situation to roughly reproduce themselves.
So, the first to know is which kind of environmental toxins to take out and then try to have again a good quality of reproduction.
In Central America, in a banana plantation, there was a pesticide that caused abortions and then, they studied it and detected which kind of product it was to take it out and reconduct the fertility situation.
