A Complete, Based on Data Book That Will Teach You About How to:
Understand Your Body Through Biological Changes; The Importance of Testing; The Connection Between Emotional Well-Being; How to Know Your Rights as a Patient.
Author: Dr Humaira Latif, Registered Medical Practitioner, Gynaecological & Obstetrics Specialist
14 years of Clinical and Practical Experience
Summary of the Key Concepts Written by Dr Latif
The male reproductive system.
Declines over time after reaching puberty (40+).
The decline will result in:
- Lower-quality sperm (less motility).
- Higher amounts of DNA fragmentation in sperm, and
- Mild increases in hormone levels, amongst other things.
Being older than 40 may also increase the likelihood of having a miscarriage, and the risk of some other problems in the baby.
To evaluate male fertility, the following tests will be done: semen analysis, hormonal testing, and other advanced testing.
Healthy living (eating, exercising, sleeping), timely medical consultation, and emotional support will improve your chances of being able to father a baby.
INTRODUCTION:
Most discussions about fertility focus on the female partner; however research has shown through modern studies that male reproductive health is also impacted by biologic age and male reproductive aging.
There are biological changes that occur to men over the age of 40:
- Quality of semen continues to decline
- Increased levels of sperm DNA damage
- Periods of hormonal change
- Slightly increased risk of miscarriage
- Slightly increased likelihood of passing on certain genetic abnormalities
Although, the majority of men over the age of 40 will be able to father healthy children, understanding these biological changes will allow for better planning for and making informed decisions surrounding fatherhood.
This guide includes:
- Clear description of biological changes
- A step-by-step process of fertility testing
- The importance of healthy lifestyle choices
- Mental health support framework
- Discussions on health disparities due to income, race and gender
- Tips on how to understand your legal rights as a parent, and how to fund the cost of having children through adoption or assisted reproduction.
1.Biological alterations in male fertility after forty:
1. Hormonal Restructuring:
The level of testosterone in men decreases year by year, on average, about 1% each year on average after age forty. In contrast to females' hormone levels, dropping fast (menopause), men's hormone levels drop slowly and can be differing amounts for different men.
Hormones that can decline:
Amounts of testosterone:
- Total testosterone.
- Free testosterone.
- Growth hormone.
- DHEA.
Possible Symptoms:
Some possible symptoms to look for in men as they approach an average of fifty-two (Averages: 87% decrease in testosterone), are:
- Reduced libido
- Slightly hard to get an erection, tiredness/fatigue.
- Moodiness.
- Less overall body muscle mass.
- Decreased muscle strength
IMPORTANT NOTE:
If men are seeking to have a child through assisted reproductive medicine, he should consult with a specialist before receiving hormone therapy due to the potential of suppressed sperm production.
Changes related to sperm parameters among aging males. Quantitative evaluations of sperm have shown a measurable change in the following parameters:
2.Magnitude of Aging Change:
Sperm DNA fragmentation %:
Higher levels of DFI have been correlated with:
- Repeated pregnancy loss
- Diminished success of assisted reproduction
- Inferior embryo quality
Contributing Factors:
- Oxidative stress
- Build-up of cellular replication errors
- Diminished ability to repair damaged DNA
Genetic Factors:
Advance paternal age has been correlated with an increased incidence of:
Autism spectrum disorder
- Schizophrenia
- Bi-polar disorder
- Achondroplasia
- New genetic mutations
All risk levels are statistical associations, not certainties. The vast majority of pregnancies will end with a healthy baby.
3.Fertility Testing for Men (In 5 Steps):
3.1! Comprehensive Medical Evaluation:
May include assessments of:
Diabetes and hypertension
- Body weight (BMI)
- Tobacco and alcohol use
- Workplace exposures
- Prior infections
- History of chemotherapy
- Medications taken (including TRT/steroids).
3.2. Semen Analysis:
Typically done twice (2–3 weeks apart).
Parameters tested include:
- Volume
- Count
- Mobility
- Shape of sperm.
In most cases results will be confirmed as part of establishing a diagnosis.
3.3 Hormone Testing:
Common labs use:
- FSH
- LH
- Total testosterone
- Prolactin
- TSH
An elevated FSH would indicate that the testicles are not functioning properly.
3.4 Advanced Testing (If needed):
- Sperm DNA Fragmentation Index
- Genetic tests
- Scrotal ultrasounds
These tests are typically reserved for certain clinical populations, e.g. recurrent pregnancy loss.Greater than 20%, average borderline fragmentation.
4. Plan of Action for Improving Fertility:
4.1 Keep a Healthy Weight:
A Body Mass Index (BMI) is a measure of body fat based on height and weight and should be between 20-25. Extra fat in the body contributes to:
- Hormonal Imbalances
- Increased Temperature in the Scrotum
- Oxidative Stress
4.2 Eat a Balanced Diet:
A. The dietary pattern most people can follow is considered Mediterranean Style.
Examples of foods that promote a healthy fertility include:
Vegetables, especially dark leafy vegetables, Whole Grains, Olive Oil, Nuts, Fish/seafood
Examples of food items to avoid to promote a healthy fertility are:
- Processed/packaged food
- Sugary drinks/beverages
- Trans/Hydrogenated fats
4.3 Remove Exposure to Excessive Heat:
Limit exposure to excessive heat by:
- Regularly taking hot baths
- Wearing tight clothes
- Wearing clothes that are too tightly fitted
- Using a laptop on your lap for long periods of time
- This will improve the chance of getting pregnant.
4.4 Time Intercourse:
The timing of each act of lovemaking will improve the chances of getting pregnant; therefore, you should have sexual intercourse every 2-3 days, more frequently during your "fertile window" (ovulating), and reduce the number of times you ejaculate in the same day if your sperm count is on the lower end.
5.Myths vs Facts:
Men may experience:
- Anxiety
- Reduced mood or depression
- Stress on relationships
- Low self-esteem
Professional help can be beneficial when:
- Symptoms persist for over two weeks
- Changes in appetite or sleeping habits
- Daily life activities suffer
The following myths regarding fertility are:
8. Financial & Insurance Planning:
- Coverage for tests related to infertility
- The caps on both the number cycles of IVF and the amount covered per cycle
- Costs of medication
- The requirement of pre-authorization prior to starting IVF treatment
- Payment Plan
- Medical Financing
- Package Plan Pricing
- Supportive resources should be:
- Comprehensive and Educational
- Culturally Appropriate
- Multiple Types of Formats Available (Printed, Visual, Audio, Internet, Etc.)
- Available to Person with All Disabilities
- By providing Inclusive Care More Patients Will Have Better Outcomes
10. Summary
1.There are many factors that can affect a male's fertility at age forty:
- Age (decrease in testosterone level)
- Increased Occurrence of Oxidative Stress (free radical damage)
- Hormonal imbalance in the body
2. Genetic Variability.
3. Economic/Social Factors.
4. An Integrative Approach Includes
5. Early Medical Evaluation:
6. Regular Healthy Lifestyle Choices
7. Emotional/Mental Support
8. Knowledge of the Cost of Fertility Treatment
9. Knowledge of Reproductive Options
10. Every Man Should Receive Respectful, Evidence-Based Reproductive Medical Care.
Author:
Dr. Humaira Latif.
Registered Medical Doctor, OBS/GYN, 14 years of experience in the clinical setting.
I am an educator dedicated to providing evidence-based reproductive health education resources to all patients.
11.Frequently Asked Questions:
1.Can men over 40 be fathers to healthy offspring?
Yes, men of 40 years or older are still able to get pregnant with their partners through intercourse, and many of them do. Sperm count and motility (the ability to swim) decline as you age; however, that decline doubles between age 40 to 43 and is complete by the time you reach 60-70. When that happens you will not be able to conceive.
2.Does advancing age of father increase risk of miscarriage?
As you get older, the risk for having a miscarriage increases but is still fairly low.
3.When should a couple seek a fertility doctor?
If the woman is under the age of 35, you should wait one year (12 months) after trying to get pregnant; if you were both over the age of 35, then you should only wait 6 months before seeking a fertility doctor; if you are a man over the age of 40, you should seek a fertility evaluation very early in the process.
4.What tests are appropriate for men over 40?
Semen analysis; hormone profile (testosterone, FSH, LH); sperm DNA fragmentation test (if necessary). Early testing will help the doctor determine what type of treatment is best for you.
5.Can lifestyle modifications help a man's fertility?
Yes, if you maintain a healthy weight, exercise regularly, eat a balanced diet (good nutrition), control stress, get enough sleep and do not smoke or drink an excessive amount of alcohol, then you will improve your odds of producing healthy sperm.
6.Do I always need to use assisted reproductive Technology to get pregnant?
No, while many couples do conceive naturally, they are often using ART (IUI/IVF) based on their own personal clinical history.
7.Should I consider genetic counseling if I am thinking of having a child?
Yes, genetic counseling is often indicated for men who have had recurrent miscarriages and/or men who have a family history of congenital or genetic disorders, or have advanced paternal age and want to conceive with a female partner.
12. Must Read Related Articles:
You may also find these helpful:
1.Ectopic Pregnancy Definition and Ultrasound Findings
2.Missed Abortion: Causes, Symptoms, and Management
3.Hormones and Fertility Explained.
4.Understanding Recurrent Pregnancy Loss
13.References:
1.World Health Organization (WHO).
WHO Laboratory Manual for the Examination and Processing of Human Semen. 6th Ed. 2021 Update.
2.American Society for Reproductive Medicine (ASRM).
Effects of Advanced Paternal Age on Reproductive Success (2023).
3.Centers for Disease Control and Prevention (CDC).
Infertility FAQ (2024).
4.Practice Committee of ASRM. Clinical Utility of Sperm DNA Integrity Testing (2023).
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