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• W2112529026 abstract "The topic of advanced paternal age has become quite relevant over the last decade. Men are now fathering children at an older age than in the past. It is now estimated that fathers aged 35–54 years now account for 40% of live births (1Wiener-Megnazi Z. Auslender R. Dirnfeld M. Advanced paternal age and reproductive outcome.Asian J Androl. 2012; 14: 69-76Crossref PubMed Scopus (81) Google Scholar, 2Bray I. Gunnell D. Davey Smith G. Advanced paternal age: how old is too old?.J Epidemiol Community Health. 2006; 60: 851-853Crossref PubMed Scopus (162) Google Scholar). Likewise, the number of fathers in the 50–54-year age group has seen a notable increase. With the maturation of the baby-boomer population, the number of men over the age of 60 years is predicted to increase significantly over the next 10 to 20 years. As a result of these changes, an increasing number of older men will likely be seeking help with fertility issues.Reproductive function gradually declines with advanced paternal age from a variety of causes. However, there is a notable lack of understanding regarding underlying mechanisms or even a general consensus on what constitutes advanced paternal age (3Kovac J.R. Addai J. Smith R.P. Coward R.M. Lamb D.J. Lipshultz L.I. The effects of advanced paternal age on fertility.Asian J Androl. 2013; 15: 723-728Crossref PubMed Scopus (69) Google Scholar). In contrast to female reproductive physiology, male functions do not cease abruptly, and androgen production and spermatogenesis continue throughout life. Semen quality declines in the sixth decade of life, and pregnancy rates may be similarly impacted.The study by Ramasamy et al. (4Ramasamy R. Trivedi N.N. Reifsnyder J.E. Palermo G.D. Rosenwaks Z. Schlegel P.N. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction.Fertil Steril. 2014; 101: 653-655Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar) brings together two timely topics: advanced paternal age and microdissection testicular sperm extraction (micro-TESE) for nonobstructive azoospermia (NOA). The take-home messages from this study provide valuable clinical guidance for assessing and counseling the >50-year-old male. Namely, sperm can be found on micro-TESE more than half the time in men with NOA, regardless of age. When sperm are successfully harvested, clinical pregnancy rates are dependent on female, not male, age. There are several cautionary notes that should be considered. First, the findings of this study do need to be confirmed with larger series, because the number of men >50 years of age was modest. Second, the success rate of sperm retrieval in men with NOA is dependent on the underlying testis histopathology. It is of interest that hypospermatogenesis was the most common pathology identified in men aged >50 years, compared with Sertoli cell only in men aged <50 years.There has been increasing concern that paternal aging may have an impact on sperm DNA damage. Specifically, the rate of genetic abnormalities that occur during spermatogenesis and the frequency of numerical and structural abnormalities in sperm chromosomes increases with aging. A recent landmark study identified that the number of single-gene de novo mutations in the offspring increased by two mutations per year according to paternal age (5Kong A. Frigge M.L. Masson G. Besenbacher S. Sulem P. Magnusson G. et al.Rate of de novo mutations and the importance of father’s age to disease risk.Nature. 2012; 488: 471-475Crossref PubMed Scopus (1300) Google Scholar). Advanced paternal age has also been linked with neurocognitive disorders, such as autism and schizophrenia. Although the Ramasamy study cannot address these issues, given the relatively low frequency of genetic findings and our best available evidence to date, I wholeheartedly agree with the authors’ recommendation that increased male age should not deter couples from treatment when the man has NOA and is contemplating micro-TESE. The topic of advanced paternal age has become quite relevant over the last decade. Men are now fathering children at an older age than in the past. It is now estimated that fathers aged 35–54 years now account for 40% of live births (1Wiener-Megnazi Z. Auslender R. Dirnfeld M. Advanced paternal age and reproductive outcome.Asian J Androl. 2012; 14: 69-76Crossref PubMed Scopus (81) Google Scholar, 2Bray I. Gunnell D. Davey Smith G. Advanced paternal age: how old is too old?.J Epidemiol Community Health. 2006; 60: 851-853Crossref PubMed Scopus (162) Google Scholar). Likewise, the number of fathers in the 50–54-year age group has seen a notable increase. With the maturation of the baby-boomer population, the number of men over the age of 60 years is predicted to increase significantly over the next 10 to 20 years. As a result of these changes, an increasing number of older men will likely be seeking help with fertility issues. Reproductive function gradually declines with advanced paternal age from a variety of causes. However, there is a notable lack of understanding regarding underlying mechanisms or even a general consensus on what constitutes advanced paternal age (3Kovac J.R. Addai J. Smith R.P. Coward R.M. Lamb D.J. Lipshultz L.I. The effects of advanced paternal age on fertility.Asian J Androl. 2013; 15: 723-728Crossref PubMed Scopus (69) Google Scholar). In contrast to female reproductive physiology, male functions do not cease abruptly, and androgen production and spermatogenesis continue throughout life. Semen quality declines in the sixth decade of life, and pregnancy rates may be similarly impacted. The study by Ramasamy et al. (4Ramasamy R. Trivedi N.N. Reifsnyder J.E. Palermo G.D. Rosenwaks Z. Schlegel P.N. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extraction.Fertil Steril. 2014; 101: 653-655Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar) brings together two timely topics: advanced paternal age and microdissection testicular sperm extraction (micro-TESE) for nonobstructive azoospermia (NOA). The take-home messages from this study provide valuable clinical guidance for assessing and counseling the >50-year-old male. Namely, sperm can be found on micro-TESE more than half the time in men with NOA, regardless of age. When sperm are successfully harvested, clinical pregnancy rates are dependent on female, not male, age. There are several cautionary notes that should be considered. First, the findings of this study do need to be confirmed with larger series, because the number of men >50 years of age was modest. Second, the success rate of sperm retrieval in men with NOA is dependent on the underlying testis histopathology. It is of interest that hypospermatogenesis was the most common pathology identified in men aged >50 years, compared with Sertoli cell only in men aged <50 years. There has been increasing concern that paternal aging may have an impact on sperm DNA damage. Specifically, the rate of genetic abnormalities that occur during spermatogenesis and the frequency of numerical and structural abnormalities in sperm chromosomes increases with aging. A recent landmark study identified that the number of single-gene de novo mutations in the offspring increased by two mutations per year according to paternal age (5Kong A. Frigge M.L. Masson G. Besenbacher S. Sulem P. Magnusson G. et al.Rate of de novo mutations and the importance of father’s age to disease risk.Nature. 2012; 488: 471-475Crossref PubMed Scopus (1300) Google Scholar). Advanced paternal age has also been linked with neurocognitive disorders, such as autism and schizophrenia. Although the Ramasamy study cannot address these issues, given the relatively low frequency of genetic findings and our best available evidence to date, I wholeheartedly agree with the authors’ recommendation that increased male age should not deter couples from treatment when the man has NOA and is contemplating micro-TESE. Age does not adversely affect sperm retrieval in men undergoing microdissection testicular sperm extractionFertility and SterilityVol. 101Issue 3PreviewTo evaluate the effect of male age on the outcome of microdissection testicular sperm extraction (micro-TESE) and assisted reproductive technology. Full-Text PDF Microdissection testicular sperm extraction in older menFertility and SterilityVol. 101Issue 3PreviewWomen experience a notable decrease in oocyte production in their late thirties; however, the effect of age on spermatogenesis is less well described. Indeed, although there are no known limits to the age at which men can father children, the effects of advanced paternal age are incompletely understood. Reproductive concerns related to advanced paternal age are less well defined (1), with a recent whole-genome sequencing study suggesting an increased risk for rare de novo mutations for older fathers (2). Full-Text PDF" @default.
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• W2112529026 title "Using contemporary microdissection testicular sperm extraction techniques, older men with nonobstructive azoospermia should not be deterred from becoming fathers" @default.
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