Putting Off Having a Family? What Men Should Know

DadFamily planning includes not just determining how many kids to have, but also when to have them. You may decide to delay starting your family because you want to go back to school. Maybe you want to be more established in your career before you have kids. You might want to be a homeowner before you bring home a baby. Or maybe you just want to be debt-free before piling on hospital bills associated with pregnancy and birth. Whatever the case may be, before you decide to say “Not right now,” there are a few things you should consider.

Male Fertility Declines with Age

You probably know that your wife’s fertility declines as she grows older and eventually goes through menopause. But she’s not the only one with a biological clock. One study found that a man’s ability to reproduce declines sharply after the age of 41. According to researchers, fertility declines at a rate of 7% for each year after 41, with an even steeper rate of decline after the age of 45. In fact, in this short period, the rate of successful pregnancy drops from 60% (age 41) to just 35% (age 45)1. So if you wait until you are 45 to start your family, you may not like your chances.

Age Increases the Chance of Birth Defects

Not only is the chance of pregnancy reduced by age, but a father’s age can also introduce other complications. Studies have shown that older men are at higher risk to father children with birth defects and genetic abnormalities. One study found that, when both parents of a child with Down syndrome were over 35, the father’s age “played a significant role” in the child’s genetic abnormality. When the mother was over 40, the incidence of Down syndrome related to sperm was about 50%2.

Ditto schizophrenia. In one study, researchers concluded that “men between the ages of 45 to 49 were twice as likely to have children with schizophrenia as were men 25 and younger.” But for men over 50, the risk was three times as high2.

You Can Grow Old While Your Sperm Stays Young

Both of these concerns are related to the age of a man’s sperm, but not necessarily the man himself. You can keep your sperm young while you continue to mature toward your pre-family goals. Sperm banking allows you to cryopreserve your semen for later use. If you want a family, but not right now, you might consider banking your sperm. That way you can plan your family on your timetable while avoiding the complications that accompany the ticking of your biological clock.

References

1. Macrae, F. (2011, October 20). The male biological clock: After 41 your chances of becoming a father ‘declines rapidly’. Mail Online. Retrieved from http://www.dailymail.co.uk/health/article-2051041/MALE-biological-clock-After-41-chance-father-declines-rapidly.html

2. Heubeck, E. Reviewed by Brunilda Nazario, MD. Age raises infertility risk in men, too. Retrieved from http://www.webmd.com/infertility-and-reproduction/features/age-raises-infertility-risk-in-men-too

CatSper the Friendly Ion Channel and Male Infertility

In sperm tail, CatSper is activated through alkalinization and perhaps other activators. Intracellular alkalinization can be potentially achieved through a Na+/H+ exchanger (NHE) that might be sensitive to cAMP [downstream of a soluble cyclic adenylyl cyclase (sACY)] and voltage. Activation of receptors (e.g., ZP receptors in sperm head) generates messengers that eventually lead to CatSper channel activation in the tail. Ca2+ ions entering the sperm tail through CatSper act not only locally on motor proteins to affect sperm motility but also globally to lead to [Ca2+]i increases in sperm midpiece and head. There are likely unidentified Ca2+-permeable channels responsible for the CatSper-independent, sustained [Ca2+]i increases important for the acrosome reaction. Many of the proposed signaling pathways have not been directly tested and are indicated by question marks.

“I’ve got swimmers!” One of our patients actually listed this as the reason he was ready to discard the sperm he had banked with us prior to starting cancer treatment. I laughed aloud when I read it. What a humorous way of telling us that he recently had a semen analysis that demonstrated good motility and forward progression.

Being a swimmer (good motility) is critical to sperm’s ability to fertilize an egg. Sperm start to move once they’ve been ejaculated from the male urethra. However just because they’re moving doesn’t mean they’re able to fertilize an egg. First sperm must undergo a maturation process called capacitation. Capacitation involves the movement of calcium ions into the sperm cell. The calcium ions move into the sperm cell through specialized ion channels named CatSper. Once inside the cell, the calcium ions trigger a series of events that will hyperactivate sperm motility. In the female reproductive tract, hyperactivated motility occurs right by the egg, at the site of fertilization, and enables the sperm to penetrate the egg and achieve fertilization.

Sperm that are unable to undergo capacitation cannot penetrate an egg and thus fertilize it.  Researchers have discovered two gene mutations that cause sperm to be produced without CatSper channels. These genes are CatSper1 and CatSper2. Men with either of these mutations are infertile.

Clinically diagnosing CatSper-related male infertility can be tricky.  Changes in motility caused by the absence of CatSper channels are frequently missed in standard semen analyses.  “A more rigorous clinical examination that includes measurement of sperm motility parameters like path velocity, progressive velocity, and track speed”1 is required to help determine if sperm cells are hyperactivated. Computer-aided sperm analysis (CASA) systems have been developed that are capable of performing this type of assessment of motility. Genetic testing is also available to confirm a diagnosis of CatSper-related male infertility.

If lack of CatSper channels is the cause of a couple’s fertility woes, there is no treatment option available that will enable them to achieve a pregnancy naturally. However, pregnancy can be achieved with intracytoplasmic sperm injection (ICSI) using sperm from ejaculate, testis tissue, or epididymal tissue.

References

Hildebrand MS, Avenarius MR, Fellous M, et al. Genetic male infertility and mutation of CatSper ion channels. European Journal of Human Genetics. 2010; 18(11): 1178-1184.

Calcium Signaling Through CatSper Channels in Mammalian Fertilization, Dejian Ren and Jingsheng Xia, Physiology June 1, 2010 vol. 25 no. 3 165-175

Fertility and the Male Cancer Patient: The Need to Sperm Bank to Preserve Fertility

Couple in hug watching sunrise togetherMany people facing cancer know about some of the side effects of common treatment options. Chemotherapy can cause you to lose your hair and change the way food tastes to you. It can make you nauseous and fatigued. These are symptoms that cancer patients expect to face during treatment. But one side effect you may not have thought about is infertility. For both men and women, treatments can affect the ability to conceive children1. If you are planning on starting or expanding your family, this may be a concern you should talk about with your doctor. A medical professional can help you understand your risk for infertility due to cancer and treatments.

Sperm production can be temporarily reduced by certain cancers and treatments2. Some treatments, however, permanently alter your ability to reproduce. Cancer cells are fast growing. Cancer treatments are designed to target and eliminate fast-growing cells in the body. This is intended to eradicate cancer cells, but other fast-growing cells, like hair and sperm, are destroyed in the process3. Both radiation and chemotherapy treatments can slow or stop sperm production, and the effects can be permanent3. Additionally, chemotherapy and radiation therapy may alter the DNA of sperm, and it is recommended that a cancer survivor wait 1 to 2 years before trying to conceive a child for this effect to dissipate4.

If you have been diagnosed with cancer and are worried that treatment may interfere with your plans to have a family, there are options you can pursue to preserve your fertility before you begin treatment. Cryopreserving sperm is a simple, inexpensive process that can save sperm for years, in case you need it for intrauterine insemination or in vitro fertilization. Sperm must be collected and banked before your cancer treatment begins4 to ensure the best possible sample of undamaged cells.  Cryopreserving your sperm helps ensure your ability to have your own biological children in the event that cancer treatment has impacted your fertility or you are interested in having a child during or soon after treatment.

References

1. American Society of Clinical Oncology. Side effects of chemotherapy. Retrieved from http://www.cancer.net/all-about-cancer/cancernet-feature-articles/treatments-tests-and-procedures/side-effects-chemotherapy

2. Livestrong Foundation. Male fertility preservation. Retrieved from http://www.livestrong.org/we-can-help/just-diagnosed/male-fertility-preservation/

3. Roswell Park Cancer Institute. Cancer and male infertility. Retrieved from https://www.roswellpark.org/patients/fertility-guide/male-infertility

4. New York Cryo. FAQs: 3. When does one bank sperm? Retrieved from https://nycryo.com/faqs/

For additional information on Sperm Banking please visit NYCryo.com