Are You A Gambling Man?

The case of the month is an actual patient of The Turek Clinic.

He appeared healthy. No issues with testosterone, erections, or sex drive. No infertility problem. No pain. No lumps or bumps. All dialed in with a primary care provider. He was even on time for his appointment. So, why was he here?
“Doc, I’m 40 and single. Just haven’t met ‘the one’ yet. I want kids, but can’t see having them for a good 5-10 years. Should I bank sperm?”

True, True, Kinda Related

He had two concerns: Would he be less fertile down the line, and would his kids be at higher risk of birth defects or other issues if he waited until he were an older Dad. Great questions. And what gave rise to these concerns? “I hear this kind of thing all the time about women’s fertility and thought it might be true for men too.”
Well, he’s right. Sorta. Male fertility does decrease with age but not as dramatically as with women. Here are the truths surrounding male fertility with advancing age:

  • Sperm counts generally don’t fall with age until the 7th or 8th decade of life.
  • Sperm motility (the proportion of sperm that move) falls with age, but ever so slowly, at a rate of <1%/year.
  • Sperm DNA integrity, or the packaging quality of the sperm’s genetic payload, also tends to decrease with age. This is not picked up on a semen analysis.
  • Erections and sex drive tend to be less robust with age.

So, although each of these issues alone may not cause a problem when combined, they lead to decreased male fertility with age.

What About the Kids?

And, he’s sorta right on the healthy kids point too. Advanced maternal age tends to bring chromosomal issues to bear on children, and this can lead to birth defects and miscarriages. Luckily, they are testable during pregnancy. Similarly, older Dad’s also bring genetic risk to kids but they are quite different and consist mainly of things called point mutations rather than chromosomal issues. This results in different set of disorders in offspring that can occur either early on, or later in life, and can be very debilitating. They include schizophrenia, bipolar disorder and autism. Unfortunately, many of these conditions are not testable during pregnancy.
Also realize that, in the big picture, the chance of kids with an a inherited problem due simply to parental age is low in general, and is driven far more by maternal (90%) than paternal (10%) age. Again, that’s somewhat reassuring because maternal age issues are commonly testable during pregnancy.
Finally, technically, sperm banking is not as simple as “wham, bam, thank you Ma’am.” The Feds (FDA) require blood tests that look at sexually transmitted diseases before banking, and dollars (usually hundreds) need to be forked out to begin and keep an account active. And this bank account isn’t like many others in that it doesn’t just get automatically handed down to next of kin like a mutual fund or a coin collection. The owner of these iced mighty movers needs to prescribe in a will or other formal document exactly what they would like done with the boys if they pass on or can’t decide. Destroy or donate? And to whom? Ethical issues of migraine proportions can result if these issues are not sorted out ahead of time.
So, should he bank sperm? Well, it’s really up to him (and he did). It doesn’t matter much to sperm, as they can remain in deep freeze for a decade or two and come out just fine.