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Male Fertility: Older Paternal Age And More

Host: Dr. Melanie Carminati, PT, DPT, GTS, NCPT

Guest: Marc Goldstein, MD, DSc (hon), FACS

In a recent interview on the Know and Do Better podcast, Dr. Marc Goldstein, a distinguished expert in Reproductive Medicine and Urology, shared valuable insights into the often-overlooked topic of paternal age and its significant role in fertility. This comprehensive guide delves deeper into the lesser-known concerns of older fatherhood and the crucial aspects of male fertility.

Paternal Age and Lesser-Known Concerns

While the public is generally aware of the impact of maternal age on birth defects, Dr. Goldstein emphasizes that paternal age, significantly beyond 45, plays a pivotal role. Studies reveal a doubling in the incidence of Down syndrome major birth defects, a threefold increase in schizophrenia, and a fivefold rise in autism. Despite being published in reputable journals, these findings are not as widely recognized as their maternal counterparts.

Awareness Gap in Paternal Age Concerns

Dr. Goldstein attributes the lack of awareness to a significant gap in understanding male fertility issues. Unlike women, who establish lifelong relationships with gynecologists, men often lack the same awareness and proactive healthcare habits. Conditions like testicular cancer, more prevalent than breast cancer, often go unnoticed until later stages, contributing to the overall gap in knowledge.

Freezing Sperm and Egg 

The option of freezing sperm, Dr. Goldstein suggests, is a viable consideration for men. With a successful history spanning over a century, frozen sperm can maintain viability for decades. Like egg freezing, the age at which sperm is frozen influences its success rate. Younger men freezing sperm generally experience higher success when utilizing it later in life.

Male Fertility Evaluation

Beyond age, critical considerations for male fertility evaluation include a semen analysis, thorough examination, and medical history. At-home semen analysis tests provide a screening option, while medical history, including prior surgeries and conditions like undescended testicles, plays a crucial role. Blood tests, such as FSH and testosterone level assessments, offer insights into sperm production and overall reproductive health.

Impact of Medical History

Conditions like bilateral hernia operations or undescended testicles significantly impact fertility. The history of testicular cancer and its treatment, including radiotherapy or chemotherapy, can also have lasting effects on male fertility.

Vasectomy Reversal and Changing Perspectives

Vasectomy, a common contraception choice, can be reversed. Dr. Goldstein highlights changing perspectives on family planning, where couples who pursued reversal due to a change of heart or the loss of a child often experience remarkably high success rates.

Advocacy for Fertility Preservation

In the context of cancer treatment, fertility preservation efforts are essential. Dr. Goldstein stresses the need for increased awareness among oncologists about discussing fertility preservation options, particularly sperm banking, with male patients facing cancer treatments.


Understanding the intricate relationship between paternal age and fertility, considering medical history, and advocating for increased awareness are crucial steps toward comprehensive reproductive health. Dr. Goldstein’s insights shed light on acknowledging male and female factors in fertility discussions. For personalized medical advice, it’s essential to consult with healthcare providers.

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