The Risks for Men Who Want to Be Fathers After 50

While there is plenty of information readily available about the potential risks of women having children after age 35, there is less talk and information at hand about the risks and challenges for men deciding to have children later in life.

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In the western world, more and more men are having children over the age of 50, thanks to increased life expectancy, later marriages and other reasons.

As a urologist, many of my patients come to me looking for a vasectomy in order to control their family size. However, I do see the occasional patient who is looking to start, or expand, his existing family. These patients have questions about sexual health, possibly reversing a vasectomy and even potential congenital abnormalities as a result of having children later in life.

Recently, a 56-year-old patient of mine came to see me in my office; I had performed a vasectomy on him two years earlier. This time, he told me that he had remarried and wanted to have more kids with his new, younger wife. He asked for my opinion about his chances for having children at 56 and wanted to know what some of the complications might be as a result of his age and prior vasectomy.

This patient was embarrassed to talk about issues related to his age and sexual function with his wife, and told me that he had done some research on the internet and the found the information contradictory.

Here are some of my brief answers in response to his questions:

As a urologist, I see quite a few couples with concerns about infertility issues. According to the American Urological Association guidelines, approximately 15% of couples are unable to get pregnant after one year of sex. In 20% of cases, the male is solely responsible for the infertility, and male fertility complications can be a contributory factor in about 30% to 40% of cases.

Fertility in men is a multifactorial question, but overall, yes, age matters. At around about age 34, a man begins to have a lower sperm count. At 40, the concentration, as well as the percentage, of normal sperm (in layman's terms) begins to decline. Generally, the sperm motility and the amount of ejaculated sperm begins to decline between ages 43 and 45.

But it's more complex than just age. Researchers have discovered that male reproductive aging includes a variety of factors that also include sexual function and activity, nutrition and lifestyle, hormones and disease.

If fertility is an issue for my patients, I usually order specific lifestyle changes, including exercise and diet regimens, stress reduction techniques and, potentially, psychotherapy, as well as hormone treatment and multivitamins.

Erectile dysfunction is a harsh reality for many men over 50. Most people know about the most commonly prescribed medications, such as tadalafil (Cialis), sildenafil (Viagra) and vardenafil (Levitra). However, I also recommend my patients make some important lifestyle changes, regardless of whether they are taking medicine, including the following:

• Stop smoking.
• Stay physically active one hour a day, three days a week. By staying active I mean cardiovascular exercise — such as fast walking, jogging, bicycling or jumping rope — and light weightlifting. I don’t recommend running marathons. Also, please don’t forget to warm up for at least 10 minutes and hold each stretch for a minimum of 15 seconds each. Once you’re no longer working as hard at completing the same exercise routine, then begin to increase the difficulty.
• Maintain a healthy body weight.
• Consider seeking psychological help to deal with stressors at work, home, finances, family, etc.

Most of my patients come to me looking for vasectomies, but between 3% and 6% of American men with vasectomies choose to have their vasectomies reversed. If you've had a vasectomy, there is a chance you can undo it. The operation isn't usually covered by health insurance, so it's pretty expensive.

While the surgery is often successful, depending on the health of the patient, it can't always be performed. If a man over 50 is considering a reverse vasectomy, he must first be evaluated by a urologist to see if it's a possibility. As urologists, we have to evaluate: the size and texture of the testicles; the epididymis, which is part of the testicle; and scars from any previous surgeries.

If you've had a vasectomy and want to reverse the surgery, you will want to see a specialist. While all urologists are surgeons, some urologists specialize in this type of microsurgery that is technically more complicated. If you're already seeing a urologist, ask if the doctor performs this procedure or could provide a referral for a urologist who specializes in it.

Make sure to also speak to your urologist about cryopreservation of sperm (sperm banking) at the time of the operation in the off-chance the reversal doesn't work.

Some men have come to me asking whether if having children later in life would expose their children to health risks, like congenital abnormalities. The answer is: it's much more complicated than age alone, and the research isn't conclusive.

More studies need to be done to conclusively determine that increased paternal age is an absolute indicator of increased risks for serious disorders in children of older fathers.

So, be wary of what you read on the internet. There are plenty of men who, after the age of 50, have had healthy children. Until a link between paternal age and disorders is established, I wouldn't advise patients not to have children over 50 simply because of age.

My top tips for patients who are over 50 is to stay fit and eat healthy. That means an emphasis on fruits and vegetables and less on animal protein. I also recommend limiting alcohol intake, drinking lots of water and, for patients who smoke — quit immediately.

In addition, all men approaching 50 should be screened for prostate cancer, which is the second-leading cause of cancer death in American men.

If you have any questions about fertility, erectile dysfunction or prostate cancer, you should see a trusted urologist.