Why men should worry about their biological clocks too

Article originally published in “The Times” newspaper. November 22, 2013

Ask any man if he is worried about his reproductive abilities or the ticking of his biological clock and he will probably laugh out loud at the very idea.

Most men assume they can father children well into their sixties and beyond if they want.

“We live in a society where infertility is generally considered a women’s issue,” says sociologist Liberty Walther Barnes of the University of Cambridge, who has spent six years following infertile couples.

The results of her research will be published in a book next year.

“When a couple cannot conceive, it is the wife who appears not pregnant, and it is the wife who more often feels the stigma of childlessness and who bears the brunt of medical treatments.”

According to Harry Fisch, a professor of reproductive medicine at Weill Medical College of Cornell University, very few men realise they have biological clocks too — although, unlike women’s fertility which ends with menopause, a man’s window of fatherhood does not end abruptly.

“The male biological clock doesn’t strike midnight, it just slowly unwinds,” said Dr Fisch, author of The Male Biological Clock, adding that men who become fathers in their sixties, seventies, or eighties are “dangerously deceptive exceptions”.

Because of this biological clock, Dr Fisch says, men over 35 are twice as likely to have problems fathering children during 12 months of trying, compared with men who are younger than 30.

After 30, he says, there is a drop in testosterone — the hormone needed to make good quality sperm — of 1 per cent every year.

As the quality of sperm declines, there is an increased chance of miscarriage, a Down’s syndrome baby, and other genetic abnormalities.

HEALTH EVALUATION

Last year, in a report published in the journal Nature, researchers in Iceland found that older fathers pass on more new genetic mutations than younger ones and that this may be a factor in the increased rates of children with brain disorders such as autism and schizophrenia.

“Sperm regenerates and this constant turnover of cells lends itself to genetic mutation,” says Dr Fisch.

“The older you are, the more often the sperm cells divide and the more chance there is of a disorder occurring.”

Silver-haired fathers might be more patient with their young offspring and able to spend more time with them, but biologically, he says, it is better to be a younger father.

“I’d tell both women and men to try to have children before they’re 30,” Dr Fisch says.

“Most men do not believe that they have a biological clock — fertility and indeed infertility is still largely seen as a women’s issue,” says Florence Comite, a noted American endocrinologist.

The secrecy and stigma surrounding men’s fertility is compounded by the fact that, traditionally, doctors have focused on women’s reproductive health, says Dr Comite, the author of Keep it Up, a book about andropause.

She believes both men and women trying for a baby should have an in-depth evaluation of their overall health.

INFERTILITY CAN RUN ACROSS THE BOARD

In fact, male issues with infertility are actually as common as women’s, says Dr Marc Goldstein, the chief of surgery at the Cornell Centre for Male Reproductive Medicine in New York.

Infertility affects one in every six couples trying to conceive, he says.

Among struggling couples, a third of cases can be attributed to men’s problems, another third to women’s problems, and the remaining third is a combination of both.

In at least half of all cases, a male factor is a major or contributing cause, he says. “It is only within the past 50 years that the importance of the male factor contribution to infertility has been recognised at all,” he says.

“The mistaken notion that infertility is associated with decreased masculinity has contributed to this fear.

The good news is that research advances have brought dramatic changes in the ability to diagnose and treat male infertility and the majority of couples suffering from infertility can now be helped to conceive.”

In the research for her upcoming book, Conceiving Masculinity; Male Infertility, Medicine and Identity, Dr Barnes attended support groups for fertile couples, shadowed doctors in fertility clinics in the United States, and conducted interviews with 24 couples, all of whom fit the clinical definition of infertility — no pregnancy after 12 months of unprotected sex.

“Two-thirds of the men I interviewed did not self-identify as infertile,” she said.

“They were not trying to blame their wives for their infertility issues.

In most cases it just had not occurred to them that they had fertility issues that were hampering their ability to get their wives pregnant.

With the exception of men who were dealing with more life-threatening issues, most of the men I interviewed were stunned to learn they had few or no sperm.

WHO GOES “UNDER”?

When couples were given the choice to pursue a female-focused treatment such as IVF or a male-focused treatment such as surgery, they unanimously chose the male treatment, she says.

“There was a strong sense that male-focused treatments were a more “natural” solution to achieving pregnancy.

Furthermore, men appreciated being able to participate in infertility treatments and saw it as a way to protect their wives from the rigours of IVF.”

“Doctors sense that women are less patient than men to become parents,” she continues, “and so doctors assume that women are willing to make more sacrifices and go to greater lengths to achieve pregnancy.

In actuality, many of the women I interviewed had serious reservations about IVF and encouraged their husbands to undergo medical treatments first.”

Dr Barnes says one of the great puzzles of male fertility is why it continues to be shrouded in secrecy and stigma when erectile dysfunction and Viagra are household words.

“Before Viagra was invented, men felt deep shame about their impotence, as it used to be called.

But when impotence was reframed as erectile dysfunction, a physical condition with a reliable medical solution, it became less stigmatised.”

She says that men are beginning to see that infertility is a medical condition beyond their control and does not reflect anything about their strength, masculinity, or fortitude.

INFERTILITY CAN BE COOL?

Male infertility lacks a celebrity face, she adds.

“Celebrities do not make various conditions cool or desirable.

Rather, they raise awareness that these issues exist, that they are medical issues, and that manly men deal with them too,” said Barnes.

“It probably wouldn’t hurt if George Clooney or a famous footballer suddenly announced they were suffering from male infertility.”

As a sociologist and feminist, Barnes added, she would like to see the stigma removed from male infertility.

“I would like to see men take personal responsibility for their reproductive health,” she added.

“Both of these things would happen if there was simply more public education about male fertility.”

Some doctors in America suggest that prospective fathers should consider collecting their sperm at a young age and storing it for later use, as women now do with their eggs.

Men over 35, Dr Fisch says, should at the very least do everything they can to decrease the likelihood of having abnormal sperm or genetic abnormalities.

“That means leading a better lifestyle, quitting smoking, taking care of infections you might have, and taking care of varioceles — enlarged veins in the scrotum that could harm sperm production.”

At the very least men might soon start to face the same questions as women — can they afford to wait until their careers are settled before starting a family?