Reproductive axis ageing and fertility in men

Abstract

Compared to women, increasing male age is not accompanied by such marked changes in reproductive function but changes certainly do happen. These include alterations to the hypothalamo-pituitary-testicular axis, with resultant implications for testosterone production and bioavailability as well as spermatogenesis. There is a decline in sexual function as men age, with a dramatic increase in the prevalence of erectile dysfunction after the age of 40, which is a marker for both clinically evident as well as covert coronary artery disease. Despite a quantitative decline in spermatogenesis and reduced fecundability, the male potential for fertility persists throughout adult life, however there are also increasingly recognised alterations in sperm quality and function with significant implications for offspring health. These changes are relevant to both natural and medically assisted conception.

Keywords: ART; Male ageing; Male fertility; Male hypogonadism; Reproductive axis; Spermatogenesis.

Fig. 1

A Standardised mean age at fatherhood in the UK, 1980–2020. B: Age specific fertility rates for men in the UK, 5 year age groups. Data show paternities per 1000 men. Data from The Office of National Statistics (https://www.ons.gov.uk), accessed 5 September 2022