1. REPRODUCTIVE FUNCTIONS OF THE AGEING MALE Moshe Shalev MD Department of Urology Meir Medical Center Kfar-Saba, Israel

2. REPRODUCTIVE FUNCTIONS OF THE AGEING MALE Do semen parameters show age-dependent alterations? Is there a male contribution to reduced fertility and fecundity of older couples? Is there a genetic risk for offspring attributable to increased paternal age?

3. REPRODUCTIVE FUNCTIONS OF THE AGEING MALE Do semen parameters show age-dependent alterations? Is there a male contribution to reduced fertility and fecundity of older couples? Is there a genetic risk for offspring attributable to increased paternal age?

4. (Kühnert 2004)

5. Achondroplasia and paternal age

6. Genetic diseases of complex aetiology Ventricular septal defect, atrial septal defect, patent ductus arteriosus – among men aged >35y, 5% may be due to paternal age. (Olshan 1994, Ewing 1997, Loffredo 2001, Cadergren 2002.) Conflicting data correlating paternal age and Alzheimer disease. The risk of multiple sclerosis increases steadily with father’s age but not mother’s age. ( Montgomery 2004)

7. Genetic diseases of complex aetiology Increased risk of schizophrenia with paternal age. Patients without a family history of schizophrenia had significantly older fathers than familial patients. Pre-eclampsia, which is considered to be a risk factor for schizophrenia, is also associated with paternal age. (Bertranpetit 1993, Malaspina 2001, 2002; Dalman 2002, Harlap 2002.)

8. Paternal age and cancer in offspring In the Framingham study an association between paternal age and the son’s risk of prostate cancer in general and especially with early onset CaP was found. (Zhang 1999) Conflicting data about: breast cancer, nervous system ca., acute lymphoblastic leukemia.

9. Summary The gradual deterioration in fertility in ageing males is within a broad individual spectrum. Reduced fertility in men begins to become evident in the late 30’s. Increased male age is associated with increased risk of miscarriage. The effect of paternal age on miscarriage becomes relevant in women aged >30.

10. Summary Advancing paternal age is associated with diseases of complex aetiology such as schizophrenia and multiple sclerosis and autosomal dominant inherited diseases like achondroplasia and apert’s syndrome. Increased risk of trisomy 21.

11. Summary Couples should be informed, however: 1. That the male contribution to reduced fertility is less pronounced than the female’s 2. That the absolute risk for the aforementioned genetic disturbances is low. 3. It has been shown that children born to older parents do better at school. ( Zyhert 1978, Cohen 1980)

12. תודה רבה ! שום דבר לא יוכל לאהבה !