It’s risky! Become a dad after 40 years?

Assessing a patient’s risk tolerance is important for any doctor, and especially for surgeons, who carry knives to things. Although the risks of life and limbs are common discussions before surgery, I have recently been captivated by a very different type of risk conversation I am having with patients: the risks of being an older parent. What is an older father? Most researchers agree that the term applies to men 40 years of age or older.

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Of course, you may not feel that you qualify as an older parent. But no matter how fit you are or how young you look, your genes are aging and changing. A review of current research on sperm genetics (recently published by me and a colleague) shows that as men get older, so does the DNA in their sperm. And the older a man (and his sperm), the greater the chances that these genetic changes in his sperm can cause health problems for his offspring.

So what does the most recent research show? As men grow, their offspring will have a higher risk of:

• Spontaneous abortion
• Early (premature) birth
• Prenatal death
• Birth defects
• Chromosomal abnormalities
• Disease due to single gene mutations.
• Childhood and adult diseases (ie, autism, schizophrenia, bipolar, epilepsy)

If you are over 40 years old and interested in becoming a father (or having another child), that list probably sounds pretty scary. Let me clarify the risks a bit more with some perspective:

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• The degree of risk increases with age. It is never zero, but remains low for some time before it is triggered. Think of a hockey stick lying on the floor. Grab the blade so that it is facing up and lift it so that the end of the stick is a few centimeters from the ground. That is the shape of the risk curve with advanced paternal age. Pretty flat until the age of 60 and then a steep climb north after that.
• The potential for human male fertility generally decreases dramatically after age 70. Sperm production definitely stops after that. Such is the rhythm of life. Then, the men who have the highest risk of paternal age are those who want to conceive after 60 years and still produce sperm.

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• The conditions found in the offspring of older parents are not really known in advance, since these problems are more subtle than the chromosomal problems associated with the woman’s advanced age.
• Although the relative risk (that is, the risk at baseline) is several times higher in older men, the absolute risk is still quite small. In perspective, do you know the chances of a couple in the US?. Have a child with a birth defect? I ask why this barely arises when couples are building a family. It is around 3-4%, more or less. And that is the same risk of schizophrenia or autism that an older father (> 60 years old) brings to his son.

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• We still have a lot to learn about the risks associated with being an older parent: this field of study is in its infancy (after all, until recently, humans generally did not live long enough to have children after 40 years of age). So, if you are considering paternity later in life, have conversations with your doctor and be aware of health news headlines about the latest developments.

The risk that comes with the paternal age is very real, very personal and very different from other types of risks in life. But the desire to be a father at any age is as deep as any other in this good land. That is why this risky conversation with patients is as important as any other.

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