Fisch Harry
Department of Urology, Columbia University College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
Geriatrics. 2009 Jan;64(1):14-7.
Couples are waiting longer to have children, and advances in reproductive technology are allowing older men and women to consider having children. The lack of appreciation among both medical professionals and the lay public for the reality of a male biological clock makes these trends worrisome. The age-related changes associated with the male biological clock affect sperm quality, fertility, hormone levels, libido, erectile function, and a host of non-reproductive physiological issues. This article focuses on the potentially adverse effects of the male biological clock on fertility in older men. Advanced paternal age increases the risk for spontaneous abortion as well as genetic abnormalities in offspring due to multiple factors, including DNA damage from abnormal apoptosis and reactive oxygen species. Increased paternal age is also associated with a decrease in semen volume, percentage of normal sperm, and sperm motility. Older men considering parenthood should have a thorough history and physical examination focused on their sexual and reproductive capacity. Such examination should entail disclosure of any sexual dysfunction and the use of medications, drugs, or lifestyle factors that might impair fertility or sexual response. Older men should also be counseled regarding the effects of paternal age on spermatogenesis and pregnancy.
夫妻生育孩子的年龄越来越大，生殖技术的进步让年龄较大的男性和女性也开始考虑生育。医疗专业人员和普通大众都没有充分认识到男性生物钟的现实，这使得这些趋势令人担忧。与男性生物钟相关的年龄变化会影响精子质量、生育能力、激素水平、性欲、勃起功能以及许多非生殖方面的生理问题。本文重点关注男性生物钟对老年男性生育能力的潜在不利影响。父亲年龄增大由于多种因素会增加自然流产以及后代出现基因异常的风险，这些因素包括异常细胞凋亡和活性氧导致的DNA损伤。父亲年龄增大还与精液量减少、正常精子百分比降低以及精子活力下降有关。考虑为人父母的老年男性应该进行全面的病史询问和体格检查，重点关注他们的性和生殖能力。这样的检查应该包括披露任何性功能障碍以及使用可能损害生育能力或性反应的药物、毒品或生活方式因素。还应该向老年男性提供有关父亲年龄对精子发生和怀孕影响的咨询。
