Morris Guy, Mavrelos Dimitrios, Odia Rabi, Viñals Gonzalez Xavier, Cawood Suzanne, Yasmin Ephia, Saab Wael, Serhal Paul, Seshadri Srividya
Centre for Reproductive and Genetic Health, London, UK.
Reproductive Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK.
Acta Obstet Gynecol Scand. 2021 Oct;100(10):1858-1867. doi: 10.1111/aogs.14221. Epub 2021 Aug 17.
To study whether paternal age exerts an effect, independent of maternal age, on the outcomes of fresh in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles. Semen quality deteriorates with increasing paternal age; however, there is conflicting evidence for any impact paternal age may have on the outcome of IVF/ICSI. Several retrospective and prospective cohort studies have shown that paternal age increases the miscarriage rate and reduces the live birth rate. Some studies have shown no effect of paternal age on live birth rate or miscarriage rate. Studies involving donor oocytes have tended to show no independent effect of paternal age on assisted reproductive technology (ART) outcomes. The age at which paternal age may exert a significant deleterious effect on outcome is not known and there is no limit to paternal age in IVF/ICSI treatment.
A single-center retrospective cohort study was carried out at the Centre for Reproductive and Genetic Health, London, UK. Included in the analysis were all couples with primary or secondary infertility undergoing IVF/ICSI cycles in which the male partner produced a fresh semen sample and the cycle proceeded to fresh embryo transfer. All cycles of IVF/ICSI that used donor oocytes-donor sperm, frozen sperm, cycles leading to embryo storage and cycles including preimplantation genetic testing (PGT-A/PGT-M)-were excluded from analysis. The primary outcome was live birth rate and secondary outcomes were clinical pregnancy rate and miscarriage rate. Multivariate logistic regression analysis with live birth as a dependent variable and maternal and paternal age class as independent variables was performed.
During the study period there were 4833 cycles, involving 4271 men, eligible for analysis; 1974/4833 (40.8%, 95% confiene intervals [CI] 39.5-42.2%) cycles resulted in a live birth. A significantly lower proportion of men over 51 years met World Health Organization semen analysis criteria (56/133, [42.1%, 95% CI 34.1-50.6]) compared with men under 51 years of age (2530/4138 [61.1%, 95% CI 60.0-62.6]) (p = 0.001). Both maternal and paternal age were retained in the multivariate model and for all maternal age subgroups the probability of live birth decreased with paternal age over 50 years (odds ratio [OR] 0.674, 95% CI 0.482-0.943) (p = 0.021). Paternal age over 50 years was not an independent predictor of miscarriage (OR 0.678, 95% CI 0.369-1.250) (p = 0.214).
Paternal age over 50 significantly affects the chance of achieving a live birth following ART. Paternal age does not independently affect the risk of miscarriage following ART. There should be a public health message for men not to delay fatherhood.
研究父方年龄是否独立于母方年龄对新鲜体外受精/卵胞浆内单精子注射（IVF/ICSI）周期的结局产生影响。精液质量会随着父方年龄的增加而下降；然而，关于父方年龄对IVF/ICSI结局可能产生的任何影响，证据并不一致。多项回顾性和前瞻性队列研究表明，父方年龄会增加流产率并降低活产率。一些研究表明父方年龄对活产率或流产率没有影响。涉及供体卵母细胞的研究倾向于表明父方年龄对辅助生殖技术（ART）结局没有独立影响。父方年龄可能对结局产生显著有害影响的年龄尚不清楚，并且IVF/ICSI治疗中对父方年龄没有限制。
在英国伦敦生殖与遗传健康中心进行了一项单中心回顾性队列研究。纳入分析的是所有患有原发性或继发性不孕症且接受IVF/ICSI周期治疗的夫妇，其中男性伴侣提供了新鲜精液样本且周期进行了新鲜胚胎移植。所有使用供体卵母细胞-供体精子、冷冻精子的IVF/ICSI周期、导致胚胎冷冻保存的周期以及包括植入前基因检测（PGT-A/PGT-M）的周期均被排除在分析之外。主要结局是活产率，次要结局是临床妊娠率和流产率。以活产为因变量、母方和父方年龄组为自变量进行多因素逻辑回归分析。
在研究期间，有4833个周期，涉及4271名男性，符合分析条件；1974/4833（40.8%，95%置信区间[CI]39.5 - 42.2%）个周期实现了活产。与51岁以下男性（2530/4138[61.1%，95%CI 60.0 - 62.6]）相比，51岁以上男性符合世界卫生组织精液分析标准的比例显著更低（56/133，[42.1%，95%CI 34.1 - 50.6]）（p = 0.001）。母方和父方年龄均保留在多因素模型中，对于所有母方年龄亚组，父方年龄超过50岁时活产概率降低（优势比[OR]0.674，95%CI 0.482 - 0.943）（p = 0.021）。父方年龄超过50岁不是流产的独立预测因素（OR 0.678，95%CI 0.369 - 1.250）（p = 0.214）。
父方年龄超过50岁会显著影响ART后实现活产的机会。父方年龄不会独立影响ART后的流产风险。应该向男性传达一条公共卫生信息，即不要推迟生育。
