Does age of the sperm donor influence live birth outcome in assisted reproduction?

Advanced Paternal Age in Focus: Unraveling Its Influence on Assisted Reproductive Technology Outcomes

As global demographics shift toward increasing paternal age, the realm of assisted reproductive technologies (ARTs), particularly in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), faces new challenges and opportunities. This study provides a comprehensive exploration of the implications of advanced paternal age on ART outcomes. Background research highlights the social, cultural, and economic factors driving men toward later fatherhood, with a focus on the impact of delayed paternity on reproductive outcomes. Methods involve a thorough review of existing literature, centering on changes in testicular function, semen quality, and genetic and epigenetic shifts associated with advancing age. Study results point to intricate associations between the father's age and ART outcomes, with older age being linked to diminished semen quality, potential genetic risks, and varied impacts on embryo quality, implantation rates, and birth outcomes. The conclusions drawn from the current study suggest that while advanced paternal age presents certain risks and challenges, understanding and mitigating these through strategies such as sperm cryopreservation, lifestyle modifications, and preimplantation genetic testing can optimize ART outcomes. Future research directions are identified to further comprehend the epigenetic mechanisms and long-term effects of the older father on offspring health. This study underscores the need for a comprehensive approach in navigating the intricacies of delayed fatherhood within the context of ART, aiming for the best possible outcomes for couples and their children.

Sperm DNA Fragmentation after Cryopreservation and Sperm Selection Has No Implications for Clinical Pregnancies and Live Births after Intrauterine Insemination with Donor Sperm

Intrauterine insemination with donor sperm (IUI-D) requires multiple in vitro manipulations such as sperm selection and cryopreservation during which spermatozoa may be exposed to oxidative stress (OS) and other insults that may produce potential damage including sperm DNA fragmentation (SDF). High levels of SDF, referring to damage or breaks in the genetic material of sperm cells, are linked to an increased risk of reproductive failure. This retrospective, observational study set out to evaluate whether SDF assessment could predict clinical outcome in an IUI-D program, where sperm donors are selected on strict conventional semen parameters. A total of 18 donors and 106 recipients were matched for IUI-D. Out of 429 cycles, 100 (23.3%) resulted in clinical pregnancy. We counted 78 live births (18.2% of cycles), while 20 pregnancies ended in miscarriage (4.7% of cycles), 1 in extra-uterine pregnancy and 1 in stillbirth. Female age significantly influenced clinical pregnancy and miscarriage rates. SDF increased after cryopreservation (26.3 ± 14.5%; p < 0.001) and more so after post-thaw density gradient (34.9 ± 22.1%; p = 0.04) without affecting clinical pregnancy (OR [95% CI] 1.01 [0.99; 1.02]; p = 0.27), live birth (1.00 [0.99; 1.02]; p = 0.72) and miscarriage rates (1.02 [1.00; 1.05]; p = 0.08). The implications of our findings extend to a better selection of sperm donors and a better sperm preparation technique tailored to the donor semen's properties in order to maximize the chances of a favorable treatment outcome.

Impact of paternal age on assisted reproductive technology outcomes and offspring health: a systematic review

BACKGROUND

The increase in paternal age and the percentage of births after assisted reproductive technologies (ART) may have consequences on offspring and society's position regarding access to ART must be questioned. Most countries recommend limiting ART to men under 60 years. What is the rationale for this threshold?

OBJECTIVE

This systematic review assesses scientific arguments to establish links between paternal age, male fertility, and offspring health.

MATERIAL AND METHODS

Using the PRISMA guidelines, this systematic review of the literature analyzed 111 articles selected after screening PubMed, ScienceDirect, and Web of Science for articles published between January 1, 1995 and December 31, 2021.

RESULTS

A strong correlation was highlighted between advanced paternal age and a decrease of some sperm parameters (semen volume and sperm motility) and infant morbidity (exponentially increased incidence of achondroplasia and Apert syndrome, and more moderately increased incidence of autism and schizophrenia). The impact of paternal age on pregnancy and fetal aneuploidy rates is more controversial. No association was found with spontaneous abortion rates.

DISCUSSION AND CONCLUSION

The scientific parameters should be explained to older parents undergoing ART. And for countries that discuss a limit on paternal age for access to ART, the debate requires consideration of social and ethical arguments.

Male Age and Progressive Sperm Motility Are Critical Factors Affecting Embryological and Clinical Outcomes in Oocyte Donor ICSI Cycles

This retrospective cohort study aimed to explore whether paternal age and semen quality parameters affect the embryological and clinical outcomes of ICSI with oocyte donation. A total of 339 oocyte donation (OD)-ICSI cycles were categorized into four groups according to the semen parameter profiles of the male counterparts: normozoospermia (NS, n = 184), oligozoospermia (OS, n = 41), asthenozoospermia (AS, n = 50), and oligoasthenozoospermia (OAS, n = 64). The effect of age, total sperm count, and progressive motility was separately analyzed for reproductive outcomes and compared between the study groups: fertilization, blastulation, and top-quality embryo rate, biochemical and clinical pregnancy, live birth, and miscarriage. A negative correlation between male age and fertilization rate was observed (r_s =  - 0.23, p < 0.0001), while male age was a significant factor for biochemical pregnancy (p = 0.0002), clinical pregnancy (p = 0.0017), and live birth (p = 0.0038). Reduced total sperm count and lowered progressive motility led to poorer fertilization rates (r_s = 0.19 and 0.35, respectively, p < 0.0001) and affected embryo quality (r_s = 0.13, p = 0.02, and r_s = 0.22, p < 0.0001, respectively). OD-ICSI cycles with asthenozoospermia had significantly lowered success rates in biochemical pregnancy, clinical pregnancy, and live birth (p < 0.05). Our study demonstrated that both advanced male age and reduced progressive motility of spermatozoa exert a significant negative influence on the outcome of assisted reproduction, even in controlled procedures with gamete selection and optimization such as in OD-ICSI. Improvement in treatment strategies and male fertility evaluation requires incorporation of such evidence to obtain better prognosis towards personalized management.

Influence of paternal age on assisted reproductive technology cycles and perinatal outcomes

OBJECTIVE

To characterize paternal age among assisted reproductive technology (ART) cycles performed in the United States and to evaluate the influence of paternal age on ART cycles and perinatal outcomes.

DESIGN

Retrospective cohort.

SETTING

Not applicable.

PATIENT(S)

All reported fresh, nondonor, noncancelled in vitro fertilization (IVF) cycles performed in 2017.

INTERVENTION(S)

Not applicable.

MAIN OUTCOME MEASURE(S)

The primary outcomes were intrauterine pregnancy, live birth (≥20 weeks), and miscarriage (<20 weeks) per cycle start and per embryo transfer. The secondary outcomes were full-term live birth (≥37 weeks) among singleton and twin gestations. Modified Poisson regression was performed to estimate associations between paternal age and cycle and perinatal outcomes, overall and stratified by maternal age.

RESULT(S)

Among 77,209 fresh nondonor, noncancelled IVF cycles, the average paternal age was 37.8 ± 6.3 years and the average maternal age was 35.5 ± 4.6 years. Compared with paternal age ≤45 years, paternal age ≥46 years was associated with a lower likelihood of pregnancy per cycle (adjusted risk ratio [aRR] 0.81; 95% confidence interval [CI] 0.76-0.87) and per transfer (aRR 0.85; 95% CI 0.81-0.90), as well as a lower likelihood of live birth per cycle (aRR 0.76; 95% CI 0.72-0.84) and per transfer (aRR 0.82; 95% CI 0.77-0.88) after controlling for maternal age and other confounders. When restricted to women aged <35 years, there were no significant differences in the rates of live birth or miscarriage among couples in which the men were aged ≤45 years compared with those aged ≥46 years.

CONCLUSION(S)

Compared with paternal age ≤45 years, paternal age ≥46 years is associated with a lower likelihood of pregnancy and live birth among couples undergoing IVF. The negative effect of paternal age is most notable among women aged ≥35 years, likely because maternal age is a stronger predictor of ART outcome.

Assessing the impact of semen quality on embryo development in an egg donation model

OBJECTIVE

To investigate if any of the World Health Organization semen parameters and/or male age are associated with embryo development.

DESIGN

Retrospective chart review between January 2008 and May 2015.

SETTING

Academic fertility practice.

PATIENTS

Anonymous egg donors aged ≤30 years.

INTERVENTIONS

Chart review.

MAIN OUTCOME MEASURES

Sperm parameters were evaluated on a continuum and were dichotomized to determine if low values (strict morphology < 4%, concentration < 15 × 106, low motility < 40%) or older age (>50 years) are associated with embryo morphology. Repeated linear regression measures to determine the associations and multivariate testing to determine independent effects for each predictor were performed.

RESULTS

Three hundred eighty-four donors with 574 egg donation cycles were identified, and 205 subjects with 275 cycles were included in the final analysis. The mean donor age was 25.31 ± 2.81 years, with a mean antral follicle count of 28.09 ± 10.5. The mean male age was 43.25 ± 6.65 years. The mean World Health Organization semen parameters at fertilization were 55.8 × 106 ± 44.3 × 106/mL concentration, 44.8% ± 20.2% motility, and 6.9% ± 5.3% strict morphology. Neither male age nor sperm morphology was associated with embryo morphology. A low total motile count was significantly associated with a higher cell number in day-3 embryos and a 1.56-times higher chance of poor day-3 cell symmetry. There was no statistically significant difference in blastocyst formation, clinical pregnancy, or live-birth rates.

CONCLUSIONS

Although statistically significant, the effect of the low total motile count on day-3 cell number and cell symmetry are likely clinically insignificant. Male age, race, or poor sperm morphology were not associated with a poor cycle outcome or impaired embryo development. The use of intracytoplasmic sperm injection likely alleviates the negative effect of diminished semen quality on treatment outcome.

Advanced paternal age: effects on sperm parameters, assisted reproduction outcomes and offspring health

Many factors, including postponement of marriage, increased life expectancy, and improved success with assisted reproductive technologies have been contributing to increased paternal age in developed nations. This increased average paternal age has led to concerns about adverse effects of advanced paternal age on sperm quality, assisted reproductive outcomes, and the health of the offspring conceived by older fathers. This review discusses the association between advanced paternal age and sperm parameters, assisted reproduction success rates, and offspring health.

A comparison of the characteristics, motivations, preferences and expectations of men donating sperm online or through a sperm bank

STUDY QUESTION

How do the demographic characteristics, motivations, experiences and expectations of unregulated sperm donors (men donating sperm online through a connection website) compare to sperm donors in the regulated sector (men donating through a registered UK sperm bank)?

SUMMARY ANSWER

Online donors were more likely to be older, married and have children of their own than sperm bank donors, were more varied in their preferences and expectations of sperm donation, and had more concerns about being a sperm donor.

WHAT IS KNOWN ALREADY

While studies have examined motivations and experiences of both regulated sperm bank, and unregulated online sperm donors, no study has directly compared these two groups of donors.

STUDY DESIGN, SIZE, DURATION

An email was sent to the 576 men who were registered sperm donors at the London Sperm Bank, the UK’s largest sperm bank regulated by the Human Fertilisation and Embryology Authority (HFEA), who had commenced donation between January 2010 and December 2016, and had consented to be contacted for research. The online survey, which contained multiple choice and open-ended questions, was completed by 168 men over a 7-week period. The responses were compared to those of sperm donors registered on Pride Angel, a large UK-based connection website for donors and recipients of sperm: our research team had already collected these data. In total, 5299 sperm donors were on Pride Angel at time of data capture and 400 men had completed a similar survey. The responses of 70 actual online sperm donors (i.e. those whose sperm had been used to conceive at least one child) were used for comparison with the sperm bank donors.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The survey obtained data on the sperm donors’ demographic characteristics, motivations, experiences and expectations of sperm donation. Data from sperm bank donors were compared to online donors to examine differences between the two groups. The study compared online and clinic donors who had all been accepted as sperm donors: online donors who had been ‘vetted’ by recipients and sperm bank donors who had passed the rigorous screening criteria set by the clinic.

MAIN RESULTS AND THE ROLE OF CHANCE

A response rate of 29% was obtained from the sperm bank donors. Online donors were significantly older than sperm bank donors (mean ± SD: 38.7 ± 8.4 versus 32.9 ± 6.8 years, respectively) and were more likely to have their own children (p < 0.001 for both characteristics). Both groups rated the motivation ‘I want to help others’ as very important. Online donors rated ‘I don’t want to have children myself’, ‘to have children/procreate’ and ‘to enable others to enjoy parenting as I have myself’ as more important than sperm bank donors, whereas sperm bank donors rated financial payment as more important than online donors, as well as confirmation of own fertility. Most (93.9%) online donors had donated their sperm elsewhere, through other connection sites, fertility clinics, sperm banks or friends and family, compared to only 2.4% of sperm bank donors (p < 0.001). There was a significant difference in how donors viewed their relationship to the child, with online donors much less likely than sperm bank donors to see their relationship as a ‘genetic relationship only’. Online donors had more concerns about being a donor (p < 0.001), for example, being concerned about ‘legal uncertainty and child financial support’ and ‘future contact and uncertainty about relationship with donor-conceived child’.

LIMITATIONS, REASONS FOR CAUTION

Findings may not be representative of all sperm donors as only one online connection site and one HFEA registered sperm bank were used for recruitment.

WIDER IMPLICATIONS OF THE FINDINGS

Despite concern regarding shortages of sperm donors in licensed clinics and unease regarding the growing popularity of unregulated connection websites, this is the first study to directly compare online and sperm bank donors. It highlights the importance of considering ways to incorporate unregulated online sperm donors into the regulated sector. With many online donors well aware of the legal risks they undertake when donating in the unregulated online market, this would both increase the number of sperm donors available at clinics but also provide legal protection and support for donors.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported by the Wellcome Trust Grants 104 385/Z/14/Z and 097857/Z/11/Z. The authors have no conflicts of interest.

Donor IUI is equally effective for heterosexual couples, single women and lesbians, but autologous IUI does worse

STUDY QUESTION

Are there differences in the clinical outcomes of IUI among different populational groups (heterosexual couples, single women and lesbian couples)?

SUMMARY ANSWER

The outcome of donor IUI (D-IUI) is similar in all populational groups and better than that seen with autologous insemination.

WHAT IS KNOWN ALREADY

A vast body of literature on clinical outcome is available for counselling heterosexual couples regarding decisions related to ART. The reproductive potential of single women, lesbian couples and heterosexual couples who need donor semen is assumed to be better, but there is a scarcity of data on their ART performance to actually confirm it.

STUDY DESIGN, SIZE, DURATION

In this retrospective multicentric cohort study, a total of 7228 IUI treatment cycles performed in 3807 patients between January 2013 and December 2016 in 13 private clinics belonging to the same reproductive medicine group in Spain were included. Patients with previous IUI attempts were excluded from the study. Only 1.9% of cycles were lost to follow-up.

PARTICIPANTS/MATERIALS, SETTING, METHODS

A total of 5318 D-IUI cycles were performed in three different populational groups: heterosexual couples (D-HC, 1167 cycles), single women (SW, 2839 cycles) and lesbian couples (LC, 1312), while a total of 1910 autologous IUI cycles were performed in heterosexual couples (A-HC). This last one was considered the control group and was composed of cycles performed in couples with a male partner with sperm parameters equivalent to those requested from donors. In order to identify factors with an impact on clinical outcome, a multivariate logistic regression analysis was performed. Regarding live birth rate (LBR), mixed effect models were employed to control for the fact that different patients were submitted to different numbers of treatments.

MAIN RESULTS AND THE ROLE OF CHANCE

Parameters that were significant to the primary outcome (LBR) according to the multivariate analysis were the populational group (D-HC, SW, LC and A-HC) to which the patient belonged, female age and a diagnosis of low ovarian reserve. At the age range of good prognosis (≤37 years), LBR was similar in all groups that underwent D-IUI (18.8% for D-HC, 16.5% for SW and 17.6% for LC) but was significantly lower in the autologous IUI (A-HC) group (11%). For all these significant findings, the strength of the association was confirmed by P values <0.001. From 38 years of age on, no significant differences were observed among the populational groups studied, and for all of them, LBR was below 7% from 40 years of age on.

LIMITATIONS, REASONS FOR CAUTION

To the best of our knowledge, a smoking habit was the only known factor with a potential effect on ART outcome that could not be controlled for, due to the unavailability of this information in a significant percentage of the clinical files studied. Our study was not capable of precisely quantifying the impact of a diagnosis of low ovarian reserve on the LBR of both IUI and D-IUI, due to the number of cycles performed in patients with such diagnosis (n = 231, 3.2% of the total).

WIDER IMPLICATIONS OF THE FINDINGS

For the first time, a comparison among D-HC, SW, LC and A-HC was performed in a study with a robust sample size and controlling for potential sources of bias. There is now sound evidence that equivalent clinical outcome is seen in the three groups treated with donor semen (D-HC, SW and LC). Specifically, regarding the comparison between SW and LC, our findings rule out differences in LBR proposed by previous publications, with very similar clinical outcomes within the same age ranges. At age ranges of good prognosis (≤37 years), reproductive performance of D-IUI is significantly better than that seen in heterosexual couples undergoing autologous IUI, even when only cases of optimal sperm quality are considered in this last group. This finding is in agreement with the concept that, as a group, A-HC are more prone to have female factor infertility, even when their infertility assessment finds no contraindication to IUI. Age affects all these groups equally, with none of them reaching a 7% LBR after the age of 40 years. Our findings will be useful for the counselling of patients from the different populations studied here about ART strategies.

STUDY FUNDING/COMPETING INTEREST(S)

None.

Effect of paternal age on treatment outcomes in couples undergoing assisted reproductive technology for non-male factor infertility: a retrospective analysis of 809 cycles

Background

Worldwide, there is an increase in uptake of assisted reproductive technology (ART) treatment. The impact of paternal age on ART outcomes is unclear. In view of the conflicting results reported by studies evaluating effect of paternal age on ART outcomes, we planned a study to investigate the impact of advanced paternal age in couples undergoing ART for non-male factor infertility. We conducted a retrospective cohort study at a university-level teaching hospital in South India. All couples who underwent ART for non-male factor infertility were included. The couples were divided into two groups based on the age of the male partner. Group I included couples with male partner’s age less than 40 years, taken as reference group. Group II included couples with male partners age more than or equal to 40 years. The primary outcome was live birth rate. Secondary outcomes included clinical pregnancy, miscarriage, fertilization, embryo development, and blastulation rates.

Results

A total of 809 cycles were included for the study. Following exclusion of 39 cycles, 770 cycles were analyzed for outcomes. Group I comprised of 556 (72%) cycles and group II comprised of 214 (28%) cycles. There was no significant difference in live birth rate per embryo transfer between groups I and II (31.8% vs. 29.4%; odds ratio, OR, 0.89; 95% CI 0.63 to 1.26). After adjustment for potential confounders, the live birth rate did not differ significantly (adjusted odds ratio, aOR, 1.10; 95% CI 0.74 to 1.65). The clinical pregnancy (39.4% vs. 36%; aOR 1.06; 95% CI 0.72 to 1.56) and the miscarriage rates (18.3% vs. 15.6%; aOR 0.73; 95% CI 0.32 to 1.66) were also similar between the two groups. There was significant decrease in the blastulation rate (36.8% vs. 32.1%; P 0.002) in the advanced paternal age group as compared to the reference group.

Conclusion

The current study suggests that in couples undergoing ART for non-male factor, there is no detrimental effect of increasing paternal age on treatment outcomes.

UK guidelines for the medical and laboratory procurement and use of sperm, oocyte and embryo donors (2019)

This article updates the 2008 UK guidelines for the medical and laboratory screening of sperm, egg and embryo donors. This was achieved by a working group composed of representatives from: the Association of Biomedical Andrologists, the Association of Clinical Embryologists, the British Andrology Society and the British Fertility Society, with subsequent review and commentary from their respective memberships. Information and guidance on core facts which should be made evident to all parties involved in donation are provided. Changes with regard to transmissible disease screening include: (i) extended guidance regarding history taking, risk factors and deferral periods; (ii) recommended quarantine period for donors screened by Nucleic Acid Testing (NAT) and serology is now 3 months; (iii) recommended quarantine period for donors screened by serology alone is legally required to be 6 months; (iv) if donor oocytes, or embryos created with donor oocytes, are cryopreserved then the quarantine period should be observed as best practice. We further recommend that consideration be given to HPV vaccination of women who outside of insemination may not be exposed to HPV. For heritable diseases, the discussion and assessment of genetic risk have been fundamentally reviewed in light of technological advances. After review of scientific evidence, it has also been deemed acceptable for men to donate sperm up to their 46th birthday.

Paternal age and assisted reproductive technology: problem solver or trouble maker?

In our society, the number of couples with advanced reproductive age seeking fertility treatment is increasing steadily. While the negative effect of female age on assisted reproductive technology (ART) outcomes is well established, the impact of paternal age needs to be clarified. We reviewed the current literature to determine whether advanced paternal age affects the results of ART and the health of resulting offspring. We found that the published literature is overall supportive of a positive association between advanced paternal age (>40 years) and semen quality deterioration. However, the existing evidence does not corroborate nor discard the influence of advanced paternal age on ART outcomes. Similarly, the effect of paternal age on the health of ART offspring remains equivocal, although data from naturally-conceived children clearly indicates that advanced paternal age increases the frequency of genetic, neurodevelopmental, and psychiatric diseases in the progeny. Noteworthy, the current literature is limited and subjected to bias due to the impact of maternal age as a critical confounder. Health care providers should discuss with concerned couples the available options to counteract the possible negative influence of advanced paternal age on ART outcomes and health of resulting offspring. These include identification and treatment of underlying conditions with potential negative long-term effects on fertility, sperm freezing at a young age, and use of antioxidant supplements for men at risk of excessive oxidative stress. Aged male partner from couples undergoing ART, in particular men of 50 years and older, should consider use of preimplantation genetic testing as a means to detect embryo abnormalities and select euploid embryos for transfer to the uterine cavity.