Ep 349: Does His Age Matter? The Truth About Paternal Age & Fertility

0:00You're listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you're struggling to conceive or just planning for your future family, we're here to guide you every step of the way.

0:22Dr. Carrie Bedient: Hello and welcome to another episode of Fertility Docs Uncensored. I am joined by my magically, mischievously, magnificently marvelous co-host, Dr. Susan Hudson from Texas Fertility Center. Hello, everyone. And I'm Dr. Keri Bedian from Fertility Center of Las Vegas. And today we are joined once again by Maria Katz, who is a board-certified genetic counselor and the director of clinical product at Orchid Health, which is all about genetic testing. So that's what our episode is going to dive in today, looking at how paternal age really impacts having babies and going through all this. But Maria, we are delighted to have you back again.

0:59Dr. Carrie Bedient: Thank you for joining us. Thanks so much for having me again. And when I look at your background, it's the same as it was the last time recorded. But you said that the rest of your house is falling, not necessarily falling down around you, but falling down. Yes, I feel like we've been under construction for three years now. Our house is finally at a stage where it doesn't feel like I'm going to fall into a construction zone. Yes, we were taking our first break this summer, but as soon as we're back from our last vacation of the summer, we are back to putting holes in our house again. Oh, lots of fun, but also I'm tired of it.

1:36Dr. Susan Hudson: So there are certain people who start at one end of their house and they gradually remodel. And by the time they get to the end, they're like, oh, it's time to start back over. Or is that your mantra? I really hope not because we started off by our whole downstairs. We started off really strong where we had no livable space and we were on a mattress in one room. And then we just decided to slow down. But I'm hoping we get to enjoy the full house and not have to start back from scratch again. But yes, some people do do that. So what are you working on right now then? Is your downstairs now livable?

2:12It is livable, which is great. We're doing the last part of the downstairs that missed on purpose, which is our bathroom downstairs. It's a house from the 70s. And through every renovation, we made more holes in the bathroom, too, looking for things. So right now, it's just like a toilet in the middle of the room and then just holes everywhere. So I'm really excited for this one.

2:33Dr. Carrie Bedient: Now, if you have a guest come into perhaps the guest bedroom that's right next to the master bathroom, can you have a conversation while peeing? Is it that kind of a hole? It's an excellent question. No, but mostly we just give them a warning before they open the door to not be alarmed at everything that is falling out. We have this huge blue tape that's holding the ceiling together. And so we have to tell people, it's safe. Nothing will fall on you. Yes. That sounds incredibly stressful. Yes. We're at a place now where we look around and we're like, we're in a different place than we were three years ago.

3:06So it's positive, but it's definitely been an adventure. So to all the listeners who are also doing renovations, good for you because it's so hard.

3:15Dr. Carrie Bedient: Are you doing all of the work yourself or are you bringing people in or is it a combination? How are you fixing that part of it? Combination. We started off very bold that we were going to do a lot by ourself because my husband's in architecture and my dad did a lot of building of our house growing up. So I was overly confident. And then we have just gone to being more and more tired and being like, maybe we will pay someone to do this next one. So, yes, we're learning our lesson that maybe it's smart to contract out. It's a progression. Yes, exactly. Yes. Hopefully it all finishes soon and you have an entire house that you can live in and not exist in.

3:53Yes, exactly. But I may start again. I think that's what people do. You're right.

3:57Dr. Carrie Bedient: So, yeah, I think I know you're a counselor, but maybe we should get you a different type of counselor before you dive into the next renovation. Yes, yes, I agree. I completely agree. All right, Susan, what kind of question do we have today?

4:09Dr. Susan Hudson: Okay, our question for today is, I'd appreciate your perspective on my clinic experience. We just completed our first IUI, but the nurse told me that my husband's sperm sample had only 600 ,000 modal sperm, making it likely to fail. I was devastated. REI emailed me the next day with well wishes and mentioned that we had nine more vials of sperm frozen for future use. This left me so confused. Why split up the sperm into 10 vials? Why not use more than one for the IUI? Why not unfreeze more until there were enough sperm? And why not ask my husband for a fresh sample the same day? We used the frozen sperm because we thought he'd be out of town.

4:51Dr. Susan Hudson: I feel the IUI was pointless and the clinic was careless. Am I being too harsh? I don't know if I can trust their actions and protocols now.

4:58Dr. Carrie Bedient: That is a complex question with a couple of different layers here.

5:02Dr. Susan Hudson: Yeah.

5:03Dr. Carrie Bedient: And I think all of this merits a conversation with your REI. And there's probably a blend of things going on. One is whatever type of treatment you guys were planning on doing from the get-go. Two is lab protocols. Three is how the sperm survived, which is a big one that many patients don't really know about and don't consider because we know that when we freeze a sperm sample, we're going to lose about half of it. And most of the time, we are splitting up sperm specimens. So you get one specimen, but you divide it up into however many vials in order to get what you need at the end. And if you know you're doing an IUI, you divide up into fewer vials because you need higher counts.

5:43Dr. Carrie Bedient: An ITI is a little bit less. IVF is a little bit less. IVF with ICSI is even less. What the goal was makes a difference there. They may have said, we thawed this and got really poor results when we were expecting very normal results, so maybe we shouldn't go forward on thawing more. Sometimes clinics are very reticent to thaw and use up all of their samples because we never take it for granted that we're going to be able to get more. And we don't know all of the circumstances, if it was just travel or if there's something else going on. Maybe he was on testosterone. Maybe he's got a cancer diagnosis.

6:18Dr. Carrie Bedient: Maybe he had chemotherapy in the past. Maybe he had some injury. Maybe he's got a hydrocele or varicocele and needs surgery. There's a ton of different things that can influence this. Maybe they knew that all you wanted were IUIs. And so by having to use up more samples and subsequently freeze more samples, that's adding a fair amount to your bill. There are a ton of potential reasons for this. It really merits a discussion with your doc. Now, that said, and I think all of us will tell our patients this, if you don't trust your clinic, find another clinic. And that's not trashing your clinic at all.

6:51Dr. Carrie Bedient: They may have done absolutely everything perfectly right. And when you talk to them, whether you understand that or not, they may have done absolutely everything right. But if you don't trust them, then find someplace else. because there are many circumstances in our field where we are giving you bad news. And if we're giving you bad news, you need to feel confident that we were doing everything that we reasonably could to get you good news. And that if it didn't work, it's because human reproduction is horribly inefficient, not because somebody dropped the ball. It's painful to leave a clinic.

7:25Dr. Carrie Bedient: Nobody likes to start over. Clinics don't like to lose patience. It sometimes can be the best for everybody involved if you decide, all right, maybe this isn't a great fit for us, or maybe we're going to walk away and come back. Or maybe you talk to them and you're like, I get it. That makes sense. Thank you for looking out for me in ways that I couldn't see at the time because it's very common for us to tell people bad news and then for absolutely every other piece of information we give to disappear. It doesn't get heard. There's not the opportunity to say it because it's really hard to give a very technical explanation to someone who is utterly falling apart in front of you.

8:00Dr. Carrie Bedient: It's not necessarily the right thing to do. Maria, you can probably speak to that as well as we can. So it's worth a conversation. It's worth going in with an open mind. It's worth trusting your gut and just see how it is. What do you think, Susan?

8:13Dr. Susan Hudson: I think the most important thing when I read this is you need to have a conversation with your physician because I can't help but think that there was some sort of communication snafu that happened between point A and point Z, whether it was between you and the doctor, the doctor and the nurse, the clinic and the andrology laboratory. communication problems happen, but the best way to fix communication problems is to communicate. Just because there was one communication problem doesn't mean that there will be in the future. And you really have to go with your gut on this. But I do think that having a conversation, because it just feels like there's something else to the story that none of us, including you, may have privy information to at this point, I would really encourage you to either call the clinic, ask to speak to the doctor or make an appointment, go and see the doctor and really be like, hey, this is what happened.

9:17Dr. Susan Hudson: I don't understand why other solutions were not provided at this moment in time. And ideally, you'll be able to move on from there. But also, it only takes one good sperm. So we've all seen IUIs work in that situation. Yes, statistically, it is going to be a lower chance, but it only takes one. Absolutely.

9:38Dr. Carrie Bedient: All right. So let's be excited about today. I am too. And it's not just because we are picking on the guys, not that we ever pick on anybody, but we're picking on the guys today because women get such bullshit, honestly, about our age and how it impacts childbearing. And so it's nice to turn the tables and go with the guys because when we're writing down some of our assessments and our maternal fetal medicine, the high-risk OBs are writing down their assessments. Advanced maternal age is one that's used all the time. Advanced reproductive age is one that's used all the time. Geriatric pregnancies, which is just terrible.

10:14Dr. Carrie Bedient: It's awful. I don't know who the hell came up with that, but they need to be fired. There's in some of the egg freezings, one of the acronyms comes out to be age, A-G-E, which is just mean. And so it's a nice change of pace to talk about how the guy's age contributes to all of this. So with that, a very dignified leading. Maria, what to you constitutes advanced paternal age? I am going to second everything you said before I talk about paternal age because of how much this bothers me that women, when getting anywhere close to the magic number 35 start freaking out. And there is this misconception that a light turns off or on, again, analogies, that suddenly there's so much risk, but there is a steady increase of risk as women get older and as men get older.

11:09So that is my pivot to paternal age. There's also no magic number for men either. And it really depends on what study you're looking at for a number that they're putting for what is advanced paternal age. We started by talking about 50, and that has now moved to 40. So the reason it has shifted is for this same idea that there's no magic 35, there's no magic 40 or 45 or 50. There just is clearly a steady increase of risks, genetic risks, that are associated with age. So for women, we typically think about chromosomal differences, that there's an increased risk for there being an extra or missing copy of a chromosome.

11:54We typically have 23 pairs, so there's going to be an increased chance that there will be differences. For men, the conversation is different. There are some studies that have looked at dad's age and there being a slight increased chance of differences in chromosomes as well, particularly the sex chromosomes, but that's not really the risks that we are really talking about here. The risks are more related to what are called de novo mutations. What de novo mutations are, are we have billions of letters across our genome. Typically, when we think about our genome, we're thinking about genes, which provide instructions for tasks in our bodies.

12:32A de novo mutation is having a spelling mistake in a gene. Those spelling mistakes, that is what increases with age. And there's a lot to break down there, but that's what we're thinking about with paternal age is these single genes versus maternal age. We're really more focusing on the chromosomes, but they're both important, but for different reasons.

12:51Dr. Carrie Bedient: So if you Google or chat GBT or pick your AI of choice and say, what are pregnancy rates with advancing female age? You're going to get a very clean set of very well-supported graphs that have this really nasty decline. It's like rolling down a hill where the hill gets a little steeper and steeper, the further you go on one side as you look at female age and pregnancy rates declining as women get older. And then on the flip side, you're going to see the miscarriage rate go up as a mirror of that. So pregnancies go down, miscarriages go way up. And the end result is you don't have a live birth.

13:30Dr. Carrie Bedient: If you were to put that same thing in for guys, would you get the same kind of falling off a cliff? Not a full drop off, think Wile E. Coyote in all of the Looney Tunes, but that more gradual come down. Would you see that for the guys or is it different? Yes, you would see that. Just the risks are different. So what I won't touch on today, because the two of you will be much better at speaking at this, is what that question was earlier, right? About sperm quality and quantity, et cetera. I'm not touching that. I'm going to touch genetics. So when we are looking at those graphs related to paternal age, there are studies that are also looking at outcomes and birth weight and all of that.

14:09I'm also not going to touch that, but there are papers. But what we are seeing is that there is this steady increase in risk that's related to genetic conditions, just like there's a steady increase of risk related to these chromosomal differences with women. And that then is associated with, instead of for females, there's an increased risk of chromosomal differences, which is typically related to miscarriage or children who have health symptoms related to differences in chromosomes. The reason why it's so much more complex for men is that when we think about these increased chance of these new mutations occurring, one, a lot of them don't cause any signs and symptoms.

14:54But two, when they do cause signs and symptoms, there are some that are related to severe single gene disorders that may appear during pregnancy, which could result in a stillbirth or a miscarriage, but most have to do with conditions related to pediatric disease or later on. So we may not even be capturing it unless we're studying it much more closely. So that's part of the problem too with the research. One, because we like picking on women, which I think will be the theme that we keep going back to. But the other part is, honestly, a lot of the risks are happening outside of the time we're really following up because we're focused on implantation, pregnancy, miscarriage rate, and live births.

15:32That's a big part of this too.

15:36Dr. Susan Hudson: Let's play a game. How many tabs do you have open right now about IVF? One says your chances are great. Another says they're terrible. Reddit has one opinion. TikTok has another. Facebook is full of horror stories. And somehow, after two hours of searching, you have more questions than answers. Sound familiar? That's exactly why we wrote the IVF blueprint. This isn't another fertility book filled with opinions or miracle cures. It's an evidence-based guide that walks you through every stage of IVF, from understanding your fertility evaluation and choosing a treatment plan, to medications, egg retrieval, embryos, genetic testing, transfers, and the two-week wait, and beyond.

16:20Dr. Susan Hudson: Because the last thing you need during IVF is more noise. Close the tabs, put down your phone, open the IVF blueprint instead. Available now wherever books are sold.

16:34Dr. Susan Hudson: If you had to name four or five conditions that our listeners may have heard about that can be related to advanced paternal age, what are some of these conditions that could develop either in childhood or adulthood? So I'm going to break them down into two categories because I think that's an important part. And so this will be a very long-winded answer, and I apologize for that. So first is when we think about diseases, health conditions, they fall on a spectrum in terms of genetics. One side is called monogenic, where there's one gene that causes disease. And that's when I talk about a single gene disorder that is monogenic.

17:18On the other side is called polygenic or multifactorial, where there's genetic and environmental factors that contribute. So those are conditions like mental health conditions, heart disease, that there's not one gene that causes signs and symptoms. So with paternal age, if you're using AI, AI is very good at mixing up the two of those, which is why I want to define it, is that there are conditions on both sides of the spectrum we're talking about here. So the first side is monogenic or the single gene disorders. The conditions that we see related to paternal age are usually genes that are related to the bones, connective tissue, cancer risks.

18:00So those are conditions like achondroplasia, which sounds like a very fancy name, but it's a name of a condition that people are probably aware of. It's a genetic condition that causes short stature. And typically, there's very specific differences in the long bones that are characteristic of achondroplasia. So that is one example of a single gene disorder. But there are also more significant conditions like osteogenesis imperfecta, which can be very severe and actually can cause either miscarriage, usually stillbirth, or neonatal demise because of the severity of the bones. The ribs usually don't develop, which causes the lungs to not grow.

18:42So that is what we're thinking about with the single gene disorders. I really don't want to scare people. These are rare conditions. So when we talk about an increased risk of these forms of conditions, they're still rare. They just increase as men get older. So that's the monogenic side. On the other side for multifactorial conditions, and this is where I find a lot of families having some confusion because there's a lot of papers out there, are conditions like autism and schizophrenia. So for autism and schizophrenia, when we're thinking about paternal age, the reason why I want to say autism specifically is because there are genetic forms of autism and there are multifactorial, I should use the same terms, there are monogenic forms of autism and there are polygenic complex forms of autism.

19:28And there are some monogenic forms that we're seeing related to paternal age that may have autism as a feature or some sort of Other neurodevelopmental or learning disability, for example, neurofibromatosis, that is monogenic. But the majority of the research related to autism is actually the complex side. So autism and schizophrenia, there's just large publications and large studies that have looked at if men get older, is there a higher chance or group of when you look at parents who are fathers that are over the age of 50. and then you look at fathers between 20 and 30, and you look at how common is autism in both of those groups, they're significantly more common when men are over the age of 50.

20:14So that's why this is a really complex topic because we have these single gene disorders and we have these multifactorial disorders, but both are backed up with research that has been done for decades. It just, there hasn't been enough publicity and also strong enough numbers for people to be comfortable to talk about it.

20:35Dr. Carrie Bedient: When we are thinking about women as REIs, I think a lot of us group patients into under 35, 35 to 40, 40 to 45, and over 46 and greater. And when we think of those, it's the, I'm not worried at all, to, I'm a little worried, I'm aware, to, this is a problem, but we can, there's a chance we can still get through it, to the this is just flat out not going to work, period, end of story. Are there that level of classifications, maybe not in the same age groups, but is there a point at which with women you go, I'm really sorry, you're 50 years old. I will accept a complete miracle, but there's nothing I can do to make this better.

21:14Dr. Carrie Bedient: Are there any ages like that for guys? I think that is an excellent question. And I think 10, 20 years from now, we're going to have much better categorization of the ages. Because right now, I would say 40 to 45, their risks are starting to get higher. 45 to 50, we should really start talking about it. 50 plus, we definitely need to start talking about these risks. But there's no age. There are children out there who have fathers that are in their 50s, 60s plus. A lot of those individuals are healthy and don't have these health concerns, but we're not studying everyone and we're not looking at the conditions that are happening later in childhood and adulthood that these individuals are at increased risk force.

22:03there would need to be really long-term studies to give better risk estimates. Do I think there'll be an age in which there will be more of a conversation to say, hey, there is a high chance, insert number, that your child will have autism, schizophrenia, potentially a single gene disorder. These few are the highest chance, and this is what those numbers look like. Yes, I do think we'll get there. We just aren't there yet.

22:29Dr. Susan Hudson: So one thing that I think of is when we start getting to the point of really high chances in women of having embryos and children that may potentially have chromosomal abnormalities, their chances of getting pregnant become less than 5%. Yes. Okay. The flip side of it for men is though we do see decreases in sperm quantity and quality for various reasons as men get into those older age groups, there is not a huge decline in their fertility as compared to women when we're starting to be more concerned about these things. So as a genetic counselor, if we have somebody who their partner is 40, 45, 50, 60 plus, because we do have patients who have partners in those older age groups.

23:24Dr. Susan Hudson: Is there an age group that you really feel with the information, hey, these people should probably talk to either a genetic counselor or a medical geneticist? So I would honestly say any man who's over the age of 40 should have a discussion with a genetic counselor about this. I think that all of the families we have spoke to, and even before I was in the embryo screening space, in the prenatal space, who did have effective pregnancies or were having a conversation with me for whatever the reason may be. We always have to talk about paternal age. That is on a genetic counselor's checklist of discussion points.

24:05And before, what was hard was you tell a family of risks and then there's no screening options. And that's what's very different with men versus women is for men, there's no screening options. For women, And we talk about you have the option of doing PGTA if you're doing embryo screening. You have the option of NIPT if you are pregnant. For men, we say, here's the risks. Okay, bye. That's not great either, right? So now that there is whole genome embryo screening and there is an option to screen for some of these conditions, I do feel quite passionately that parents should know that there is options that are available.

24:40And then they should make a choice of whether or not that feels right for them. The big part of our discussions with them is that, unfortunately, though, we can't give you great numbers. There are some studies that will put some numbers to relative increased risk of certain diseases, but they're not perfect and they're not based on every single year of age. It's 40-ish, 50-ish plus, right?

25:03Dr. Carrie Bedient: Let's say a couple decides that they want this information. Maybe the man is 55 plus years old. They're having to use an egg donor. We know getting embryos is less likely to be an issue and they decide they want this information. When they get the report on this information, what kind of stuff is going to be on it? Excellent question. It would depend on what they opted in for. So a big part of what we do is we categorize each subset of our screen for families. So whole genome sequencing feels very big and overwhelming for some families. So being able to break it down by this is a group of genes that are related to birth defects or severe pediatric diseases is much more tangible and families can opt in.

25:51Something that we have done is we have categorized groups of genes within each of those groups that are related to age. So there is a subset of genes that cause birth defects, that there's increased prevalence for aging fathers. There's a group of genes that there's an increased risk for pediatric cancers. So we've categorized all of them and so families can opt in. And part of that is that then patients are aware of what they're selecting very deeply. So when there is a finding, they're not surprised because they opted in. So what's clear about monogenic conditions is they're well studied. We're not reporting out on conditions we don't know about.

26:35We're reporting out on conditions that have a name we've seen symptoms of across many, many individuals. Some people have heard the word syndrome be used instead of condition. The reason the word syndrome is used is because it means that there was many, many people who are not related to each other, who had the same change. Well, typically different changes, but in the same gene and they had the same ish signs and symptoms. That's what a syndrome is. So then it's quite simple to explain it to someone in terms of someone who has achondroplasia has differences in their bones. These are the signs and symptoms.

27:09So it becomes something that's very tangible to a family. An important part is not only if there is a finding, but if an embryo screens negative, that does not eliminate risk for disease, especially we had talked about. There's a whole group of conditions that there's an increased risk for that are due to not only genetic factors, but environmental factors as well. No test is going to eliminate risk for these diseases. Same with maternal age. Doing PGTA and screening for chromosome differences doesn't eliminate all the other risks that are related to maternal age. So same goes with paternal age.

27:43So it is important to put the two together.

27:46Dr. Susan Hudson: When we're talking about these different types of tests to help minimize risk, and I'm going to phrase this in what we see geographically happen with PGTA. So there are many places in the world that PGTA simply figuring out if we think we have the right number of chromosomes or not is illegal. Like really cannot obtain this except in very, very rare circumstances. And then you have the United States where PGTA is relatively widely available. I think all clinics probably offer it to some degree, some more than others. When we're talking about things that are less tangible and less certain, we start getting into more ethical, moral, philosophical views of what's appropriate testing and what's not appropriate testing.

28:43Dr. Susan Hudson: Within the United States, I would say that there are probably some places that support this type of testing. When I'm saying places, I mean some clinics that support this type of testing or even between physician to physician and some that are not. How do patients navigate that within the United States? Yeah, I'd say there's two parts. One part is first find out if whole genome embryo screening is right for you. Meet with a genetic counselor, have an extensive conversation and decide whether or not it's something you want to pursue. And then step two is to talk to your doctor and your fertility center about it.

29:24See if it's an available option. And if it's not, then as you mentioned before, it may be worth it to go to a center where it's offered because you've had that conversation already. and you said, this is very important for me and this is what I want to do and that's a deal breaker for me. Or you may say, I love my doctor, I love my clinic. This is really hard for me, but I think I'm gonna stick with my clinic and unfortunately not going to do the screening. So I think it's important for patients to have the conversation with a genetic counselor first to decide if it's right. And then of course, talk to your doctor and then balance out what feels right to you.

29:56What I would say to clinicians who may be skeptical or fearful of new technology is that whole genome sequencing itself is not new. What's new is doing it on embryos. We're doing whole genome sequencing in some places already on pregnancies. We're doing prenatal samples with whole genome sequencing, but it is common recommended practice in the pediatric space if a child has certain signs and symptoms. It's recommended by the American College of Medical Genetics and Genomics, the American Academy of Pediatrics if a child has an autism spectrum disorder, epilepsy, et cetera. So I think a really important piece here is that all whole genome embryo screening is doing is moving the timeline to the embryo stage rather than waiting for an effective pregnancy or child as long as the company is being responsible of how they're reporting.

30:47Genetics is complex. There are some genes we don't know a lot of information on. Are they only reporting on genes that we know about? And then what are the changes that they're reporting out on the genes? Are they one that are well established or not? So those are important questions to ask the laboratory and make sure that it feels right for your patient and your center and, you know, have a discussion as well with the laboratory.

31:08Dr. Susan Hudson: If someone's listening today and they're like, you know what, I really want to talk to a genetic counselor, how does somebody go about finding somebody like this? Yes. So there's two ways to find a genetic counselor. And what I'm describing is talking to a genetic counselor at the laboratory that you're interested in. So for ORCID, we have genetic counselors that are available. We have genetics at orchidhealth.com and you will get in touch with the genetic counselor, schedule a call. We always like you talking to other genetic counselors. So there are genetic counselors that are not related to any laboratory.

31:42You can meet with them. Often they reach out to all the other genetic counselors to get more information. We're all connected, but we're all here to support you. So you can reach out to laboratory. I recommend you do that. You're going to get information about the technical parts of the test. But the other part is there's many genetic counselors and you can go to National Society of Genetic Counselors and search, find a genetic counselor and you can find one near you.

32:03Dr. Susan Hudson: Does the genetic counselor need to have any special training in this specific area? Do we need to have somebody who's counseling, who's familiar with testing of embryos and not necessarily a pediatric or adult genetic counselor? Excellent question. So it would depend on what your questions are. So if specifically you're interested in talking about paternal age, usually that would be a preconception genetic counselor, maybe a general genetic counselor, but probably a preconception genetic counselor because they also know about embryo screening. But when you're thinking about the laboratory genetic counselors, they are specialized in whatever test and platform.

32:43So I always recommend that you meet with them because they are going to be able to tell you the most up-to-date information about the test that you are potentially considering. Whereas the preconception genetic counselor will do very important pieces of the assessment, which is they're going to ask you about your family history. They're going to ask you about what your concerns may be. They may ask you more granular questions about your age and reproductive planning and your pregnancy history. Those are all really important parts, too, when you're considering what your options are and what you want to do.

33:15Dr. Carrie Bedient: How does the health of the man involved make a difference? So, for example, we've got a ton of patients where the male partner comes in and he's in his 50s or sometimes 60s and he is the picture of health. He works out, he gets good sleep, he is more meticulous about his nutrition than any of the office staff. How do those things play into improving risk or not really affecting risk? What's happening with the sperm? I think that's a good place to start biologically. So what is happening for sperm is sperm is being made constantly, which is very different than women who are born with all the eggs they ever have and you're losing an egg every period.

33:56For men, sperm is constantly being produced and there are specific cells that their job is to make new sperm. And when that's happening every single year and it's supposed to make a perfect copy, it makes errors with those copies as it gets older, just like we're not as fast as we were 10 years ago. Same goes with the sperm producing cells. They're more likely to make mistakes as men age. So there are many studies that have shown that there are about one to two new mutations in children of men as they get older. So every year of age, children have these new mutations more frequently. Most of those new mutations don't cause disease.

34:40I don't want people to be really fearful of that. We all have new mutations in us. That's what makes us different and unique and change. But that has been seen consistently that as men get older, on average, there's new changes. So if that is the mechanism, yes, health is going to slightly change that. If you use your brain more, if you're more active, you're healthier, your brain's going to be healthier. Sure. So of course, I'm not going to say that I don't think it's related at all. But on average, the sperm producing cells are going to do a worse job because you're getting older. So long answer.

35:12Dr. Carrie Bedient: And the same different version of the same question, but are there any supplements or things that men can do to make it better?

35:20Dr. Susan Hudson: You just took my question. You're welcome. Not to my knowledge, but I'm sure there are people out there who know more about this that may have an answer. And I'm going to ask them and report back. Very good. I like it. Perfect.

35:33Dr. Carrie Bedient: What other questions should we be asking about paternal age? What have we not talked about yet that we should have? I think a big part of it is really just out there. I think people should know more about paternal age, not just for balancing out women and men and fertility, but I think so that there could be more research because the men that we are talking to are very interested in this and are concerned, rightfully so, about the risks that are related to very significant conditions. But because they are conditions that happen later in life and are less to do with implantation, it's not as well studied and not as well discussed.

36:12But it is very important. And I do think it is important as well that there are couples who, well, in general, people are deciding to have children later in life. That's just a trend that we've seen. Exactly. Exactly. And we're very quick to going to egg donors and comfortable using older sperm, which completely fine. But the couple needs to know what those risks are. And I'm finding I'm counseling a lot of families that are in this situation and they had absolutely no clue that there was anything related to sperm. If it works, it works is the thought process. Right. And that may be true for the beginning of implantation and having enough embryos to biopsy if we go even further up the line.

36:56But I think it is just important for people to know. Education is really, really important so that people know. But often people are just really surprised. I didn't know that there was an increased risk for these conditions.

37:06Dr. Susan Hudson: On the education side, are you aware of any specific resources that we or patients could access that have good visuals of these risks? We at ORCID have a couple of guides about this and a few one-pagers that we're happy to share. Otherwise, no, I have not found good resources, which is why I think it's so important to talk about this topic. because at least now the positive of being able to talk about different questions we have about fertility to AI is that these studies are starting to pop up via AI. They're confusing summaries that are happening, but people are starting to know more about things that are not discussed as well, but then there's no resources or education to follow up with it.

37:49So no, there's not a lot of great resources out there, but we're working on improving that so that we can share information.

37:55Dr. Carrie Bedient: Is there any negative impact to gene integrity when you freeze sperm? So for example, if a guy says, I'm 40 years old, I'm not going to have kids for another 10, 15 years, but I want to freeze my sperm now. Is that a viable option or does that just trade one set of problems for another? A good question that we should be studying, and I don't think I've seen a good study on it. But if we go to go back to the biological mechanisms of where the errors are occurring, they're occurring already in that sperm that's frozen. So they either were or weren't present. So it's just a similar concept to women that freezing earlier, the better.

38:34So same with, yeah. Thank you.

38:35Dr. Carrie Bedient: Yes. Well, thank you so much for joining us today, Maria. To our listeners, our guest has been Maria Katz, a board-certified genetic counselor with Orchid Health. And we are very appreciative for all of your information. Thank you so much for joining us today. Thanks for having me. For our listeners, thank you so much for spending part of your day with us.

38:55Dr. Susan Hudson: If you enjoyed this episode, subscribe, leave a review, and send us your questions at FertilityDocsAndSensor.com.

39:02Dr. Carrie Bedient: And if you want even more infertility information, pick up a copy of the IVF Blueprint, which is our practical guide to understanding fertility treatment, IVF, and the decisions you'll face along the way.

39:10Dr. Susan Hudson: Before we go, remember, this podcast is meant for education and entertainment only.

39:15Dr. Carrie Bedient: While we're fertility doctors, we're not your doctors.

39:18Dr. Susan Hudson: Nothing we discuss should replace medical advice from your own physician who knows your individual history and circumstances. Thanks for listening. Bye. Bye.