JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):168
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263920

P-156. Male Biological Clock: Reproductive and Emotional Implications of Advanced Paternal Age – Narrative Review

Igor Faria Dutra¹, Leticia Rodrigues de Almeida¹, Luisa Machado Rocha¹, Angelo Maurilio Fosse Junior¹, Rodrigo Barros¹

¹ Universidade Federal Fluminense – Niteroi – RJ - Brasil

Objective: Advanced paternal age (above 40 years) has been associated with compromised male reproductive quality, including alterations in semen parameters, increased epigenetic changes, and poorer outcomes in assisted reproduction techniques (ART). In parallel, infertile men experience identity crises linked to societal expectations regarding fatherhood, along with depression, anxiety, and sexual dysfunction. This review evaluated the effects of advanced paternal age on male fertility, reproductive outcomes, offspring health, and associated emotional impacts, integrating medical and psychological perspectives.
Methods: Narrative review with a multidomain biomedical and psychosocial approach. Searches were conducted in PubMed, PsycINFO, and SciELO (2014–2025) using the terms "male infertility," "psychological effects," "advanced age," and related keywords. Qualitative and quantitative studies addressing the biopsychosocial implications of male infertility were included. Fifty-six articles were screened by two independent reviewers; standardized data extraction followed (authors, year, sample, psychosocial outcomes, including analyses of depression, anxiety, quality of life, and marital conflict in infertile men vs controls), yielding 10 selected studies. The final synthesis integrated medical and psychosocial evidence to enable a multidimensional, multidisciplinary analysis.
Results: Advanced paternal age was associated with annual reductions of 0.7% in sperm motility and 0.9% in normal morphology, and a 1.8% annual increase in sperm DNA fragmentation. A 14% decrease in euploid blastocyst formation and a 32% increase in miscarriage were reported in men >45 years undergoing ICSI/PGT-A (Rakesh Sharma et al., 2015). Men > 45 years, compared with those <30 years, showed 3 to 22% lower semen volume and 3 to 37% lower motility (Kidd et al., 2015). Studies also indicate alterations in DNA methylation, histones, and noncoding RNA profiles with potential effects on spermatogenesis and offspring health (Ashapkin et al., 2023). Epidemiologic data link paternal age to elevated risks of autism, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, psychosis, suicidal ideation, substance use, and poorer academic performance (D'Onofrio et al., 2014). Emotionally, infertile men reported anxiety, depression, guilt, and marital conflict (Xu et al., 2024). An exploratory meta-analysis indicated an 18% reduction in live birth rates among patients with high stress scores. ART negatively impacted sexual life and couple dynamics, and lack of psychological support exacerbated these effects (Machado et al., 2023).
Conclusion: The male biological clock requires an interdisciplinary approach that integrates medical interventions to optimize semen parameters with psychological care to mitigate emotional distress. Awareness strategies are essential to reduce stigma and promote early help-seeking, improving both reproductive outcomes and mental health. Advanced paternal age negatively affects male fertility through structural and functional sperm changes, increased genomic and epigenetic instability, and worse ART outcomes. These factors also influence men's emotional health, underscoring the need for clinical recognition of the male biological clock and interdisciplinary strategies for prevention, counseling, and psychosocial support. Health professionals caring for infertile men should consider these factors and provide integrated approaches addressing physical concerns and psychological and social repercussions.