For years, when discussing the passing of time and fertility, the focus was almost exclusively on women. However, paternal age can also have an impact on the reproductive and genetic health of offspring, and it is a factor that specialists are increasingly considering important to include within counseling for those who wish to have children.
This was one of the major topics of the 22nd Argentine Congress of Reproductive Medicine, organized by the Argentine Society of Reproductive Medicine (SAMeR), which was held from September 16 to 18 in Buenos Aires under the motto “From the Beginning to the Future.”
The meeting brought together local and international specialists and featured a very special guest: Louise Brown, the first person born through in vitro fertilization in the world, in 1978.
Her presence allowed putting into perspective how much reproductive medicine has changed in less than five decades: from that first in vitro fertilization to ICSI, gamete donation, vitrification and preservation of eggs and embryos, and, more recently, the use of artificial intelligence at different stages of treatments.
Becoming a father after 40: what happens with paternal age
One of the axes of particular interest was the so-called advanced paternal age and its possible genetic implications.
Dr. Gabriel Ercoli, a specialist at Procrearte, explained during his presentation that in recent decades the number of men who become fathers after 40 and even 50 has increased considerably.
The finding that begins to change the conversation? The father’s age should also be taken into account when a couple receives reproductive counseling.
“The fact of having a paternal age of 40 years or older increases the probability that genes mutate randomly; that is, the number of de novo mutations increases,” explained Ercoli.
De novo mutations are new genetic alterations that appear in the egg or the sperm and were not present as such in the parents.
Unlike maternal age, where the increase in age is clearly related to a higher risk of certain chromosomal alterations, in men the focus is mainly on mutations that can occur in specific genes.
What risks may increase?
According to Ercoli, a higher paternal age can be statistically associated with an increased risk of certain genetic or developmental conditions, including some skeletal dysplasias, certain congenital malformations, and rare syndromes.
There are also studies that have found associations between advanced paternal age and some neurodevelopmental disorders.
This does not mean that a man over 40 will necessarily have a child with any of these conditions. It is about population risk increases and, especially in complex diseases, numerous genetic, environmental and biological factors can intervene.
Therefore, more than setting an age limit to fatherhood, specialists emphasize personalized counseling.
Ercoli recommended analyzing both maternal and paternal age and reviewing personal and family history, ideally contemplating up to three generations. When there are relevant family histories, consulting a medical geneticist can allow evaluating each situation on a case-by-case basis.
Fertility preservation: much more than freezing eggs
Another major topic of the Congress was fertility preservation, an area that has advanced considerably in recent years.
Dr. Liliana Blanco, director of Procrearte and Maternity Bank, highlighted that there are two very different scenarios that can lead a person to preserve their fertility.
On one hand, there is the decision to postpone motherhood for personal, professional, or social reasons. On the other, there are medical situations in which preserving eggs or reproductive tissue can become a fundamental tool, as occurs with some oncology patients or with people who must undergo treatments capable of affecting fertility.
“We are seeing major advances in all areas, and fundamentally in fertility preservation,” Blanco explained.
Among the techniques that continue to be developed is ovarian tissue cryopreservation, which can be reimplanted later, and the possibility of recovering immature oocytes to attempt to complete their maturation in the laboratory.
This latter strategy could be especially valuable in cases where a medical treatment must begin quickly and there is not enough time to perform conventional ovarian stimulation.
From the first in vitro fertilization to artificial intelligence
If Louise Brown represents the start of a new era in assisted reproduction, artificial intelligence today appears as one of the possible protagonists of its next chapter.
“The presence of Louise Brown represents a before-and-after,” said Dr. Gabriel E. Fiszbajn, president of the Congress Scientific Committee, recalling how that birth spurred the subsequent development of embryology and of techniques that today are part of routine treatments.
Now, artificial intelligence is starting to be incorporated at different moments of the process.
It can be used to analyze large amounts of information, collaborate in decision-making, and develop tools that help evaluate different variables related to the treatments.
One of the fields that generates the greatest interest is the embryology laboratory, where various technological developments seek to collaborate in the analysis of embryonic development.
During the scientific meeting, a study was also presented on the use of artificial intelligence for predicting pregnancy in assisted fertilization, a demonstration of how these tools are beginning to be investigated within the specialty.
Fertility enters a new stage
“Reproductive medicine is constantly evolving,” summarized Dr. Gastón Rey Valzacchi, medical director of Procrearte.
And the Congress laid out a transformation that goes beyond a technology or a particular treatment.
The age at which men and women seek to have children has changed. The ability to preserve fertility has advanced, genetic tools have progressed, and artificial intelligence has begun to be incorporated into patients’ journeys.
Almost half a century after the birth of Louise Brown, that in vitro fertilization which seemed revolutionary in 1978 is today only the starting point of a specialty that continues trying to answer one of the most personal and universal questions: how to expand the possibilities of forming a family in a safe and informed way.
