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Reproductive Genetics and the Aging Male
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Paternal age

  1. 1. Paternal age Outcome of ICSI
  2. 2. Introduction <ul><li>Life expectancy is increasing and is associated with changing patterns of marriage and divorce, so that remarriage and the wish to father a child in a new relationship are becoming increasingly common at an older age (Kühnert and Nieschlag, 2004). </li></ul>
  3. 3. Evidence <ul><li>In the United States, there has been a 16% increase in the birth rate for fathers over the age of 35 (Ventura et al. , 1997). </li></ul>
  4. 4. ??? ART <ul><li>It is important to know whether advanced paternal age is associated with low outcome of assisted reproduction </li></ul>
  5. 5. Insufficient evidence <ul><li>Contrary to the large number of studies which correlate maternal age with pregnancy rate in ART, there are few studies which reported relation of paternal age with fertilization and pregnancy rates in assisted reproduction. </li></ul>
  6. 6. <ul><li>A major difficulty for the study of the relationship between paternal age and outcome of ART is the difficulty in controlling for age of women in two groups with a large difference in the age of men </li></ul>
  7. 7. Aim <ul><li>is to study the effect of paternal age on the outcome of ICSI. </li></ul>
  8. 8. Inclusion criteria <ul><li>male partners were 50 years of age or more </li></ul><ul><li>first ICSI cycle </li></ul><ul><li>long agonist down-regulation protocol. </li></ul><ul><li>subdivided into Group AI with their age ranging from 50-59 years and </li></ul><ul><li>group A2 with their age of ≥ 60 . </li></ul>
  9. 9. Exclusion criteria <ul><li>female partners more than 40 years old </li></ul><ul><li>azoospermia </li></ul>
  10. 10. Control <ul><li>with paternal age below 50 years </li></ul><ul><li>with maternal age which matched maternal age in Group A. </li></ul>
  11. 11. primary outcome <ul><li>Fertilization rates </li></ul><ul><li>clinical pregnancy rates </li></ul>
  12. 12. Interventions <ul><li>Ovarian stimulation, ICSI and Embryo transfer were done as described before (Mansour et al, 1996)usual </li></ul>
  13. 13. Results Characteristic Group A Older men ( n = 227) Group B Younger men ( n = 227) P -value Paternal age (years) 53.9  5.0 38.4  5.8 <0.0001 Maternal age (years) 33.2  4.9 32.7  4.8 NS Duration of infertility (years) 7.8  6.2 7.8  5.4 NS Aetiology n (%) Male factor 119 (52.4) 88 (38.8) 0.0047 Unexplained infertility 41 (18.1) 47 (20.7) NS Tubal factor 28 (12.3) 46 (20.3) 0.031 Mixed 25 (11.0) 32 (14.1) NS Ovulatory factor 14 (6.2) 14 (6.2) NS
  14. 14. Semen Quality Characteristic Group A Older men ( n = 227) Group B Younger men ( n = 227) P -value Sperm concentration (  10 6 /ml) 39.0  26.3 46.0  32.6 0.05 Sperm motility (%) 37.4  20.4 46.4  15.5 <0.0001 Sperm abnormal forms (%) 74.0  11.5 81.3  10.6 0.019
  15. 15. primary outcome <ul><li>The fertilization rate was significantly higher in group B compared with group A (P < 0.0001; </li></ul><ul><li>There was no significant difference between the number of grade I embryos in group A and group B </li></ul><ul><li>There was no significant difference in clinical pregnancy rate between group A and group B (OR = 1.06, 95% CI = 0.72  1.55) </li></ul>
  16. 16. Outcome of intracytoplasmic sperm injection cycles in Group A (male age ≥50 years) and Group B (male age <50 years). a,bP<0.0001. There were no other statistically significant differences. Outcome Group A ( n = 227) Group B ( n = 227) No. of oocytes 10.8  6.8 10.5  6.2 No. oocytes with polar body 7.9  5.3 8.1  4.9 No. 2PN embryos 5.1  3.8 5.4  3.5 Fertilization rate (%) 64.9  25.4 a 66.7  25.6 b Grade of embryo 0.6  1.1 0.7  1.0 No. of cryopreserved embryos 1.9  3.3 1.7  2.8 No. of embryos transferred 2.7  1.1 2.8  1.0 Pregnancy rate (%) 37.9 36.6
  17. 17. Subgroup analysis There were no statistically significant differences between the two groups Parameter Group A1 ( n = 198) Group A2 ( n = 29) Paternal age (years) 52.5  2.7 64.1  6.2 Maternal age (years) 33.2  4.9 33.5  4.8 Duration of infertility (years) 8.0  6.3 6.7  5.7 No. of oocytes 10.9  6.8 9.7  6.3 No. of oocytes with polar body 8.0  5.3 7.1  5.1 No. 2PN embryos 5.2  3.9 4.6  3.5 No. of cryopreserved embryos 1.9  3.3 1.7  2.7 No. of embryos transferred 2.7  1.1 2.5  1.2 Pregnancy rate (%) 38.2 35.2
  18. 18. Multiple logistic regression analysis for factors affecting pregnancy rate Factor P -value Male age 0.6507 Female age 0.6356 Duration of infertility 0.8428 No. of oocytes 0.0079 No. oocytes with polar body 0.0056 No. 2PN embryos 0.8628 No. of cryopreserved embryos 0.6374 No. of embryos transferred 0.9361
  19. 19. <ul><li>Several publications support the present data in suggesting that pregnancy outcome after ICSI is not affected by male age (Gallardo et al. , 1996; Spandrofer et al. , 1998). </li></ul>
  20. 20. However <ul><li>This is the first study to report the effect of different paternal age groups on the outcome of ICSI where maternal age was not significantly different between all groups and subgroups. </li></ul>
  21. 21. <ul><li>The motility of spermatozoa in group B was significantly higher than group A ( P < 0.0001); however, this is probably irrelevant, as ICSI was used in all patients. </li></ul>
  22. 22. Fertilisation rate <ul><li>In an egg donation programme, it was found that age (up to 64 years) does not affect sperm characteristics or the ability of spermatozoa to fertilize human eggs. Embryo development in vitro , as well as implantation in recipient uteri, were not affected by the age of the male providing the semen sample. </li></ul>
  23. 23. <ul><li>On the other hand, epidemiological studies have shown reduced fertilization potential with age in humans (Schwartz and Mayeaux, 1982; Mehken et al. , 1986). </li></ul>
  24. 24. In our study <ul><li>The higher fertilization rate in group (B) was not shown to affect pregnancy rate; one possible reason is that a much larger sample size would be required to show a difference in pregnancy rate </li></ul>
  25. 25. Conclusion <ul><li>it seems that increased paternal age, apart from its effect on lower fertilization rate, has no effect on pregnancy rate. </li></ul>
  26. 26. Thank You
  • SaraAshraf30

    Nov. 26, 2017
  • drfarraj

    May. 29, 2016
  • AbdalahElmongy

    Dec. 25, 2015

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