Age and infertility

Infertility or involuntary childlessness is a growing medical and social problem in the

world and affecting 17 and 25% of all couples. Infertility is defined as a failure of achieving a
clinical pregnancy after 12 months or more of frequent, unprotected and well-time intercourse.
(Practice Committee of American Society for Reproductive Medicine, 2013). Approximately
15% of couples of reproductive age experiences infertility and more than quarter of infertility
cases may be attributed to male factors.
The purpose of male evaluation among the couple attending the infertility clinic is to
identify and treat the correctable cause of sub fertility. Many studies has been conducted to
evaluate the age effects on semen parameters among infertile male subjects among which was
studies conducted by Omran et al., 2013. According to the study, the result shows that as the
patients age increases, there was a significant reduction in sperm counts, sperm vitality and
motility.Based on the result, the sperm count declined from youngest age group between 18 to 25
year old where the mean of sperm count was 45.18 million/ml to the elderly age more than 45
years old where the mean of sperm count was 7.37 million/ml. The mean sperm vitality also
decreased with advanced age, from 56.45% in younger age group to 13.67% in the older age
group. Mean percentage of motile sperms also declined with advanced age from 45.73% in the
younger age group to 8.33% in the older age group.Percentage of morphologically normal
sperms also varied between age groups. In younger group, the mean value was 48.0% whereas in
the older group, the mean was 16.67%.
However, in this study, there is no significant relation of age and leukocyte count of
patients sample. This statement is supported by Kuhnert and Nieschlag who also concluded that
advanced male age has deteriorated effect on sperm count, particularly after the age of 40.
(Molina et al1990) also agrees that there are significant decrease in seminal volume, sperm
count, motility, viability and normal and morphology in relation to age leaving a firm support to
the whole statement.

The role that stress plays in infertility remains controversial, largely because despite
medical advances a large percentage of infertility still remains unexplained. Most current
definitions state that stress is the mental and physical response and adaptation by our bodies to
the real or perceived changes and challenges in our lives. A stressoris any real or perceived
physical, social, or psychological event or stimulus that causes our bodies to react or respond.(K.
Glanz and M. Schwartz, 2008).
These stimuli are mainly originates from the environment, some are derived from the
response of the individual to the environmental factors, and some are psychogenic and in certain
cases may be result of the interaction of what the individual perceives from the environment and
elicited response. Cultural, occupation, and many other behavioral differences can modify or
sensitize the stress response and the ensuing change to reproductive system. Stress has been
reported to decrease sperm count, motility, and morphology in men. Other disturbances, such as
impotence, sham ejaculation, retrograde ejaculation, and oligospermia, have been reported
associated with psychological factors in male infertility (Andres Nigro-Vilar, 1993).
Stress causes an increased secretion of hypothalamic corticotropin-releasing factor,
increased pituitary adrenocorticotropic hormone release, and augmented secretion of adrenal
cortex hormones, including cortisol. Therefore, it can be assumed that stress has a direct effect
on cortisol level production and therefore, a negative effect on fertility. Thus, it is apparent that
psychological functioning interacts with endocrinological levels, which significantly influence
fertility (Chung TKH et al., 2001).
A variety of occupational activities with high level of stress, including business, combat
or combat training have been reported to decrease plasma testosterone levels (Mc Grady et al.,
1984). Emotional stress associated with the evaluation or treatment for infertility of couples has
also been associated with oligospermia and may contribute to the variations in semen quality
observed during evaluation ( Mogishi et al., 1983).
Male aging was positively related to increase of DNA fragmentation. A wide variety of
exposures to physical agents, such as irradiation or heat, or to chemicals, including therapeutic
drugs, such as cancer chemotherapeuticsand environmental toxicants, such as pesticides,metals
or the components of tobacco smoke or air pollutants,target male germ cells. These exposures
may have adverse effectson sperm production and sperm function, with the potential of

transmittinga damaged male genome to subsequent generations.At least some of these exposures
directly target DNA, whereasothers induce oxidative stress, in which case it is the
reactiveoxygen species that are generated that form DNA adducts anddamage DNA (Aitken and
De Iuliis, 2009).This relation can attribute to ageing process leading with defect in the control of
spermatogenesis which could lead to infertility.Omran et al., 2013also concluded that men with
delayed fatherhood have lower likelihood of a successful pregnancy.
Understanding the effect of male age has become increasingly important in public health
as a growing number of men are choosing to father children in older age. Whether there is any
firm statement suggesting age factors could cause infertility in male population is much less
clear. Therefore the present study was carried out to provide substantial scientific data the
possible effect of male age on the semen parameters.