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Fertility: Having Children in Your 40s, 50s, and Beyond

Having children later in life is happening more often than ever before. For men, these are the main health considerations as one approaches parenting at an older age.


With changing lifestyles, increased lifespans and advances in science and medicine, couples are considering starting families later in life more often. If you are a male in your 40s or 50s and are thinking about becoming a father or growing your existing family, here are some things you need to consider. As with any major health decision, discussing your options with your healthcare team is an important part of the process.

Know the Barriers to Parenting Later in Life

Understanding the barriers associated with starting or expanding your family later in life is important before you start trying to conceive. From the men’s health side of the equation, there are fewer considerations compared to women, though some do exist. Steven Rosenberg, MD, urologist at The Iowa Clinic, points out that the numbers and quality of sperm begin to diminish after age 40. However, unlike females who have a firm endpoint at menopause, men can conceive much later than that. A common question he receives from men looking to become a father in their 40s or 50s is whether a prior vasectomy is reversible.

“Vasectomy reversal is one of the main fertility procedures we perform on older men. It is a safe and minor outpatient surgical procedure that is effective in restoring sperm in the ejaculate in as many as 80-90% of men if the vasectomy was done within the last 10 years, and it can be successful even if the vasectomy was done longer ago than that,” Dr. Rosenberg said.

The considerations for women span a wider range and fertility becomes a trickier subject for women as they age compared to men but working closely with your doctors will help you assess and manage those issues. Ultimately, the choice to start a family at any age is in your hands, but because of the higher risks of pregnancy in later decades, communicating and coordinating closely with your doctor is crucial.

Men’s Fertility Treatments and Procedures

Dr. Rosenberg notes that fertility issues that typically affect younger men can still play a role in men as they age as well. “If there are problems with diminished sperm numbers or motility, for example, we can do testing to learn more and determine an appropriate plan,” Dr. Rosenberg said.

The first course of action when a patient comes in with the desire to start a family and concerns about fertility is to perform a thorough history and a relevant physical examination. A semen analysis is a laboratory examination of the ejaculate. It is typically the first test done as part of an exam and informs related follow up. This assesses the volume of the ejaculate as well as the numbers or sperm and their motility and appearance.

For some men, infertility can relate to lifestyle choices and can also be a hormonal issue, in which case the testosterone and pituitary gland can be tested as well. “We look at the full landscape of male infertility to assess all potential concerns,” Dr. Rosenberg said.

If there is an indication that a patient may have a fertility issue Dr. Rosenberg notes that there are a number of procedures available, such as treating varicose veins in the spermatic cord, aspirating sperm from the testicle or its ducts through the skin, and even opening up blocked ejaculatory ducts through the urethra. Additionally, there are medicines available, such as Clovid or Arimidex, which may be helpful.

“Really, it all comes down to what’s best for that individual patient based on their other health considerations, as well as their hopes and desires, individually and as a couple,” Dr. Rosenberg said.

Coordinated Care for All of Your Parenting Needs

Approximately 10-15 percent of men experience fertility issues. If you desire to become a new parent in your 40s, 50s, and beyond, The Iowa Clinic offers the unique advantage of coordinated care across your entire healthcare team during the entire process—from planning to pregnancy and beyond.

Contact us to schedule an appointment today. 

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