How does a man’s age affect fertility and the health of a future child? And what should prospective parents actually know about the genetic risks associated with paternal age? In this episode of Fertility Docs Uncensored, Dr. Carrie Bedient and Dr. Susan Hudson are joined by genetic counselor Maria Katz for an honest, informative conversation about paternal age, fertility, and genetics. They break down what happens to sperm as men get older, how age-related genetic changes can affect reproductive outcomes, and how paternal age risks compare with the more familiar risks associated with maternal age. From de novo mutations and embryo screening to sperm freezing and future research, this episode separates the science from the fear and gives listeners practical information to consider when planning a family.

Episode Transcript:

Susan Hudson (00:01)

You’re listening to the Fertility Docs Uncensored podcast, featuring insight on all things fertility from some of the top rated doctors around America. Whether you’re struggling to conceive or just planning for your future family, we’re here to guide you every step of the way.

Carrie Bedient MD (00:22)

Hello and welcome to another episode of Fertility Docs Uncensored. I am joined by my magically, mischievously, magnificently marvelous co-host, Dr. Susan Hudson from Texas Fertility Center.

Susan Hudson MD (00:32)

Hello everyone

Carrie Bedient MD (00:34)

And I’m Dr. Carrie Bedient from Fertility Center of Las Vegas. And today we are joined once again by Maria Katz, who is a board-certified genetic counselor and the director of clinical product at Orchid Health, which is all about genetic testing. So that’s what our episode is gonna dive in today, looking at how paternal age really impacts having babies and going through all this. But Maria, we are delighted to have you back again. Thank you for joining us.

Maria Katz (01:00)

Thanks so much for having me again.

Carrie Bedient MD (01:02)

And when I look at your background, it’s the same as it was the last time recorded, but you said that the rest of your house is falling, not necessarily falling down around you, but falling down

Maria Katz (01:12)

Yes, I feel like we’ve been under construction for three years now. Our house is finally at a stage where it doesn’t feel like I’m going to fall into a construction zone. Yes, we are taking our first break this summer, but as soon as we’re back from our last vacation of the summer, we are back to putting holes in our house again. So lots of fun, but also I’m tired of it.

Susan Hudson MD (01:36)

So there are certain people who start at one end of their house and they gradually remodel and by the time they get to the end, they’re like, it’s time to start back over. Is that your mantra?

Maria Katz (01:47)

I really hope not because we started off by our whole downstairs. We started off really strong where we had no livable space and we were on a mattress in one room and then we just decided to slow down. But I am hoping we get to enjoy the full house and not have to start back from scratch again. But yes, some people do do that.

Carrie Bedient MD (02:08)

So what what are you working on right now then? Is your downstairs now livable?

Maria Katz (02:12)

It is livable, which is great. We’re doing the last part of the downstairs that missed on purpose, which is our bathroom downstairs. It’s a house from the 70s, and through every renovation we made more holes in the bathroom too, looking for things. So right now it’s just like a toilet in the middle of the room and then just holes everywhere. So I’m really excited for this one.

Carrie Bedient MD (02:33)

Now if you have a guest come into perhaps the guest bedroom that’s right next to the master bathroom, can can you have a conversation while peeing? Is it that kind of a hole?

Maria Katz (02:42)

It’s an excellent question. No, but mostly we just give them a warning before they open the door to not be alarmed at everything that is falling out. We have this huge blue tape that’s holding the ceiling together. And so we have to tell people, it’s safe, nothing will fall on you. Yes.

Carrie Bedient MD (02:59)

That sounds incredibly stressful.

Maria Katz (03:01)

Yes, we’re at a place now where we look around and we’re like, we’re in a different place than we were three years ago. So, it’s positive, but it’s definitely been an adventure. So to all the listeners who are also doing renovations, good for you because it’s so hard.

Susan Hudson MD (03:15)

Yeah.

Carrie Bedient MD (03:15)

Are you doing all of the work yourself or are you bringing people in or is it a combination? How are you fixing that part of it?

Maria Katz (03:21)

Combination. We started off very bold that we were gonna do a lot by ourselves because my husband’s an architecture and my dad did a lot of building of our house growing up. So I was overly confident. And then we have just gone to being more and more tired and being like, maybe we will pay someone to do this next one. So yes, we’re learning our lesson that maybe it’s smart to to contract out.

Carrie Bedient MD (03:43)

That’s fantastic.

Susan Hudson MD (03:43)

It’s a progression.

Carrie Bedient MD (03:46)

Yes.

Maria Katz (03:44)

Yes, exactly. Exactly.

Carrie Bedient MD (03:47)

Hopefully it all finishes soon and you have an entire house that you can live in and not exist in.

Maria Katz (03:53)

Yes, exactly. But I may start again. I think that’s what people do. You’re right. So who knows?

Carrie Bedient MD (03:58)

Yeah, I think I know you’re a counselor, but maybe we should get you a different type of counselor before you dive into the next renovation.

Maria Katz (04:04)

Yes, yes, I agree. I completely agree.

Carrie Bedient MD (04:07)

All right, Susan, what kind of question do we have today?

Susan Hudson MD (04:09)

Okay, our question for today is, I’d appreciate your perspective on my clinic experience. We just completed our first IUI, but the nurse told me that my husband’s sperm sample had only 600,000 motile sperm, making it likely to fail. I was devastated. REI emailed me the next day with well wishes and mentioned that we had nine more vials of sperm frozen for future use. This left me so confused.

Why split up the sperm into ten vials? Why not use more than one for the IUI? Why not unfreeze more until there were enough sperm? And why not ask my husband for a fresh sample the same day? We used the frozen sperm because we thought he’d be out of town. I feel the IUI was pointless and the clinic was careless. Am I being too harsh? I don’t know if I can trust their actions and protocols now.

Carrie Bedient MD (04:58)

That is a complex question with a couple of different layers here. And I think all of this merits a conversation with your REI and and there’s probably a blend of things going on.

One is whatever type of treatment you guys were planning on doing from the get-go. Two is lab protocols. Three is how the sperm survived, which is a big one that many patients don’t really know about and don’t consider because we know that when we freeze a sperm sample, we’re gonna lose about half of it. And most of the time we are splitting up sperm specimens. So you get one specimen, but you divide it up into however many vials in order to get what you need at the end. And if you know you’re doing an IUI, you divide up into fewer vials because you need higher counts. An ITI is a little bit less. IVF is a little bit less. IVF with ICSI is even less. What the goal was makes a difference there. They may have said, we thawed this and got really poor results when we were expecting very normal results. So maybe we shouldn’t go forward on thawing more. Sometimes clinics are very reticent to thaw and use up all of their samples because we never take it for granted that we’re going to be able to get more and we don’t know all of the circumstances if it was just travel or if there’s something else going on. Maybe he was on testosterone, maybe he’s got a cancer diagnosis, maybe he chemotherapy in the past, maybe he had some injury, maybe he’s got a hydrocele or varicocele and needs surgery. There’s a ton of different things that can influence this.

Maybe they knew that all you wanted were IUIs. And so by having to use up more samples and subsequently freeze more samples, that’s adding a fair amount to your bill. There’s there are a ton of potential reasons for this.

It really merits a discussion with your doc. Now, that said, and I think all of us will tell our patients this: if you don’t trust your clinic, find another clinic. And that’s not trashing your clinic at all. They may have done absolutely everything perfectly right. And when you talk to them, whether you understand that or not, they may have done absolutely everything right. But if you don’t trust them, then find someplace else because there are many circumstances in our field where we are giving you bad news. And if we’re giving you bad news, you need to feel confident that we were doing everything that we reasonably could to get you good news. And that if it didn’t work, it’s because human reproduction is horribly inefficient, not because somebody dropped the ball. It’s painful to leave a clinic. Nobody likes to start over. Clinics don’t like to lose patients.

It sometimes can be the best for everybody involved if you decide, all right, maybe this isn’t a great fit for us, or maybe we’re gonna, walk away and come back. or maybe you talk to them and you’re like, I get it. That makes sense. Thank you for looking out for me in ways that I couldn’t see at the time, because it’s very common for us to tell people bad news and then for absolutely every other piece of information we give to disappear.

It doesn’t get heard. There’s not the opportunity to say it because it’s really hard to give a very technical explanation to someone who is utterly falling apart in front of you. It’s not necessarily the right thing to do. Maria, you can probably speak to that as well as we can. So it’s worth a conversation. It’s worth going in with an open mind. It’s worth trusting your gut and just see, see how it is. What do you think, Susan?

Susan Hudson MD (08:13)

I think the most important thing when I read this is you need to have a conversation with your physician because I can’t help but think that there was some sort of communication snafu that happened between point A and point Z, whether it was between you and the doctor, the doctor and the nurse, the clinic and the andrology laboratory.

Communication problems happen, but the best way to fix communication problems is to communicate. Just because there was one communication problem doesn’t mean that there will be in the future. And you really have to go with your gut on this, but I do think that having a conversation, because it just feels like there’s something else to the story that that none of us, including you, may have privy information to you at this point, I would really encourage you to, either call the clinic, ask to speak to the doctor or make an appointment, go and see the doctor and and really be like, hey, this is what happened. I don’t understand why other solutions were not provided at this moment in time. And ideally you’ll be able to move on from there. But also it only takes one good sperm. So We’ve all seen IUIs work in that situation. Yes, statistically it is going to be a lower chance, but it only takes one.

Carrie Bedient MD (09:36)

Mm-hmm. Absolutely. All right. So let’s talk.

Susan Hudson MD (09:40)

I’m so excited about today.

Carrie Bedient MD (09:41)

I am too. And it’s not just because we are picking on the guys, not that we ever pick on anybody, but we’re picking on the guys today because women get such bullshit, honestly, about our age and how it impacts childbearing. And so it’s nice to turn the tables and and go with the guys because when we’re writing down some of our assessments and our maternal fetal medicine, the high risk OBs are writing down their assessments. Advanced maternal age is one that’s used all the time. Advanced reproductive age is one that’s used all the time. Geriatric pregnancies, which is just…

Maria Katz (10:12)

So bad.

Susan Hudson MD (10:14)

Terrible.

Maria Katz (10:14)

So bad.

Carrie Bedient MD (10:15)

It’s awful. I don’t know who the hell came up with that, but they need to be fired. There’s in some of the egg freezings, one of the acronyms comes out to be Age, A-G-E, which is just mean. And so it’s a nice change of pace to talk about how the guy’s age contributes to all of this. So with that very dignified lead-in. Maria, what to you constitutes advanced paternal age?

Maria Katz (10:40)

I am going to second everything you said before I talk about paternal age because of how much this bothers me that women, when getting anywhere close to the magic number 35, start freaking out. And there is this misconception that a light turns off or on. Again, analogies, that suddenly there’s so much risk, but there is a steady increase of risk.

As women get older and as men get older. So that is my pivot to paternal age. There’s also no magic number for men either. And it really depends on what study you’re looking at for a number that they’re putting for what is advanced paternal age. We started by talking about 50, and that has now moved to 40. So the reason it has shifted is for this same idea.

That there’s no magic 35, there’s no magic 40 or 45 or 50. There just is clearly a steady increase of risks, genetic risks, that are associated with age. So for women, we typically think about chromosomal differences, that there’s an increased risk for there being an extra or missing copy of a chromosome. We typically have 23 pairs.

So there’s going to be an increased chance that there will be differences. For men, the conversation is different. There are some studies that have looked at dad’s age and there being a slight increased chance of differences in chromosomes as well, particularly sex chromosomes, but that’s not really the risks that we are really talking about here. The risks are more related to what are called de novo mutations. What de novo mutations are, or we have billions of letters across our genome. Typically, when we think about our genome, we’re thinking about genes, which provide instructions for tasks in our bodies. A de novo mutation is having a spelling mistake in a gene. Those spelling mistakes, that is what increases with age. And there’s a lot to break down there, but that’s what we’re thinking about with paternal age is these single genes versus maternal age. We’re really more focusing on the chromosomes, but they’re both important, but for different reasons.

Carrie Bedient MD (12:51)

So if you Google or Chat GPT or pick your AI of choice and say, what are pregnancy rates with advancing female age? You’re gonna get a very clean set of very well-supported graphs that have this really nasty decline. It’s like, rolling down a hill where the hill gets a little steeper and steeper the further you go, on one side, as you look at female age and pregnancy rates declining as women get older. And then on the flip side, you’re gonna see the miscarriage rate go up, as a mirror of that. So pregnancies go down, miscarriages go way up, and the end result is you don’t have a live birth. If you were to put that same thing in for guys, would you get the same kind of falling off a cliff. Not a full drop off think Wiley Coyote in all of the Looney Tunes, but, that more gradual come down. Would you see that for the guys, or is it different?

Maria Katz (13:44)

Yes. Yes. You would see that. Just the risks are different. So what I won’t touch on today, because the two of you will be much better at speaking at this, is what that question was earlier, right? About sperm quality and quantity, et cetera. I’m not touching that. I’m gonna touch genetics. So when we are looking at those graphs related to paternal age, there are studies that are also looking at outcomes and birth weight and all of that. I’m also not going to touch that, but there are papers. But what we are seeing is that there is this steady increase in risk that’s related to genetic conditions, just like there’s a steady increase of risk related to these chromosomal differences with women. And that then is associated with instead of for females, there’s an increased risk of chromosomal differences, which is typically related to miscarriage or children who have health symptoms related to differences in chromosomes. The reason why it’s so much more complex for men is that when we think about these increased chance of these new mutations occurring, one, a lot of them don’t cause any signs and symptoms. But two, when they do cause signs and symptoms, there are some that are related to severe single gene disorders that may appear during pregnancy, which could result in a stillbirth or a miscarriage. But most have to do with conditions related to pediatric disease or later on. So we may not even be capturing it unless we’re studying it much more closely. So that’s part of the problem, too, with the research. One, because we like picking on women, which I think will be the theme that we keep going back to. But the other part is honestly a lot of the risks are happening outside of the time or really following up because we’re focused on implantation, pregnancy, miscarriage rate, and live births.

That’s a big part of this too.

Susan Hudson MD (15:36)

Let’s play a game.

How many tabs do you have open right now about IVF? One says your chances are great, another says they’re terrible. Reddit has one opinion, TikTok has another. Facebook is full of horror stories. And somehow, after two hours of searching, you have more questions than answers. Sound familiar? That’s exactly why we wrote The IVF Blueprint. This isn’t another fertility book filled with opinions or miracle cures. It’s an evidence-based guide that walks you through every stage of IVF, from understanding your fertility evaluation and choosing a treatment plan to medications, egg retrieval, embryos, genetic testing, transfers, and the two-week wait and beyond. Because the last thing you need during IVF is more noise. Close the tabs, put down your phone, open The IVF blueprint instead. Available now wherever books are sold.

Susan Hudson MD (16:34)

If you had to name four or five conditions that our listeners may have heard about that can be related to advanced paternal age, what are some of these conditions that could develop either in childhood or adulthood?

Maria Katz (16:53)

So I’m gonna break them down into two categories because I think that’s an important part. And so this will be a very long-winded answer, and I apologize for that. So, first is when we think about diseases, health conditions, they fall on a spectrum in terms of genetics. One side is called monogenic, where there’s one gene that causes disease. And that’s when I talk about a single gene disorder that is monogenic.

On the other side is called polygenic or multifactorial, where there’s genetic and environmental factors that contribute. So those are conditions like mental health conditions, heart disease, that there’s not one gene that causes signs and symptoms. So with paternal age, if you’re using AI, AI is very good at mixing up the two of those, which is why I want to define it, is that there are conditions on both sides of the spectrum we’re talking about here.

So the first side is monogenic or the single gene disorders. The conditions that we see related to paternal age are usually genes that are related to the bones, connective tissue, cancer risks. So those are conditions like achondroplasia, which is it sounds like a very fancy name, but it’s a name of a condition that people are probably aware of. It’s a genetic condition that causes short stature. And typically there’s very specific differences in the long bones that are characteristic of achondroplasia. So that is one example of a single gene disorder. But there are also more significant conditions like osteogenesis imperfecta, which can be very severe and actually can cause either a miscarriage, usually stillbirth, or neonatal demise because of the severity of the bones. The ribs usually don’t develop, which causes the lungs to not.

Grow. So that is what we’re thinking about with the single gene disorders. I really don’t want to scare people. These are rare conditions. So when we talk about an increased risks of these forms of conditions, they’re still rare. They just increase as men get older. So that’s the monogenic side. On the other side, for multifactorial conditions, and this is where I find a lot of families having some confusion because there’s a lot of papers out there, are conditions like autism and schizophrenia. So for autism and schizophrenia, when we’re thinking about paternal age, the reason why I want to say autism specifically is because there are genetic forms of autism and there are multifactorial, I should use the same terms, there are monogenic forms of autism, and there are polygenic complex forms of autism. And there are some monogenic forms that we’re seeing related to paternal age that may have autism as a feature.

or some sort of other, neurodevelopmental or learning disability, for example, neurofibromatosis. that is monogenic, but the majority of the research related to autism is actually the complex side. So autism and schizophrenia, there’s just large publications and large studies that have looked at if men get older, is there a higher chance or group of when you look at parents who are fathers that are over the age of 50. And then you look at fathers between 20 and 30, and you look at how common is autism in both of those groups, they’re significantly more common when men are over the age of 50. So that’s why this is a really complex topic, because we have these single gene disorders and we have these multifactorial disorders, but both are backed up with research that has been done for decades. It just there hasn’t been enough publicity and also strong enough numbers for people to be comfortable to talk about it.

Carrie Bedient MD (20:35)

When we are thinking about women, as REIs, I think a lot of us group patients into under 35, 35 to 40, 40 to 45, and over 46 and greater. And when we think of those, it’s the I’m not worried at all to, I’m a little worried, I’m aware, to this is a problem, but we can there’s a chance we can still get through it, to the this is just flat out not going to work, period, end of story.

Are there that level of classifications, maybe not in the same age groups, but there is there a point at which, with women, you go, I’m really sorry, you’re fifty years old. I will accept a complete miracle, but there’s nothing I can do to make this better. Are there any ages like that for guys?

Maria Katz (21:16)

I think

that is an excellent question. And I think 10, 20 years from now, we’re going to have much better categorization of the ages because right now I would say 40 to 45. The risks are starting to get higher. 45 to 50, we should really start talking about it. 50 plus, we definitely need to start talking about these risks. But there’s no age, There are there are children out there who have fathers that are in their 50s, 60s, plus. A lot of those individuals are healthy and don’t have these health concerns. But we’re not studying everyone and we’re not looking at the conditions that are happening later in childhood and adulthood that these individuals are at increased risk for. So they’re would need to be really long-term studies to give better risk estimates. Do I think there will be an age in which there will be more of a conversation to say, hey, there is a high chance, insert number, that your child will have autism, schizophrenia, potentially a single gene disorder. These few are the highest chance, and this is what those numbers look like. Yes, I do think we’ll get there. We just aren’t there yet.

Susan Hudson MD (22:29)

So one thing that I think of is when we start getting to the point of really high chances of in women of having embryos and children that may potentially have chromosomal abnormalities, their chances of getting pregnant become less than five percent. Okay.

Maria Katz (22:46)

Yes, yes.

Susan Hudson MD (22:47)

The flip side of it for men is though we do see decreases in sperm quantity and quality for various reasons as men get into those older age groups, there is not a huge decline in their fertility as compared to women when we’re starting to be more concerned about these things. So as a genetic counselor, if we have somebody who their partner is 40, 45, 50, 60 plus, because we do have patients who have partners in those older age groups, is there an age group that you really feel with the information hey, these people should probably talk to either a genetic counselor or a medical geneticist?

Maria Katz (23:36)

So I would honestly say any man who’s over the age of 40 should have a discussion with a genetic counselor about this. I think that all of the families we have spoken to, and even before I was in the embryo screening space, in the prenatal space, who did have effected pregnancies or were having a conversation with me for whatever the reason may be.

We always have to talk about paternal age. That is on a genetic counselor’s checklist of discussion points. And before, what was hard was you tell a family of risks and then there’s no screening options. And that’s what’s very different with men versus women is for men, there’s no screening options. For women, we talk about you have the option of doing PGT-A if you’re doing embryo screening. You have the option of NIPT if you are pregnant. For men, we say, Here’s the risks. Okay. Bye. That’s not great either, right? So now that there is whole genome embryo screening and there is an option to screen for some of these conditions, I do feel quite passionately that parents should know that there is options that are available. And then they should make a choice of whether or not that feels right for them. The big part of our discussions with them is that unfortunately though, we can’t give you great numbers. There are some studies that will put some numbers to relative increased risk of certain diseases, but they’re not perfect and they’re not based on every single year of age. It’s 40-ish, 50-ish plus, right?

Carrie Bedient MD (25:03)

Let’s say a couple decides that they want this information. maybe the man is 55 plus years old, they’re having to use an egg donor. We know getting embryos is less likely to be an issue. And they decide they want this information. When they get the report on this information, what kind of stuff is going to be on it?

Maria Katz (25:23)

Excellent question. It would depend on what they opted in for. So, a big part of what we do is we categorize each subset of our screen for families. So, whole genome sequencing feels very big and overwhelming for some families. So, being able to break it down by this is a group of genes that are related to.

Birth defects or severe pediatric diseases is much more tangible, and families can opt in. Something that we have done is we have categorized groups of genes within each of those groups that are related to age. So there is a subset of genes that cause birth defects, that there’s increased prevalence for aging fathers. There’s a group of genes that there’s an increased risk for pediatric cancers. So we’ve categorized all of them.

And so families can opt in. And part of that is that then patients are aware of what they’re selecting very deeply. So when there is a finding, they’re not surprised because they opted in. So what’s clear about monogenic conditions is they’re well studied. We’re not reporting out on conditions we don’t know about. We’re reporting out on conditions that have a name.

We’ve seen symptoms of across many, many individuals. Some people have heard the word syndrome be used instead of condition. The reason the word syndrome is used is because it means that there were many, many people who are not related to each other, who had the same change, well, typically different changes, but in the same gene, and they had the same-ish signs and symptoms. That’s what a syndrome is. So then it’s quite simple to explain it to someone in terms of someone who has achondroplasia has differences in their bones. These are the signs and symptoms. So it becomes something that’s very tangible to a family. An important part is not only if there is a finding, but if an embryo screens negative, that does not eliminate risk for disease. Especially, we had talked about there’s a whole group of conditions that there’s an increased risk for that are due to not only genetic factors, but environmental factors as well.

No test is going to eliminate risk for these diseases. Same with maternal age. There’s doing PGT-A and screening for chromosome differences doesn’t eliminate the all the other risks that are related to maternal age. So same goes with paternal age. So it it is important to put the two together.

Susan Hudson MD (27:46)

When we’re talking about these different types of tests to help minimize risk, and I’m gonna phrase this in what we see geographically happen with PGT-A. So there are many places in the world that PGT-A simply figuring out if we think we have the right number of chromosomes or not is illegal. Like really cannot obtain this except in very, very rare circumstances. And then you have the United States where PGT-A is relatively widely available. I think all clinics probably offer it to some degree, some more than others. Okay.

When we’re talking about things that are less tangible and less certain,

We start getting into more ethical, moral, philosophical views of what’s appropriate testing and what’s not appropriate testing. Within the United States, I would say that there are probably some places that support this type of testing. And when I’m saying places, I’m mean some clinics that support this type of testing, or even between physician to physician.

And some that are not. How do patients navigate that within the United States?

Maria Katz (29:05)

Yeah, I’d say there’s two parts. One part is first find out if whole genome embryo screening is right for you. Meet with a genetic counselor, have an extensive conversation, and decide whether or not it’s something you want to pursue. And then step two is to talk to your doctor and your fertility center about it, see if it’s an available option. And if it’s not, then as you’d mentioned before, It may be worth it to go to a center where it’s offered because you’ve had that conversation already and you said, This is very important for me and this is what I want to do, and that’s a deal breaker for me. Or you may say, I love my doctor, I love my clinic, this is really hard for me, but I think I’m gonna stick with my clinic and unfortunately not going to do the screening. So I think it’s important for patients to have the conversation with a genetic counselor first to decide if it’s right, and then of course, talk to your doctor and then balance out what feels right to you. What I would say to clinicians who may be skeptical or fearful of new technology is that whole genome sequencing itself is not new. What’s new is doing it on embryos. We’re doing whole genome sequencing in some places already on pregnancies. You’re doing prenatal samples with whole genome sequencing, but it is common recommended practice in the pediatric space if a child has certain signs and symptoms. It’s recommended by the American College of Medical Genetics and Genomics, the American Academy of Pediatrics if a child has an autism spectrum disorder, epilepsy, et cetera. So I think a really important piece here is that all whole genome embryo screening is doing is moving the timeline to the embryo stage rather than waiting for an affected pregnancy or child, as long as the company is being responsible of how they’re reporting.

Genetics is complex. There are some genes we don’t know a lot of information on. Are they only reporting on genes that we know about? And then what are the changes that they’re reporting out on the genes? Are they one that are well established or not? So those are important questions to ask the laboratory and make sure that it feels right for your patient and your center and have a discussion as well with the laboratory.

Susan Hudson MD (31:08)

If someone’s listening today and they’re like, you know what, I really want to talk to a genetic counselor, how how does somebody go about finding somebody like this?

Maria Katz (31:18)

Yes. So there’s two ways to find a genetic counselor. And what I’m describing is talking to a genetic counselor at the laboratory that you’re interested in. So for Orchid, we have genetic counselors that are available. Email genetics at orchidhealth.com and you will get in touch with the genetic counselor, schedule a call. We always like you talking to other genetic counselors. So there are genetic counselors that are not related to any laboratory. You can meet with them.

Often they reach out to all the other genetic counselors to get more information. We’re all connected. but we’re all here to support you. So you can reach out to laboratory. I recommend you do that. You’re gonna get information about the technical parts of the test. But the other part is there’s many genetic counselors, and you can go to National Society of Genetic Counselors and search, find a genetic counselor, and you can find one near you.

Susan Hudson MD (32:03)

Does the genetic counselor need to have any special training in this specific area? Do we need to have somebody who’s counseling who’s familiar with testing of embryos and not necessarily a pediatric or adult genetic counselor?

Maria Katz (32:18)

Excellent question. So it would depend on what your questions are. So if specifically you’re interested in talking about paternal age, usually that would be a preconception genetic counselor, maybe a general genetic counselor, but probably a preconception genetic counselor, because they also know about embryo screening. But when you’re thinking about the laboratory genetic counselors, they are specialized in whatever test and platform. So I always recommend that you meet with them because they are going to be able to tell you the most up-to-date information about the test that you are potentially considering. Whereas the preconception genetic counselor will do very important pieces of the assessment, which is they’re going to ask you about your family history, they’re going to ask you about what your concerns may be. They may ask you more granular questions about your age and reproductive planning and your pregnancy history. Those are all really important parts too when you’re considering, what your options are and what you want to do.

Carrie Bedient MD (33:15)

How does the health of the man involved make a difference? So for example, we’ve got a ton of patients where the male partner comes in and he’s in his 50s or sometimes 60s and he is the picture of health. He works out, he gets good sleep, he is more meticulous about his nutrition than any of the office staff. how do those things play into improving risk or not really affecting risk?

Maria Katz (33:40)

What’s happening with the sperm? I think that’s a good place to start biologically. So what is happening for sperm is sperm is being made constantly, which is very different than women who are born with all the eggs they ever have, and you’re losing an egg every period. For men, sperm is constantly being produced and there are specific cells that their job is to make new sperm. And when that’s happening every single year and it’s supposed to make a perfect copy, it makes errors with those copies as it gets older.

Just like we’re not as fast as we were 10 years ago. Same goes with the sperm producing cells, they’re more likely to make mistakes as men age. So there are many studies that have shown that there are about one to two new mutations in children of men as they get older. So every year of age, children have these new mutations more frequently.

Most of those new mutations don’t cause disease. So I don’t want people to be really fearful of that. We all have new mutations in us. That’s what makes us, different and unique and change. But that has been seen consistently, that as men get older, on average, there’s new changes. So if that is the mechanism, yes, health is going to slightly change that. if you use your brain more, if you’re more active, you’re healthier, your brain’s gonna be healthier. Sure. So of course, I’m not gonna say that I don’t think it’s related at all, but on average the sperm producing cells are going to do a worse job because you’re getting older. So long answer, but…

Carrie Bedient MD (35:13)

And the same different version of the same question, but are there any supplements or things that men can do to make it better?

Susan Hudson MD (35:20)

You just took my question.

Carrie Bedient MD (35:23)

You’re welcome.

Maria Katz (35:24)

Not to my knowledge, but I’m sure there are people out there who know more about this that may have an answer. And I’m going to ask them and report back.

Susan Hudson MD (35:31)

Very good.

Carrie Bedient MD (35:31)

I like it. Perfect. What other questions should we be asking about paternal age? What have we not talked about yet that we should have?

Maria Katz (35:39)

I think a big part of it is really just out there. I think people should know more about paternal age, not just for balancing out women and men and fertility, but I think so that there could be more research because the men that we are talking to are very interested in this and are concerned, rightfully so, about the risks that are related to very significant conditions.

But because they are conditions that happen later in life and are less to do with implantation, it’s not as well studied and not as well discussed, but it is very important. and I do think it is important as well that there are couples who, well, in general, people are deciding to have children later in life. That’s that’s just a trend that we’ve seen.

Maria Katz (36:25)

Exactly. Exactly. And were very quick to going to egg donors and comfortable using older sperm, which completely fine. But the couple needs to know what those risks are. And I’m finding I’m counseling a lot of families that are in this situation and they had absolutely no clue that there was anything related to sperm. If it works, it works is is the the thought process, right? And that may be true for the beginning of implantation and having enough embryos to biopsy if we go even, further up the line. But I think it is just important for people to know. Education is really, really important so that people know. but often people are just really surprised, I didn’t know that there was an increased force for these conditions.

Susan Hudson MD (37:06)

On the education side, are you aware of any specific resources that we or patients could access that have good visuals of these risks?

Maria Katz (37:16)

Hmm.

We at Orchid have a couple of guides about this and a few one pagers that we’re happy to share. Otherwise, no, I have not found good resources, which is why I think it’s so important to talk about this topic. Because at least now, the positive of being able to talk about different questions we have about fertility to AI is that these studies are starting to pop up via AI. They’re confusing summaries that are happening, but people are starting to know more about things that are not discussed as well. But then there’s no resources or education to follow up with it. So no, there’s not a lot of of great resources out there, but we’re working on improving that so that we can share information.

Carrie Bedient MD (37:55)

Is there any negative impact to gene integrity when you freeze sperm? So for example, if a guy says, I’m 40 years old, I’m not gonna have kids for another 10, 15 years, but I wanna freeze my sperm now, is that a viable option? Or does that just trade one set of problems for another?

Maria Katz (38:14)

Good question that we should be studying. And I don’t think I’ve seen a good study on it. But if we go to go back to the biological mechanisms of where the errors are occurring, they’re occurring already in that sperm that’s frozen. So they either were or weren’t present. So it’s just a similar concept to women that freezing earlier the better. 

Carrie Bedient MD (38:36)

Well, thank you so much for joining us today, Maria.

Maria Katz (38:38)

Thank you.

Carrie Bedient MD (38:39)

To our listeners, our guest has been Maria Katz, a board certified genetic counselor with Orchid Health. And we were very appreciative for all of your information. Thank you so much for joining us today.

Maria Katz (38:50)

Thanks for having me.

Carrie Bedient MD (38:52)

For our listeners, thank you so much for spending part of your day with us.

Susan Hudson MD (38:56)

If you enjoyed this episode, subscribe, leave a review, and send us your questions at fertilitydocsuncensored.com.

Carrie Bedient MD (39:02)

And if you want even more infertility information, pick up a copy of the IVF Blueprint, which is our practical guide to understanding fertility treatment, IVF, and the decisions you’ll face along the way.

Susan Hudson MD (39:10)

Before we go, remember this podcast is meant for education and entertainment only.

Carrie Bedient MD (39:15)

While we’re fertility doctors, we’re not your doctors.

Susan Hudson MD (39:18)

Nothing we discussed should replace medical advice from your own physician who knows your individual history and circumstances. Bye.

Carrie Bedient MD (39:25)

Thanks for listening. Bye-bye.