The Male Biological Clock

Say "biological clock" and most people think of women. Most people know that a woman's ovaries stop producing eggs at some point and that natural fertility ends with menopause. But most people don't know that men have biological clocks too.

The male equivalent to menopause is andropause, which is a steady drop in the levels of male sex hormones that affect fertility, sexual desire and sexual performance. The male biological clock doesn't strike midnight and stop like the female clock, it just slowly unwinds.

The effects on fertility and sexual performance in men can be significant. For example, men 35 or older have half the chance of fathering a child within 12 months, compared with a man who is a younger than 30. In addition, as men age, the genetic quality of their sperm declines significantly.

Unfortunately, infertility is almost always viewed as a "woman's problem" by both men and many doctors. For a lot of reasons, the field of fertility treatment sometimes ignores the male role despite the fact that in any instance of infertility, the problem is as likely to be with the man as it is with the woman.

The lack of attention to male infertility, the lopsided media and advertising attention paid to female infertility, and the profit motive combined to create a silent epidemic of male infertility. It's a trend that's made more acute by the related fact that couples are waiting longer to have children. The number of births to parents older than 35 has more than doubled from 1970 to 2000. There has been a corresponding rise in rates of infertility.

Each year about six million American men and women realize they have a fertility problem. Sadly, most of these couples assume first that the problem must be with the woman, and second, that their only option is some sort of assisted reproductive technology such as in vitro fertilization. Now don't get me wrong: I'm not against IVF and other assisted reproductive technologies - they are terrific for the right couple at the right time. It's just that I've also seen too many couples jump into IVF before they need to, before they've understood all their options, and before the male side of the equation has been thoroughly explored for possible problems.

The male biological clock affects more than fertility, of course - it affects sexual performance, overall physical health, mental function and intimate relationships. Problems with male sexual performance are even more widespread than infertility - despite the huge success of erection-enhancing pills. To the 30 million men with erectile dysfunction must be added the millions more whose sexual pleasure is eroded by premature ejaculation, lack of sexual desire, or inability to have orgasm. And, obviously, these conditions don't just affect the men - they impact their partners as well.

Viewing male sexual health through the lens of the male biological clock is a new and helpful way of approaching things. First, it reminds couples that difficulties with sexuality or fertility are as likely to arise on the male side as the female side of the equation.

Acknowledging the reality of the male biological clock creates a level playing field at the outset. No longer is the man merely a bystander, cooling his heels in the waiting room, assuming his anatomy and physiology are perfect while his partner is poked and prodded to uncover an assumed problem. And even if a problem is found on the woman's side, simply recognizing that it could as easily have been with the man makes it more likely a couple will feel united in their effort to conceive a child.

Reprinted with permission. Dr. Fisch is the director of the Male Reproductive Center in New York City. He is a board-certified urologist and microsurgeon who is also one of the nation's leaders in the diagnosis and treatment of Men's health issues as well as sexuality and fertility problems in couples. He is the author of The Male Biological Clock and Size Matters.

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