Do Fathers Matter?: What Science Is Telling Us About the Parent We've Overlooked (23 page)

*   *   *

While researchers now generally accept the findings on older fathers, not everyone agrees on what those results mean. “I think it’s very interesting work,” said Daniel R. Weinberger, a psychiatrist and schizophrenia expert who directs the Lieber Institute for Brain Development in Baltimore. He accepts the finding that the incidence of schizophrenia is higher in the children of older fathers. But he doesn’t buy Malaspina’s speculation that this could be one of the most important causes of schizophrenia—because, he said, researchers know too little about which genes conspire to cause schizophrenia. “It’s a seminal observation, but like many seminal observations, it doesn’t identify a mechanism.” Weinberger wants to know exactly how this happens before he can say what it means.

Malaspina has thought a lot about the mechanism. What happens to the sperm of men as they age that could give rise to these increased risks to their offspring? The first idea was that it was a classic kind of genetic mutation, as some research has suggested. But another possibility is an alteration in the epigenetics of fathers’ genes. As we’ve seen, some genes have a stamp, or imprint, that marks them as originating in fathers or mothers. Malaspina hasn’t yet proven it, but she now believes that as men grow older, they may develop defects in cellular machinery that stamps this code on the genes. It’s these imprinting defects, she suspects, that give rise to the increased risk of schizophrenia, autism, and perhaps some of the other ailments related to the father’s age. It’s not possible to poke around in people’s brains and see whether those with schizophrenia have errors in this imprinting. But that can be done in Gingrich’s mice. He is examining imprinting in the mice’s brain tissue, and he’s betting he’ll find errors there. That’s precisely the kind of research that could address Weinberger’s concerns about the mechanism responsible for increasing the incidence of schizophrenia in the children of older dads.

If the genetic culprits underpinning schizophrenia and autism are identified, that would represent a big jump in understanding the illnesses. “This is work that we will pursue and fund, because we’re so eager to get the genetics worked out,” explains Thomas R. Insel of the National Institute of Mental Health. “It’s a very interesting observation.” With persistence—and some luck—the research could lead to better treatments or even, one day, a cure for schizophrenia and autism.

Until that happens, nothing can be done to test for schizophrenia or autism the way that doctors routinely test the fetuses of older women for, say, Down syndrome. There is no prenatal test for either of them, and the other genetic disorders linked to father’s age are so rare that it would be impractical to test older couples for all of them, even if tests were routinely available. Nor is it yet possible to analyze an older man’s sperm to see whether he is at special risk of having a child with problems. The only thing doctors can do is tell older fathers about the risks so they can make informed decisions. But even that isn’t happening. And that should change. Genetic counselors often don’t mention it, because nothing can be done to reduce the risks. But some couples, upon hearing the risks, might decide not to have children. And they should certainly be given that option.

The American College of Medical Genetics notes the risks, and suggests only that older fathers should be told about the increased risk of Down syndrome. It does not suggest they be advised about the risks of schizophrenia or autism. Its statement concludes by saying that “prospective couples should receive individualized genetic counseling to address specific concerns.” I interpret that to mean that if couples have a concern about the risks of older fatherhood, they should ask about that. But if they don’t express a “specific concern,” they probably won’t be told.

That seems wrong to me. I called two past presidents of the American College of Medical Genetics, Charles J. Epstein and Marilyn C. Jones, and asked them if they could explain why this “don’t ask—don’t tell” policy made sense, especially considering the new findings. “My personal philosophy has been to be truthful with people and tell them what they want to know,” Epstein told me. But “to put it out there every time somebody comes to you for counseling probably engenders more fear than light.”

Why then all the fuss about Down syndrome in the children of older women, when the risks for the children of older fathers are about the same? “You bring up Down syndrome because you get sued if you don’t,” he said. “And there are options. You can go through prenatal diagnosis, you have the option to terminate.” Epstein points out that the general rate of abnormalities of all kinds in newborns is about 2 to 4 percent. So even a 3 percent risk of schizophrenia in the children of men over fifty is not out of line with other risks. And it sounds less frightening when put this way: a fifty-year-old man has a 97 percent chance of having a child without schizophrenia.

Jones agreed with Epstein. “Paternal age is usually not addressed in counseling couples of advanced age because there is no simple test to address the risk,” she said. “If there is nothing to offer a couple but increasing anxiety, many counselors and physicians do not bring the issue up.” Arthur L. Caplan, director of medical ethics at New York University, doesn’t buy the geneticists’ hands-off approach. “They should be revealing information they have,” he said. “Parents might want to prepare, or it can affect a future reproductive decision.” It’s particularly important that parents have all the information, he said, because “this influences the health of someone whom nobody else can speak up for—the child.” Jones asked me what I would have done if I’d known about these risks when Elizabeth was pregnant with our son. The answer is: probably nothing. But I wish I’d been told.

Some researchers worry that the new findings on schizophrenia and autism are just the beginning of the problems that might one day be associated with older dads. “If there is one common disease that we know is associated with older biological fathers, we can safely assume there are more remaining to be discovered,” noted Elliot S. Gershon, a psychiatrist at the University of Chicago. “The now-common practice by men and women to delay parenting until they are almost too old to become parents has led to numerous medical disasters. It has long been known that infertility is a problem when women delay parenting, as well as Down syndrome. Now we know children of men who delay parenting also can end up paying a medical price.”

Herbert Y. Meltzer, a psychiatrist and widely recognized schizophrenia expert at Northwestern University, said he believes the risks for children of older fathers will eventually be seen to be as significant as the risks facing older mothers: “It’s going to be more and more of an issue to society,” he said. “Schizophrenia is a terrible disease, and anything that can be done to reduce it is terribly important.” According to Meltzer, women might want to think about this when choosing partners to have children with, and men might want to think about having sperm stored when they’re young.

One well-known schizophrenia researcher echoed this concern, explaining that he was concerned about his son, who just got married at forty-two. “I brought this to his attention, not to alarm him, but so he would be aware of it,” he said. “He and his wife might want to accelerate their own personal schedule for having children.”

Malaspina doesn’t think it’s proper to tell older men what to do. But even that neutral stance has gotten her into trouble. “I don’t discourage men of any age from having a family. And I’ve gotten e-mail from people saying, ‘How dare you, don’t you understand the suffering of these diseases?’ I just say the risks to any child of a man at any age are small.” Malaspina does believe that men should be aware of the risks and be able to make these judgments for themselves. “Men should know that this is an issue, just as women know it’s an issue. Men and women have their healthiest children in their twenties.”

It’s an issue Malaspina has dealt with herself. Having a sister with schizophrenia, she faced a 3 percent risk of having a child with schizophrenia—exactly the risk that I face with our son. Despite that, she decided to have a child—a daughter who’s now in college and headed for medical school.

The real problem, Malaspina said, is that we live in a world in which it’s increasingly difficult for people to have children when they’re younger. “We might provide more child care. We need to make it possible to have children and continue a career.” In her field, it’s routine for students to delay having children until after they finish their internships and residencies and can begin to earn a living—something that eats up most of their healthiest childbearing years. This was a concern when only women’s age was thought to be an issue; now, with fathers’ risks becoming clear, it’s doubly important.

While much of the news for older fathers has not been good, researchers have found some instances in which older fathers’ genes confer benefits on their children. The first I found quite dramatic and unexpected: the children of older fathers have a particular genetic characteristic associated with longer life. And so do their children—that is, the grandchildren of the older fathers. The likelihood of longer life extends across at least two generations. Kids who had older fathers—and whose grandfathers were also older when they had children—got a double hit of this benefit.

The genetic benefit we’re talking about here is a change in what are called telomeres. These are caps on the ends of chromosomes that protect chromosomes from damage as they divide. In most of our tissues, telomeres shorten as we age, and that could explain some of the consequences of aging. The children of older fathers have telomeres that are longer than normal. And they then pass those longer telomeres on to their children, who have even longer telomeres. Longer telomeres predict health and long life, making this a rather remarkable gift of older fatherhood.

A second curious finding about the children of older fathers is that they can grow to be slightly taller and slimmer than the children of younger fathers. Children born to dads over age thirty were found to be almost an inch taller, on average, than those born to fathers under thirty. And they could have a lower risk of obesity in adulthood. However, the children also had lower levels of HDL cholesterol, the kind associated with lower risks of heart disease. So the children could have an increased risk of heart disease as adults. The problems associated with older fatherhood greatly outweigh any conceivable benefits, but the mixed picture suggests that we need to know a lot more about what is happening on a molecular level. Men may have biological clocks, but biology is complicated, and those clocks seem to keep erratic time.

A few years ago, Thomas Foote, a retired professor of creative writing at Evergreen State College in Olympia, Washington, wanted to find out more about how older fathers are dealing with their erratic clocks. He began collecting narratives from older dads, in which they talked about their experiences. (Foote and his wife had a son when he was sixty, and the boy suffers from Down syndrome.) Most were in their second marriages and had been encouraged by younger wives to have children. Most were surprised at how much they were enjoying being fathers. Many of those who’d had children in an earlier marriage felt that they had the chance to get it right this time, to correct mistakes they felt they’d made with their older children. And most said they were spending more time with their children and felt they had a more intimate relationship with them than they had had when they were young fathers.

This bittersweet experience of the joys and perils of older fatherhood struck many cultural commentators as a kind of sweet revenge. Women have been grappling with decisions about childbirth for decades. Fathers seemed immune; they could continue to have children at any age, however wise or unwise that might be. The idea that fathers’ age might pose risks to children was unexpected—and disturbing. My wife and I had a second child after we knew about the risks associated with older fathers. Both are now old enough that we no longer have to worry about their risk of autism. But we must wait years before we can assure ourselves that they’ve escaped the risk of schizophrenia. I don’t worry about it often, but I can’t quite dismiss it either.

NINE

What Fathers Do

I grew up in a Detroit suburb of small, pumpkin-colored brick houses, each with a spindly young Norway pine tied to stakes in front and usually a kettle-shaped, three-legged barbecue and a concrete birdbath in the back.

Most of the fathers in the neighborhood worked in the auto plants or the parts makers and tool-and-die shops that supplied them. My father was one of them. He worked from 7:00 a.m. until 3:30 in the afternoon and was home by 4:00. We were, in many respects, a traditional family, in a traditional neighborhood, with one television, one car, and one dream—that my sister and I would go to college, something neither of my parents had done.

In another respect, however, we were quite different from any of the other families on our block. Early on, before any of the other mothers on the block started working outside their homes, my mother took a job working three nights a week as a temp at Ford. She and the other temps would show up after 5:00 p.m., when everyone else had gone home, and type memos and letters until 10:00 or 11:00 p.m., finishing the work the regular secretaries hadn’t been able to get to.

She would leave for work when my father got home, and he’d make dinner for my sister and me. We’d watch television after dinner, or play “ghost,” a game he invented, in which he’d turn off all the lights and jump out of some unexpected corner while my younger sister and I clung together, thrilled and terrified. (I didn’t know it then, but as we’ve seen, it was precisely the kind of play that fathers are known for.)

My parents weren’t trying to reinvent gender roles, demonstrate their commitment to marital equality or launch a social movement. They were trying to raise a family. They lived with my grandmother for two years after they got married, saving money for the down payment on the house where they raised my sister and me. As absurd as it now seems, they couldn’t make the $65 monthly mortgage payments on the $13,000 house unless they both worked.