Human Reproduction Update, Vol.26, No.5, pp. 650–669, 2020 Advance Access Publication on May 2, 2020 doi:10.1093/humupd/dmaa010 Advanced paternal age is associated with an increased risk of spontaneous miscarriage: a systematic review and meta-analysis Nadia A. du Fossé 1,*, Marie-Louise P.van der Hoorn1, Jan M.M. van Lith1, Saskia le Cessie2,3, and Eileen E.L.O. Lashley1 1Department of Gynaecology and Obstetrics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands 2Department of Clinical Epidemiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands 3Department of Biomedical Data Sciences, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands *Correspondence address. E-mail:
[email protected] https://orcid.org/0000-0002-1952-3608 Submitted on November 7, 2019; resubmitted on January 23, 2020; editorial decision on February 24, 2020 TABLE OF CONTENTS ....................................................................................................................................... • Introduction • Methods Systematic search Eligibility criteria Data extraction Risk of bias assessment Statistical analysis • Results Study selection Study characteristics Definition of outcome Risk of bias Narrative synthesis Quantitative synthesis of paternal age effects Maternal age effects Additional analyses • Discussion BACKGROUND: Although spontaneous miscarriage is the most common complication of human pregnancy, potential contributing factors are not fully understood. Advanced maternal age has long been recognised as a major risk factor for miscarriage, being strongly related with fetal chromosomal abnormalities. The relation between paternal age and the risk of miscarriage is less evident, yet it is biologically plausible that an increasing number of genetic and epigenetic sperm abnormalities in older males may contribute to miscarriage. Previous meta-analyses showed associations between advanced paternal age and a broad spectrum of perinatal and paediatric outcomes.