Earlier this month, Denmark announced that it will introduce an upper age limit for men seeking access to publicly funded fertility treatment. From January 1, 2027, men undergoing treatment with their partners will be required to receive a clinic referral before the age of 55, and all treatment courses must end when the man turns 56 [1]. Restrictions already apply to women seeking fertility treatment in Denmark whereby publicly funded treatment must end when the woman turns 41, while private treatment may continue until she turns 46 [2]. The new Danish rule will introduce the first equivalent upper age limit for men in the public system. However, those already undergoing treatment when the rule comes into effect will be permitted to complete it, and men above the age threshold will remain eligible to pursue treatment privately [1].

Paternal age limits are not unique and can be seen in other publicly funded fertility programmes across Europe [3]. Their use, however, remains somewhat notable given that men generally retain the biological capacity to father children considerably later in life [4]. Indeed, that reproductive capacity may persist well beyond the age of 55 [4]. This raises an important question regarding what exactly makes paternal age relevant in fertility treatment, and whether those concerns justify restricting access?

In its announcement, Denmark cited three primary concerns in support of the new rule, each of which provides a distinct reason why paternal age might matter in the provision of fertility treatment. These included:

• age-related clinical risks associated with sperm;
• the effect of sperm age on declining treatment efficacy; and
• concern for the welfare of the resulting child, including the likelihood of parental death before the child reaches adulthood [1].

The first two relate directly to a man’s role as a genetic parent and to the ways in which his chronological age may bear on both clinical risk and treatment success [1]. Advanced paternal age has been associated with changes in semen parameters, certain pregnancy complications, and stillbirth [4-6]. It has also been linked to a range of neurodevelopmental and other disorders in offspring, although findings are not always consistent and the absolute increase in risk to any individual child remains low [4, 7-8]. Some studies have also reported lower conception and live-birth rates following fertility treatment as paternal age increases [9]. Paternal age may therefore be relevant where it serves as a proxy for potential medical risks associated with sperm produced at an older age, or for the likelihood of successful treatment [4].

What’s interesting in this context, however, is that reproductive technologies can sometimes weaken the relationship between a man’s chronological age and these clinical concerns. For example, where donor sperm is used, the chronological age of the man who will raise the child may be entirely different from that of the gamete source, and the clinical concerns associated specifically with the age of the prospective father’s sperm may disappear entirely [4, 6]. Alternatively, where a man uses his own sperm cryopreserved at a younger age, his current chronological age no longer corresponds to the age of the gametes used in treatment. Indeed, a 55-year-old using sperm cryopreserved when he was 30 presents a materially different gamete-age question from a 55-year-old using sperm produced at 55 [4, 6]. Denmark’s regime provides a particularly useful illustration here because its publicly funded fertility system already provides for treatment using donor sperm [10] and contemplates the use of sperm cryopreserved earlier in a man’s life [11]. Despite this, at least as currently described, the Danish rule contains no exception where donor sperm or sperm cryopreserved at a younger age is used in treatment [1].

The rule also appears to apply irrespective of why the couple requires fertility treatment in the first place [1]. A couple may, for instance, seek treatment due to female-factor infertility rather than any impairment in the man’s fertility. A man may therefore remain capable of fathering a child without assisted reproduction, yet his age may render him ineligible for publicly funded treatment should his partner require assistance [1]. This does not necessarily render the new rule redundant and once the man’s sperm is being used in treatment, his age may still become clinically relevant [4]. However, when the clinical concerns associated with the age of the man’s sperm can themselves be mitigated by the reproductive technologies being used, relying on those same concerns to support a paternal age limit is counterintuitive.

The third concern identified in support of Denmark’s age restriction is different. It does not relate to the man’s age as a genetic contributor, but to his age as a prospective social parent who will raise the resulting child [1]. In the older parent context, several concerns might be framed as child welfare, including the prospective father’s physical capacity to care for a child, the likelihood that an age-related illness may affect caregiving, and the possibility that he may die while the child remains dependent [4]. Denmark placed particular emphasis on the last concern, expressly referring to the risk that a child may lose an older father before reaching adulthood [1].

Child welfare is important in the provision of fertility treatment generally [4], and there is nothing objectionable about Denmark taking this into account in the older parent context. Nevertheless, concerns of this kind are not unique to older parenthood. Questions about caregiving capacity can arise, for example, where parents have disabilities or serious health conditions, while children of younger parents may also experience parental illness, injury or premature death [12-14]. Advancing age may make some child welfare concerns more probable, particularly those relating to illness and death [4], but difficulties in caregiving, serious illness and loss can arise across parenthood generally [12-14].

Concerns regarding parental longevity are, however, more closely tied to age. Children born to older parents are statistically more likely to experience the death of a parent while they are minors [3], and childhood bereavement has been associated with a range of adverse psychological, social and educational outcomes in children [15]. Older parenthood does not, however, make parental death during childhood inevitable. Children can lose parents at any age, and the effects of that loss vary considerably according to the circumstances in which it occurs [13, 15]. In particular, the bereavement literature emphasizes the importance of what happens to children following the death of a parent on their eventual welfare [15]. For example, where a child experiences disruption in caregiving, living arrangements and schooling, this can compound the effects of parental loss, whereas continuity in care and stable social support may help protect a child from some of grief’s most serious consequences [15]. Accordingly, an individualized assessment of the prospective father’s health, the circumstances of the other parent, available support, and continuity of care planning might target the underlying welfare concern more directly and less restrictively than a categorical age limit.

Ultimately, paternal age can matter in the provision of fertility treatment. It may matter clinically because of the age of the gametes used in treatment, and it may matter because of the age of the person who will raise the resulting child, particularly where continuity of care is at issue [1, 4]. Where these concerns cannot be mitigated by assisted reproduction itself or addressed more directly through individualized assessment of the prospective father’s circumstances, restricting access may be justified to reduce the underlying risks associated with advanced paternal age [1, 4]. However, where those concerns can be substantially overcome, paternal age alone should not justify categorical exclusion [16].

Of course, in Denmark, the public context of the new rule complicates this [1]. Individualized assessments of the prospective father’s circumstances, including future caregiving arrangements, could be resource intensive and time consuming. Indeed, this may be a significant burden for a publicly funded system where finite resources must be allocated between patients [4, 17-18]. Moreover, while procreative liberty may protect an individual’s freedom to make reproductive choices, it does not necessarily entail a positive entitlement to have the state fund or facilitate those choices [19]. That justification, however, is considerably harder to sustain where treatment is privately funded. Here, resource allocation no longer provides the same rationale for categorical exclusion [17-18], and where the clinical and child welfare concerns associated with age can be adequately mitigated, chronological age alone should not determine access to treatment. In broader debates about older fatherhood, it is therefore worth considering what underlying risk chronological age is being used to represent, and whether that risk can be addressed through less restrictive means than categorical age caps.

References:

[1] Danske Regioner, “Danish Regions Introduce Age Limit of 55 for Men in Fertility Treatment” (1 September 2026)

[2] L. Catalini, J. Fedder, B. Nørgård and L. Joelving, “Assisted Reproductive Technology Results Using Donor or Partner Sperm: A Danish Nationwide Register-Based Cohort Study” (2023) 12 Journal of Clinical Medicine 2571.

[3] S.R. Piek, A. Martani and G. Pennings, “Against age limits for men in reproductive care” (2024) Medicine, Health Care and Philosophy.

[4] Ethics Committee of the American Society for Reproductive Medicine, ‘Assisted reproduction with advancing paternal and maternal age: an Ethics Committee opinion’ (2025) 123(6) Fertility and Sterility 999.

[5] P.T.K. Chan and B. Robaire, “Advanced Paternal Age and Future Generations” (2022) 13(6) Translational Andrology and Urology 861.

[6] K.R. Smith, “Paternal age bioethics” (2015) 41 Journal of Medical Ethics 775.

[7] R. Sharma, A. Agarwal, V.K. Roha, M. Assidi. M. Abu-Elmagd and R.F. Turki. “Effects of increased paternal age on sperm quality, reproductive outcome and associated epigenetic risks to offspring” (2015) 13 Reproductive Biology Endocrinology 35.

[8] A.M. Nybo Andersen and S.K. Urhoj, “Is advanced paternal age a health risk for the offspring?” (2017) 107 Fertility and Sterility 312.

[9] A.M. Marsidi, L.M. Kipling, J.F. Kawwass and A. Mehta, “Influence of paternal age on assisted reproductive technology cycles and perinatal outcomes” (2021) 116 Fertility and Sterility 380.

[10] Region Midtjylland, Infertilitet (2025).

[11] Region Syddanmark, Infertilitet (2026).

[12] R. Powell, ‘Disability Reproductive Justice’ (2022) 170 University of Pennsylvania Law Review 1851.

[13] J. Xu, S.L. Murphy, K.D. Kochanek and E. Arias, ‘Mortality in the United States, 2024’ (National Center for Health Statistics Data Brief No 548, January 2026), available at <https://www.cdc.gov/nchs/data/databriefs/db548.pdf>.

[14] National Council on Disability, Rocking the Cradle: Ensuring the Rights of Parents with Disabilities and their Children (2012).

[15] R.A. Haine, T.S. Ayers, I.N. Sandler and S.A. Wolchik, “Evidence-Based Practices for Parentally Bereaved Children and Their Families” (2008) 39(2) Professional Psychology: Research and Practice 113.

[16] A.A. Boni-Saenz, “Legal Age” (2022) 63 Boston College Law Review 521.

[17] K. Asplund, “Use of in vitro fertilization-ethical issues” (2020) 125(2) Upsala Journal of Medical Sciences 192.

[18] J. Lind, “Child welfare assessments and the regulation of access to publicly funded fertility treatment” (2020) 10 Reproductive Biomedicine & Society Online 19.

[19] D. Fox, “Privatizing Procreative Liberty in the Shadow of Eugenics” (2018) Journal of Law and the Biosciences 355.