Introduction. Unlike the sudden decline in reproductive capacity in women, men can maintain a certain level of reproductive function throughout their lives. However, studies show that with advancing age, the production of reproductive hormones, sexual function, the number and quality of sperm and fertility decreases. Advanced parental age is a risk factor for the occurrence of genetic mutations at the sperm level, congenital malformations or other diseases. At the same time, due to certain social, economic or medical situations, many couples address fertility problems at a relatively advanced age. The purpose of the research was to assess the causes and outcomes of treatment of infertile men over 40 years of age. Material and method. The study included 67 male infertility patients aged from 40 to 65 years (mean age 46±4.7 years). 21 with primary infertility and 46 with secondary infertility. The complex andrological evaluation established 9 (13%) men with azoospermia, 29 (41%) mem with oligoasthenoteratospermia, 1 (1.5%) with aspermia, 1 (1.5%) with retrograde ejaculation, 27 (40%) men had had other changes in the spermogram or normospermia (7/10%). The instituted treatment was pathogenic in 19 (28%) cases in which we detected concrete causes of infertility (urogenital inflammation, hydrocele, hyperprolactinemia). In 40 (63%) men we prescribed empiric treatment for infertility (antioxidants, aromatase inhibitors, follicle-stimulating hormone) and treatment for concomitant diseases (diabetes, prostate adenoma, erectile dysfunction). In 8 men (9%) we have recommended fertilisation techniques or adoption as a first option. Results. We obtained the improvement of the spermogram parameters at an interval of 6 months in 36 (59%) patients, including in 14 (21%) men, up to normospermia or with a significant reduction in the degree of sperm DNA fragmentation. In 15 (25%) patients we recommended in vitro fertilization. Conclusions. The diagnosis and treatment of infertility in the elderly man has several peculiarities due to the increase in the incidence of idiopathic or unexplained infertility. Lifestyle modification and antioxidant therapy seem promising, but studies and strategies are needed to maintain and optimize the fertility potential of the elderly man.