Psychological stress, stressful life events, male factor infertility, and testicular function: a cross-sectional study

Objective To assess the association between psychological stress and male factor infertility as well as testicular function (semen quality, serum reproductive hormones) and erectile dysfunction. Design Cross-sectional study. Setting University Hospital-based research center. Patients Men with impaired semen quality were included from infertile couples, and men with naturally conceived pregnant partners were used as a reference population. Interventions Participants completed a stressful life events (SLE) questionnaire on health and lifestyle, including a 14-item questionnaire about self-rated psychological stress symptoms and SLEs, had a physical examination performed, delivered a semen sample and had a blood sample drawn. Main outcomes Differences in stress scores (calculated from self-reported stress symptoms) and SLEs between infertile and fertile men were assessed in crude and fully adjusted linear regression models. Secondary outcomes were semen quality, serum reproductive hormones, and erectile dysfunction. Results Of 423 men, 176 (41.6%) experienced at least one SLE in the 3 months prior to inclusion (50.4%/36.9%: infertile/fertile men, P = .03); β-coefficient and 95% confidence interval for the difference between the groups on the transformed scale in fully adjusted linear regression models was 0.18 (0.06, 0.30). However, there were no differences in psychological stress symptoms between the two groups (β-coefficient and 95% confidence interval) on the transformed scale (0.14; −0.02, 0.30). No association between stress (self-reported stress symptoms and SLEs) and testicular function or with erectile dysfunction was found in any of the men. Conclusion Infertile men reported a higher number of SLEs than fertile men but did not report more psychological stress symptoms. Distress and SLEs were not associated with reduced male reproductive function.