Perceived stress in relation to testicular function markers among men attending a fertility center.

OBJECTIVE

To study whether self-reported psychological stress was associated with impaired semen parameters and reproductive hormones.

DESIGN

An observational study including men aged 18-55 years who attended the Massachusetts General Hospital Fertility Clinic.

SUBJECTS: A total of 718 men who attended the clinic provided semen and serum blood samples and completed the short version of the Cohen Perceived Stress Scale (PSS-4).

EXPOSURE: Scores from completed the short version of the PSS-4 were used to quantify perceived psychological stress.

MAIN OUTCOME MEASURES: The World Health Organization semen analysis parameters, including ejaculate volume, sperm count, concentration, motility, and morphology, were ascertained. Further analysis of sperm DNA damage was performed using the Comet Assay. Serum concentrations of luteinizing hormone, follicle stimulating hormone, prolactin, inhibin, testosterone, and estrogen were measured. Linear regression models were used to evaluate associations between self-reported stress and testicular function outcomes, adjusting for age, body mass index, abstinence time, year of semen sample collection, and time to blood sampling. Parameters with skewed distributions were natural log-transformed for analysis where appropriate to minimize the influence of outliers.

RESULTS

Compared with the lowest quartile of PSS-4 scores, men in the highest had significantly lower adjusted mean total sperm count, 118 mil/ejaculate (95% confidence interval [CI]: 101-139) vs. 153 mil/ejaculate (95% CI: 133-175) and lower adjusted mean normal morphology count, 5.97 mil/ejaculate (95% CI: 4.73-7.55) vs. 9.13 mil/ejaculate (95% CI: 7.43-11.0). Higher perceived stress showed consistent trends with lower mean levels of sperm concentration, total motile count, percentage of normal sperm morphology, and number of cells with high DNA damage in adjusted models. No associations were observed between self-reported stress and other outcomes of sperm DNA damage and reproductive hormone concentrations.

CONCLUSION

Greater perceived stress was negatively associated with certain semen quality parameters and spermatic cell DNA damage, whereas no associations were found for additional markers of sperm DNA damage or reproductive hormone levels.