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

Paige L Williams, Lidia Mínguez-Alarcón, Irene Souter, Jennifer B Ford, Jorge E Chavarro, Russ Hauser, Akshay G Reddy, Ramace Dadd, Ramy Abou-Ghayda

Journal: Fertility and sterility 2025;124(1):62-70

PMID: 39954980

Full Text on Elsevier Science View on PubMed

Abstract

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.

Address: Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: [email protected].; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.; Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachussets.; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.; University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, Ohio.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachussets; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachussets.; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachussets.

DOI: 10.1016/j.fertnstert.2025.02.012

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MeSH Terms: Humans, Male, Adult, Stress, Psychological, Adolescent, Middle Aged, Young Adult, Testis, Biomarkers, Semen Analysis, Fertility Clinics, Sperm Count, Infertility, Male, DNA Damage, Self Report, Fertility, Spermatozoa, Sperm Motility, Perception