Potential associations between semen quality and psychological stress: a cross-sectional study.

RESEARCH QUESTION: Is psychological stress associated with reduced semen quality and a higher prevalence of oligozoospermia and asthenozoospermia? DESIGN: Cross-sectional study (n = 550 men who attended a fertility counselling clinic). Sperm concentration and motility were measured using an automated semen analyser; semen quality was assessed based on the WHO sixth edition criteria. Psychological stress was evaluated using the four-item short version of Perceived Stress Scale and a checklist assessing major stressful events experienced within the past year. Logistic regression models were applied to estimate the associations, adjusting for lifestyle-related factors. RESULTS: Sperm count and sperm concentration significantly differed among stress perception level groups (both P < 0.001). Sperm count, concentration and motility were significantly lower in men who had stressful experience than in those who did not (all P < 0.001). After adjusting for lifestyle-related factors and stress perception level, a history of stressful experiences was associated with significantly increased odds of oligozoospermia (adjusted OR [aOR] 4.08, 95% CI 2.40 to 7.05) and asthenozoospermia (aOR 2.96, 95% CI 1.76 to 4.97). After adjusting for lifestyle-related factors and stressful experience, in the middle and high stress perception groups (individuals with PSS-4 scores in the >25-<75th and ≥75th percentile, respectively), odds were significantly increased for oligozoospermia (middle: aOR 2.78, 95% CI 1.66 to 4.76, high: aOR 5.10; 95% CI 2.87 to 9.30) but not for asthenozoospermia. CONCLUSIONS: High perceived stress was significantly associated with higher odds of oligozoospermia, whereas stressful experience was significantly associated with higher odds of oligozoospermia and asthenozoospermia. The importance of stress reduction in reproductive health education and preconception care is highlighted.