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Observational Study
. 2025 Jul;124(1):62-70.
doi: 10.1016/j.fertnstert.2025.02.012. Epub 2025 Feb 13.

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

Akshay G Reddy  1 , Paige L Williams  2 , Irene Souter  3 , Jennifer B Ford  4 , Ramace Dadd  4 , Ramy Abou-Ghayda  5 , Russ Hauser  6 , Jorge E Chavarro  7 , Lidia Mínguez-Alarcón  8 ; EARTH Study Team
Affiliations
Observational Study

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

Akshay G Reddy et al. Fertil Steril. 2025 Jul.

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.

Keywords: Male fertility; perceived stress; reproductive hormones; semen parameters.

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Conflict of interest statement

Declaration of Interests A.G.R. has nothing to disclose. P.L.W. reports Grant support from NIEHS for the submitted work. I.S. has nothing to disclose. J.B.F. has nothing to disclose. R.D. has nothing to disclose. R.A-G. has nothing to disclose. R.H. reports funding from NIH Grant Support from NIEHS for the submitted work. J.E.C. reports funding from National Institutes of Health for the submitted work; funding from National Institutes of Health and Food and Drug Administration; royalties from Harvard Health Publications; honoraria from Johns Hopkins University School of Medicine, Academy of Nutrition and Dietetics, University of Nebraska, Lincoln, Maine Medical Center, Tufts University, National Institutes of Health, American Society for Reproductive Medicine, British Dietetic Association, Pacific Coast Reproductive Society; travel support from Johns Hopkins University School of Medicine, National University of Singapore, University of Nebraska, Lincoln, Pacific Coast Reproductive Society, European Society of Human Reproduction and Embryology, and British Fertility Society; Doveras Inc. Scientific Advisory Board, and stock options outside the submitted work. L.M-A. reports funding from NIEHS grants already listed in manuscript for the submitted work.

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