Facteurs de stress psychologique et qualité du sperme dans une population de 450 hommes infertiles slovènes

The purpose of this prospective study was to examine the relationship between psychological stress and male reproductive function. The study population consisted of 450 men attending the infertility outpatient clinic and 45 men participating in an IVF-ICSI programme. Psychological stress was measured in four ways. Firstly, the “WHO (five) Well-Being Index” (1995 version) assessed the risk of depression in the previous two-week period. Secondly, Zung’s Anxiety Scale Inventory was used to assess the features and severity of anxiety. Thirdly, the global reaction to various types of chronic life stress events related to family, partner, sexual behaviour, job strain and stress related to infertility treatment, with a more intense reaction corresponding to a higher score. Fourthly, the participant indicated by no (=1) or yes (=2) whether he had been exposed to the following acute stress situations: unemployment, moving house, personal illness or illness of a close relative, road accident. All questionnaires were completed after collection of the semen sample. The incidence of depression and anxiety symptoms in the two study populations (6.5% and 5.3%, and 20.3% and 30.8%, respectively) was twice as high as that observed in the general population. Anxiety was more pronounced (50%) in ICSI patients than in conventional IVF patients. To assess a relationship between psychological stress factors and male reproductive function, we used multiple regression analysis after adjustment of sperm parameters for age, sexual abstinence, type of infertility (primary or secondary), elevated body temperature, varicocele, and history of cryptorchidism and genital infection. Depression scoring was associated with increased sperm concentration (a 7.3% increase by score unit), an intense reaction to chronic stress was associated with a decreased sperm count (3.1% by score unit), and decreased motility “a”, motility “a+b”, and vitality (0.5, 0.5, and 0.6% by score unit, respectively). Exposure to acute stress was associated with increased motility “a+b” (3.5% when the man was exposed to acute stress). Analysis using dichotomous division of fertile and infertile men did not reveal any significant correlation between any stress factor and infertility. These findings indicate that depression and anxiety are frequent in a population of infertile men attending the outpatient clinic or during IVF-ICSI attempts, while significant changes of sperm characteristics are related to depression (decreased sperm concentration), intense reaction to chronic stress (decreased sperm count, motility “a” and “a+b”, and vitality) and exposure to acute stress (better motility “a+b”). This study confirms that stress factors must be taken into account in the management of infertile couples with particular attention to depression and reaction to stress.