The present study evaluated the effect of psychological stress on male fertility hormones and seminal quality in male partner of infertile couples. Seventy male partners of infertile couples were evaluated for level of psychological stress using Hospital Anxiety and Depression Score (HADS) questionnaire, serum total testosterone, luteinising hormone (LH) and follicle-stimulating hormone (FSH) by electrochemiluminescence assay and serum GnRH by ELISA. Seminal analysis was performed as per WHO guideline. Nineteen (27%) of them had HADS anxiety and depression score ≥8 (abnormal HADS score). The persons having abnormal HADS had lower serum total testosterone, higher serum FSH and LH than those of persons having normal HADS. Serum total testosterone correlated negatively with HADS, but LH and FSH correlated positively. There was no change in GnRH with the change in stress or testosterone levels. Sperm count, motility and morphologically normal spermatozoa were lower in persons having abnormal HADS. Sperm count correlated positively with total testosterone and negatively with FSH and LH. Abnormal sperm motility and morphology were related to lower testosterone and higher LH and FSH levels. Psychological stress primarily lowers serum total testosterone level with secondary rise in serum LH and FSH levels altering seminal quality. Stress management is warranted for male infertility cases.

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Psychological stress is closely related to problem of infertility. The infertile couples may undergo stress from other sources also, which includes 'work related stresses' and 'family related stress'. To evaluate distribution and source of stress in 80 male partner of infertile couples, we assessed level of stress by using Hospital anxiety and depression score (HADS) questionnaire. Job-related, family related and fertility related stresses were assessed by using standard questionnaire. Serum cortisol was assayed by electrochemiluminescence based immunoassay. Sperm count was done as per WHO 2010 guideline. Thirty six (45%) of them had HADS total score more than 13. There was no significant rise in serum cortisol level in the patients having HADS more than 13. Total score of work related stress and fertility problem inventory were high and significantly correlated with HADS. There was no significant correlation between family related stress and HADS. Linear regression analysis shows that HADS had significant independent correlation only with work related stress. These results strongly suggest that work place is the source of stress among male partner of infertile couples. Stress might contribute to pathogenesis of male infertility. The attenuated cortisol response in these cases indicates a desensitization of HPA axis. Stress management to alleviate job related stress is warranted for the male partners of infertile couples.