Effects of psychological stress on male fertility

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Key Points

  • Psychological stress has been perceived clinically as a potential risk factor for male infertility, although to what extent it affects human male fertility is difficult to study and evaluate

  • Clinical studies demonstrate an inverse relationship between psychological stress and semen parameters

  • The paraventricular nucleus (PVN) in the hypothalamus regulates stress responses and activates the sympathetic–adrenal system (SAS), and the hypothalamic–pituitary–gonadal (HPG) and hypothalamic–pituitary–adrenal (HPA) axes

  • Activation of HPG and HPA axes leads to a fall in testosterone levels in the testes, affecting Sertoli cells and the blood—testis barrier


Psychological stress can be defined as any uncomfortable 'emotional experience' accompanied by predictable biochemical, physiological and behavioural changes or responses. Many clinical studies looking at the effects of psychological stress on male fertility have shown that stress is associated with reduced paternity and abnormal semen parameters. Enough scientific evidence exists to suggest that psychological stress could severely affect spermatogenesis, mainly as a result of varying testosterone secretion. The hypothalamic–pituitary–adrenal axis has a direct inhibitory action on the hypothalamic–pituitary–gonadal (HPG) axis and Leydig cells in the testes. The newly discovered hormone, gonadotropin-inhibitory hormone (GnIH), also has an inhibitory effect on the HPG axis. Inhibition of the HPG axis results in a fall in testosterone levels, which causes changes in Sertoli cells and the blood–testis barrier, leading to the arrest of spermatogenesis. Germ cells also become vulnerable to gonadotoxins and oxidation. However, the extent and severity of the effects of psychological stress on human testes is difficult to study and data mostly come from animal models. Despite this limitation, stress as a causative factor in male infertility cannot be ignored and patients should be made aware of its effects on testicular function and fertility and helped to manage them.

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Figure 1: The mechanisms of the stress response.
Figure 2: The HPA axis pathway.
Figure 3: The GnRH pathway.


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Correspondence to Vinod H. Nargund.

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Nargund, V. Effects of psychological stress on male fertility. Nat Rev Urol 12, 373–382 (2015) doi:10.1038/nrurol.2015.112

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