Association of state and trait anxiety to semen quality of in vitro fertilization patients a controlled study

The relationship between semen quality and psychological conditions relative to state and trait anxiety was investigated among 94 volunteer men enrolled in an in vitro fertilization (IVF) program.

Elisa Vellani, Ph.D., Alessandro Colasante, Ph.D., Luciana Mamazza, Ph.D., Maria Giulia Minasi, M.Sc., Ermanno Greco, M.D., Arturo Bevilacqua, Ph.D.

Volume 99, Issue 6, Pages 1565-1572.e2, May 2013


Study objective:
To investigate the relationship between semen quality and state/trait anxiety in patients enrolled in an in vitro fertilization (IVF) program and in control subjects.

Cross-sectional study.

Centre for Reproductive Medicine and Biology, European Hospital, Rome.

Ninety-four first-attempt IVF patients and 85 age-matched, random subjects recruited in the period July 2006 through March 2008.


Main Outcome Measure(s):
Behavioural features of stress, including state and trait anxiety, selfperceived impact of physical disturbance on everyday activities, ethanol consumption, cigarette smoking, and semen parameters, such as semen volume, sperm concentration, total count, motility, morphology and DNA fragmentation.

Increased levels of both state and trait anxiety were associated to lower semen volume, sperm concentration and count, reduced sperm motility and increased sperm DNA fragmentation of IVF patients, therefore influencing seminal parameters at the macroscopic and cellular/subcellular levels. Similar results were obtained on control subjects.

Our data confirm previous observations on state anxiety and show that trait anxiety is negatively associated to male fertility as well.

  • Audrey Gaskins

    This is an interesting study on the relationship between trait anxiety and semen quality. My primary question though is why the authors didn’t present any multivariate analyses? I would particularly like to see the linear regression models adjusted for age, BMI, smoking, and alcohol intake of these men as all could be plausibly related to the exposure and outcome. At present it is hard to discern what is the true effect of increased anxiety and what is due to residual confounding.

    • Arturo Bevilacqua

      Thank you for the comments and the question. We did not present multivariate analyses because the main goal of our study was to investigate the possible association between male infertility and anxiety. Additional independent variables were included for the sake of data completeness. We plan to present a study concerning all relationships in the next future.

  • Stress is very subjective. Tolerance for stress is very individualized. What is stressful for one may be tolerated well by another. Men with infertility do not become stressed until they realize that they have problems with fertility. With the parameters that these men presented with, I wonder if they were offered a trial of insemination prior to IVF. Certainly the cost of IVF/ICSI would be stressful for any couple in this economy.

    I have seen many healthy young men with difficulties conceiving. When they are advised to have regular timed intercourse around the time of ovulation, many of them develop psychogenic erectile dysfunction. I have always wondered how this would impact their semen parameters.

    I voice the same interest at Dr. Eisenberg and wonder if these men were treated with anxiolytics, would their semen parameters improve over time? Or could they be treated with empiric antioxidants/vitamins to decrease the ROS? How about yoga? How about behavioral therapy? Hypnosis? These are interesting avenues for future studies.

    • Arturo Bevilacqua

      Thanks for the precious comments. All your advices would deserve to be attempted.

  • It would be interesting and very compelling to know if interventions will improve semen parameters. In other words, if techniques can lower anxiety, will semen parameters improve?

    • Arturo Bevilacqua

      I agree. To this perspective, it would be important to collect information on
      potential modifiers of stress in IVF patients, including coping strategies, counseling interventions or social support, which may modify the effect of stress on semen

  • Very interesting piece. The authors should be congratulated for the important contribution. I wonder if the infertile men with worse semen parameters had previous knowledge of their own counts prior and for that reason may have had higher anxiety scores?

    • Arturo Bevilacqua

      Thank you for your positive feedback. As far as I know, our subjects were not previously aware of their medical condition, However, failure in conceiving for a prolonged period of time should represent a strong stressor.

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