OBJECTIVE To assess the association between psychological stress and male factor infertility as well as testicular function (semen quality, serum reproductive hormones) and erectile dysfunction. DESIGN Cross-sectional study. SETTING University Hospital-based research center. PATIENTS Men with impaired semen quality were included from infertile couples, and men with naturally conceived pregnant partners were used as a reference population. INTERVENTIONS Participants completed a stressful life events (SLE) questionnaire on health and lifestyle, including a 14-item questionnaire about self-rated psychological stress symptoms and SLEs, had a physical examination performed, delivered a semen sample and had a blood sample drawn. MAIN OUTCOMES Differences in stress scores (calculated from self-reported stress symptoms) and SLEs between infertile and fertile men were assessed in crude and fully adjusted linear regression models. Secondary outcomes were semen quality, serum reproductive hormones, and erectile dysfunction. RESULTS Of 423 men, 176 (41.6%) experienced at least one SLE in the 3 months prior to inclusion (50.4%/36.9%: infertile/fertile men, P = .03); β-coefficient and 95% confidence interval for the difference between the groups on the transformed scale in fully adjusted linear regression models was 0.18 (0.06, 0.30). However, there were no differences in psychological stress symptoms between the two groups (β-coefficient and 95% confidence interval) on the transformed scale (0.14; -0.02, 0.30). No association between stress (self-reported stress symptoms and SLEs) and testicular function or with erectile dysfunction was found in any of the men. CONCLUSION Infertile men reported a higher number of SLEs than fertile men but did not report more psychological stress symptoms. Distress and SLEs were not associated with reduced male reproductive function.

中文翻译：

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心理压力、压力生活事件、男性因素不育和睾丸功能：横断面研究

目的 评估心理压力与男性因素不育以及睾丸功能（精液质量、血清生殖激素）和勃起功能障碍之间的关系。设计横断面研究。SETTING 大学医院为基础的研究中心。患者 精液质量受损的男性来自不育夫妇，自然怀孕的男性被用作参考人群。干预 参与者完成了一份关于健康和生活方式的压力性生活事件 (SLE) 问卷，包括一份关于自评心理压力症状和 SLE 的 14 项问卷，进行了身体检查，提供了精液样本并抽取了血液样本。主要结果 在粗略和完全调整的线性回归模型中评估了不育和可育男性在压力评分（根据自我报告的压力症状计算）和 SLE 的差异。次要结果是精液质量、血清生殖激素和勃起功能障碍。结果 在 423 名男性中，176 名 (41.6%) 在纳入前 3 个月内至少经历过一次 SLE（50.4%/36.9%：不育/可育男性，P = .03）；在完全调整的线性回归模型中，转换量表上各组之间差异的 β 系数和 95% 置信区间为 0.18 (0.06, 0.30)。然而，在转换后的量表（0.14；-0.02、0.30）上，两组之间的心理压力症状（β系数和95%置信区间）没有差异。在任何男性中均未发现压力（自我报告的压力症状和 SLE）与睾丸功能或勃起功能障碍之间存在关联。结论 不育男性报告的 SLE 数量高于可育男性，但并未报告更多的心理压力症状。窘迫和 SLE 与男性生殖功能降低无关。