Research Article National Journal of Medical and Dental Research, July-August 2013: Volume-1, Issue-3, Page 11-15

“A Study of Correlation Between Emotional Stress Status

and Semen Profile of Male of Infertile Couples in Population
of U.P. & Uttarakhand’’
Sadakat AliA, Puja ChauhanB, Aparna BhardwajB, Raghuveer Singh MandloiC,
Dilshad UsmaniD
A
Assistant Professor, Department of Anatomy, TMMC&RC, TMU, Moradabad (U.P.)
B
Associate Professor, Department of Anatomy, SGRRIM&HS, Dehradun, Uttarakhand
C
Demonstrator, Department of Anatomy, TMMC&RC, TMU, Moradabad (U.P.)
D
Resident, Department of Anatomy, TMMC&RC, TMU, Moradabad (U.P.)
Correspondance to: Dr. Lavanya.K.M, Email: doclavanyarao@gmail.com
Manuscript Reference No.
NJMDR_109_13 Abstract:

Background: One-third cases of infertility are attributed to altered semen profile. The
seminal profile has been shown to be influenced by numerous factors, psychological
being the common ones.

Aims: To find out if any correlation exists between infertility-induced anxiety, stress &
depression with abnormal semen profile.

Setting And Design: Emotional stress status was calculated by applying 8 SQ and
Semen samples of case and control subjected to microscopic examination.

Material And Method: Study was conducted in 60 male of 20-35 years age group who
were seeking treatment of infertility along with same number of control of same age
group. To determine the emotional status of the individual, 8 state questionnaires was
used, Complete and fresh specimen of semen was collected from the male of infertile
couple, and was subjected to physical, microscopic and biochemical examination.

Statistical Analysis: The average value and SD of all parameter were calculated. The
significance of difference between SD of means in different sets of observation was
assessed at 95% level of confidence, by applying student ‘t’ test (p<0.05).

Results: The amount of emotional stress is significantly high, where as count, normal
forms and motility of sperms are significantly reduced in cases than control.
Date of Submission: 18 February 2013
Date of Editorial Approval: 19 February 2013 Conclusion: Infertility and related social problems induced emotional stress
Date of Peer Review Approval: 15 March 2013
aggravates the poor quality of semen, which further precipitates the vicious cycle.
Date of Publication: 30 March 2013
Conflict of Interest: Nil; Source Of Support: Nil
Name And Addresses Of Corresponding Author: Keywords: Infertility, Stress, Semen profile.
Dr. Sadakat Ali
Assistant Professor
Department Of Anatomy, Tmmc&Rc, Tmu,
Moradabad (U.P.), India. Nat J Med Dent Res 2013; 1(3) : 9-13
Mobile No. – 09634333944, 08534856610
E Mail. - drsadaqat786@rediffmail.com
Introduction: and normal gametes. In social fabric of
our society, the genealogical continuity
The perpetuation of species requires its of family has enjoyed unchallenged
primordial event the production of viable supremacy over many millennia. Couples

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 National Journal of Medical and Dental Research, July-August 2013: Volume-1, Issue-3, Page 11-15
who are unable to fulfil this criterion remain in a state of
constant psychological stress because of the fear of being
labelled as infertile by the society and it is like a life crisis
for them.
Infertility is defined as failure to conceive within one or
more years of unprotected coitus. In our male dominated
society it is the female who is most of the times cursed for
not being able to produce a baby, although one third cases
of infertility are due to male factor.
The seminal profile has been shown to be influenced by
numerous psychological stress factors, anxiety, stress and
depression being three of them.
A theoretical link has been proposed between stressful
event and sperm production from time to time [1].
There is no data on the seminal profile of unmarried males.
It’s only after few years of marriage when things have gone
far beyond the hope of treatment one realizes the seriousness
of the situation. Therefore a proper premarital evaluation of
the male would help us to a great deal, because most cases
can be diagnosed for which treatment is specific, simple
and gratifying.
Due to the scarcity of studies quantitating the psychological
stress factor and their correlation with semen profile in north
Indian male, this case-control study has been undertaken in
the population of U.P. & Uttrakhand.
Material And Methods:
Study was conducted in 60 male of infertile couples of
20-35 years age group who were seeking treatment of
infertility, along with same number of control of same age
group.
A format was given to all of them which provided data of
the following information: History taking: patient’s name,
age, address, duration of marriage, occupation, any kind of
addiction, any history of past or present illness, any history
of prolonged medication.
Patients were also physically examined for any abnormal
finding, those who have history of chronic illnesses and
mumps, orchitis, genital tuberculosis excluded.
To determine the emotional status of the individual, 8
state questionnaires was used, designed specifically for
measuring eight important emotional states. We measured
anxiety, stress and depression in each individual by
applying 8SQ test; total scores were obtained for each and
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then statistically analyzed. Average value and standard
deviation of three parameters were calculated. The
significance of difference between standard deviation of
means in different sets of observation was assessed at 95%
level of confidence, by applying student ‘t’ test(p<0.05).
Combined standard deviation was calculated by n>30in
Combined S.D=n1-SD1²+ (n2-1) SD₂²/n1+n2-1; value of t
is calculated by:
‘t’=X1-X2/CSD√1/n1+1/n2.
P value was found out from the t table.
Semen analysis: Complete and fresh specimen of semen
was collected from the male of infertile couple, and was
subjected to physical, microscopic and biochemical
examination. In physical examination following parameters
were recorded namely volume, colour, ph, liquefaction
time, odour, consistency.
After liquefaction microscopically revealed, the sperm
count, morphology and motility. Presence of any
miscellaneous feature like pus cells, epithelial cells,
leukocytes, bacteria, trichomanas or clumping of sperm
was also noted. Biochemical analysis was about quantifying
fructose level in the semen sample by Mann’s technique.
Statistical Analysis: Average value and standard deviation
of all the parameters were calculated. The significance
of difference between the standard deviation of means in
different sets of observation was assessed at 95% level of
confidence, by applying student ‘t’ test (p<0.05).Combined
standard deviation was calculated by n>30in Combined
S.D=n1-SD1²+ (n2-1) SD2²/n1+n2-1; value of t is calculated
by:‘t’=X1-X2/CSD√1/n1+1/n2. P value was found out from
the t table which showed the effect of depression and
anxiety in the cases as compared to controls.
Results
The amount of emotional stress in the form of anxiety,
stress and depression was found to be more in cases than
the control (Table 1). From the observation of semen
profiles, volume of semen in cases and controls showed
no significant difference although more abnormal forms
of sperms were found in the semen of cases (Table 2) like
pinhead, headless sperms, long tapering head, round head,
monster sperms, and abnormal acrosomal caps (Fig. 1,2,3).
 National Journal of Medical and Dental Research, July-August 2013: Volume-1, Issue-3, Page 11-15

Table – 1 – Quantitative Analysis of Anxiety, Stress And Depression

Parameters Cases (mean ± sd) Controls (mean ± sd) t value P value Inference
Anxiety 14.08±1.67 13.48±0.96 2.50 <.05 significant
Stress 13.5±0.96 14.16±1.09 3.66 <0.05 significant
Depression 13.80±1.39 13.20±1.72 2.0 <0.05 significant

Table – 2 – Quantitative Analysis of Various Parameters of Semen Profile

Parameters Cases (mean ± sd) Controls (mean ± sd) t value P value Inference
Semen volume 3.11±0.99 2.86±0.77 1.56 >0.05 Not significant
Normal morphology 88.0±5.80 91.11±3.20 3.64 < 0.001 Significant
Abnormal 11.98±5.80 8.7±3.13 3.84 < 0.001 Significant
morphology
Total sperm count 77.70±15.07 83.18±10.89 2.28 < 0.05 Significant
Active motile sperm 76.33±7.72 79.78±6.46 2.67 < 0.01 Significant
Sluggishly motile 9.58 ± 4.42 7.38 ± 2.90 3.23 < 0.001 Significant
sperm
Non motile sperm 15.25±4.91 12.86±4.49 2.81 < 0.01 Significant

Sperm count and motility showed significant reduction in
cases, but the numbers of non motile and sluggishly motile
sperms were found to be more in the cases (Table 2).
Although there was no significant difference in the semen,
fructose levels which was found within the normal range.
It was concluded that infertility induced anxiety, stress and
depression, in the study group, aggravate the poor quality
of sperm, it also observed that amount of stress has inverse
relation with quality of semen. Finally, it is concluded that
infertility and related social problems induced anxiety,
stress, and depression aggravates the poor quality of semen,
which further precipitate the vicious cycle.

Fig. 1 - Showing Low Sperm Count And Abnormal Sperm Fig. 2 - Showing Low Sperm Count And Abnormal Forms
Head

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 National Journal of Medical and Dental Research, July-August 2013: Volume-1, Issue-3, Page 11-15
Fig. 3 - Showing Low Sperm Count And Abnormal Forms
Discussion:
The general belief that women are critically responsible
for infertility has recently been revised and male infertility
resulting in a barren marriage has been reported by several
authors within five decades [2]. Our study corroborates with
publication of Journal of American Medical Association
(1908) in which Vietnam veterans had decreased sperm
count and also decreased number of morphologically
normal sperms, this was attributed to the stress produced
due to war-psychologies. Same observations were noted by
Fenster L [3] Clarke R N [4] who evaluated the negative
influence on semen quality resulting from stress of similar
observations made. Both of these studies showed an inverse
relationship between semen quality and the stress produced
due to emotionally challenged situation.
In our study sperm count in cases reduced significantly due
to adverse psychological condition (Table 2).
Our findings also corroborated with that of Zorn B [5].
They correlated the decreased sperm count to the stress
of worse socioeconomic status or negative environmental
factors, which gave birth to many diseases, like
tuberculosis, genitourinary infections leading to deranged
spermatogenesis.
Swyer [6] concluded in his work that low sperm count and
infertility were more common in affluent class, because the
factors of emotional stress are more significantly present in
them than the lower middle class and people below poverty
line.
The pus cells in the semen sample are indicative of
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subclinical infection for which no treatment was being
taken. Pus cell could be due to seminal vesiculitis or sub
acute chronic prostatitis which may develop due to poor
hygiene or negligence in treating low grade UTI which is
very common in our country.
This finding was also made by Tiwari S P [7] who
concluded that non specific infections often go unnoticed
and contributes to male infertility
The semen fructose levels in our study were found to be
within normal range (240-490mg %) as recommended
by Eliasson [8] who reported semen fructose levels to be
normal within the range of 150-600mg%.
Both the diagnosis and treatment of infertility are
inherently stressful which may further affect hormone
pathways themselves and may exacerbate both infertility
and distress. Dennerstein [9] have noted the influence of
steroidal hormones on mood and sexual behaviour.
References:
1. Amelar R and Dublin L. Other factors affecting male
fertility; p- 74: 1977.
2. Bhushan S, Pandey R C, Singh SP, Pandey DN, Seth
P. Some observations on human semen analysis. Ind J
Physiol Pharmacol 1978; 22(4):393-6.
3. Fenstar L, Katz DF, Wyrobek AJ, Peiper C, Rempel
DM, Oman D, Swan SH. Effect of psychological stress
on human semen quality. J Andrology 1997; 18:194-
202.
4. Clarke RN, Klock SC, Geoghegan A, Trevassos DF.
Relationship between psychological stress and semen
quality among IVF patients. Human Reprod 1999;
14:753-8.
5. Zorn B, Virant Klun I, Verdenik I, Meden Vrtrovee H.
Semen quality changes among 2343 Healthy Slovenian
men included in an IVF-FT programme from 1983 to
1996.int journal andro 1999; l22:178-83.
6. Tewari SP, Srivastava RK, Shukla PL. Diagnosis and
management of male infertility DME research Project;
1983-1985.
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7. Eliasson R. Parameters of male infertility in Hafez ES,

Evan TN (eds); Human reproduction conception and
contraception: Narmer and Row, NY, p39, 1973.

8. Dennerstein L, Burrowe GD, Hyman G, Sharpe

K. Hormone therapy and effects of estrogen and
progesterone. Obst Gynaecol 1980; 55:316-22.

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