Psychological Distress and Semen Quality: A Cross-Sectional Study Among Ghanaian Men in Kumasi

Abstract

Male infertility contributes substantially to the global burden of infertility, accounting for approximately 30–50% of infertility cases either independently or in combination with female factors. This study examined the association between psychological distress and semen quality among Ghanaian men attending fertility clinics in Kumasi. A cross-sectional study was conducted among 286 men undergoing fertility evaluation at fertility clinics in Kumasi, Ghana. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, while perceived stress and sleep quality were assessed using standardised instruments. Semen volume, sperm concentration, motility, and morphology were evaluated using World Health Organization laboratory guidance. Associations were examined using Kruskal–Wallis tests and multivariable linear regression. Missing observations were handled using available-case analysis without imputation. Among 286 participants, 16.43% demonstrated some degree of anxiety symptoms, while 7.34% had depressive symptoms. Abnormalities were most frequent for sperm concentration (28.06%) and sperm motility (22.38%). Anxiety status was significantly associated with sperm concentration (χ² = 6.267, p = 0.044), whereas no significant associations were observed between anxiety and semen volume. Depression was not associated with any semen parameter. In adjusted regression models, higher perceived stress scores were independently associated with lower sperm concentration (β = −0.365; 95% CI: −0.680 to − 0.049; p = 0.024). Increasing age was associated with reduced semen volume (β = −0.007; 95% CI: −0.013 to − 0.002; p = 0.010). Higher perceived stress and anxiety were associated with sperm concentration among Ghanaian men seeking fertility care. Because of the cross-sectional design, causal direction cannot be established. The findings support consideration of psychological assessment within comprehensive infertility care.