Stress and semen quality in an in vitro fertilization program.

While a greater understanding is emerging of the psychological stresses of infertility treatment, little is known about the specific effects of these stresses upon the quality of the semen sample used at the fertilization stage in an in vitro fertilization and embryo transfer (IVF-ET) program. This study evaluated two semen profiles for each of 500 couples on IVF treatment. The first semen sample was collected in the couple's pre-IVF workup, and the second sample was given by husbands after ovum aspiration, and used to inseminate the eggs in vitro. Comparisons of samples revealed that sperm density, total sperm count, and both quantitative and qualitative sperm motility were significantly lower in the second sample presented for IVF. For 91% of cases, there was no change across samples in assigned fertility index categories. However, 14 cases revealed a deterioration, falling from normal to pathologic, while 21 cases changed in semen character from normal in IVF workup to severely pathologic in IVF treatment. For these cases, the incidence of total fertilization failure in the procedure also dramatically increased. Several steps are discussed in the better management of patients with such declines in semen quality.