Depressive symptoms, semen parameters, and sexual outcomes in men undergoing fertility evaluation: a cross-sectional study

This cross-sectional study examined the associations between depressive symptoms, semen parameters, employment status, and sexual outcomes in 308 men (age, mean ± standard deviation [s.d.]: 31.9 ± 6.5 years) undergoing fertility evaluation at Kirsehir Ahi Evran University Training and Research Hospital, Kirsehir, Türkiye, between January 2024 and January 2026. Participants completed the questionnaires of Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and the International Index of Erectile Function-15 (IIEF-15). Semen analysis was performed according to the World Health Organization 2021 guidelines. Multiple linear regression revealed that depressive symptoms were the strongest independent factor associated with both erectile dysfunction (IIEF-15: β = -0.393, P < 0.001) and sexual dissatisfaction (GRISS: β = 0.421, P < 0.001), whereas semen parameters, anxiety, and age were not independently associated with sexual outcomes (all P > 0.05). Progressive motility showed a weak bivariate correlation with sexual dissatisfaction but was not an independent correlate in multivariable analysis, where depressive symptoms accounted for the observed variance. Unemployed men demonstrated lower progressive motility, normal morphology, and sperm concentration compared with employed men in bivariate analyses (all P < 0.05). These findings suggest that depressive symptoms, rather than semen quality, are the primary modifiable factor associated with sexual dissatisfaction and erectile dysfunction in men seeking fertility assessment. Routine depression screening in fertility clinics may help identify men at risk for adverse sexual outcomes.