Table 1.

Characteristics of the included studies: Male.

References	Title	Study Design	Sample size & Age	Duration of infertility	Inclusion criteria	Cause(s) of infertility	Methods of cortisol measurement	Day, time and types of biological sample collected	Methods & Results	Conclusion
(20)	Impact of emotional disorders on semen quality in men treated for infertility	Case-control prospective study	112 men (60 fertile control vs 52 low fertility) [27 -33 years]	–	Men aged between 27-33, BMI 18.5-24.9, non-smokers, no problem drinking, no history of medications, unable to conceive after 12 months of regular unprotected sexual intercourse with fertile female partner.	None specified	Cortisol level was measured in a standard laboratory.	Serum cortisol collected in the morning	Mean cortisol level was significantly higher in the low fertility group (165.35 µg/dL), compared to the control (130.78 µg/dL) (p < 0.001). Higher Beck Depression Inventory (BDI) was significantly associated with higher cortisol level (r=0.657, p<0.001). Higher State-Trait Anxiety Inventory (STAI-1 and STAI-2) scores were significantly associated with higher cortisol [STAI-1 (r=0.697, p<0.001) STAI-2 (r=0.665, p<0.001)]	Anxiety and depression in subfertile males are associated with increased secretion of prolactin and cortisol.
(17)	Male Fertility: Endocrine Stress Parameters and Coping	Case control prospective study	48 men (14 impaired fertility vs 34 fertile) (average age: Group A: 33.1 ± 5.4, Group B: 32.7 ± 4.8, Group C: 32.4 ± 6.7 to years	–	Male patients aged 18 to 45: Group A: normozoospermia, elevated prolactin (>360 IU/L). Group B: normozoospermia, normal prolactin (<360 IU/L) Group C: impaired fertility, azoospermia or oligozoospermia, or cryptozoospermia	oligozoospermia, cryptozoospermia or azoospermia	Cortisol was assessed using with chemiluminescence immunoassay.	Blood; morning	The cortisol level in group A (612.9 nmol/L) was significantly higher than Group B (478.1 nmol/L) (p<0.05). There was no significant difference between group A+B (557.4 ± 143.4 nmol/L) and group C (580.7± 134.1 nmol/L) in cortisol level. There was no significant difference in depression scores between the groups, based on SVF120 the total of coping strategy was significantly higher in infertile group.	No significant change in cortisol was seen in impaired fertility group, however no comparison was made between Group B and C alone.
(18)	Mucuna pruriens Reduces Stress and Improves the Quality of Semen in Infertile Men	Case-control prospective study	120 men (aged 30-38 years old)	–	Men (30–38 years); healthy control: had previously initiated at least 1 pregnancy and with normal semen profile; infertile group: attending infertility clinic, of same socioeconomic and ethnic status (Indo Aryan) and BMI (19 to 24 kgm2), not on nutritional supplement or vitamins	normozoospermic infertility, Oligozoospermic infertility, asthenozoospermic infertility	Serum cortisol levels were assessed by radioimmunoassay	Venous blood samples; morning (0800h) and evening (1600h)	The morning and evening serum cortisol levels were significantly higher in the infertile groups [morning cortisol ug/dL: normozoospermic (14.1 ± 3.0; P<0.01), oligozoospermic(21.5 ± 0.7; P<0.01) and asthenozoospermic(28.0 ± 1.0; P<0.01)] and [evening cortisol: normozoospermic(10.1 ± 1.6; P < 0.01), oligozoospermic 13.3 ± 4.6 (; P< 0.01) and asthenozoospermic (16.8 ± 1.3; P< 0.01) compared to the healthy control [morning: 10.2 ± 0.2, evening: 5.0 ± 0.6]	The cortisol level was significantly higher in infertile subjects compared to healthy fertile subjects.
(19)	Withania somnifera Improves Semen Quality in Stress-Related Male Fertility	120 total- 60 healthy men, normozoospermic infertile men (20), normozoospermic infertile men under psychological stress (20),normozoospermic infertile men who were cigarette smokers (20) [25-38 years]	Case-control Prospective study	–	Men (aged 25-38 years old) - Control: healthy fertile men who had initiated at least 1 pregnancy and has normal sperm count; Men attending infertility treatment divided into (i) normozoospermic infertile men, (ii) normozoospermic infertile men under psychological stress and (iii) normozoospermic infertile men who were cigarette smokers.	Normozoospermic infertility; infertility of unknown etiology	Serum cortisol was assessed based on method of Foster and Dunn [Foster & Dunn, 1974] (radioimmunoassay)	Blood; collected in the morning (0800h) and evening (1600h)	The mean serum level in the infertile group was higher than the control group in both morning and evening. The cortisol level in healthy fertile group was 10.84 ± 1.63 µg/dL in the morning and 5.8 ± 1.33 µg/dL in the evening.	The cortisol level was significantly higher in infertile subjects compared to healthy fertile subjects.