{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T09:13:25Z","timestamp":1788599605046,"version":"build-2803163510"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    Azoospermia can lead to significant psychological distress, low self-esteem, and compromised sexual function. However, the impact of these issues before any invasive diagnostic or treatment procedures is not well studied. We conducted a cross-sectional study involving 134 men diagnosed with azoospermia and 164 age-matched fertile controls. All assessments, including anxiety (Beck Anxiety Inventory [BAI]), depression (Beck Depression Inventory-II [BDI-II]), self-esteem (Rosenberg Self-Esteem Scale [RSES]), and erectile function (International Index of Erectile Function-5 [IIEF-5]), were conducted during the diagnosis visit, prior to any testicular biopsy for infertility treatment. Compared with age-matched fertile controls, men with azoospermia exhibited significantly higher anxiety levels (mean \u00b1 standard deviation [s.d.]: 17.3 \u00b1 3.9\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    9.8 \u00b1 2.8), increased depression scores (mean \u00b1 s.d.: 24.1 \u00b1 6.3\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    12.5 \u00b1 5.1), lower self-esteem (mean \u00b1 s.d.: 2.8 \u00b1 0.5\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    1.8 \u00b1 0.3), and poorer erectile function (mean \u00b1 s.d.: 17.2 \u00b1 5.1\n                    <jats:italic toggle=\"yes\">vs<\/jats:italic>\n                    21.4 \u00b1 5.2), all with\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001. Importantly, decreased self-esteem was strongly correlated with both depression (\n                    <jats:italic toggle=\"yes\">r<\/jats:italic>\n                    = 0.851) and anxiety (\n                    <jats:italic toggle=\"yes\">r<\/jats:italic>\n                    = 0.843). Additionally, erectile dysfunction showed an inverse correlation with both depression (\n                    <jats:italic toggle=\"yes\">r<\/jats:italic>\n                    = \u22120.867) and anxiety (\n                    <jats:italic toggle=\"yes\">r<\/jats:italic>\n                    = \u22120.813), with\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.05 for both correlations. The psychological and sexual effects of infertility are often overlooked in the treatment process. Therefore, we advocate that all men with azoospermia receive psychological and sexual support alongside infertility treatment.\n                  <\/jats:p>","DOI":"10.4103\/aja2025116","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T07:02:33Z","timestamp":1777359753000},"page":"646-650","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Psychological and sexual associations of azoospermia in men: a cross-sectional pre-biopsy study"],"prefix":"10.4103","volume":"28","author":[{"given":"Sule Yildirim","family":"Kopuk","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Istinye University, School of Medicine, Istanbul 34396, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Kulaksiz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Istinye University, School of Medicine, Istanbul 34396, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Urology, Mediclin Kraichgau Klinik, Bad Rappenau 74906, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhsin","family":"Balaban","sequence":"additional","affiliation":[{"name":"Androfert Mens Health Clinic, Istanbul 34000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basar","family":"Ayribas","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry and Psychotherapy, LWL Klinikum, Marsberg 34431, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asgar","family":"Garayev","sequence":"additional","affiliation":[{"name":"Department of Urology, Istanbul Florence Nightingale Hospital, Istanbul 34381, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Recep Burak","family":"Degirmentepe","sequence":"additional","affiliation":[{"name":"Department of Urology, Sakarya University, School of Medicine, Sakarya 54290, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehmet Ozay","family":"Ozgur","sequence":"additional","affiliation":[{"name":"Department of Urology, Division of Pediatric Urology, Mersin City Training and Research Hospital, Mersin 33240, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eda","family":"Ozcan","sequence":"additional","affiliation":[{"name":"School of Medicine, Sakarya University, Sakarya 54050, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Guzel","sequence":"additional","affiliation":[{"name":"Ayd\u0131n State Hospital, Urology, Ayd\u0131n 9000, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismail","family":"Baglar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Health Sciences, Kartal Dr. L\u00fctfi K\u0131rdar City Hospital, Istanbul 34865, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tuncay","family":"Toprak","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Health Sciences, Hamidiye School of Medicine, Fatih Sultan Mehmet Training and Research Hospital, Istanbul 34668, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"key":"R1-20260905","doi-asserted-by":"crossref","first-page":"15","DOI":"10.6061\/clinics\/2013(Sup01)03","article-title":"The epidemiology and etiology of azoospermia","volume":"68","author":"Cocuzza","year":"2013","journal-title":"Clinics"},{"key":"R2-20260905","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.clinbiochem.2018.03.012","article-title":"Fertility and infertility: definition and 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