Salivary Cortisol and the Reproductive Endocrine Profile in Infertile Iraqi Men, with Preserved Sperm Chromatin Maturity: A Cross-Sectional Study

Objective: To examine the associations of salivary cortisol with the reproductive hormone profiles and with sperm chromatin maturity across semen-quality phenotypes in infertile men. Study Design: Cross-sectional studyPlace and Duration of Study: This study was conducted at the Andrology Clinic, Najaf Iraq from 1st September 2025 to 30th November 2025. Methods: One hundred infertile men were classified by WHO criteria into normozoospermia, oligozoospermia, asthenozoospermia and oligoasthenoteratozoospermia were enrolled. Salivary cortisol, serum luteinizing hormone, follicle-stimulating hormone, total testosterone, prolactin and estradiol, and sperm chromatin maturity (assessed byaniline blue staining) were measured. Results: Salivary cortisol was inversely associated with follicle-stimulating hormone (rho = -0.28, p=0.005; false discovery rate q=0.026; 95% CI -0.45 to -0.09) and this association remained independent in multivariableregression (standardized beta = -0.20, p=0.029). Cortisol showed a weaker positive association with estradiol (rho = +0.22, p=0.029) that did not survive false discovery rate correction, and no significant association with luteinizing hormone, testosterone or prolactin. Follicle-stimulating hormone and testosterone differed across phenotypes (p<0.001), being highest in normozoospermia. Sperm chromatin immaturity was low (median 6% aniline-blue- positive), did not differ across phenotypes (p=0.60), and was not associated with cortisol or the endocrine profile, apart from a weak correlation with prolactin (rho = +0.28, p=0.011). Conclusion: In infertile men, higher salivary cortisol is independently associated with lower follicle-stimulating hormone, consistent with an inhibitory influence of hypothalamic-pituitary-adrenal activity on the gonadotropic axis. Sperm chromatin maturity was largely preserved and unrelated to stress or the endocrine profile.