A Systematic Review on the Impact of Mental Health on Reproductive Hormones and Fertility Outcomes

Psychological stress and mental health disorders may interact with reproductive function through neuroendocrine, metabolic, behavioural, and oxidative pathways.This systematic review aimed to synthesize the available evidence on the relationship between psychological stress, mental health, reproductive hormones, and fertility outcomes in women and men, including outcomes associated with assisted reproductive technology (ART).PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar were searched for Englishlanguage human literature published between 2015 and 2025.Of 3,265 records identified, 1,020 duplicates were removed, 2,245 records underwent title and abstract screening, and 595 full-text reports were assessed for eligibility.Fifteen publications were included in the final narrative synthesis.The included evidence was heterogeneous and consisted predominantly of narrative reviews, systematic reviews, meta-analyses, and one review of systematic reviews.A post hoc methodological appraisal was performed using Joanna Briggs Institute (JBI) critical appraisal tools appropriate to the type of review.Stress-related activation of the hypothalamic-pituitary-adrenal axis was associated across the reviewed literature with alterations in hypothalamic-pituitary-gonadal signalling, with cortisol, prolactin, ghrelin, gonadotropins, and gonadal steroids implicated in proposed mechanisms.In women, the literature described associations with menstrual and ovulatory dysfunction, while male reproductive literature reported possible effects on testosterone and semen parameters.Evidence regarding a direct adverse effect of psychological distress on ART pregnancy outcomes was inconsistent, and meta-analytic evidence did not consistently demonstrate an association between pretreatment or treatment-related emotional distress and pregnancy outcomes.Psychological interventions showed more consistent benefits for reducing distress and improving coping than for improving reproductive endpoints.Psychological stress and reproductive health appear to be interrelated; however, the available evidence does not establish a definitive causal relationship between stress and impaired fertility.Interpretation is limited by heterogeneity in study designs, populations, stress measures, and reproductive outcomes, as well as overlapping evidence bases and the predominance of secondary literature.Prospective primary studies using standardized measures and rigorously designed intervention trials are needed to clarify these relationships and determine whether improvements in psychological wellbeing translate into measurable improvements in reproductive outcomes.