The effects of radiofrequency exposure on male fertility: A systematic review of human observational studies with dose-response meta-analysis (SR 3 male)

Abstract

Overview

The World Health Organization (WHO) is compiling evidence on radiofrequency electromagnetic field (RF-EMF) exposure and health outcomes, particularly those identified as research priorities, to inform exposure guidelines. Multiple systematic reviews have been conducted by experts and methodologists to assess and synthesize data relevant for WHO exposure guidelines. This systematic review specifically evaluates the effects of RF-EMF exposure on male fertility in human observational studies, in accordance with the WHO handbook for guideline development and COSTER conduct guidelines.

Methods

• Extensive searches were performed in databases including MEDLINE, Embase, Web of Science, and EMF Portal, along with grey literature sources and organizational websites. RF-EMF experts were also consulted.
• Reference lists and citations for included study records were hand searched.
• Quantitative human observational studies examining RF-EMF effects on adult male fertility metrics (sperm concentration, morphology, motility, total sperm count, time to pregnancy) were included.
• Screening was performed in blinded duplicate with consensus input from a third reviewer as needed, and risk of bias was assessed with the OHAT tool.
• Dose-response meta-analysis was conducted where possible, and certainty of evidence was evaluated using the OHAT GRADE tool.

Findings

• Nine studies were included: seven involving the general public and two involving occupational cohorts.
• General Public:
  • Duration of phone use: The evidence is very uncertain regarding effects on sperm concentration, morphology, progressive motility, and total sperm count, with wide confidence intervals and very low-certainty evidence. Most studies suffered from risks of exposure misclassification, selection bias, confounding, and other methodological issues.
  • Position of phone: Little or no effect was found regarding carrying a phone in the front pocket on sperm quality or time to pregnancy. Some studies showed statistically significant effects, but all were at risk of bias in several domains.
  • RF-EMF source: One study on computer or electronic device use suggested little or no effect, but was at high risk of bias.
• Occupational Exposure: Two studies examined workers exposed to RF-EMF from microwaves or radar, but results were heterogeneous and at substantial risk of bias, making pooling of data infeasible.

Conclusion

Most reviewed evidence concerns localized RF-EMF exposure from mobile phone use in relation to male fertility. The current evidence is very uncertain with regard to the effect of RF-EMF from mobile phones on sperm outcomes. Only a handful of studies have evaluated the impact of device location or occupational exposure. More rigorously designed prospective studies, with stronger exposure measurement and appropriate statistical analysis, are needed to provide greater confidence in potential effects of RF-EMF on male reproductive health.

Note: There is a connection between electromagnetic field exposure and potential health risk, especially related to male fertility, though the certainty remains low and more research is needed.

Prospero Registration: CRD42021265401 (SR3A).