Environmental Pollution 282 (2021) 116952

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Environmental Pollution
journal homepage: www.elsevier.com/locate/envpol

Review

Current progress on the effect of mobile phone radiation on sperm

quality: An updated systematic review and meta-analysis of human
and animal studies
Gang Yu a, 1, Zhiming Bai b, d, 1, Chao Song a, Qing Cheng b, Gang Wang b, Zeping Tang c,
Sixing Yang a, *
a
Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
b
Department of Urology, Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China
c
Guangdong Environmental Radiation Monitoring Center, Guangzhou, China
d
Haikou Center for Medical Synchrotron Radiation Research, Haikou People’s Hospital, Haikou, China

a r t i c l e i n f o a b s t r a c t

Article history: Potential suppression of fertility due to mobile phone radiation remains a focus of researchers. We
Received 3 June 2020 conducted meta-analyses on the effects of mobile phone radiation on sperm quality using recent evi-
Received in revised form dence and propose some perspectives on this issue. Using the MEDLINE/PubMed, Embase, WOS, CEN-
6 March 2021
TRAL, and ClinicalTrials.gov databases, we retrieved and screened studies published before December
Accepted 12 March 2021
Available online 30 March 2021
2020 on the effects of mobile phone use/mobile phone RF-EMR on sperm quality. Thirty-nine studies
were included. Data quality and general information of the studies were evaluated and recorded. Sperm
quality data (density, motility, viability, morphology, and DFI) were compiled for further analyses, and we
Keywords:
Mobile phone
conducted subgroup, sensitivity, and publication bias analyses. The pooled results of human cross-
RF-EMR. Male fertility sectional studies did not support an association of mobile phone use and a decline in sperm quality.
Sperm quality Different study areas contributed to the heterogeneity of the studies. In East Europe and West Asia,
Toxicity mobile phone use was correlated with a decline in sperm density and motility. Mobile phone RF-EMR
exposure could decrease the motility and viability of mature human sperm in vitro. The pooled results
of animal studies showed that mobile phone RF-EMR exposure could suppress sperm motility and
viability. Furthermore, it reduced sperm density in mice, in rats older than 10 weeks, and in rats
restrained during exposure. Differences regarding age, modeling method, exposure device, and exposure
time contributed to the heterogeneity of animal studies. Previous studies have extensively investigated
and demonstrated the adverse effects of mobile phone radiation on sperm. In the future, new stan-
dardized criteria should be applied to evaluate potential effects of mobile phone RF-EMR dosages.
Further sperm-related parameters at the functional and molecular levels as well as changes in biological
characteristics of germ cells should be evaluated. Moreover, the impact of mobile phone RF-EMR on
individual organs should also be examined.
© 2021 Elsevier Ltd. All rights reserved.

1. Introduction radio frequency electromagnetic radiation (RF-EMR; Belpomme

Mobile phones produce a type of non-ionizing radiation termed
Abbreviations: RF-EMR, radio frequency electromagnetic radiation; WOS, Web
of Science; DFI, DNA fragmentation rate; CENTRAL, Cochrane Central Register of
controlled trials.
* Corresponding author.
E-mail address: drsixingyang@163.com (S. Yang).
1
The co-first authors: Gang Yu and Zhiming Bai.
et al., 2018). The increasing popularity and use of mobile phones
have raised concerns on whether RF-EMR can affect male sperm
quality (Jalilian et al., 2019), and the current consensus in the
general public is that mobile phone RF-EMR is a major risk factor of
decreased sperm quality. However, the results of current research
are contradictory, and whether mobile phone RF-EMR exposure
decreases male sperm quality remains an unresolved issue in the
scientific community. For instance, one study showed that sperm
deformation rates in men increased with increasing mobile phone

https://doi.org/10.1016/j.envpol.2021.116952
0269-7491/© 2021 Elsevier Ltd. All rights reserved.
G. Yu, Z. Bai, C. Song et al.
usage time (Agarwal et al., 2008), whereas a different study found
no such a correlation (Erogul et al., 2006). Mobile phone radiation
was reported to suppress sperm motility and viability (Mailankot
et al., 2009; Ghanbari et al., 2013), whereas some different
studies suggested that this type of radiation didi not affect sperm
density, motility, and viability in rodents (Dasdag et al., 2013; Trosic
et al., 2013). In 2014, Liu et al. pooled the results of four cross-
sectional studies, four human sperm in vitro studies, and four ani-
mal studies and attempted to conduct a meta-analysis on the re-
lationships of mobile phone use and sperm quality in terms of the
three aforementioned aspects (Liu et al., 2014). The results of this
meta-analysis did not suggest that mobile phone usage was asso-
ciated with changes in human sperm quality; however, direct
mobile phone RF-EMR exposure could reduce human sperm
motility and viability in vitro. Moreover, the results of animal ex-
periments suggested that mobile phone RF-EMR exposure could
decrease sperm density and motility (Liu et al., 2014). At approxi-
mately the same time, Adams et al. conducted a meta-analysis on
human sperm quality, which included 10 studies (five cross-
sectional studies and five in vitro studies of human sperm) and
found that mobile phone RF-EMR exposure could affect human
sperm motility and viability (when the results of the two afore-
mentioned study types were pooled; Adams et al., 2014). The
additional subgroup analysis conducted by Adams et al. using these
limited studies only supported that mobile phone RF-EMR did not
decrease sperm density in vitro (Adams et al., 2014). These previous
studies pooled the findings of earlier studies, formulated some
hypotheses, and revealed preliminarily relationships between
mobile phone RF-EMR exposure and male subfertility. However,
owing to large differences in experimental conditions among the
included studies, the meta-analyses by Liu et al. and Adams et al.
were highly heterogeneous in terms of results. Moreover, because
of the small number of studies available for analysis, further het-
erogeneity analysis was limited. Thus, both research groups pro-
posed that their preliminary conclusions should be further
examined and that their hypotheses should be further tested to
elucidate the effects of mobile phone RF-EMR on male fertility.
Taken together, additional data analyses are required to test the
effects of mobile phone RF-EMR exposure on sperm quality.
In the past six years, the rapid advancement of communication
technology and the advent of 5G technology has led to increased
cell phone use and subsequent higher exposure rates to associated
RF-EMR. Therefore, it is imperative to gain scientific understanding
of the effect of mobile phone RF-EMR on male fertility (Choi et al.,
2018; Simko
and Mattsson 2019). Whether mobile phone RF-EMR
and other RF-EMR types emitted by wearable devices or the
“Internet of Things” may exert reproductive toxicity has garnered
social attention and has attracted research interest. Many new
studies using different experimental conditions have been pub-
lished, and we conducted a meta-analysis based on these studies to
examine the impact of mobile phone RF-EMR on sperm quality and
to test some of the hypotheses proposed in previous studies. Our
analyses may elucidate the progress in the research on the rela-
tionship of mobile phone use and male fertility. Furthermore, we
discuss personal views on the topic to provide suggestions for
future research.
2. Methods
2.1. Search strategies
This meta-analysis was conducted according to the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses
guidelines, the Meta-analyses of Observational Studies in
2
Environmental Pollution 282 (2021) 116952
Epidemiology guidelines, and the guidelines for reporting animal
research. We searched the MEDLINE/PubMed, EMBASE, Web of
Science (WOS), Cochrane Central Register of Controlled Trials
(CENTRAL) and ClinicalTrials.gov. databases for respective studies
on this topic.
A mesh was applied to define the subject heading, which was
supplemented and simplified to achieve a more accurate literature
retrieval. The search strategy in MEDLINE/PubMed was as follows:
(“cell phone*"[Title/Abstract] OR “cellular phone*"[Title/Ab-
stract]) OR “cellular telephone*"[Title/Abstract]) OR “mobile pho-
ne*"[Title/Abstract]) OR “mobile telephone*"[Title/Abstract]) OR
“electromagnetic"[Title/Abstract]) AND ((“sperm*"[Title/Abstract]
OR “semen"[Title/Abstract]) OR “Seminal"[Title/Abstract]).
We searched for studies conducted before December 2020. The
search strategies employed on the EMBASE and WOS databases are
shown in Supplement 1. We also screened references in respective
articles to identify other potential studies.
2.2. Inclusion and exclusion criteria
The inclusion criteria were as follows: 1. human cross-sectional
studies, human sperm studies in vitro (i.e., experiments were con-
ducted on ejected semen in vitro), and animal experiments on the
relationships of mobile phone use/mobile phone EMR and sperm
quality/semen quality; 2. associated studies with a control or
comparison group; 3. associated studies with semen analysis/
sperm quality analysis; 4. a specific absorption rate (SAR) of mobile
phone RF-EMR below 2 W/kg for human sperm studies in vitro and
animal studies.
The exclusion criteria were as follows: 1. studies investigating
the relationship of mobile phone base stations, radar EMR,
extremely low EMR, wireless fidelity, mobile phone RF-EMR jam-
mers, and joint electromagnetic fields with male sperm quality; 2.
studies investigating the effects of mobile phone RF-EMR exposure
on pregnancy; 3. animal studies in vitro (i.e., studies on biological
changes in various germ cell lines such as GC2 and TM4, but lacking
data on mature sperm quality); 4. studies containing data values
with incorrect decimal points; 5. studies in which the mean or
standard deviation could not be calculated based on the accessible
data; 6. special article types, including reviews, meta-analyses,
comments, statements, and retracted articles.
2.3. Quality assessment
We used the Joanna Briggs Institute Practical Application of
Clinical Evidence System (JBI) list to evaluate the included human
cross-sectional studies (Laidsaar-Powell et al., 2019). We referred to
the method proposed by Liu et al. and evaluated the quality of
human sperm in vitro studies based on four parameters (Liu et al.,
2014): representativeness of subjects, type of the radiation expo-
sure device, comparability of the exposure and the control group,
and representativeness of evaluation indices. The scoring system
ranged from 0 (low quality) to 4 (high quality). We applied the
Collaborative Approach to Meta-Analysis and Review of Animal
Data from Experimental Stroke (CAMARADES) list to evaluate ani-
mal studies (Tong et al., 2019). Details are provided in Supplement
2.
2.4. Data extraction
Basic information of the included studies was extracted ac-
cording to different study types. Data on sperm quality data
including sperm density, motility, viability, morphology, and DNA
fragmentation index (DFI) were pooled. Sperm quality data of rats
and mice were pooled separately.
G. Yu, Z. Bai, C. Song et al.
2.5. Statistical analyses
Meta-analyses were performed using RevMan 5.3. Standardized
mean differences (SMD) and mean differences (MD) were used to
analyze sperm quality. Cochran’s Q test was applied to test het-
erogeneity, after which at P > 0.1, a fixed effects model was fitted,
and at P
0.1, a random effects model was fitted. Heterogeneity is
represented by I2. Subgroup analyses were performed to analyze
the origin of heterogeneity using RevMan 5.3. Regarding human
cross-sectional studies, we performed a subgroup analysis based on
study area, exposure time, and evaluation method. For animal
studies, subgroup analyses were conducted with respect to animal
age (younger or older than 10 weeks), radiation exposure device
(mobile phone or simulator), animal status during modeling
(restrained or unrestrained), and modeling time (short-term
exposure at < 140 h or long-term exposure at > 140 h).
A one-by-one exclusion method was applied to the sensitivity
analysis. For parameters included in more than seven studies, we
applied a funnel chart, Egger’s test, and Begg’s test using Stata 16.0
to evaluate potential publication bias.
Literature retrieval, quality assessment, and data extraction
were independently completed by two reviewers. If the opinions
were inconsistent, the reviewers consulted with each other or with
a third party.
3. Results
3.1. Search results
A flow chart of the screening process is shown in Fig. 1. In total,
Fig. 1. Flow chart of the screening process.
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Environmental Pollution 282 (2021) 116952
1073 studies were retrieved, and after screening, 137 studies
remained for full-text reading; of these, 98 studies were excluded,
and 39 studies were included, which comprised 5 human cross-
sectional studies, 8 human sperm in vitro studies, and 26 animal
studies (20 studies on rats and 6 studies on mice) for meta-
analyses. These 39 studies included results on sperm quality anal-
ysis of 2567 men of childbearing age (including 225 semen samples
of men of childbearing age for sperm experiments in vitro) and 836
epididymal semen samples of animals (583 rats and 253 mice). Full
texts of five studies could not be obtained even after contacting the
respective authors by e-mail. One study with a data value with an
incorrect decimal point mark and one study in which the standard
deviation could not be calculated were excluded during screening;
despite inquiring with the respective authors by e-mail, no further
information was obtained.
3.2. Basic information
The basic information of the included studies is shown in
Tables S1, S2, and S3.
3.3. Quality evaluation
As shown in Table 1, the JBI score of the human studies ranged
from 9 to 15, and only in one study was the JBI score below 10,
whereas in four studies, it was higher than 10. The JBI score for
human sperm in vitro studies ranged from 8 to 10; in one of these
studies, the JBI score was 8, while in seven studies, the JBI score was
9. Regarding animal studies identified through the CAMARADES
list, the JBI scores of four studies were below 7, while those of 22
G. Yu, Z. Bai, C. Song et al. Environmental Pollution 282 (2021) 116952

Table 1
Quality evaluation of included studies.

Human study Score Human sperm study Score Animal study Score

Fejes(Fejes et al., 2005) 11 Erogul(Erogul et al., 2006) 9 Dasdag(Dasdag et al., 2003) 10

Agarwal(Agarwal et al., 2008)
Fejio(Feijo et al., 2011)
Rago(Rago et al., 2013)
Yildirim(Yildirim et al., 2015)
11 Agarwal(Agarwal et al., 2009) 9 Yan(Yan et al., 2007) 10
9 Ahmad(Ahmad and Baig 2011) 9 Ribeiro(Ribeiro et al., 2007) 12
12 Dkhil(Dkhil et al., 2011) 9 Mailankot(Mailankot et al., 2009) 8
12 Veerachari(Veerachari and Vasan 2012) 9 Lee(Lee et al., 2010) 8
Gorpinchenko(Gorpinchenko et al., 2014) 8 Imai(Imai et al., 2011) 6
Zalata(Zalata et al., 2015) 9 Nisbet(Nisbet et al., 2012) 6
Nakatani-Enomoto(Nakatani-Enomoto et al., 2016) 9 Ab Zayed(Zayed et al., 2012) 4
Trosic(Trosic et al., 2013) 8
Ghanbari(Ghanbari et al., 2013) 10
Shahin(Shahin et al., 2014) 12
Tas(Tas et al., 2014) 10
Liu(Liu et al., 2015) 12
Gohari(Gohari et al., 2017) 12
Oyewopo(Oyewopo et al., 2017) 10
Pandey(Pandey et al., 2017) 10
Almasiova(Alma
siova

et al., 2018) 12
Pandey(Pandey and Giri 2018) 10
Shahin(Shahin et al., 2018) 10
Narayanan(Narayanan et al., 2019) 8
Gautam(Gautam et al., 2019) 6
Yahyazadeh(Yahyazadeh and Altunkaynak 2019) 10
Shahin(Shahin et al., 2019) 10
Yu(Yu et al., 2020) 12
Vafaei(Vafaei et al., 2020) 10
Pardhiya(Pardhiya et al., 2020) 10

studies were higher than 7. 3.5.2. Sperm motility

3.4. Meta-analysis results
3.4.1. Research status
Currently, relevant human epidemiological studies are still
lacking. Studies have been predominantly conducted using animal
experiments, some of which used mobile phones, while others
used RF simulators to produce mobile phone RF-EMR. Only few
studies discussed effects of RF-EMR produced by 4G or 5G devices
on reproductive functions, and considerable differences between
evaluation methods of the actual RF-EMR dosages in the exposure
area were observed. Most studies assessed the effects of RF-EMR on
sperm density, motility, viability, and morphology, however, only
few investigated the effects of mobile phone RF-EMR exposure on
reproduction through advanced sperm function tests, sperm DFI
test, and offspring quality tests. Almost all included studies inves-
tigated the effects of whole-body RF-EMR exposure on male
fertility, and only few investigated the effects of local RF-EMR
exposure on certain reproductive organs.
3.5. Meta-analysis results of human cross-sectional studies
3.5.1. Sperm density
As shown in Fig. 2A, five studies were included for sperm den-
sity analysis (random model; MD ¼ 1.21 [-15.14, 12.73]; P ¼ 0.87;
I2 ¼ 91%; Q test P < 0.001). Owing to the large heterogeneity of
studies, subgroup analyses were conducted, and the results showed
that I2 decreased to 0% (Q test P ¼ 0.77), P was 0.0003 in the East
Europe and West Asia group, while in other regions I2 was 97% (Q
test P < 0.0001) and P was 0.98.
The sensitivity analysis showed that MD decreased to 7.99
(19.13, 3.15), I2 decreased to 79% (Q test P ¼ 0.003), and P
decreased to 0.16 after removing the Feijo’s study. The total effect
scale, I2, Q test P, and the statistical P-value did not significantly
change when other studies were removed.
4
As shown in Fig. 2B, the sperm motility analysis included five
studies (random model; MD ¼ 4.77 [-11.68, 2.15]; P ¼ 0.18;
I2 ¼ 87%; Q test P < 0.0001). Heterogeneity of the studies was high.
The subgroup analysis showed that I2 decreased to 0% (Q test
P ¼ 0.65), P was 0.04 in the East Europe and West Asia group
whereas in the America group, I2 was 95% (Q test P < 0.0001), P was
0.59. I2 decreased to 56% (Q test P ¼ 0.10), P was 0.56 in the forward
motility group, whereas I2 was 92% (Q test P ¼ 0.0003), and P was
0.12 in the total motility group.
The sensitivity analysis showed that removing the study by
Agarwal et al. reduced MD to 2.25 (6.55, 2.04), and I2 to 35% (Q
test P ¼ 0.20), P ¼ 0.30; the analysis results did not significantly
change after removing other studies.
3.5.3. Sperm viability
As is shown in Fig. 3A, the sperm viability analysis included two
studies (random model; MD ¼ 4.91 [-23.53, 13.72]; P ¼ 0.61;
I2 ¼ 95%; Q test P < 0.0001).
3.5.4. Sperm morphology
As shown in Fig. 3B, the analysis of sperm morphology included
four studies (random model; MD ¼ 0.32 [-1.01, 0.37], P ¼ 0.36, and
I2 ¼ 91%; Q test P < 0.00001). The subgroup analysis showed that in
the East Europe and West Asia group, I2 was 0% (Q test P ¼ 0.87),
and P ¼ 0.25, while in the America group, I2 was 97% (Q test
P < 0.00001), and P ¼ 0.46.
The sensitivity analysis suggested that removing the study by
Agarwal et al. decreased the MD to 0.05 (0.17, 0.07), I2 to 0% (Q
test P ¼ 0.44), and P to 0.41. Removing other studies did not
significantly change the analysis results.
3.6. Meta-analysis results of human sperm studies
3.6.1. Total sperm motility, viability, and density
As shown in Fig. 4, the total sperm motility analysis included
seven studies (fixed model; MD ¼ 3.56 [-5.11, 2.00];
P < 0.00001; I2 ¼ 0%; Q test P ¼ 0.69). The sperm viability analysis
Fig. 2. Forest plot and subgroup analysis of sperm density (A) and motility (B) in human cross-sectional studies. The pooled results did not suggest that mobile phone use was
associated with a decline in sperm density in humans. Study area contributed to study heterogeneity in the analyses of sperm density and motility. The evaluation method
contributed to study heterogeneity regarding sperm motility analysis. Mobile phone use in East Europe and West Asia was associated with decreased sperm density and motility.

5
G. Yu, Z. Bai, C. Song et al.
Fig. 3. Forest plot and subgroup analysis of sperm viability (A) and morphology (B) in human cross-sectional studies. The pooled results did not indicate that mobile phone use was
associated with decreased sperm viability and morphology in humans. The study area contributed to the study heterogeneity of sperm morphology.
included four studies (random model; MD ¼ 3.51 [-4.32, 2.70];
P < 0.00001; I2 ¼ 0%; Q test P ¼ 0.74). Three studies (random model)
were included in the density analysis, (MD ¼ 1.07 [-8.34, 6.20];
P ¼ 0.77; I2 ¼ 0%; Q test P ¼ 0.99). The sensitivity analysis of total
sperm motility, viability, and density showed that excluding any of
the studies did not significantly affect the observed total effect
scale, I2, Q test P, and the statistical P-value.
3.6.2. Sperm DFI
As is shown in Fig. 4D, the sperm DFI analysis included two
studies (random model; MD ¼ 1.30 [-0.57, 3.18]; P ¼ 0.17; I2 ¼ 94%;
Q test P < 0.0001).
3.7. Meta-analysis results of animal studies
3.7.1. Sperm density in rats
As is shown in Figs. 5A and 17 studies (random model) were
included in the analysis of epididymal sperm density (SMD ¼ 0.32
[-0.64, 0.00]; P ¼ 0.05; I2 ¼ 58%; Q test P ¼ 0.001). The subgroup
analyses are shown in Table 2. Study heterogeneity (I2 ¼ 56%; Q test
P ¼ 0.003) was significantly reduced in the restrained group
(I2 ¼ 28%; Q test P ¼ 0.22) and in the simulator group (I2 ¼ 40%; Q
test P ¼ 0.11). In addition, subgrouping by animal age did not
significantly affect study heterogeneity; however, in animals older
6
Environmental Pollution 282 (2021) 116952
than 10 weeks, the P-value of pooled results changed to 0.03,
indicating statistical significance.
The sensitivity analysis suggested that removing any study did
not change the total effect scale, I2, Q test P, or the statistical P-value,
suggesting robustness of the results. As shown in Figure S1A, the
funnel plot, Begg’s test (Pr ¼ 0.06), and Egger’s test (P ¼ 0.33) did
not suggest significant publication bias in these studies.
3.7.2. Sperm motility in rats
As shown in Figs. 5B and 11 studies (random model) were
included in the analysis of sperm motility (SMD ¼ 0.83
[-1.41, 0.24]; P ¼ 0.005; I2 ¼ 80%; Q test P < 0.00001). As shown in
Table 2, the subgroup analyses showed that study heterogeneity
(80%; Q test P < 0.00001) may be reduced in the restrained group
(0%; Q test P ¼ 0.82), in rats older than 10 weeks (28%; Q test
P ¼ 0.22), and in the mobile phone group (56%; Q test P ¼ 0.08).
The sensitivity analysis showed that after removing the study by
Ozlem et al. SMD was reduced to 1.00 (1.49, 0.52) and I2 was
reduced to 66% (Q test P ¼ 0.002; P < 0.0001), whereas the analysis
results were not significantly changed after removing other studies.
As shown in Figure S1B, the funnel plot, Begg’s test (Pr ¼ 0.06), and
Egger’s test (P ¼ 0.111) did not suggest significant publication bias
in the included studies.
G. Yu, Z. Bai, C. Song et al.
Fig. 4. Forest plot of sperm motility (A), viability (B), density (C), and DFI (D) in human studies in vitro. The pooled results supported the claim that mobile phone RF-EMR exposure
reduces total sperm motility and viability of human sperm in vitro.
3.7.3. Sperm viability in rats
As shown in Fig. 5C, four studies (fixed model) were included in
the analysis of epididymal sperm viability (MD ¼ 8.20 [-10.33,
6.07]; P < 0.00001; I2 ¼ 0%; Q test P ¼ 0.57). The sensitivity analysis
showed that excluding any study did not significantly change the
observed total effect scale, I2, Q test P, or the statistical P-value.
7
Environmental Pollution 282 (2021) 116952
3.7.4. Sperm morphology in rats
As is shown in Fig. 5D, seven studies (random model) were
included (SMD ¼ 0.37 [-1.12, 0.37]; P ¼ 0.33; I2 ¼ 79%; Q test
P < 0.00001). The subgroup analysis (Table 2) showed that I2
decreased to 0% (Q test P ¼ 0.59), and the P-value changed to 0.01 in
the mobile phone group. Sensitivity analysis showed that after
removing the studies by Nisbet et al. or Yahyazadeh and Altun-
kaynak, the SMD was reduced to 0.59 (1.25, 0.08) and 0.13
(0.70, 0.44), respectively, I2 was reduced to 67% (Q test P ¼ 0.01)
and 68% (Q test P ¼ 0.008), respectively, and P was 0.08 and 0.65,
respectively. Removing other studies did not significantly change
the pooled results. The funnel plots, Begg’s test (Pr ¼ 0.54), and
Egger’s test (P ¼ 0.48) did not suggest significant publication bias in
the included studies (Figure S1C).

3.7.5. Sperm density in mice

As shown in Fig. 5E, epididymal sperm density analysis included
six studies (random model; SMD ¼ 2.62 [-3.79, 1.44],
P < 0.00001; I2 ¼ 83%; Q test P ¼ 0.0001). A subgroup analysis
showed that there was no significant change in the analysis results
after grouping by modeling device, exposure time, or age. The
sensitivity analysis showed that removing any study did not
significantly change the observed total effect scale, I2, Q test P, and
the statistical P-value, suggesting robustness of the results.

4. Discussion

In the past six years, studies on the effects of mobile phone

radiation on sperm quality were mostly conducted using animal
experiments rather than human surveys. Consistent with the re-
sults of a meta-analysis from 2014 (Liu et al., 2014), the pooled
results of cross-sectional studies in our study did not suggest that
mobile phone use is associated with a decline in human sperm
quality. Current evidence from human sperm in vitro studies sup-
port the claim that mobile phone RF-EMR exposure can suppress
sperm mobility and viability. The meta-analysis by Liu et al. sug-
gested that mobile phone RF-EMR exposure can decrease sperm
density and motility in rats (Liu et al., 2014). Our pooled results
indicate that mobile phone RF-EMR exposure can reduce sperm
motility in rats but that it does not significantly decrease sperm
density (P ¼ 0.05); moreover, our pooled results also suggest that
mobile phone RF-EMR reduces sperm viability in rats, which has
not been shown previously. Despite considerable heterogeneity
among included human and animal studies, the large number of
studies enabled us to conduct subgroup analyses to further analyze
these heterogeneities caused by different experimental conditions.

4.1. Human cross-sectional studies

For the first time, our results suggest that differences in study
areas may cause heterogeneity when investigating sperm quality,
while the evaluation method contributed to heterogeneity of sperm
motility results. Analysis of sperm density, motility, and
morphology indicated that the respective studies in East Europe
and West Asia were less heterogeneous. The fact that study area
may be a source of heterogeneity may be due to differences in
ethnicities, habits, and research methods; moreover, statistical
fluke may not be ruled out, which should be considered in future
studies.
There are three particularly important aspects of the present
study. First, theoretically, if mobile phone use is associated with
reduced sperm quality, such correlations should become stronger
with increasing exposure time. Unfortunately, our present sub-
group analysis failed to show that duration of phone use affected
the pooled results or study heterogeneity, which may be attributed
to the recall bias in the epidemiological survey on mobile phone
use, which causes inaccuracy of survey results (Halgamuge et al.,
2020). Second, the sensitivity analysis suggested that the study Fig. 5. Forest plot of sperm density (A), motility (B), viability (C), and morphology (D)
by Feijo et al. significantly affected the pooled results, which may be in rat studies, and sperm density (E) in mouse studies. The pooled results suggested
that mobile phone RF-EMR exposure reduced sperm motility and viability in rats, and
due to the authors’ unique research method regarding mobile sperm density in mice.
phone use as they recorded only speaking time (Feijo et al., 2011),
8
G. Yu, Z. Bai, C. Song et al. Environmental Pollution 282 (2021) 116952

Table 2
Subgroup analysis of sperm density, motility and morphological normality of rats.

Condition Subgroup n MD/SMD I2（P） Model P

Sperm density Modeling method

Before analysis 16 0.26[-0.59,0.06] 56%(0.003) Random 0.11
Activity-free 10 0.16[-0.61,0.29] 62%（0.005） 0.49
Activity-restricted 6 0.45[-0.84,-0.07] 28%(0.22) 0.02
Age
Before analysis 16 0.36[-0.69,-0.02] 59%（0.001） Random 0.04
＞10 weeks 9 0.45[-0.87,-0.04] 52%（0.04） 0.03
＜10 weeks 7 0.25[-0.82,0.31] 65%(0.009) 0.38
Exposure device
Before analysis 17 0.32[-0.64,0.00] 58%（0.001） Random 0.05
Mobile phone 9 0.54[-1.11,0.03] 64%（0.005） 0.06
Simulator 8 0.14[-0.48,0.20] 40%（0.11） 0.43
Sperm motility Modeling method
Before analysis 11 0.83 [-1.41, 0.24] 80%（＜0. 00001） Random 0.005
Activity-free 8 0.95 [-1.85, 0.06] 85%（＜0. 00001） 0.04
Activity-restricted 3 0.61 [-0.97, 0.25] 0%（0.82） 0.001
Age
Before analysis 10 0.70[-1.29, 0.12] 78%（＜0.00001） Random 0.02
＞10 weeks 6 0.79 [-1.23, 0.36] 28%（0.22） Random 0.0003
＜10 weeks 4 0.49 [-1.83, 0.85] 89%（＜0. 00001） 0.47
Exposure time
Before analysis 12 0.97[-1.57, 0.37] 81% Random 0.002
＞140 h 5 0.45 [-1.36, 0.46] 87%（＜0.00001） Random 0.34
＜140 h 7 1.33 [-1.93, 0.73] 46%（0.09） ＜0.0001
Exposure device
Before analysis 11 0.83[-1.41, 0.24] 80%（＜0.00001） Fixed 0.005
Mobile phone 4 0.91 [-1.66, 0.16] 56%（0.08） Random 0.02
Simulator 7 0.77 [-1.65, 0.11] 85%（＜0.00001） 0.09
Sperm morphology normality Modeling method
Before analysis 7 0.37[-1.12, 0.37] 79%（＜0. 0001） Random 0.33
Activity-free 3 0.27[-0.60, 1.15] 66%（0. 05） 0.54
Activity-restricted 4 0.98[-2.06, 0.10] 78%（0. 003） 0.08
Exposure device
Before analysis 7 0.37[-1.12, 0.37] 79%（＜0. 0001） Random 0.33
Mobile phone 3 0.47[-0.83, 0.10] 0%（0.59） 0.01
Simulator 4 0.81[-2.41, 0.79] 88%（＜0.0001） 0.32

whereas other researchers recorded the entire duration of mobile
phone use. The duration of mobile phone use is a broad concept
that includes speaking time, thus in the future, researchers should
take measures to accurately record mobile phone usage to obtain
more reliable results. Third, in daily life, men who use their mobile
phones for prolonged periods of time are frequently highly pres-
sured and have irregular lifestyles; therefore, they are more prone
to smoking, drinking, and other unhealthy habits which may affect
sperm quality (Toda et al., 2006; Zhang et al., 2016). Compared with
the effects of mobile phone use on reproductive functions, the ef-
fects of these confounding factors on sperm quality would be
considerably stronger. Without distinguishing these factors, intra-
group differences in sperm quality would increase, resulting in
high heterogeneity in the analysis results. Therefore, further studies
should consider the importance of using appropriate research and
statistical methods that can eliminate the influence of confounding
factors. In the MARHCS cohort study, Zhang et al. conducted
multivariate analyses using health data of 794 men of childbearing
age living in Chongqing, China, and after accounting for potential
confounding factors such as smoking and drinking, extended
speaking time on mobile phones was found to be a risk factor for
the decline in sperm concentrations (Zhang et al., 2016). Apart from
cross-sectional surveys, new ways of exploring the effects of mobile
phone use on male health should also be encouraged. For example,
Volkow et al. used positron emission tomography scanning tech-
nology to detect brain function changes in humans when talking on
mobile phones, and they found that 50 min mobile phone exposure
was associated with increased brain glucose metabolism in the
region closest to the antenna (Volkow et al., 2011).
9
4.2. Human sperm in vitro studies
The pooled results of human sperm in vitro studies showed that
mobile phone RF-EMR can affect mature sperm in vitro, leading to a
decline in sperm motility and viability. These results suggest that
when performing in vitro sperm manipulation in reproductive
medicine, researchers should be attentive to the harmful effects of
EMR including mobile phone RF-EMR. However, present evidence
may not directly support that carrying mobile phones in trouser
pockets adversely affects sperm quality in men, resulting in a
decline in male fertility. The reason is that mature sperm are stored
within the human body where they are shielded by several tissues
such as the scrotal wall and the epididymal wall, and are protected
by semen components. After passing through these tissue walls, the
intensity of RF-EMR may have decreased sufficiently to not affect
mature sperm.
The total number of studies included in the sperm DFI analysis
was small, and heterogeneity of the results was large. For this
reason, even though the pooled results suggested that mobile
phone radiation did not affect sperm DFI in vitro, further studies are
required to support this conclusion.
4.3. Animal studies
Over the past six years, the total number of animal studies on
the effects of mobile phone RF-EMR on sperm function has signif-
icantly increased. Based on the pooled results, mobile phone RF-
EMR suppresses sperm motility and viability in rats and de-
creases sperm density in mice. For the first time, our subgroup
G. Yu, Z. Bai, C. Song et al.
analysis suggested decreased heterogeneity of the pooled results of
rats which were restrained during radiation exposure, which may
be attributed to the fact that restrained rats received more
consistent RF-EMR at larger doses than non-restrained rats. Further
analyses showed that sperm density of restrained rats decreased
significantly, which differed from the conclusions of Liu et al. as
their results showed high heterogeneity (Liu et al., 2014).
Rats are sexually mature at 10e12 weeks of age, and environ-
mental pollution can reduce sperm quality in immature or mature
rats via different mechanisms (Berndston 1977). Age may also be an
important factor affecting the heterogeneity of rat studies, which
has been shown in our analysis of sperm density and motility in rats
exposed to mobile phone RF-EMR. In addition, the results of the
present study indicate that mobile phone RF-EMR causes a signif-
icant decrease in sperm density and motility in rats older than 10
weeks, whereas in rats younger than 10 weeks, exposure to mobile
phone RF-EMR at an immature stage does not exert such significant
effects. These results may be explained by the low energy of mobile
phone RF-EMR and the strong recovery ability of immature rats.
Previously, Liu et al. hypothesized that exposure time and ra-
diation devices may be important factors affecting between-study
heterogeneity (Liu et al., 2014). The results of our study showed
that exposure time contributed to heterogeneity when investi-
gating sperm motility in rats; however, heterogeneity was large in
the long-term exposure subgroup, which may be attributed to the
considerable differences in exposure time between studies in this
subgroup (the shortest and longest exposure durations were 168 h
and 1095 h, respectively). Our results also supported the claim that
radiation device type is another important factor that affected
heterogeneity when investigating sperm density, motility, and
morphology in rats. However, some inconsistencies were observed
in the results of the respective subgroup analyses. Compared with
the mobile phone group, the simulator group was less heteroge-
neous regarding sperm density and was more heterogeneous
regarding motility and morphology. Generally, RF-EMR produced
by simulators is theoretically more stable than that produced by
mobile phones, thus heterogeneity in the simulator group should
be lower. These inconsistencies may be explained by the results of
our sensitivity analysis, which showed that the simulator group
included the study by Ozlem et al. which significantly increased
heterogeneity of the sperm motility analyses; in the morphology
analysis, the simulator group included studies by Nisbet et al. and
Yahyazadeh and Altunkaynak, which exerted substantial effects on
the heterogeneity of pooled studies (Nisbet et al., 2012; Yahyazadeh
and Altunkaynak, 2019). Unfortunately, our results cannot explain
how these studies increased the heterogeneity of the pooled
results.
Current animal studies have mostly investigated reproductive
effects of systemic exposure. As male reproductive ability is
affected by multiple tissues such as the hypothalamus, pituitary
gland, and the testes (Ajayi et al., 2020), researchers only prelimi-
narily explored whether mobile phone RF-EMR affects male
fertility via experiments with systemic exposure. However, they
could not determine the main reproductive organ through which
mobile phone RF-EMR exerts these effects. The National Institute of
Toxicology also proposed that investigating the effects of mobile
phone RF-EMR on certain organs was important for further clari-
fying the mechanism of mobile phone RF-EMR exposure on human
health when exploring the relationship between mobile phone RF-
EMR exposure and cancer (NIEHS 2018). This perspective is also
applicable regarding reproductive-toxicity research on mobile
phone RF-EMR. Moreover, the development of 5G, smart multi-
antenna, and beamforming technology may cause electromag-
netic field energy to concentrate in local space, resulting in a locally
high electromagnetic field pattern in certain organs. Research
10
Environmental Pollution 282 (2021) 116952
investigating local exposure to certain reproductive organs is thus
becoming increasingly important and necessary. Lastly, it should be
noted that some studies included in this meta-analysis were of low
quality, and their research information was incomplete, which may
have contributed to the high study heterogeneity and prevented in-
depth analysis.
4.4. Personal views
In the present study, we did not perform a subgroup analysis of
SAR owing to inconsistencies in the calculation of SAR values of
reproductive organs in the reviewed studies. For many years, SAR
has been recognized as a key index for evaluating environmental
safety of mobile phone RF-EMR (Chen and Wang 1994). However,
the current safety threshold of SAR can only reflect the thermal
effect of RF-EMR and does not account for non-thermal effects
(Gaestel 2010). In addition, the calculation of SAR is based on a fixed
value of a human body model and does not consider the actual
density, permeability, and dielectric constant of specific organs
affecting SAR values (Sallomi 2012). Moreover, SAR measurements
are not standardized. According to a previous report (Davis 2010),
the SAR value of the same product varies substantially between
measurements by different manufacturers. Thus, the current SAR
threshold may not be sufficiently safe to protect human health. The
academic community should identify other appropriate indices
that are more suitable for health evaluation, and interdisciplinary
cooperations should be established to redefine the safe threshold of
mobile phone RF-EMR dosages.
Mobile phone RF-EMR is a low-energy electromagnetic radia-
tion. The effects of this radiation on reproductive functions have
been examined using some macro-indices such as sperm density,
motility, and testicular morphology; however, normality of such
indices does not necessarily preclude adverse effects of mobile
phone RF-EMR on reproductive parameters. Further sperm-related
functional and molecular indices (especially at the genetic and
epigenetic levels) should be investigated because macroscopic
occurrence of a disease is frequently the result of cumulative
changes in the microenvironment.
Recently, low-dose toxins were suggested to alter the biological
characteristics of cells (Fernandez-Antoran et al., 2019). Based on
this, it is reasonable to assume that even though short-term or
intermittent mobile phone RF-EMR exposure is not strong enough
to damage organs, it may affect biological characteristics of germ
cells, resulting in alterations of disease-resistance ability of the
male reproductive system or, even more concerning, of offspring
health. Therefore, further research is needed to explore this issue in
depth.
Even though effects of mobile phone RF-EMR exposure on male
fertility have been studied extensively, progress in this field is slow,
and respective studies are limited regarding research scope and
depth. Further studies revealing the reproductive effects of mobile
phone RF-EMR are still of great practical importance because even
if mobile phone RF-EMR exerts only minor effects on the human
body and causes health problems in only a few permille of users, it
may still result in a global medical catastrophe (Falcioni et al., 2018).
With the development of model communication technology, the
presence of mobile phone RF-EMR in our lives will increase (Eeftens
et al., 2018; Havas 2017), and ignoring the problems caused by this
radiation may lead to a lack of relevant protective measures and
further decline in male fertility.
5. Conclusion
The results of our meta-analysis indicated that in East Europe
and West Asia, mobile phone use is associated with a decline in
G. Yu, Z. Bai, C. Song et al.
human sperm density and motility. Mobile phone RF-EMR can
reduce motility and viability of mature human sperm in vitro, and it
can also reduce sperm motility and viability in male animals and
decrease sperm density of sexually mature restrained rats. Some
important factors that affect the results of animal experiments are
study setup and radiation device as well as age and exposure time.
Our study is an extension of previous studies and has scientific
value for future studies on effects of mobile phone RF-EMR asso-
ciated with sperm quality.
Declaration of competing interest
The authors declare that they have no known competing
financial interests or personal relationships that could have
appeared to influence the work reported in this paper.
Acknowledgements
None.
Appendix A. Supplementary data
Supplementary data to this article can be found online at
https://doi.org/10.1016/j.envpol.2021.116952.
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