Effects of radiofrequency electromagnetic field (RF-EMF) exposure on male fertility: A systematic review of experimental studies on non-human mammals and human sperm in vitro

BACKGROUND

The World Health Organization is coordinating an international project aimed at systematically reviewing the evidence regarding the association between radiofrequency electromagnetic field (RF-EMF) exposure and adverse health effects. Reproductive health outcomes have been identified among the priority topics to be addressed.

OBJECTIVES

To evaluate the effect of RF-EMF exposure on male fertility of experimental mammals and on human sperm exposed in vitro.

METHODS

Three electronic databases (PubMed, Scopus and EMF Portal) were last searched on September 17, 2022. Two independent reviewers screened the studies, which were considered eligible if met the following criteria: 1) Peer-reviewed publications of sham controlled experimental studies, 2) Non-human male mammals exposed at any stage of development or human sperm exposed in vitro, 3) RF-EMF exposure within the frequency range of 100 kHz-300 GHz, including electromagnetic pulses (EMP), 4) one of the following indicators of reproductive system impairment:Two reviewers extracted study characteristics and outcome data. We assessed risk of bias (RoB) using the Office of Health Assessment and Translation (OHAT) guidelines. We categorized studies into 3 levels of overall RoB: low, some or high concern. We pooled study results in a random effects meta-analysis comparing average exposure to no-exposure and in a dose-response meta-analysis using all exposure doses. For experimental animal studies, we conducted subgroup analyses for species, Specific Absorption Rate (SAR) and temperature increase. We grouped studies on human sperm exposed in vitro by the fertility status of sample donors and SAR. We assessed the certainty of the evidence using the GRADE approach after excluding studies that were rated as "high concern" for RoB.

RESULTS

One-hundred and seventeen papers on animal studies and 10 papers on human sperm exposed in vitro were included in this review. Only few studies were rated as "low concern" because most studies were at RoB for exposure and/or outcome assessment. Subgrouping the experimental animal studies by species, SAR, and temperature increase partly accounted for the heterogeneity of individual studies in about one third of the meta-analyses. In no case was it possible to conduct a subgroup analysis of the few human sperm in vitro studies because there were always 1 or more groups including less than 3 studies. Among all the considered endpoints, the meta-analyses of animal studies provided evidence of adverse effects of RF-EMF exposure in all cases but the rate of infertile males and the size of the sired litters. The assessment of certainty according to the GRADE methodology assigned a moderate certainty to the reduction of pregnancy rate and to the evidence of no-effect on litter size, a low certainty to the reduction of sperm count, and a very low certainty to all the other meta-analysis results. Studies on human sperm exposed in vitro indicated a small detrimental effect of RF-EMF exposure on vitality and no-effect on DNA/chromatin alterations. According to GRADE, a very low certainty was attributed to these results. The few studies that used EMP exposure did not show effects on the outcomes. A low to very low certainty was attributed to these results.

DISCUSSION

Many of the studies examined suffered of severe limitations that led to the attribution of uncertainty to the results of the meta-analyses and did not allow to draw firm conclusions on most of the endpoints. Nevertheless, the associations between RF-EMF exposure and decrease of pregnancy rate and sperm count, to which moderate and low certainty were attributed, are not negligible, also in view of the indications that in Western countries human male fertility potential seems to be progressively declining. It was beyond the scope of our systematic review to determine the shape of the dose-response relationship or to identify a minimum effective exposure level. The subgroup and the dose-response fitting analyses did not show a consistent relationship between the exposure levels and the observed effects. Notably, most studies evaluated RF-EMF exposure levels that were higher than the levels to which human populations are typically exposed, and the limits set in international guidelines. For these reasons we cannot provide suggestions to confirm or reconsider current human exposure limits. Considering the outcomes of this systematic review and taking into account the limitations found in several of the studies, we suggest that further investigations with better characterization of exposure and dosimetry including several exposure levels and blinded outcome assessment were conducted.

PROTOCOL REGISTRATION

Protocols for the systematic reviews of animal studies and of human sperm in vitro studies were published in Pacchierotti et al., 2021. The former was also registered in PROSPERO (CRD42021227729 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID = 227729) and the latter in Open Science Framework (OSF Registration DOI https://doi.org/10.17605/OSF.IO/7MUS3).

Effect of electromagnetic radiation on the liver structure and ultrastructure of in utero irradiated rats

The aim of this study was to observe the influence of electromagnetic radiation (EMR) on the structure and ultrastructure of the rat’s liver. The pregnant rats used in the experiment were exposed to a pulsed microwave radiation (frequency of 2.45 GHz; mean power density of 2.8 mW/cm2) daily for 2 h, throughout their pregnancy. After delivery, the offspring was not exposed to EMR. Samples of the liver of 5-week-old offspring were subjected to histopathological evaluation. They were processed for light and transmission electron microscopy. Our results indicated that EMR did not cause pronounced changes in the structure of the liver of the investigated offspring. The size and shape of liver lobuli was preserved and the amount of connective tissue in the liver parenchyma did not increase. However, electron microscopy revealed changes in the shape and number of microvilli at the vascular pole of hepatocytes, and formation of vesicles of various shapes and sizes. The endothelial cells were swollen with larger fenestrations compared to the control group. The spaces of Disse were irregular and dilated. Even though these changes were only mild, further studies are needed to determine the effect of EMR and clarify its potential risk during pregnancy.

Effects of mobile phone radiofrequency radiation on sperm quality

In the last decades, the universal use of mobile phones has contributed to radiofrequency electromagnetic radiation environmental pollution. The steady growth in mobile phone usage has raised concerns about the effects of phone radiation on male reproductive health. Epidemiological studies report a sharp decline in sperm counts in developing countries, and worldwide with c. 14% of couples having difficulties to conceive, many of which are attributed to a male infertility factor. Environment and lifestyle factors are known to contribute to male infertility. Exposure to heat, radiation, or radioactivity might induce damage to biological tissue organs, including the testis. Given the ubiquitous use of mobile phones, the potential adverse effects of the resulting environmental radiation needs to be elucidated further. It seems to be an apparent relationship between the increased exposure to mobile phone radiofrequency and sperm quality decline, but the evidence is not conclusive. Our review summarizes the evidence concerning the possible adverse effects of cell phone radiation on the male reproductive system, with a focus on sperm quality. Also, we critically analyze the effects of elevated testicular temperature and oxidative stress on male fertility and how these factors could interfere with the physiological activities of the testis.

Current progress on the effect of mobile phone radiation on sperm quality: An updated systematic review and meta-analysis of human and animal studies

Potential suppression of fertility due to mobile phone radiation remains a focus of researchers. We conducted meta-analyses on the effects of mobile phone radiation on sperm quality using recent evidence and propose some perspectives on this issue. Using the MEDLINE/PubMed, Embase, WOS, CENTRAL, and ClinicalTrials.gov databases, we retrieved and screened studies published before December 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 conducted subgroup, sensitivity, and publication bias analyses. The pooled results of human cross-sectional studies did not support an association of mobile phone use and a decline in sperm quality. Different study areas contributed to the heterogeneity of the studies. In East Europe and West Asia, 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 standardized 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.

Effects of 1.5-GHz high-power microwave exposure on the reproductive systems of male mice

High-power microwaves (HPMs) have been reported to have hazardous effects on multiple human and animal organs. However, the biological effects of 1.5-GHz HPMs on the reproductive system are not clear. Here, we studied the effects of 1.5 -GHz HPM whole-body exposure on the pathological structure of the testicles and changes in spermatozoa mobility. C57BL/6 mice of groups L, M, and H were exposed to 1.5-GHz HPM fields for two 15-min intervals at the average specific absorption rates of 3, 6, and 12 W/Kg, respectively. The pathological structure of the testicles and spermatozoa, as well as serum testosterone and sperm motility parameters, were evaluated at 6 h, 1 d, 3 d, and 7 d after exposure. As a result, there were no significant pathological or ultrastructural changes in the testicles or spermatozoa and serum testosterone levels. The number of progressively motile spermatozoa, curvilinear velocity, linear velocity, and average path velocity of the exposure group increased at 6 h, decreased at 1 d, and recovered at 3 d. The opposite results were considered a stress response to the thermal effect of the microwaves. Our results indicated that 1.5-GHz HPM whole-body exposure in mice at SARs of 3, 6, and 12 W/Kg for 30 min did not cause obvious damage to the reproductive system.

Exogenous Factors Affecting the Functional Integrity of Male Reproduction

Natural processes along with increased industrial production and the irresponsible behavior of mankind have resulted in environmental pollution. Environmental pollutants can be categorized based on their characteristics and appearance into the following groups: physical, biological, and chemical. Every single one of them represents a serious threat to the male reproductive tract despite the different modes of action. Male gonads and gametes are especially vulnerable to the effect of exogenous factors; therefore, they are considered a reliable indicator of environmental pollution. The impact of xenobiotics or radiation leads to an irreversible impairment of fertility displayed by histological changes, modulated androgen production, or compromised spermatozoa (or germ cells) quality. The present article reviews the exogenous threats, male reproductive system, the mode of action, and overall impact on the reproductive health of humans and animals.

Establishment of injury models in studies of biological effects induced by microwave radiation

Microwave radiation has been widely used in various fields, such as communication, industry, medical treatment, and military applications. Microwave radiation may cause injuries to both the structures and functions of various organs, such as the brain, heart, reproductive organs, and endocrine organs, which endanger human health. Therefore, it is both theoretically and clinically important to conduct studies on the biological effects induced by microwave radiation. The successful establishment of injury models is of great importance to the reliability and reproducibility of these studies. In this article, we review the microwave exposure conditions, subjects used to establish injury models, the methods used for the assessment of the injuries, and the indicators implemented to evaluate the success of injury model establishment in studies on biological effects induced by microwave radiation.