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The effects of radiofrequency exposure on male fertility and adverse reproductive outcomes: A protocol for two systematic reviews of human observational studies with meta-analysis

Lookup NU author(s): Dr Ryan KennyORCiD, Adenike AdesanyaORCiD, Catherine Richmond, Fiona Beyer, Professor Judith Rankin, Professor Mark PearceORCiD, Professor Dawn CraigORCiD, Dr Fiona Pearson



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2021. Background: The World Health Organization (WHO) is bringing together evidence on radiofrequency electromagnetic field (RF-EMF) exposure in relation to health outcomes, previously identified as priorities for evaluation by experts in the field, to inform exposure guidelines. A suite of systematic reviews are being undertaken by a network of topic experts and methodologists in order to collect, assess and synthesise data relevant to these guidelines. Here, we present the protocol for the systematic review on the effect of exposure to RF on adverse reproductive outcomes (human observational studies), also referred to as Systematic Review (SR) 3 within the series of systematic reviews currently being commissioned. Objectives: Following the WHO handbook for guideline development and the COSTER conduct guidelines, we will systematically review the effect of RF-EMF exposure on both male fertility (SR3A) and adverse pregnancy outcomes (SR3B) in human observational studies. Herein we adhere to the PRISMA-P reporting guidelines. Data sources: We will conduct a broad search for potentially relevant records relevant for both reviews within the following bibliographic databases: MEDLINE; Embase; and EMF Portal. We will also conduct searches of grey literature through relevant databases and organisational websites. RF-EMF experts will also be consulted. We will hand search citation and reference lists of included study records. Study eligibility criteria: We will include quantitative human observational studies on the effect of RF-EMF exposure: (in SR3A) in adult male participants on infertility, sperm morphology, concentration or total sperm count or motility; and (in SR3B) in preconception adults or pregnant women on preterm birth, small for gestational age (associated with intrauterine growth restriction), miscarriage, stillbirth and congenital anomalies. Study appraisal and synthesis methods: Titles, abstracts and then full texts will be screened in blinded duplicate against eligibility criteria with input from a third reviewer as required. Data extraction from included studies will be completed by two reviewers as will risk of bias assessment using the Office of Health Assessment and Translation (OHAT) tool. If appropriate we will undertake meta-analysis to pool effect measures and explore heterogeneity using sub-group analyses or meta-regression as feasible. We will conduct sensitivity analysis to assess the impact of any assumptions made throughout the review process. The OHAT methodology, based on the GRADE guidelines for evidence assessment, will be used to evaluate the certainty of evidence per outcome and to conclude the level of evidence of a health effect. Conclusion: This manuscript details the protocols for two systematic reviews. The aims of publishing details of both protocols are to: pre-specify their scope and methods; reduce the impact of reviewer bias; promote transparency and replicability; and improve the review process. Prospero registration: CRD42021265401 (SR3A), CRD42021266268 (SR3B).

Publication metadata

Author(s): Kenny RPW, Millar EB, Adesanya A, Richmond C, Beyer F, Calderon C, Rankin J, Toledano M, Feychting M, Pearce MS, Craig D, Pearson F

Publication type: Article

Publication status: Published

Journal: Environment International

Year: 2022

Volume: 158

Print publication date: 01/01/2022

Online publication date: 01/11/2021

Acceptance date: 28/10/2021

Date deposited: 15/11/2021

ISSN (print): 0160-4120

ISSN (electronic): 1873-6750

Publisher: Elsevier Ltd


DOI: 10.1016/j.envint.2021.106968


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