BACKGROUND Evidence of the negative impacts of contemporary use insecticides on sperm concentration has increased over the last few decades; however, meta-analyses on this topic are rare. OBJECTIVES This investigation assessed the qualitative and quantitative strength of epidemiological evidence regarding adult exposure to two classes of contemporary use insecticides-organophosphates (OPs) and N-methyl carbamates (NMCs)-and sperm concentration using robust and reproducible systematic review and meta-analysis methods. METHODS Three scientific databases (PubMed, Scopus, and Web of Science), two U.S. government databases (NIOSHTIC-2 and Science.gov), and five nongovernmental organization websites were searched for relevant primary epidemiological studies published in any language through 11 August 2022. Risk of bias and strength of evidence were evaluated according to Navigation Guide systematic review methodology. Bias-adjusted standardized mean difference effect sizes were calculated and pooled using a three-level, multivariate random-effect meta-analysis model with cluster-robust variance estimation. RESULTS Across 20 studies, 21 study populations, 42 effect sizes, and 1,774 adult men, the pooled bias-adjusted standardized mean difference in sperm concentration between adult men more- and less-exposed to OP and NMC insecticides was -0.30 (95% CI: -0.49, -0.10; PSatt<0.01). Sensitivity and subgroup analyses explored statistical heterogeneity and validated the model robustness. Although the pooled effect estimate was modified by risk of bias, insecticide class, exposure setting, and recruitment setting, it remained negative in direction across all meta-analyses. The body of evidence was rated to be of moderate quality, with sufficient evidence of an association between higher adult OP and NMC insecticide exposure and lower sperm concentration. DISCUSSION This comprehensive investigation found sufficient evidence of an association between higher OP and NMC insecticide exposure and lower sperm concentration in adults. Although additional cohort studies can be beneficial to fill data gaps, the strength of evidence warrants reducing exposure to OP and NMC insecticides now to prevent continued male reproductive harm. https://doi.org/10.1289/EHP12678.

中文翻译：

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成人有机磷和氨基甲酸酯杀虫剂暴露和精子浓度：流行病学证据的系统回顾和荟萃分析。

背景技术在过去的几十年里，越来越多的证据表明当代使用的杀虫剂对精子浓度产生负面影响。然而，关于这个主题的荟萃分析很少。目的 本次调查使用稳健且可重复的系统评价和荟萃分析方法，评估了成人接触两类当代使用的杀虫剂（有机磷酸酯 (OP) 和 N-甲基氨基甲酸酯 (NMC)）以及精子浓度的流行病学证据的定性和定量强度。 。方法 检索三个科学数据库（PubMed、Scopus 和 Web of Science）、两个美国政府数据库（NIOSHTIC-2 和 Science.gov）和五个非政府组织网站，查找截至 2022 年 8 月 11 日以任何语言发表的相关主要流行病学研究。根据导航指南系统评价方法评估偏倚风险和证据强度。使用三水平、多变量随机效应荟萃分析模型和聚类稳健方差估计来计算和汇总偏差调整后的标准化平均差异效应大小。结果 在 20 项研究、21 个研究人群、42 个效应大小和 1,774 名成年男性中，更多和更少接触 OP 和 NMC 杀虫剂的成年男性之间精子浓度的汇总偏差调整标准化平均差异为 -0.30（95% CI ：-0.49，-0.10；PSatt<0.01）。敏感性和亚组分析探讨了统计异质性并验证了模型的稳健性。尽管汇总效应估计因偏倚风险、杀虫剂类别、暴露环境和招募环境进行了修改，但在所有荟萃分析中，它的方向仍然是负面的。证据质量被评为中等，有足够的证据表明成人 OP 和 NMC 杀虫剂暴露量较高与精子浓度较低之间存在关联。讨论 这项全面的调查发现了足够的证据表明成人中较高的 OP 和 NMC 杀虫剂暴露与较低的精子浓度之间存在关联。尽管额外的队列研究可能有助于填补数据空白，但有充分的证据表明现在应减少接触 OP 和 NMC 杀虫剂，以防止持续的男性生殖伤害。https://doi.org/10.1289/EHP12678。