Association Between Bisphenol A Exposure and Declining Sperm Quality and Its Potential Mechanism: A Systematic Review and Meta‐Analysis Based on the Evidence of Epidemiological and Rodent Studies

Accumulating evidence suggests an association between bisphenol A (BPA) exposure and decreased sperm quality. This study aimed to investigate the relationship between BPA exposure and sperm quality through a systematic review and meta-analysis, utilizing epidemiological and rodent studies. Furthermore, we systematically elucidated the potential molecular mechanism of spermatogenesis disorder after exposure to BPA. We searched and collected studies from the Web of Science, PubMed, Embase, and Cochrane Controlled Trials Centers registers up to September 24, 2025. Meta-analyses used random-effects models to calculate regression coefficients (β), standard mean differences (SMD), and 95% CI to assess the effect of BPA on sperm quality (including semen volume, total sperm count, sperm concentration, progressive motility, and sperm morphology). Sixteen studies were included, involving six epidemiological studies and 10 rodent studies. Based on epidemiological studies, the findings indicated no association between BPA exposure and sperm quality. Inversely, the rodent data demonstrated a negative correlation between BPA exposure and sperm quality (pooled SMD = -3.87, 95% CI: -4.75, -3.00, p = 0.001), including semen volume (SMD = -7.09, 95% CI: -11.26, -2.96, p = 0.001), total sperm count (SMD = -3.87, 95% CI: -5.73, -2.01, p = 0.001), sperm concentration (SMD = -3.53, 95% CI: -5.29, -1.76, p = 0.004), sperm normal morphology rate (SMD = -2.56, 95% CI: -5.02, -0.10, p = 0.001), and progressive motility (SMD = -4.99, 95% CI: -6.60, -3.38, p = 0.001). Mechanistically, BPA destroys male reproductive health through oxidative stress, hormone disorders, inflammatory response, and epigenetic regulation, and ultimately leads to decreased male fertility. In summary, there is an adverse association between BPA exposure and semen quality based on rodent evidence, but not on epidemiological evidence. It provided insight cautiously into the association between BPA exposure and sperm quality in terms of updated evidence.