Objective: This systematic review and meta-analysis was aimed at determining whether paternal age is a risk factor for offspring birth defects.

Results: A total of 38 and 11 studies were included in the systematic review and meta-analysis, respectively. Compared with reference, fathers aged 25 to 29, young fathers (< 20 years) could increase the risk of urogenital abnormalities (OR: 1.50, 95 % CI: 1.03–2.19) and chromosome disorders (OR: 1.38, 95 % CI: 1.12–1.52) in their offsprings; old fathers (≥ 40 years) could increase the risk of cardiovascular abnormalities (OR: 1.10, 95 % CI: 1.01–1.20), facial deformities (OR: 1.08, 95 % CI: 1.00–1.17), urogenital abnormalities (OR: 1.28, 95 % CI: 1.07–1.52), and chromosome disorders (OR: 1.30, 95 % CI: 1.12–1.52).

Conclusions: Our study indicated that paternal age is associated with a moderate increase in the incidence of urogenital and cardiovascular abnormalities, facial deformities, and chromosome disorders.

Methods: PubMed, Web of Science, the Cochrane Library, and Embase were searched for relevant literatures from 1960 to February 2020. The systematic review follows PRISMA guidelines. Relevant meta-analyses were performed.