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Organic solvents are widely used, but conflicting reports exist concerning paternal exposure and adverse pregnancy outcomes. We conducted a meta-analysis to assess the risks of spontaneous abortions (SAs) and major malformations (MMs) after paternal exposure to organic solvents.Medline, Toxline, Reprotox, and Embase from 1966 to 2003 were searched. Two independent reviewers searched for cohort and case-control studies in any language on adult human males exposed chronically to any organic solvent. Two non-blinded independent extractors used a standardized form for data extraction; disagreements were resolved through consensus discussion.Forty-seven studies were identified; 32 exclusions left 14 useable studies. Overall random effects odds ratios and 95% confidence intervals (CI95%) were 1.30 (CI95%: 0.81–2.11, N = 1,248) for SA, 1.47 (CI95%: 1.18–1.83, N = 384,762) for MMs, 1.86 (CI95%: 1.40–2.46, N = 180,242) for any neural tube defect, 2.18 (CI95%: 1.52–3.11, N = 107,761) for anencephaly, and 1.59 (CI95%: 0.99–2.56, N = 96,517; power = 56.3%) for spina bifida.Paternal exposure to organic solvents is associated with an increased risk for neural tube defects but not SAs. Am. J. Ind. Med. 47:37–44, 2005. © 2004 Wiley-Liss, Inc.