Air pollution affects not only sperm quality, such as the amount of sperm, sperm concentration, motility, progressive movement, morphology and other physical characteristics, but also the sperm genome, such as DNA fragmentation index and chromosome integrity. Air pollution has also been shown to influence male fertility by affecting the testosterone level or even testicular tissue cells. This review summarizes these issues on two levels: epidemiologically at the population level and from findings in animal research. This review also presents four possible mechanisms by which air pollutants affect spermatogenesis and development: as endocrine disruptors, by inducing reactive oxygen species, by destroying the blood-testosterone barrier, and by causing DNA mutations and epigenetic modifications. Finally, this review surveys recent studies suggesting medicines that have protective effects on sperm development.