Background/Objectives: The reproductive effects of antiseizure medications (ASMs) in men remain insufficiently characterized, particularly for individual agents. We comprehensively evaluated associations across multiple ASMs, reproductive endpoints, and comparator groups using meta-analysis and FAERS-based pharmacovigilance analysis. Methods: Clinical studies of men with epilepsy receiving ASMs were systematically reviewed and quantitatively synthesized using untreated patients and healthy individuals as comparators. Male reproductive adverse events reported to the FDA Adverse Event Reporting System (FAERS) from 2019Q1 to 2026Q2 were assessed using reporting odds ratios and information components. Results: Twenty studies involving 1,530 participants were included. Valproate was associated with adverse changes in reproductive hormones, semen parameters, and sexual function, whereas carbamazepine and phenytoin showed alterations mainly in hormonal outcomes. In FAERS, valproate showed disproportionate reporting of male reproductive disorders (IC₀₂₅=1.792). Conclusions: Reproductive effects differed across individual ASMs. Valproate showed the broadest pattern of alterations, while carbamazepine and phenytoin were predominantly associated with endocrine changes. These findings support drug-specific consideration of reproductive health during long-term ASM therapy.