Background The growing population of male adolescent and young adult (AYA, 15-40 years old) cancer survivors has heightened interest in their reproductive health. However, studies have reported conflicting findings on the potential risks of cancer and its treatments on birth and obstetric outcomes. Methods We utilized encrypted identification numbers for both fathers and mothers to link three nationwide Taiwan datasets from 2004 to 2019, identifying 3,785 births with a paternal history of AYA cancer. For comparison, we included 37,850 matched fathers without a cancer history, matched by paternal age and infant birth year. We employed multivariable logistic regression analysis to identify independent associations between adverse birth outcomes (e.g., preterm labor, low birthweight, and congenital malformations) and obstetric outcomes (e.g., fetal growth restriction, threatened labor, and threatened abortion) and being born to male AYA cancer survivors. Results The offspring of male AYA cancer survivors did not exhibit a significantly increased risk of adverse birth (odds ratio [OR] = 1.0; 95% confidence interval [CI] = 0.9-1.1) or obstetric (OR = 1.1; 95% CI = 1.0-1.1) outcomes compared to offspring born to cancer-free matched fathers. Furthermore, the risk of preterm labor, low birthweight, congenital malformations, fetal growth restriction, and threatened labor or miscarriage was comparable between groups. Conclusions Paternal cancer history during adolescence or young adulthood does not appear to increase offspring's risk of adverse birth or obstetric outcomes. Impact This study reassures about this population's reproductive health, providing valuable insights for oncology and reproductive medicine, potentially influencing patient counseling and guidelines.