The diagnosis of male fertility is based on microscopic assessment and analysis of sperm concentration, motility and morphology as routine indicators of human semen quality. Successful pregnancy requires a sperm with genetic integrity. Several studies have shown that male fertility is affected by sperm DNA damage. Subsequently, the assessment of DNA integrity in sperm and the study of its consequences have received considerable attention. Several clinical studies have examined the relationships between sperm DNA damage and reproductive outcomes in the context of natural and ART pregnancies. For IVF and ICSI, the true utility of sperm DNA damage assays remains to be firmly established, since the available studies are generally small, heterogeneous, with conflicting results. Current data suggest that impaired sperm DNA integrity may have the greatest effect on IUI pregnancy rates, further prospective studies are needed before testing becomes a routine part of patient management.