Over the past 20 years, there has been growing interest in understanding the genomic integrity of human spermatozoa and the clinical relevance of sperm chromatin and DNA defects. We have learned that the etiology of human sperm DNA damage is multi-factorial and that sperm DNA defects are associated with abnormal semen parameters. While we have observed that tests of sperm DNA integrity are correlated with reproductive outcomes, use of these complementary biomarkers in the management of male infertility remains controversial. In this chapter, we review the etiologic factors associated with sperm DNA damage and the utility of these tests in clinical practice. We also review the treatment options for infertile men with sperm DNA damage.

One of the contemporary challenges in treating infertility is to identify those couples that will likely fail to conceive naturally or after assisted reproduction and will require more extensive interventions to achieve conception. The conventional sperm parameters (sperm concentration, motility, and morphology) provide us with information on the functionality of the seminiferous tubules and the reproductive tract. However, a major drawback of the semen analysis is that conventional sperm parameters are crude indicators of male fertility potential and the reference ranges for these parameters were set based on a population of fertile couples who succeeded in achieving a natural conception [1]. Moreover, these same parameters are not useful in predicting reproductive outcomes with assisted reproductive technologies. As such, there is a real need to identify markers that can accurately assess male fertility potential and help predict reproductive outcomes with assisted reproductive technologies