DNA fragmentation, or the accumulation of sin- gle- and double-strand DNA breaks, is a common property of sperm, and an increase in the level of sperm DNA fragmentation is known to influence natural reproduction. The effect of sperm DNA fragmentation on male infertility and assisted reproductive treatment (ART) outcomes remains controversial and is one of the most frequently debated topics of reproductive medicine. For the past 30 years, a number of assays have been devel- oped to quantify the level of sperm DNA fragmen- tation. In this chapter, we review the causes of sperm DNA fragmentation, describe the com- monly used tests to evaluate these abnormalities, and perform a systematic review of existing stud- ies to determine the impact of sperm DNA frag- mentation on male fertility and ART outcomes.

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