Sperm DNA damage: clinical significance in the era of assisted reproduction

Evidence suggests that damage to human sperm DNA might adversely affect reproductive outcomes and that the spermatozoa of infertile men possess substantially more sperm DNA damage than do the spermatozoa of fertile men. This is particularly relevant in an era where advanced forms of assisted reproductive technologies are commonly used (technologies that often bypass the barriers to natural selection), because there is some uncertainty regarding the safety of using DNA-damaged spermatozoa. In this review, we outline our current understanding of how sperm DNA is organized, what causes sperm DNA damage, what impact this damage may have on reproductive capacity and whether tests of sperm DNA damage are clinically useful.