Interest in the use of sperm DNA integrity as a predictor of fertility potential is on the rise. Clear differences in the levels of sperm DNA damage have been observed between fertile and infertile men. Sperm DNA damage has been found to be adversely affected by age. Men with a high percentage of DNA fragmentation have very low potential for in vitro and in vivo fertility. Moreover, DNA fragmentation is linked to effects on embryonic development, implantation and risk of recurrent miscarriages, and the health of offspring. The potential causes of sperm DNA damage are complex with multiple factors acting at both the intratesticular and posttesticular levels. Oxidative stress, defective sperm chromatin packaging, and disordered abortive apoptosis, are the three putative mechanisms most commonly associated with DNA damage. Sperm DNA damage can occur and can be assessed at different levels in the reproductive tract. Several methods have been developed to evaluate sperm DNA damage as well as assess DNA maturity, quality of packaging, and protamination of the chromatin. The challenge in the management of patients with elevated DNA damage increases proportionately with the rise of such damage. Positive effect of oral antioxidants has been reported. Several methods designed to separate superior spermatozoa from normal DNA have shown promising results, but await further evaluation and confirmation.