One of the most promising markers in the evaluation of male infertility is sperm DNA fragmentation. Studies have shown that the etiology of sperm DNA fragmentation is multifactorial, and includes genetic and developmental abnormalities, ageing, gonadotoxins, hyperthermia, varicocele, medications, and endocrine abnormalities. Clinical studies have demonstrated that sperm DNA damage is associated with poor reproductive outcomes and based on these observation investigators have proposed that tests of sperm DNA fragmentation be used in the evaluation of infertile couples, particularly in those with recurrent pregnancy loss, failed ICSI cycles, and unexplained infertility. An abnormal sperm DNA test in these couples should prompt a thorough evaluation as it may help the clinician uncover the etiology of DNA damage and initiate cause-specific treatment to optimize reproductive outcomes.