Female factors are known to be strongly associated with assisted reproduction outcomes, such as egg quality, mother’s age, endometrial thickness, etc., so does sperm quality affect assisted reproduction outcomes? Three recent reports in this area are presented. 1. Is the age of the sperm donor related to the outcome of assisted pregnancy? A large retrospective cohort study published in January of this year in the journal Human Reproduction (reveals the age of the sperm donor and the outcome of assisted reproduction. The study included 46,078 patients registered from 1991 to 2012 for assisted reproduction using donor sperm (DI) or in vitro fertilization (IVF)/intracytoplasmic monosperm microinjection (ICSI). In both the DI and IVF/ICSI groups, after using sperm donor age 41-45 years as a control group, the remaining sperm donor age groups did not significantly elevate the live birth rate or significantly decrease the miscarriage rate. The conclusion of this study therefore suggests that more studies may be needed in the future to confirm the upper age limit of sperm donors. However, the study also presents limitations, such as: sperm donor age is an important indicator of sperm quality, so the present findings cannot be applied to the general population, and many other important factors, such as smoking, maternal body mass index, etc., could not be determined in the present study. Correlation of apoptotic markers in sperm with assisted pregnancy outcome Traditionally, sperm quality has been evaluated using only microscopic morphology, but morphology alone is not a complete indicator of sperm quality. A Polish study recently confirmed the correlation between sperm surface apoptosis markers and their quality, and the results were published in the January issue of Human Cell. The study recruited 116 men from a fertility clinic and tested their semen for apoptotic markers of sperm cells, namely intracellular-extracellular phosphatidylserine (PST) and cysteine aspartate protease 3. Fertilization rate was standardized according to the percentage of prokaryotic presentation of the eggs after surgery. The results showed that PST and caspase-3 were detectable in the middle of the active mirror and that sperm concentration, morphological excellence and viability showed a negative correlation with both markers. In the IVF group, both markers were significantly negatively correlated with fertilization rate; in the ICSI group, both markers were not associated with fertilization rate. The study concluded that PST and caspase-3, which are located in the midpiece of spermatozoa, not only alter sperm motility and morphology, but also are closely related to sperm fertilization. These two markers can be applied to detect sperm quality in the future. 3. What if the sperm DNA fragmentation index is too high? Sperm DNA Fragmentation Index is an indicator that evaluates the structural integrity of sperm chromosomes. A recent Swiss study showed that the use of ICSI for sperm samples with a high DFI resulted in more satisfactory assisted reproduction outcomes than traditional IVF. The results were published in the January issue of the journal Andrology. The study collected 1,633 samples from IVF versus ICSI cycles and categorized the sperm samples into four groups from low to high DFI. The results showed that in the conventional IVF group, the lower the rate of high-quality embryos and the rate of live births were significantly lower as the DFI index increased. And this trend was not found in the ICSI group. For sperm samples with DFI higher than 20%, the live birth rate after ICSI intervention was significantly higher than that in the conventional IVF group. However, the study also found that the rate of spontaneous abortion was higher in the ICSI group than in the conventional DFI group, and there was no significant difference in pregnancy rates between the two groups. The conclusion of the study proposes that ICSI may be a more favorable option for sperm with higher DFI. It should also be noted that this study is a retrospective data analysis and the results need to be supported by further prospective studies.