For couples with high levels of sperm DNA damage, assisted reproductive techniques (ART) employing intracytoplasmic sperm injection (ICSI) or intracytoplasmic morphologically selected sperm injection (IMSI) are recommended. These methods allow for the selection of sperm with normal morphology, offering an improved approach compared to intrauterine insemination (IUI) and conventional in vitro fertilization (IVF). In certain cases, the use of testicular sperm, obtained through testicular sperm extraction (TESE), is also a preferred option over ejaculated sperm. These advanced interventions have been shown to lead to higher rates of pregnancy and live births.