Sperm selection for assisted reproductive technology: do we have a winner?

Assisted reproductive technology (ART) has emerged as a pivotal solution for human infertility, with intracytoplasmic sperm injection (ICSI) being widely adopted. The quality of sperm is critical to the outcomes of ART, and the selection of optimal sperm is essential for enhancing embryo quality. In recent years, researchers have developed various advanced sperm selection methods that simulate the natural sperm selection process occurring in the female reproductive tract. Although many studies have been conducted to identify the selection technique, many doubts and disagreements still remain. In this review, we will examine the characteristics, advantages, and limitations of both traditional and advanced sperm selection methods, evaluate their impact on sperm quality and functional parameters, as well as ART outcomes for infertile couples, and provide evidence-based recommendations for embryologists to optimize sperm selection strategies.