The quality of the spermatozoa likely influences embryo development and subsequent pregnancy outcomes. Advanced sperm selection techniques choose viable, mature, and structurally intact sperm with high DNA integrity for fertilization. This review study aimed to determine whether there is evidence on the overall benefit of these techniques on the morphokinetic parameters of embryos and clinical outcomes in ICSI. The protocol was registered with PROSPERO, and comprehensive searches were carried out in the Cochrane, PubMed, Google Scholar, and Scopus databases. After removal of duplicates, 35 articles underwent title and abstract screening, of which 16 were excluded. Full‐text assessment was performed on the remaining studies, resulting in the inclusion of seven randomized controlled trials for qualitative synthesis. Most of the included studies were assessed as having a low risk of bias. Studies have reported higher fertilization, improved embryo morphology scores, and increased clinical pregnancy rates using advanced selection techniques compared to density gradient centrifugation or swim‐up methods. While improvements in intermediate outcomes are consistently reported, the evidence for improved live birth rates remains less robust, with some studies failing to reach statistical significance. This underscores the need for larger, randomized clinical trials to validate the clinical utility of these techniques and establish standardized protocols for their use.
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