Purpose To determine whether the use of Magnetic Activated Cell Sorting (MACS) as a sperm selection technique improves ART success rates in couples undergoing assisted reproduction treatment. Methods Systematic review and meta-analysis of prospective randomized trials. Two reviewers conducted study selection and data extraction independently. Results Five studies (prospective randomized trials) that comprised 499 patients were included. Sperm selection using MACS resulted in statistically significant differences in pregnancy rates when compared with density gradient centrifugation and swim-up techniques (RR= 1.50, 95 % CI 1.14-1.98). No differences were found between the groups according to the implantation (RR= 1.03, 95 % CI 0.80-1.31) and miscarriage (RR=2. 00, rates. Conclusions MACS appears to be a safe and efficient method to select functional sperm with consistently good results. This technique may improve pregnancy rates when used to complement standard sperm selection methods in ART.