This survey describes the results of a questionnaire on the methodology of sperm morphology assessment. A questionnaire form was sent to 410 fertility centres. A total of 170 answer forms (41.5%) from 40 different countries was evaluated. Most responding centres (147 or 86.5%) treat more than 200 new couples per year. According to our results, a wide and complex variation in different methods of sperm preparation, staining procedures and classification systems is observed world wide. WHO recommendations for sperm preparation seem to be poorly followed. Only 86 centres (50.6%) reported the use of a single approach to both semen preparation and sperm morphology evaluation. Our results indicate an urgent need for standardization and consensus on sperm morphology methodology to regain the power of this important sperm parameter.