This chapter describes the role of surgery in male infertility. Over the past couple of years the indications and techniques of surgery for male infertility have been significantly refined, resulting in substantially increased success in the management of male-factor infertility. These advances include refined microsurgical techniques for sperm retrieval combined with in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) for men with nonobstructive azoospermia (NOA), improved techniques for microsurgical reconstruction for obstruction, and increasing use of genetic and molecular biologic markers to better select patients for surgical treatment. Surgical treatment includes varicocele repair, transurethral resection of the ejaculatory duct, and reconstructive surgery of the vas deferens and epididymis. Varicocele treatment based on the presence of clinically palpable varicocele and abnormal semen parameters should be reconsidered in light of the newly proposed guidelines.