In recent years, infertility has become the subject of significant media attention and public discussion, particularly in light of new advances in the technology of assisted reproduction. Male factor infertility plays a role in approximately 50% of infertility cases with male factor as a sole cause in about 35%. In India, approximately 15% of couples are unable to initiate a pregnancy without some form of assistance or therapy. These patients are said to be “primarily infertile.” In approximately 2% of these couples there are factors other than seminal abnormalities, which prevent conception. This chapter covers the biological basis of male sexual response, nonconsummation of marriage, ejaculatory disturbances, vibratory stimulation, and erectile dysfunction introduction. The revolutionary technique of intracytoplasmic sperm injection (ICSI), which involves the injection of a single sperm into an oocyte, is particularly applicable for these patients and has been very successful in initiating pregnancies. The potential for improvement in semen recovery and processing is great and must be considered a challenge for the immediate future.