Spectacular progress in the therapeutic management of patients with severe male infertility was obtained with the implementation of intracytoplasmic sperm injection (ICSI) and has opened avenues to treating previously untreatable cases of infertility. However, it must be recognized that in the vast majority of ICSI cycles, the selection of the spermatozoon followed by the intracytoplasmic injection is done very quickly at low magnification and without detection possibilities for potential pathological morphological anomalies of spermatozoa. Strong correlations between sperm morphological characteristics and male fertility have been demonstrated. Thus, it seems reasonable to implement optimized non-invasive sperm selection techniques in ART based on morphological ’normalcy’ of spermatozoa. Almost 20 years ago, ’motile-sperm organelle morphology examination’ (MSOME) was introduced by Bartoov et al. Using Nomarski differential interference contrast optics (DIC) an improved three-dimensional view of the head and midpiece became available. This chapter will describe different aspects of sperm selection by morphology.