Asthenozoospermia associated with the MMAF phenotype results in male infertility. Recent findings have confirmed that a genetic etiology is often responsible for this phenotype. In such situations, you can get pregnant with the help of ICSI. However, few studies to date have provided a detailed analysis of the ultrastructural flagellar defects underlying this phenotype, its genetic etiology, and the outcome of ICSI in such cases of male infertility. A retrospective study of 25 infertile men with severe asthenozoospermia associated with the MMAF phenotype detected by standard sperm analysis was performed. This study did not find any adverse outcomes of ICSI associated with MMAF, but men requiring ICSI for severe asthenozoospermia should still be considered for early and extensive phenotypic and genetic testing.