Microsurgical Epididymal Sperm Aspiration (MESA) for obstructive azoospermia: Clinical, embryological and reproductive outcomes from a single-center case series in Kazakhstan
DOI:
https://doi.org/10.37800/RM.3.2026.808Keywords:
obstructive azoospermia , microsurgical epididymal sperm aspiration , intracytoplasmic sperm injection , male infertility, sperm aspiration, assisted reproductive technologiesAbstract
Relevance: Obstructive azoospermia (OA) is one of the leading causes of severe male infertility. In the era of assisted reproductive technologies, surgical sperm retrieval has become the gold standard of treatment. Microsurgical epididymal sperm aspiration (MESA) has theoretical advantages over other techniques; however, local data on its effectiveness remain limited.
This study aimed to comprehensively evaluate the clinical effectiveness, safety, and embryological outcomes of MESA in patients with obstructive azoospermia in the southern region of the Republic of Kazakhstan.
Materials and Methods: This retrospective analysis included prospectively collected data from 16 patients with confirmed OA who underwent MESA at IRM Clinic Shymkent (Shymkent, Kazakhstan) between January 2024 and October 2025. We assessed sperm retrieval rate (SRR), sperm concentration, fertilization rate (percentage of zygotes with two pronuclei [2PN] from the total number of mature MII oocytes), clinical pregnancy rate, live birth rate, and postoperative complication profile.
Results: The SRR was 93.75% (viable spermatozoa were obtained in 15 of 16 patients). The mean sperm concentration in the aspirate reached 47.3 million/mL, enabling successful cryopreservation in 100% of patients with positive SRR. The normal fertilization rate was 53.4% (93/174 MII oocytes). The clinical pregnancy rate per embryo transfer reached 53.8% (7 pregnancies). The live birth rate was 38.4%. One minor complication was recorded (scrotal hematoma, 6.25%).
Conclusion: MESA is a highly effective, predictable, and safe method for overcoming male infertility in patients with OA, providing a high yield of quality gametes for intracytoplasmic sperm injection (ICSI) programs and cryopreservation.
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Copyright (c) 2026 Е.Ж. Конакбаев , У. Жанбырбекұлы , Э.Ж. Октамбаев , А.С. Абишев , У.C. Жапаров
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