***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES Testicular sperm extraction ( TESE ) is an effective procedure to retrieve sperm from some men with nonobstructive azoospermia ( NOA ) . To optimize treatment effectiveness , we have review ed our experience with TESE for NOA to better underst and technical factors needed for sperm retrieval and lead to an optimized approach to TESE . METHODS Eighty-one men with confirmed NOA underwent attempted TESE using an open technique under optical magnification . Each testis sample was dispersed and examined in the operating room . Sequential biopsy attempts were made until sperm were visualized or until further biopsies were thought to jeopardize testicular blood flow . In 20 patients ,  st and ard  biopsy and initial mechanical dispersion of the seminiferous tubules were compared with the passage of tissue through a 24-gauge angiocatheter after initial dispersion to quantitate spermatozoal yield . RESULTS Overall , 47 ( 58 % ) of 81 patients who underwent TESE had direct intraoperative visualization of spermatozoa . The average number of biopsy attempts for all patients was 8.9 and for patients with sperm isolated 6.4 ( P = 0.002 ) . Passage of the testicular tissue suspension through a 24-gauge angiocatheter increased sperm retrieval in matched tissue specimens from 83,000 to 390,000 or 470 % over that achieved with st and ard dispersion alone ( P = 0.005 ) . An initial , substantive tissue biopsy revealed sperm in only 23 ( 28 % ) of 81 patients . Using this approach with sequential biopsies under optical magnification , no patient had evidence of testis injury or devascularization . CONCLUSIONS Because multiple TESE procedures can cause transient and permanent alterations in testicular function , it is imperative to perform TESE as safely and as efficiently as possible . We suggest that open TESE with optical magnification provides a safe method of retrieving sperm . A single biopsy for extraction is inadequate to detect spermatozoa for men with NOA . Use of the needle dispersion technique with passage of testicular tissue through an angiocatheter enhances detection of sperm and could potentially reduce the need for subsequent biopsies . An algorithm to minimize biopsies and allow sperm retrieval is presented Testicular sperm extraction ( TESE ) may provide spermatozoa for attempts at fertility with assisted reproduction ; however , the physiological effects of TESE on testicular function are not well understood . In order to evaluate the effects of TESE on the testis , 64 patients were evaluated after TESE for non-obstructive azoospermia with physical examinations , serial scrotal sonography , histological analyses and evaluation of the success of repeated sperm retrieval attempts . At 3 months after TESE , 82 % of evaluated patients had ultrasonographic abnormalities in the testis suggesting resolving inflammation or haematoma at the biopsy site . By 6 months , these acute inflammatory changes typically resolved leaving linear scars or calcifications . Two patients had documented impaired testicular blood flow , with complete devascularization of the testis for one patient after TESE with multiple biopsies . Repeat TESE procedures were far more likely to retrieve spermatozoa if the second TESE attempt was performed > 6 months after the initial TESE procedure ( 80 % ) , relative to those performed within 6 months ( 25 % ) . Transient adverse physiological effects are common in the testis for up to 6 months after TESE . In addition , permanent devascularization of the testis can occur following TESE procedures with multiple biopsies . The risk of this complication may be minimized by using an open biopsy technique with optical magnification to directly identify testicular vessels OBJECTIVE To evaluate the outcomes of microdissection testicular sperm extraction ( micro-TESE ) in patients with high FSH . DESIGN Clinical retrospective study . SETTING Department of urology at a tertiary university hospital . PATIENT(S ) Seven hundred ninety-two men with nonobstructive azoospermia . INTERVENTION(S ) Micro-TESE followed by intracytoplasmic sperm injection was performed . The men were classified into four groups based on serum FSH levels : < 15 , 15 - 30 , 31 - 45 , and > 45 IU/mL. MAIN OUTCOME MEASURE(S ) Sperm retrieval , clinical pregnancy , and live birth rates . RESULT ( S ) Testicular sperm were successfully retrieved in 60 % of the men . Sperm retrieval rates in the groups of men with FSH values 15 - 30 , 31 - 45 , and > 45 IU/mL was 60 % , 67 % , and 60 % respectively ; this was higher than the group of men with FSH < 15 ( 51 % ) . Of those men who had sperm retrieved , clinical pregnancy and live birth rates were similar in the four groups ( 46 % , 50 % , 52 % , 46 % and 38 % , 45 % , 44 % , 36 % , respectively ) . CONCLUSION ( S ) The chances of sperm retrieval using micro-TESE is just as common , if not better for men with elevated FSH levels than for men with lower FSH . Micro-TESE results appear to differ from earlier series that report low retrieval rates with r and om biopsies for men with elevated FSH . High FSH is not a contraindication for micro-TESE In a population of non-obstructive azoospermia patients , the efficacy of microsurgical testicular sperm extraction ( microTESE ) and conventional TESE was evaluated in a r and omized controlled study on 138 testicles , classified and paired in a 48-square table according to the different classes of the following three variables :  patient plasma FSH concentration , orchidometry and testicular histology . Sperm retrieval was positive in 21/22 testicles with hypospermatogenesis ( 11/11 , 10/11 ; microTESE , TESE respectively ) , in 12/14 with maturation arrest ( 6/7 , 6/7 ) , in 16/22 with incomplete Sertoli cell-only syndrome ( 8/11 , 8/11 ) , and in 16/80 with complete Sertoli cell-only syndrome ( 11/40 , 5/40 ) . Sperm recovery was positive in 5/24 patients with FSH concentration > or = 3 x maximum value of normal range ( N ) ( 4/12 , 1/12 ) , in 17/40 patients with 2N < or = FSH < 3N ( 9/20 , 8/20 ) , in 30/48 patients with N < FSH < 2N ( 17/24 , 13/24 ) , and in 13/26 patients with FSH = N ( 6/13 , 7/13 ) . Regarding orchidometry , sperm recovery was positive in 11/18 testicles with volume ( V ) > or = 12 ml ( 6/9 , 5/9 ) , in 27/56 testicles with 8 ml < or = V < 12 ml ( 15/28 , 12/28 ) , and in 27/64 testicles with V < 8 ml ( 15/32 , 12/32 ) . FSH value and the surgical procedure were the two variables significantly ( P < 0.05 ) predicting positive sperm retrieval OBJECTIVE To perform conventional and microdissection testicular sperm extraction ( TESE ) at the same session and compare their effectiveness . DESIGN Prospect i ve comparative study . SETTING University hospital setting . PATIENT(S ) The study included 335 patients with nonobstructive azoospermia . INTERVENTION(S ) Microdissection TESE was performed to 77 patient with atrophic testes . An additional 258 patients underwent conventional TESE using three incisions on three quadrants of the testis ( upper , middle , and lower ) . Microdissection TESE was performed by enlarging the middle incision vertically when no spermatozoa could be detected using the conventional technique . MAIN OUTCOME MEASURE(S ) Sperm retrieval , fertilization , clinical pregnancy rate ( PR ) , and live birth rate were evaluated . The relation between sperm retrieval rate and FSH level and testis volume was also investigated . RESULT ( S ) Spermatozoa was detected in 33.7 % of patients using conventional TESE . The spermatozoa detected increased to 50.8 % using microdissection TESE . The increase was statistically significant . In the primary microdissection TESE group , the surgical retrieval rate was 20.8 % . The overall sperm retrieval rate was 43.9 % . There was a significant relation between the sperm retrieval rate and testis volume , whereas there was no relation between sperm retrieval rate and FSH levels . The overall fertilization rate , clinical PR , and live birth rate were 57.1 % , 50.4 % , 36.4 % , respectively . CONCLUSION ( S ) Conventional TESE combined with microdissection TESE can be used in selected patients . Sperm retrieval rate of TESE can be low in patients with atrophic testes The value of testicular sperm extraction ( TESE ) by microdissection was evaluated according to its physiological consequences compared with open , classic surgical biopsy in the same patient . A total of 100 patients with non-obstructive azoospermia and bilateral identical testicular histology underwent bilateral diagnostic TESE via the conventional method on one side and the microsurgical method on the other side . The spermatozoa recovery rate by microdissection TESE was significantly higher than by conventional TESE ( 47 and 30 % respectively ; P < 0.05 ) . In order to assess the safety of this new procedure , 60 patients were followed-up ultrasonographically  for 1 , 3 and 6 months . Acute and chronic complications were significantly lower in the microsurgical side compared with the conventional side ( 15 and 58.3 % respectively and 3 and 30 % respectively ; P < 0.05 ) . Segmental devascularization was detected in seven testes operated on conventionally , and in two testes operated on microsurgically . However , permanent devascularization could not be detected in any patient after 6 months . These findings suggest that microdissection TESE is not devoid of complications , but that it is relatively safer than the conventional technique and improves sperm yield significantly in patients with non-obstructive azoospermia 
    Output:
    
Fewer complications were observed on ultrasound examination after microTESE procedure .
Pseudo-r and omized prospect i ve data , however , show more favourable sperm retrieval in NOA for microTESE , especially in histological patterns of patchy spermatogenesis such as Sertoli cell only syndrome .
However , in patients with uniform histological patterns such as maturation arrest outcome of microTESE seems less favourable