The procedure is usually carried out under local or general anesthesia. After induction of anesthesia, the testis is stabilized, and the epididymis is held between the surgeon′s thumb and forefinger. A butterfly needle with a 20 ml syringe is inserted into the caput epididymis and gently withdrawn until fluid can be seen entering the tubing of the aspiration set. After removing the syringe, the tubing is clamped and backflushed with media. This procedure is repeated until enough epididymal fluid with motile sperm is retrieved. If no sperm is retrieved, then it is vital to proceed with MESA, testis biopsy, or testicular aspiration.