Will a Vasectomy Reversal Work?

Posted on July 7, 2011 by admin

Because of the development of medical technologies, researches and studies regarding vasectomy reversal techniques increased the awareness of the people about it, and the number of medical institutions that conduct it. They say that there is a high chance of getting success though this procedure, but there are studies that showed that there are some people who have higher chance of making it successful, than the others.

When you decided to have a vasectomy, the doctor should have briefed you that this process is permanent and irreversible. That time, you should have considered the factors and the consequences that might happen to your life and your family. Also, when you decided that this procedure should be done on you, you know that it is very effective and also, will have an effect forever.

But there are some instances that you take a turn in your decision. There are some factors that you considered before, but now are not problems anymore. That is why, during the last few tears, the number of those who want a vasectomy reversal surgery increased. While the number of those who want vasectomy also increased, there are also those who want to have another child.

Probably, the main reason of those who want a reversal is remarriage. Because they have a new life now with another woman, they want to start a brand new family by having a baby. But the thing is, you need to know first the information about this process before considering it as an option. Your doctor should discuss to you the risks that you need to take when doing this procedure, and also, the latest techniques and development that you can use.

According to the researches conducted to know the effectiveness of vasectomy reversal procedure showed that it is generally effective. But there are some people who are more susceptible to the latest techniques used in vasectomy reversal. This technique involves rejoining the once cut ends of the vas deferens. This process is greatly more challenging than doing a vasectomy

The key to an effective vasectomy reversal is the skill and experience of the one conducting the procedure. Of course, the process is tedious and needs specialization in the process. It should only eb conducted by a surgeon who knows the risk of failure so he or she strives harder to make everything right the first time.

Also, according to statistical studies, they found out that it is important that when they rebuild a vas deferens, there should be live sperm flowing in the tubes. It is more likely to be possible to reconnect the vas deferens than those who did not have a live sperm flowing.

There are also personal factors that might affect the success of the surgery. It is important to discuss the details first with your doctor in order to achieve maximum efficiency. But according to the study, after the surgery, there is a higher chance of conceiving a baby. If problems persist, let your doctor know your situation immediately.

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Vasectomy Reversal: The things you need to know

Posted on July 7, 2011 by admin

Vasectomy is acknowledged as a scientifically effective procedure because its effect is meant to be permanent. However, there are circumstances that change the first position of the couple or a man to have a vasectomy. That is why, there is now what we call vasovasostomy or the reversal of the vasectomy. Around 10 per cent of those who had vasectomy wanted to reverse the procedure because of their own personal reasons.

There are doctors who specialized in this field because doing the vasectomy reversal is a tricky job. It is done under a microscope that is why, there is no room for error. But because of the trainings of surgeons, they can easily accomplish the task minimizing the risks of danger.

According to students, not all people have high probability of reversing the effects of the vasectomy. But the general population reacts positively to this procedure. Technically, vas deferens can be reconnected but working out the original function of the vas deferens is not that easy to achieve. According to surgeons, it is easier to perform vasectomy than to reverse the process.

Having a positive result is highly dependent on different factors. One great factor that affects the result is the length of time the vasectomy surgery had been performed. It was verified by clinical studies that those who did vasectomy within 10 years have a greater chance of achieving a good result. However, if the length of time is shorter, for example three years, the chance of failure drops to three per cent. But, if it happened 15 years ago, the success rate dramatically drops.

It is important to take into consideration the emotion of the patient who will undergo vasectomy reversal. This is a very sensitive topic that should be handled by the professionals only. The doctor should emotionally prepare the patient about the possible repercussions and risks of the procedure. The doctor should also ensure that the patient is physically and emotionally fit to finish the whole surgery. There are times that the effect is not immediate because of the low chance in pregnancy. That is why, it is important to seek help from the professionals.

Every case of vasectomy procedure is a unique case. Therefore, there are no existing vasectomy reversal techniques nowadays that can give a hundred per cent success rate. Every technique has its own weakness and failure point. The important thing to realize is the amount of effort that was given just to help you. Remember that the chances of getting it right for the first time vary on your physical capabilities and how well your body reacts to the procedure.

This is a great family issue that should be discussed by the couple. Take into consideration the things that forced you to have a vasectomy at the first place for you to realize if there is really a need to do it again. Remember, once you undo the process of vasectomy, you can always repeat it and have another shot of getting vasectomy.

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Things to Know About Tubal Ligation

Posted on July 7, 2011 by admin

Tubal ligation is a process conducted to a woman to permanently prevent pregnancy by surgically cutting or blocking the fallopian tubes. This process is a voluntary request to a licensed OB- Gynecologist that is normally requested by a woman if she does not want to have another child anymore.

This process is usually suggested to couples who want to have a secured family growth control method. There are women who chose this process because they are still sexually active and always fertile that is why they want to have no limitations in terms of pregnancy. In this way, they do not have to rely to other birth control methods. Also, this is recommended to those women who are suffering from a condition that forbids them to have a pregnancy.

This process was chosen by a significant number in the population, amounting to 10 million women across the country, making it one of the leading methods to prevent pregnancy. Almost 15% of those who chose this method were still in their reproductive age. Also, according to the study, most of the patients who chose this method are those women who are already on their 30’s and have two to three children.

When you say tubal ligation, it means tying your fallopian tubes as a mean of female sterilization. This process aims to prevent birth conception. The operation deals with the process of blocking or cutting the patient’s fallopian tubes. These tubes are found near the outer sides of the patient’s uterus. They are about 10 cm long and half a centimetre in diameter. Fallopian tubes are the place where fertilization occurs because this is the place where the egg and sperm meets. Because of the tubal ligation, the tubes will be cut or blocked therefore, sperm will never reach the egg.

The normal procedure of tubal ligation happens in about 20-30 minutes. The patient will be sedated with anesthesia and within the same day, the patient can go home already. But, it must be taken into consideration the willingness of the patient. This surgery should not be conducted if the patient is still not sure if she will pursue it or not. Most of the cases of tubal ligation are not reversible. According to the studies, there are about 10% of those who undergone this process who regret their decision while another per cent try to seek treatments in order to restore fertility.

Before the surgery, the patient should be given sufficient information and counselling. The patient should understand the consequences and the benefits of the surgery. In this way, she can decide intelligently. Also, the medical history should be reviewed and a physical examination should be conducted. The patient should not eat or drink anything several hours before the actual procedure.

After the process, the patient will be monitored in order to determine if problems occurred. But, if everything is fine, she will be allowed to go home with prescriptions. Usually, the patient is advised to monitor the effects of the surgery as they might be signs of bigger complications.

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How Does Sperm Condition Affects Male Infertility?

Posted on June 17, 2011 by admin

Among couples who are diagnosed with infertility, 20% to 30% of the traced root problem has something to do with male infertility. It is not very surprising that this issue becomes the subject in different web fora and discussions. To dwell with male infertility is the same as digging holes on the walls to take a look at how this condition is being developed.

Male Infertility vs. Female Infertility

Male infertility is the inability of male to impregnate his partner. This happens when fertilization has been obstructed by different internal and external factors.

The normal process of fertilization occurs when the sperm meets the egg in the fallopian tube and then, fertilization happens. It will travel down to the uterus as it develops embryo. However, prior fertilization, there are other processes of which both egg and sperms cells undergo. And these are where the probable causes of male infertility are developed.

Sperm Cells Defects

A successful fertilization requires a healthy and sufficient number of sperm cells during the ejaculation of the male. Otherwise, the process can be negatively affected which can result to infertility. Thus, it is very vital to have healthy and well-shaped sperm cells during sperm production.

However, there are deficiencies that can be developed in sperm cells. One most common abnormal condition of sperm is azoospermia. The azoospermia is a condition of the male where there is no sperm production at all in the testicles. It can be genetically inherited but there are external factors that can also be considered why azoospermia is being developed.

According to statistics, 15% of infertile males are diagnosed with azoospermia, which appears to be one of the primary problems of male infertility.

Another defective condition of the sperm is the oligospermia. It is quite similar with azoospermia, aside from the fact that sperm production occurs with a very low count of sperm cells produced.

Further, asthenozoospermia is another abnormal condition of sperm that cause infertility among males. It pertains to the abnormal movement of the sperm cells. This harsh movement can affect the transportation of the sperm as well as its penetration to fertilize the egg.

One other defective sperm condition is the necrozoospermia. In this case, the sperm is immobile. The sperm can neither be determined whether it is still alive or already dead. But no matter, whether the sperm cells are dead or not, still, its inability to move could not penetrate the egg even if it is transported to the fallopian tube along with the semen.

These sperm problems can be attributed to hormonal imbalance. It occurs when the release of hormones from pituitary glands, hypothalamus, and gonads is disrupted. Once there is disruption, the hormones responsible for sperm production will affect the result process, thus, resulting to defective sperm cells.

Aside from sperm cell defects, there are other causes of male infertility such as sexual dysfunctions like short erection period, retrograde ejaculation, varicocele, and prior surgical procedure like vasectomy.

 

Treatments and Medication

Nowadays, there are different treatments and medications that can treat male infertility. There are both surgical and non-surgical procedures which can be done to infertile males. These procedures, though, do not always guarantee the patient of 100% fertility after undergoing the operation. There are still factors to consider after operation such as the healing process and suitable daily practices that can help boost male fertility.

The best option for any male, who suspects himself as infertile, is to consult a doctor and determine the real problem. This would help a patient to pick the most appropriate medication and procedures that can be applied successfully. And lastly, it is best to stay healthy and fit. Proper eating habits and lifestyle can greatly contribute to the success of the treatment to relieve the male from infertility.

 

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Helpful Tips in Choosing Vasectomy Reversal Surgeon

Posted on June 17, 2011 by admin

There are lots of preparations necessary for the couple before the male partner can undergo vasectomy reversal. Unknowing what lies ahead after the operation is seemingly the most stressful part of the process. But during this crucial point of planning the future of the family, good decision making is all that matters.

For a couple who decided to undergo vasectomy reversal, one of the most important factors that they have to consider is the surgeon who will be performing the very delicate and painstaking operation. This is where the success of the technical parts of the operation depends on. Thus, the couple should be guided by the following reminders to help them look for the best surgeon who can reverse their future after the operation.

Accreditation and License

The American Board of Urology is the agency who accredits and gives license to urologists who can perform vasectomy reversal. When you already have prospect surgeon in mind, never hesitate to go to him and ask him if he is legitimate to perform the operation. You can ask for the license number, the date when the license was given, and cross reference it to the American Board of Urology. This is the best way to confirm if the surgeon is really in capacity of performing vasectomy reversal.

Once the vasectomy reversal if performed by a bluff surgeon (or con-artist), the repercussions might be severed. First, the success of the operation is at very high risk. Aside from that, a surgeon who does not really perform vasectomy reversal might cause worse complication instead of giving remedy to your problem. You will not be ensured legally once you involved your operation into a non-licensed surgeon. If the operation is failed, most of the time, the surgeon will do away with moral and professional responsibility to the patient.

Professional Experience on the Operation

It is better to choose high paying surgeons who have prolific background in performing vasectomy reversal than taking chances on surgeons who can give you lower rates. Investment in this kind of operation is important to increase your chance of achieving successful vasectomy reversal. Look for surgeons who have already success accounts of vasectomy reversal. You can ask your friends or even browse some profile of urologists in the internet. It will give you an edge to attain your desired result of the reverse procedure.

Affiliation

Your prospect surgeon should be a member of Fellow of the American College of Surgeons or FACS. This organization is recognized as one which has the highest standards of selecting their members. Thus, before a surgeon becomes a fellow member, he or she should have outstanding professional background in his or her field of expertise. You can cross check your surgeon if he or she is a member of FACS so that you will be able to know his or her backgrounds when it comes to performing vasectomy reversal.

Technique Preference

It is important that your preference of which type of vasectomy reversal will be performed is the forte of your surgeon. There are different techniques and methods that are now being used by surgeons. And there are surgeons who are specializing in one or two techniques only so that the mastery of the procedure can be assured. If your preference, for example, is the vasovasostomy, you will not go to a surgeon whose epididymostomy is the specialization in vasectomy reversal.

These are just few tips when it regards to choosing the right surgeon for the surgery of the male. There are still other important things to consider but the reminders mentioned above will surely help the couple on their way to successful vasectomy reversal.

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Factors Affecting Cost of Vasectomy Reversal

Posted on June 17, 2011 by admin

Vasectomy reversal is one of promising surgeries that can help restore your fertility once it is successfully done. It is just reasonable that this operation is a lot costly than vasectomy and other operations.

However, the cost of vasectomy reversal varies. It is affected by different factors related with vasectomy reversal. So, as much as possible, it is advisable for men to look for health insurance that covers this operation and other similar procedures that they can resort to in the near future. This is to lessen or minimize the cash out during operations.

It is better if one has full understanding of expenses and the reasons why such amount is incurred. And here are some of considerable factors that directly affect the cost of the reverse operation.

Professional Fee of Surgeon and Anaesthesiologist

Urologists are the ones who usually perform vasectomy reversal. And mind you, these are not just resident urologists in the clinics. These licensed urologists are highly trained and more than skilful of performing such delicate and time-intensive operation. That is why, the 50% bulk of the costs goes to their professional fees. The usual minimum cost of professional fee is around $4,000.

Aside from urologists, the anaesthetist is also paid with corresponding fees. Anaesthesiologist provides you general anaesthesia during the operation which normally costs from $2,000 up to $2,500. During the entire operation, the anaesthetist also stays in the operating room to respond in case anaesthesia has subsided earlier than the expected time.

Hospital and Facility

The hospital where you will be checking in and the facilities that will be used during your operation also affect the operation cost of vasectomy reversal. Logically, the more advanced equipment found in your room, the higher the price that you will pay.

If the reverse operation will be performed in a bigger hospital, it usually entails higher costs compare to regular clinics usually found in the city. This is because bigger hospital has complete sets of equipment and other medical services that you may need during your operation.

Type of Surgery

Vasectomy reversal has two types of microsurgery. These are the vasovasostomy and epididymostomy. The former is said to be more expensive than the latter because it yields higher percentage of successful pregnancy after the operation. On the other hand, the epididymostomy has lower rate of pregnancy afterwards since the two vas deferens will be connected to the edpididymis, instead of reconnecting the two to each other.

However, even after a successful vasectomy reversal, you may still find it difficult to attain successful pregnancy with your partner. That is why after the reverse procedure, sperm aspiration and other assisted reproduction technologies are performed to both female and male partners. For example, if you still need to undergo in vitro fertilization, it will cost you at least twice the amount of vasectomy reversal.

Country and City Where You Live in

Your location also defines the rates of the medical fees in your operation because the economy of the state affects the fluctuation of the currency. In countries like Canada and Mexico, you can save up to 50% of your expenses compare when getting the procedure done in the US.

The more natural type of fertility restoration, the lower the cost and the more effective it is. Find a vasectomy reversal procedure package that can accommodate your resources capability without compromising your individual needs. This is the rule of the thumb among couples who badly wants children but in tight financial situation.

 

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Discover Treatment of Male Infertility

Posted on June 17, 2011 by admin

Male infertility is a big issue to a lot of couples. We have a preconceived notion that it is more acceptable for a female to be infertile than for a male. Fertility symbolizes the power of the male in a relationship. Therefore, it is important for so many men to not have a fertility problem. That is why, if you are suffering from this problem, then you need to discover possible treatments for male infertility.

The type of treatment that you should receive will depend on the cause of your problems. There are also other factors that will be considered such as the duration of the problem, your personal choices and your age. Even if the male has the problem, it is important that the female partner should undergo a treatment also. This will ensure a higher probability of solving the problem.

There are two approaches that doctors use when treating male infertility. The first one is correcting the cause of the problem, such as removal of blockage in the tubes connecting your testes and penis, or improving the function of your other body organs to help you become fertile again. Most of the time, the exact root of infertility cannot be determined. But still, the doctors can tell you some ways to improve your current condition.

The following are some ways to treat male infertility:

  1. Treating infections in your reproductive system. There are some cases that the cause of the problem is the infection inside your genitalia. It is determined by the unusually high white-blood cells in your blood. Doctors can prescribe antibiotics to cure the problem. But using medications does not guarantee restoring fertility.
  2. Improving testosterone can also help solving infertility. There are many available hormone medications and treatments. The unusually low level of testosterone affects sperm production and vitality. That is why, by ensuring a sufficient level of testosterone in the body, it can help ensure a sufficient supply of sperm during ejaculation.
  3. Surgery can also correct the root of the problems especially if the cause is just a blockage in one of the internal tubes. Also, it can help in correcting the positioning of other organs that affect the process of transporting the sperm.
  4. Treating problems during sexual intercourse. There are many problems related to sexual intercourse that were seen as causes of infertility. Because of the men’s inability to maintain an erection, to ejaculate and to control ejaculation, most of the time they lead to inability of the sperm to reach the egg. By giving medications and proper advice, it can be solved easily.
  5. Applying assisted reproductive technology (ART). It is a process that can help people who have problems with sperm delivery such as retrograde ejaculation and blockages found in the vas deferens. This is the process where in the sperm will be taken strain from the testes to be injected to fertilize an egg. There is a more common ART process which is known as vitro fertilization. In this method, the egg will be surgically removed from the ovary. Then, it will be combined with the sperm in the laboratory to ensure proper fertilization. Once the egg is already fertilized, it will be transferred again to a female’s uterus. This will ensure proper conception of the child in a faster, safer way.
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The Leading Causes of Male Infertility

Posted on June 17, 2011 by admin

There are many couples suffering from problems due to inability to have a child. Most of the time, it leads to family problems and divorce. But, it is important for a couple to determine the cause of the problem. This will ensure a more healthy relationship between them.

Male infertility is a big issue among men. Many of us have a pre-conceived notion that if a couple has a problem in having a baby, it is usually the female’s fault. But what we do know is, there is a significant percentage of couples who were not able to conceive a child because of the males’ infertility. That is why, it is vital that we know the causes of it for us to be able to look for solutions.

There are many causes of infertility. The most common causes include deficiency in testosterone, problems in sperm production and problems in delivery of sperm from testes to penis.

Deficiency in testosterone maybe a congenital case or can be acquired later on. This condition is further classified according to its location in the hyphotalamic-pituary-gonadal axis. If the disruption is in the testes, it is called a primary case. If it is in the pituitary gland, it is a secondary case. Lastly, if the problem is in the hypothalamus, it is a tertiary case.

Klinefelter syndrome is the most common cause of congenital disease leading to infertility. It is caused by the existence of another X chromosome that causes infertility, and other problems such as abnormal breast enlargement, sparse body and facial hair and relatively smaller testes.

Other congenital hormonal problems that might lead to infertility are gonadotropin-releasing hormone or GnRH and leutenizing hormone-releasing hormone deficiency or LHRH.

There are also other congenital problems such as anorchism or the absence of testes and cryptorchidism or the failure of the testes to go down to the scrotum.

There are many causes of infertility that may be acquired or developed later on. That is why it is important to keep our endocrine system healthy in order to preserve the natural cycle of hormones in the body affecting our fertility. These are the other causes of male infertility.

  1. Sexually transmitted diseases. There are infections and bacteria that can be transferred during intercourse. It must be noted that it can be avoided through a good hygiene and the use of protection.
  2. Other diseases such as sickle cell anemia, cystic fibrosis, etc.
  3. Medical procedures such as chemotherapy.
  4. It can also be caused by an injury resulting to testicular trauma.
  5. Side-effects of other medications and antibiotics.
  6. Systemic disease such as kidney problems and high fever.

Another discovered cause of male infertility is retrograde ejaculation. This is a problem that occurs in the muscles or nerves in the bladder neck that stops it from closing when ejaculating. It can be caused by a prior surgery in the bladder, a disease affecting the whole nervous system or a birth defect in urethra or bladder. There is a simple way of knowing whether it is the cause of not. If the ejaculation seems dry or very little and after ejaculating, your urine is cloudy and there are whitish parts, then you might be suffering from retrograde ejaculation.

There are many ways to solve these problems. It is better to ask for a doctor’s advice in order to not only find a good solution but more importantly, understand your own situation.

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What you Must Know About Male Infertility

Posted on June 17, 2011 by admin

The inability of a couple to achieve pregnancy is not mainly because of the female’s inability to have healthy eggs. Sometimes, it is the male who has the problem. It might be unusual but it is certainly real.

Male infertility is definitely not something to be afraid of and there are some medical treatments available to solve the problem. There are also supplements that can improve the condition of the male. But, it must be understood that these methods are not hundred percent effective. If the problems still persist, it should be better to entertain the idea of sperm donation and adoption.

There is a significant number of couples who could not achieve pregnancy because of male infertility. Studies showed that almost one-fifth of the cases are due to male’s problems. These findings are based on clinical tests done on a significant number of couples.

The most common way of determining male infertility is through semen analysis. The man will be asked to give a small vial of semen and the doctors will evaluate it. They will evaluate the shape and movement of the sperm. In this way, they will have an idea on how the sperm moves inside a female’s genitalia. Also, the samples will be used to predict the amount of sperm released during ejaculation.

To get an accurate and reliable result, this test should be done at least twice. It will validate the result and at the same time, it will ensure the non-existence of human errors affecting the result.

Although semen analysis is enough to verify the cause of your problems, sometimes, further tests are recommended in order to gain more verifiable result. These tests include physical exam done by a licensed urologist, blood tests to check hormone levels in the blood, urine testing, vasography, ultrasound and testicular biopsy. A specialized semen analysis can be conducted. It includes deeper analysis of the genetic composition of the sperm to determine if the problem runs in the genes of the person.

It is important to determine the symptoms of male infertility in order to provide solutions as soon as possible. That is why, the couple should be observant especially during the first year of their unprotected sexual intercourse. If still, they failed to have a baby, then they should be both evaluated to trace the problems.

The problem with male fertility is the symptoms are not that common unlike in the female. Irregular periods can be a sign of problems with women but with men, nothing something like that can indicate a problem.

There are some signs that can be connected to hormonal imbalance such as hair problems, low libido and problems during sexual intercourse. Hormonal imbalance can cause infertility but it is not always the case so it is better to be checked.

There are options for treatments available for men who are suffering from infertility. Doctors can recommend the best option that will give solution to the apparent problems of the couples.

Antibiotics are common prescription of doctors in case the problem is caused by an infection. Also, surgical procedures can be done to ensure that there are no blocks in the tubes connecting the testes and the penis. Lastly, there are safe medications and drugs that can improve the production of healthy sperm.

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Factors Affecting Pregnancy after Vasectomy Reversal

Posted on May 6, 2011 by admin

The strength of the bond of couples depends on several internal and external factors of their relationships. And among others, one of the most important factors is child bearing. If a man has had vasectomy in the past and has found a new love life, the first thing he would always want to do is to build a new family. Fortunately, vasectomy reversal came to the picture.

What is Vasectomy Reversal?

Vasectomy reversal is, literally, a process to reverse the intended result of vasectomy, which is to halt the sperm production of the man. During the course of vasectomy reversal, the deactivated (cut) reproductive tract of the male will be reconnected to vas deferens. Once the tracts are reconnected, the male can produce sperms again.

This operation becomes very helpful among men who were already decided before to undergo vasectomy but for some reasons, has changed their minds to give themselves another chance of having more children. But not only men who have undergone vasectomy are thankful of vasectomy reversal operation. Those men who have congenital problem in their reproductive tracts can also be treated by the said procedure.

What will happen after vasectomy reversal?

The vasectomy reversal is a surgical procedure that will cause pain and wounds on patient’s end. Normally, it takes at most eight months to a year to heal the wounds once a man had undergone vasectomy reversal. The healing process is longer than usual surgical procedures since it involves the sensitive parts of the body. These body parts have to recover first from the rigid medical operation before they can be used again for physical activity. It may heal earlier than the usual eight months, but those cases are very rare though.

Once healed, the male’s reproductive system will be able to produce sperms again so that the male can have a child of their own with this partner.

In the US, there are already successful accounts of vasectomy reversal. Approximately 65% of male population who opted to undergo vasectomy reversal is successful of conceiving a baby right after.

Why are the possible reasons of unsuccessful vasectomy Reversal?

Any procedure that involves genital parts of the body is sensitive and delicate, and so is vasectomy reversal. When one decided to go for this option, he should invest on good surgeon. Vasectomy reversal should be done very precisely to achieve the desired outcome. One criterion that a patient should look up is the track record of the surgeon. It will not hurt to ask people who already had vasectomy reversal before. They can definitely give recommendations of surgeons who are not only experts in the field but proven highly reliable as well.

If the patient is still unable to impregnate his partner despite vasectomy reversal, he can also check other symptoms that may cause male infertility. Some of these factors are varicocele, low sperm count, and sexual dysfunction. These male infertility problems can be treated with other  non-surgical and surgical procedures.

Vasectomy reversal is, indeed a brilliant product of science which gives men the chance to conceive a child. Once done with caution and precision on the surgeon’s side, and supplemented with proper habit and lifestyle on the patient’s end, there is no reason why vasectomy reversal would not work out a miracle of conception.

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